When concealed handgun licensees break bad: criminal convictions of concealed handgun licensees in Texas, 2001-2009.

OBJECTIVES: We explored differences in criminal convictions between holders and nonholders of a concealed handgun license (CHL) in Texas. METHODS: The Texas Department of Public Safety (DPS) provides annual data on criminal convictions of holders and nonholders of CHLs. We used 2001 to 2009 DPS data to investigate the differences in the distribution of convictions for these 2 groups across 9 types of criminal offenses. We calculated z scores for the differences in the types of crimes for which CHL holders and nonholders were convicted. RESULTS: CHL holders were much less likely than nonlicensees to be convicted of crimes. Most nonholder convictions involved higher-prevalence crimes (burglary, robbery, or simple assault). CHL holders' convictions were more likely to involve lower-prevalence crimes, such as sexual offenses, gun offenses, or offenses involving a death. CONCLUSIONS: Our results imply that expanding the settings in which concealed carry is permitted may increase the risk of specific types of crimes, some quite serious in those settings. These increased risks may be relatively small. Nonetheless, policymakers should consider these risks when contemplating reducing the scope of gun-free zones.

In-hospital mortality and unintentional falls among older adults in the United States.

PURPOSE OF THE STUDY: To estimate the odds of death associated with documented unintentional falls and acute care hospitalization among older adults in the United States. DESIGN AND METHOD: Data were abstracted from the 2005 Nationwide Inpatient Sample (NIS) and odds of death were modeled using logistic regression. RESULTS: The age 65 and older fall rate per 1,000 discharges was 53.0 while the mortality rate for those who fell was 33.2. Older-old (odds ration [OR] = 2.93; confidence interval [CI] = [2.50, 3.43]), men (OR = 1.64, CI = [1.54, 1.75]), and non-White (OR = 1.09; CI = [1.01, 1.19]) had higher odds of death compared to younger-old, women, and Whites. Additional comorbidity (OR = 3.41, CI = [3.05, 3.82]), dehydration (OR = 1.14; CI = [1.05, 1.25]) and intracranial fractures (OR = 4.46; CI = [4.02, 4.95]) resulted in greater odds of death. IMPLICATIONS: Among older adults who experienced a fall and hospitalization, odds of mortality appear influenced by factors beyond injury severity related to falling. Additional research is necessary to delineate the mechanisms behind these phenomena to inform the public about falls-prevention programs.

Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes.

BACKGROUND: Urinary tract infections (UTIs) are the most commonly treated infection among nursing home residents. Even in the absence of specific (e.g., dysuria) or non-specific (e.g., fever) signs or symptoms, residents frequently receive an antibiotic for a suspected infection. This research investigates factors associated with the use of antibiotics to treat asymptomatic bacteriuria (ASB) among nursing home residents. METHODS: This was a cross-sectional study involving multi-level multivariate analyses of antibiotic prescription data for residents in four nursing homes in central Texas. Participants included all nursing home residents in these homes who, over a six-month period, received an antibiotic for a suspected UTI. We investigated what factors affected the likelihood that a resident receiving an antibiotic for a suspected UTI was asymptomatic. RESULTS: The most powerful predictor of antibiotic treatment for ASB was the presence of an indwelling urinary catheter. Over 80 percent of antibiotic prescriptions written for catheterized individuals were written for individuals with ASB. For those without a catheter, record reviews identified 204 antibiotic prescriptions among 151 residents treated for a suspected UTI. Almost 50% of these prescriptions were for residents with no documented UTI symptoms. Almost three-quarters of these antibiotics were ordered after laboratory results were available to clinicians. Multivariate analyses indicated that resident characteristics did not affect the likelihood that an antibiotic was prescribed for ASB. The only statistically significant factor was the identity of the nursing home in which a resident resided. CONCLUSIONS: We confirm the findings of earlier research indicating frequent use of antibiotics for ASB in nursing homes, especially for residents with urinary catheters. In this sample of nursing home residents, half of the antibiotic prescriptions for a suspected UTI in residents without catheters occurred with no documented signs or symptoms of a UTI. Urine studies were performed in almost all suspected UTI cases in which an antibiotic was prescribed. Efforts to improve antibiotic stewardship in nursing homes must address clinical decision-making solely on the basis of diagnostic testing in the absence of signs or symptoms of a UTI.

The relationship between formal and informal care among adult Medicaid Personal Care Services recipients.

