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1.
Indoor Air ; 30(2): 284-293, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31814168

RESUMO

Chlorine-based disinfectants protect pool water from pathogen contamination but produce potentially harmful halogenated disinfection by-products (DBPs). This study characterized the bioaccumulation and elimination of exhaled DBPs post-swimming and investigated changes in exhaled breath profiles associated with chlorinated pool exposure. Nineteen participants provided alveolar-enriched breath samples prior to and 5, 90, 300, 510, and 600 minutes post-swimming. Known DBPs associated with chlorinated water were quantitated by thermal desorption-gas chromatography-mass spectrometry. Two distinct exhaled DBP elimination profiles were observed. Most participants (84%) reported peak concentrations immediately post-swimming that reduced exponentially. A sub-group exhibited a previously unobserved and delayed washout profile with peak levels at 90 minutes post-exposure. Metabolomic investigations tentatively identified two candidate biomarkers associated with swimming pool exposure, demonstrating an upregulation in the hours after exposure. These data demonstrated a hitherto undescribed exhaled DBP elimination profile in a small number of participants which contrasts previous findings of uniform accumulation and exponential elimination. This sub-group which exhibited delayed peak-exhaled concentrations suggests the uptake, processing, and immediate elimination of DBPs are not ubiquitous across individuals as previously understood. Additionally, non-targeted metabolomics highlighted extended buildup of compounds tentatively associated with swimming in a chlorinated pool environment that may indicate airway responses to DBP exposure.


Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Desinfetantes/análise , Exposição por Inalação/estatística & dados numéricos , Piscinas , Natação , Biomarcadores , Cloro/análise , Desinfecção/métodos , Expiração , Halogenação , Humanos , Trialometanos/análise
2.
Am J Cardiol ; 122(5): 851-858, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30037422

RESUMO

Outcomes in asymptomatic patients with aortic stenosis (AS) have been reported primarily from tertiary centers. Whether observations from a community hospital cohort would be similar or if clinical variables would assume a more important role remains uncertain. This retrospective cohort study from one community hospital followed asymptomatic patients with moderate to severe AS for 3 years following an index echocardiogram. Patients underwent standard echocardiographic imaging and assessment of AS severity. Outcomes included aortic valve replacement, onset of Class 4 heart failure and cardiovascular death. Inclusion or exclusion criteria were met by 190 patients (body mass index of 30.8 ± 7.5 kg/m2 and age 70.9 ± 13.0 years). In this obese and racially diverse cohort, adverse outcomes occurred in 72 of 190 (38%), aortic valve replacement in 33 of 72 (46%), heart failure in 30 of 72 (42%), and cardiovascular death in 9 of 72 (13%). Univariate analyses found that the echocardiographic variables assessing AS severity (Vmax, mean aortic valve gradient, and the dimensionless index) were strongly associated with outcomes. A model predicting time to adverse outcomes included age, gender, Charlson index, Vmax, aortic valve area, the electrocardiographic variables of atrial fibrillation and left ventricular strain, and echocardiographic variables unrelated to the direct measurements of stenosis severity. In conclusion, direct echocardiographic measures of AS severity, echocardiographic parameters unrelated to AS severity plus the electrocardiographic variables of atrial fibrillation and left ventricular strain were the dominant predictors of adverse outcomes in a community hospital cohort of asymptomatic patients with moderate to severe AS.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/terapia , Comorbidade , Ecocardiografia , Eletrocardiografia , Feminino , Hospitais Comunitários , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
3.
Surg Obes Relat Dis ; 14(1): 60-64, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29287756

RESUMO

BACKGROUND: Over the last 20 years, bariatric surgery has emerged as a highly effective weight loss intervention that can also improve co-morbid medical conditions. However, some payors have required preoperative supervised diets and weight loss. OBJECTIVE: To determine if preoperative weight loss is the best predictor of postoperative weight loss. SETTING: Academic county hospital, United States. METHODS: A retrospective chart review of 218 patients. Patients who received psychological evaluation and bariatric surgery were followed up at 1 year. All preoperative patients were encouraged to lose weight; however, no specified amount of weight loss was required. Preoperative weight loss and postoperative weight loss in body mass index (BMI), percent excess weight loss, and percent total weight loss were measured. Bariatric outcome predictor variables evaluated included age, race, and sex; BMI change; measures of depression and anxiety; number of unhealthy eating types; and co-morbid medical conditions. A linear regression model and stepwise regression analyses were used to estimate contributions of independent variables to the 1-year weight loss. RESULTS: All patients had a mean 28% reduction in BMI (63.3% excess weight loss and 29.1% total weight loss) at 1 year postoperatively. As a single independent variable, preoperative weight loss was a significant predictor of 1-year change in postoperative BMI (P = .006). However, when age, race, and sex were added to the regression equation, the predictive value of preoperative weight loss became nonsignificant (P = .543). CONCLUSION: The present findings indicate that preoperative weight loss should not be considered in isolation when clearance for bariatric surgery is being evaluated.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Redução de Peso/fisiologia , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas , Obesidade/cirurgia , Seleção de Pacientes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Adulto Jovem
4.
Neurosurg Focus ; 42(5): E6, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28463621

RESUMO

The authors have developed a simple device for computer-aided design/computer-aided manufacturing (CAD-CAM) that uses an image-guided system to define a cutting tool path that is shared with a surgical machining system for drilling bone. Information from 2D images (obtained via CT and MRI) is transmitted to a processor that produces a 3D image. The processor generates code defining an optimized cutting tool path, which is sent to a surgical machining system that can drill the desired portion of bone. This tool has applications for bone removal in both cranial and spine neurosurgical approaches. Such applications have the potential to reduce surgical time and associated complications such as infection or blood loss. The device enables rapid removal of bone within 1 mm of vital structures. The validity of such a machining tool is exemplified in the rapid (< 3 minutes machining time) and accurate removal of bone for transtemporal (for example, translabyrinthine) approaches.


Assuntos
Desenho Assistido por Computador/instrumentação , Desenho de Prótese/instrumentação , Base do Crânio/cirurgia , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Imageamento Tridimensional/instrumentação , Imageamento Tridimensional/métodos
5.
Psychiatr Serv ; 68(9): 883-890, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28502243

RESUMO

OBJECTIVES: A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus. METHODS: The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control. RESULTS: Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group. CONCLUSIONS: TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.


Assuntos
Transtorno Bipolar/terapia , Transtorno Depressivo/terapia , Diabetes Mellitus/terapia , Avaliação de Resultados em Cuidados de Saúde , Esquizofrenia/terapia , Autogestão/métodos , Adulto , Transtorno Bipolar/epidemiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esquizofrenia/epidemiologia
6.
J Oral Maxillofac Surg ; 72(4): 750-4, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24529568

RESUMO

PURPOSE: The purpose of this study was to compare and characterize 2 cohorts of patients with maxillofacial fractures within the same institution over 2 6-year time frames 20 years apart. MATERIALS AND METHODS: A retrospective review of patients with maxillofacial fractures at the authors' institution from 2004 to 2010 was performed, and a comparison was made with the authors' experience from 1984 to 1990. RESULTS: The 1990 study showed 458 maxillofacial fractures (152 midface and 306 mandibular fractures). In the 2010 study, there were 1,731 maxillofacial fractures (1,313 midface and 418 mandibular fractures). There were significant differences in the mechanism of injury between the 1990 and 2010 studies: assaults decreased from 48.8% to 29.7%, motor vehicle collisions decreased from 39.1% to 29.6%, and falls increased from 3.6% to 22.1%. Comparison by age categories showed major changes in the following groups: maxillofacial fractures in patients 21 to 40 years old decreased from 61.7% to 35.3%, those in patients 41 to 65 years old increased from 13.1% to 35.4%, and those in patients at least 66 years old (elderly) increased from 0.2% to 14.5%. All these changes were statistically significant (P < .0001). CONCLUSION: Maxillofacial trauma has changed significantly over the past 2 decades in the authors' institution. A decrease in assault-related injuries in the younger populations and an increase in the incidence of falls in the elderly were the main differences. There was a significant increase in elderly patients with maxillofacial trauma. This change emphasizes the need for adequate prevention programs and appropriate maxillofacial surgery teams to manage these injuries in the older patient.