OBJECTIVES: To test hypotheses concerning the relationship between formal and informal care and to estimate the impact of hours of formal care authorized for Medicaid Personal Care Services (PCS) on the utilization of informal care. DATA SOURCES/STUDY SETTING: Data included home care use and adult Medicaid beneficiary characteristics from assessments of PCS need in four Medicaid administrative areas in Texas. STUDY DESIGN: Cross-sectional design using ordinary least-squares (OLS) and instrumental variable (IV) methods. DATA COLLECTION/EXTRACTION METHODS: The study database consisted of assessment data on 471 adults receiving Medicaid PCS from 2004 to 2006. PRINCIPAL FINDINGS: Both OLS and IV estimates of the impact of formal care on informal care indicated no statistically significant relationship. The impact of formal care authorized on informal care utilization was less important than the influence of beneficiary need and caregiver availability. Living with a potential informal caregiver dramatically increased the hours of informal care utilized by Medicaid PCS beneficiaries. CONCLUSIONS: More formal home care hours were not associated with fewer informal home care hours. These results imply that policies that decrease the availability of formal home care for Medicaid PCS beneficiaries will not be offset by an increase in the provision of informal care and may result in unmet care needs.

Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items.

BACKGROUND: To test the validity and reliability of scales intended to measure activity limitations faced by children with chronic illnesses living in the community. The scales were based on information provided by caregivers to service program personnel almost exclusively trained as social workers. The items used to measure activity limitations were interRAI items supplemented so that they were more applicable to activity limitations in children with chronic illnesses. In addition, these analyses may shed light on the possibility of gathering functional information that can span the life course as well as spanning different care settings. METHODS: Analyses included testing the internal consistency, predictive, concurrent, discriminant and construct validity of two activity limitation scales. The scales were developed using assessment data gathered in the United States of America (USA) from over 2,700 assessments of children aged 4 to 20 receiving Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, specifically Personal Care Services to assist children in overcoming activity limitations. The Medicaid program in the USA pays for health care services provided to children in low-income households. Data were collected in a single, large state in the southwestern USA in late 2008 and early 2009. A similar sample of children was assessed in 2010, and the analyses were replicated using this sample. RESULTS: The two scales exhibited excellent internal consistency. Evidence on the concurrent, predictive, discriminant, and construct validity of the proposed scales was strong. Quite importantly, scale scores were not correlated with (confounded with) a child's developmental stage or age. The results for these scales and items were consistent across the two independent samples. CONCLUSIONS: Unpaid caregivers, usually parents, can provide assessors lacking either medical or nursing training with reliable and valid information on the activity limitations of children. One can summarize these data in scales that are both internally consistent and valid. Researchers and clinicians can use supplemented interRAI items to provide guidance for professionals and programs serving children, as well as older persons. This research emphasizes the importance of developing medical information systems that allow one to integrate information not only across care settings but also across an individual's life course.

Self-reported physical and mental health of older adults: the roles of caregiving and resources.

OBJECTIVES: This study examined factors associated with self-reported physical and mental health, focusing on caregiving status and the availability of social supports and financial resources. METHODS: Two bivariate analyses were performed to examine the sociodemographic characteristics as well as perceived health outcomes among caregiving and non-caregiving participants. Two-equation probit models were used to determine independent predictors of self-reported physical and mental health, using data from 1071 community-based adults (≥ 60 years). An additional bivariate analysis was conducted to investigate the characteristics of caregivers who reported better physical health. RESULTS: Approximately 17% (n=183) of respondents reported being caregivers, and those in caregiving roles tended to be ethnic minorities, married, and have telephone communication with family or friends on a daily basis. Better physical and mental health outcomes were common for caregivers and non-caregivers who reported having more resources (e.g., higher income, better preparedness for future financial need, higher satisfaction with transportation and housing, and no limitation of usual daily activities). However, sociodemographic and social support factors were not significantly associated with physical and mental health among caregivers, unlike their non-caregiver counterparts. In the probit model, caregivers were more likely to be physically healthy compared to non-caregivers (Coefficient=0.34; p-value=0.031). Compared with healthy non-caregivers (n=631), healthy caregivers (n=141) tended to be ethnic minorities, married, and have telephone communication with family or friends on a daily basis. CONCLUSIONS: Findings suggest that preparing resources and maintaining strong social support systems may foster health status among older family caregivers.