Assuntos
Traumatismos Maxilofaciais/epidemiologia , Fraturas Cranianas/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Traumatismos em Atletas/epidemiologia , Estudos de Coortes , Ossos Faciais/lesões , Humanos , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/mortalidade , Traumatismos Maxilofaciais/mortalidade , Pessoa de Meia-Idade , Ohio/epidemiologia , Estudos Retrospectivos , Fraturas Cranianas/mortalidade , Violência/estatística & dados numéricos , Adulto Jovem
7.
SOCRA Source ; 81: 12-21, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25774099

RESUMO

BACKGROUND: Little attention has been given to the cultural competence education needs for researchers. OBJECTIVES: To describe the planning and implementation of a neighborhood visit approach to cultural competency education in the community. METHODS: A committee of community partners and academics planned, conducted and evaluated the visit. The cultural competence and confidence (CCC) model was used to engage researchers. An evaluation survey assessed participant satisfaction and experiences. RESULTS: Of the 74 attendees 64 (84%) completed the conference evaluation. Attendees expressed that the visit and conference objectives were met and that the content was relevant to their work. Nearly all (95%) responded they would incorporate what they learned into practice. CONCLUSION: A neighborhood visit approach is feasible and acceptable to researchers and community partners. Evaluation of this community based education program showed preliminary evidence of changing both the way researchers think about the community and conduct research.

8.
Am J Trop Med Hyg ; 88(3): 433-40, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23324217

RESUMO

We measured prevalence of Schistosoma haematobium, Wuchereria bancrofti, Plasmodium falciparum, hookworm, and other geohelminths among school-aged children in four endemic villages in Kwale County, Kenya and explored the relationship between multiparasite burden, undernutrition, and anemia. In 2009-2010 surveys, cross-sectional data were obtained for 2,030 children 5-18 years old. Infections were most prevalent for S. haematobium (25-62%), hookworm (11-28%), and falciparum malaria (8-24%). Over one-half of children were anemic, with high rates of acute and chronic malnutrition. Associations with infection status showed significant age and sex differences. For boys, young age, low socioeconomic standing (SES), S. haematobium, and/or malaria infections were associated with greater odds of anemia, wasting, and/or stunting; for girls, heavy S. haematobium infection and age were the significant cofactors for anemia, whereas low SES and older age were linked to stunting. The broad overlap of infection-related causes for anemia and malnutrition and the high frequency of polyparasitic infections suggest that there will be significant advantages to integrated parasite control in this area.


Assuntos
Anemia/etiologia , Infecções por Uncinaria/complicações , Malária Falciparum/complicações , Desnutrição/etiologia , Schistosoma haematobium , Esquistossomose Urinária/complicações , Adolescente , Fatores Etários , Anemia/epidemiologia , Animais , Criança , Pré-Escolar , Feminino , Infecções por Uncinaria/epidemiologia , Humanos , Quênia/epidemiologia , Malária Falciparum/epidemiologia , Masculino , Desnutrição/epidemiologia , Razão de Chances , Fatores de Risco , Esquistossomose Urinária/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
9.
J Stud Alcohol Drugs ; 72(5): 787-98, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21906506

RESUMO

OBJECTIVE: Patients with hepatitis C virus (HCV) are advised to refrain from alcohol consumption. A questionnaire was developed to measure concepts associated with alcohol use for individuals with HCV. METHOD: Subjects with HCV (N = 527) completed a telephone survey. Eligible respondents had screened negative for current abuse/dependence disorders (Alcohol Use Disorders Identification Test [AUDIT] ≤ 10). Measures of personality, self-efficacy, knowledge, readiness, coping styles, stigma, and symptoms were examined for associations with alcohol use. RESULTS: Factor analysis supported a measurement structure of 105 items in 35 subdomains. A total of 26 subdomains had significant bivariate associations with alcohol use. Higher self-efficacy for resisting drinking in social situations was associated with lower alcohol use (r = -.68, p < .001), as was knowledge of alcohol and HCV (r = -.27, p < .001). Although agreeableness and marital status are typically associated with lower current drinking in samples of those with alcohol use problems, in our study agreeableness (ß = .13, p < .01) and marital status (ß = .08, p < .05) were modestly associated with higher current drinking. The final multivariate R² was .55. CONCLUSIONS: The pattern of associations suggests the importance of the social aspects of drinking for drinking decisions. Existing brief interventions will need to be tailored to a contextualized psychosocial model for medical patients with HCV and AUDIT scores ≤ 10 to optimize effectiveness. Such future interventions should emphasize the potential medical hazards of drinking for persons with HCV, the maintenance of social relationships in the absence of alcohol use, and strategies for building confidence for resisting drinking in specific situations.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/psicologia , Hepatite C/psicologia , Comportamento Social , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Saúde da População Urbana
10.
PLoS Negl Trop Dis ; 5(7): e1213, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21750742

RESUMO

BACKGROUND: To date, there has been no standardized approach to the assessment of aerobic fitness among children who harbor parasites. In quantifying the disability associated with individual or multiple chronic infections, accurate measures of physical fitness are important metrics. This is because exercise intolerance, as seen with anemia and many other chronic disorders, reflects the body's inability to maintain adequate oxygen supply (VO(2) max) to the motor tissues, which is frequently linked to reduced quality-of-life in terms of physical and job performance. The objective of our study was to examine the associations between polyparasitism, anemia, and reduced fitness in a high risk Kenyan population using novel implementation of the 20-meter shuttle run test (20mSRT), a well-standardized, low-technology physical fitness test. METHODOLOGY/PRINCIPAL FINDINGS: Four villages in coastal Kenya were surveyed during 2009-2010. Children 5-18 years were tested for infection with Schistosoma haematobium (Sh), malaria, filaria, and geohelminth infections by standard methods. After anthropometric and hemoglobin testing, fitness was assessed with the 20 mSRT. The 20 mSRT proved easy to perform, requiring only minimal staff training. Parasitology revealed high prevalence of single and multiple parasitic infections in all villages, with Sh being the most common (25-62%). Anemia prevalence was 45-58%. Using multiply-adjusted linear modeling that accounted for household clustering, decreased aerobic capacity was significantly associated with anemia, stunting, and wasting, with some gender differences. CONCLUSIONS/SIGNIFICANCE: The 20 mSRT, which has excellent correlation with VO(2), is a highly feasible fitness test for low-resource settings. Our results indicate impaired fitness is common in areas endemic for parasites, where, at least in part, low fitness scores are likely to result from anemia and stunting associated with chronic infection. The 20 mSRT should be used as a common metric to quantify physical fitness and compare sub-clinical disability across many different disorders and community settings.


Assuntos
Teste de Esforço/métodos , Parasitos/isolamento & purificação , Doenças Parasitárias/complicações , Doenças Parasitárias/fisiopatologia , Aptidão Física/fisiologia , Adolescente , Animais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hemoglobinas/análise , Humanos , Lactente , Quênia , Masculino , Parasitos/classificação , População Rural , Adulto Jovem
11.
J Clin Densitom ; 12(1): 11-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19195620

RESUMO

Diagnostic criteria for postmenopausal osteoporosis using central dual-energy X-ray absorptiometry (DXA) T-scores have been widely accepted. The validity of these criteria for other populations, including premenopausal women and young men, has not been established. The International Society for Clinical Densitometry (ISCD) recommends using DXA Z-scores, not T-scores, for diagnosis in premenopausal women and men aged 20-49 yr, though studies supporting this position have not been published. We examined diagnostic agreement between DXA-generated T-scores and Z-scores in a cohort of men and women aged 20-49 yr, using 1994 World Health Organization and 2005 ISCD DXA criteria. Four thousand two hundred and seventy-five unique subjects were available for analysis. The agreement between DXA T-scores and Z-scores was moderate (Cohen's kappa: 0.53-0.75). The use of Z-scores resulted in significantly fewer (McNemar's p<0.001) subjects diagnosed with "osteopenia," "low bone mass for age," or "osteoporosis." Thirty-nine percent of Hologic (Hologic, Inc., Bedford, MA) subjects and 30% of Lunar (GE Lunar, GE Madison, WI) subjects diagnosed with "osteoporosis" by T-score were reclassified as either "normal" or "osteopenia" when their Z-score was used. Substitution of DXA Z-scores for T-scores results in significant diagnostic disagreement and significantly fewer persons being diagnosed with low bone mineral density.


Assuntos
Absorciometria de Fóton , Osteoporose/diagnóstico , Absorciometria de Fóton/instrumentação , Adulto , Estudos Transversais , Feminino , Fêmur/patologia , Colo do Fêmur/patologia , Quadril/patologia , Humanos , Modelos Logísticos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Software
12.
Behav Ther ; 40(1): 23-38, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19187814

RESUMO

Even though generalized anxiety disorder (GAD) is one of the most common of the anxiety disorders, relatively little is known about its precursors. Bowlby's attachment theory provides a framework within which these precursors can be considered. According to Bowlby, adult anxiety may be rooted in childhood experiences that leave a child uncertain of the availability of a protective figure in times of trouble.Furthermore, adult "current state of mind with respect to attachment" is thought to relate to adult anxiety. Both attachment-related components were assessed with 8 subscales of the Perceptions of Adult Attachment Questionnaire(PAAQ). Clinically severe GAD clients who were about to begin therapy reported experiencing less maternal love in childhood, greater maternal rejection/neglect, and more maternal role-reversal/enmeshment than did control participants.In keeping with a cumulative risk model, risk for GAD increased as indices of poor childhood attachment experience increased. GAD clients, in contrast to controls,also reported greater current vulnerability in relation to their mothers as well as more difficulty accessing childhood memories. Logistic regression analyses revealed that elevations on PAAQ subscales could significantly predict GAD vs.non-GAD status. Results and the implications for advancing the theory and treatment of GAD are discussed.


Assuntos
Transtornos de Ansiedade/psicologia , Ansiedade/psicologia , Relações Mãe-Filho , Apego ao Objeto , Inquéritos e Questionários , Adulto , Idoso , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Análise de Regressão , Fatores de Risco , Adulto Jovem
13.
J Mix Methods Res ; 3(1): 65-86, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20046861

RESUMO

Most studies of decisions to curtail alcohol consumption reflect experiences of abusing drinkers. We employ an exploratory sequential research design to explore the applicability of this research to the experience of nonabusing drinkers advised to curtail alcohol consumption after a Hepatitis C diagnosis. A qualitative component identified 17 new decision factors not reflected in an inventory of factors based on synthesis of existing scales. We triangulated qualitative data by supplementing semi-structured interviews with Internet postings. A quantitative component estimated prevalence and association with current drinking of these new decision factors. Patients who quit drinking tended to attribute post-diagnosis drinking to occasional triggers, whereas patients who were still drinking were more likely to endorse rationales not tied to specific triggers.

14.
J Clin Densitom ; 10(4): 351-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17662630

RESUMO

Central dual-energy X-ray absorptiometry (DXA) is the gold standard for non-invasive measurement of bone mineral density (BMD). Using this value and subject demographics, DXA software calculates T-scores and Z-scores. Professional society guidelines for the management of osteoporosis are based on T-scores and Z-scores, rather than on the actual BMD value. Although one expects T-scores and Z-scores to be very similar in young men and women for any given BMD measurement, little literature exists on this issue. Our clinical experience shows that some younger adult individuals (premenopausal women and men younger than 50 yr) have larger than expected difference between their DXA T-score and Z-score. This cross-sectional study evaluates the extent of this discordance between Z-scores and T-scores in a sample of 4275 men and women aged 20-49 yr. All subjects were scanned by central DXA using equipment manufactured by GE Lunar, GE, Madison, WI, or Hologic, Inc., Bedford, MA. Significant differences between Z-scores and T-scores were seen within individuals at the lumbar spine, total hip, femoral neck, and trochanter (p value<0.001) for both DXA systems. Although these differences were less than half a standard deviation (SD) in most instances, the magnitude of difference was substantial at times, being 1 or more SD in up to 11% of cases (range: -1.95 to +1.54 SD). The smallest differences were seen at the total hip and the largest differences were seen at the femoral neck for both technologies. This is in part because there is no single standard Z-score definition, resulting in different methods of calculation across, and even within, DXA manufacturers. Standardization of Z-score definition and method of calculation is indicated. DXA Z-scores should be interpreted with caution in men and women aged 20-50 yr.


Assuntos
Densitometria/instrumentação , Densitometria/métodos , Adulto , Densidade Óssea , Osso e Ossos/patologia , Osso e Ossos/fisiologia , Calibragem , Interpretação Estatística de Dados , Densitometria/normas , Desenho de Equipamento , Feminino , Humanos , Vértebras Lombares/patologia , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/patologia , Análise de Regressão , Software , Raios X
16.
Dev Psychol ; 43(1): 173-85, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17201517

RESUMO

The purpose of this study was to examine the effects of program interventions in a school-based teen pregnancy program on hypothesized constructs underlying teens' attitudes toward sexuality. An important task related to this purpose was the validation of the constructs and their stability from pre- to postintervention measures. Data from 1,136 middle grade students were obtained from an earlier evaluation of an abstinence-based teen pregnancy prevention program (S. Weed, I. Ericksen, G. Grant, & A. Lewis, 2002). Latent trait structural equation modeling was used to evaluate the impact of the intervention program on changes in constructs of teens' attitudes toward sexuality. Gender was also taken into consideration. This investigation provides credible evidence that both 1st- and 2nd-order constructs related to measures of teens' attitudes toward risky sexual behavior are sufficiently stable and sensitive to detect program effects.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Gravidez na Adolescência/prevenção & controle , Educação Sexual , Comportamento Sexual , Adolescente , Currículo , Feminino , Humanos , Grupo Associado , Gravidez , Avaliação de Programas e Projetos de Saúde , Sexo Seguro , Autoeficácia , Fatores Sexuais , Abstinência Sexual
17.
Med Care ; 43(11): 1109-15, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16224304

RESUMO

BACKGROUND: The prospective payment system (PPS) for nursing homes was designed to curtail the rapid expansion of Medicare costs for skilled nursing care. This study examines the changes that occurred in nursing home patients and rehabilitation services following the PPS. SETTING: Free-standing Medicare and/or Medicaid certified nursing homes in Ohio. PRIMARY OUTCOMES: The percent of new admissions receiving therapy and the amount of rehabilitation therapy provided. SAMPLE: A total of 7006 first admissions in 1994-6 (pre-PPS) and 61,569 first admissions in 2000-1 (post-PPS). METHODS: A logistic model predicting likelihood of rehabilitation was developed and validated in pre-PPS admissions and applied to the post-PPS patients. Rehabilitation services were compared in the pre-PPS and post-PPS cohorts overall, stratified by quintile of predicted score, diagnosis group, and by nursing home profit status. RESULTS: Post-PPS patients had less cognitive impairment, more depression, and more family support. The amount of rehabilitation services declined the most in the higher quintiles of predicted likelihood of rehabilitation and among patients with stroke. The percent of patients receiving rehabilitation services increased the most in the lowest quintile and among patients with medical conditions. These changes were greater in for-profit nursing homes. CONCLUSIONS: The implementation of the PPS in nursing homes has been associated with a decrease in the amount of rehabilitation services, targeted at those predicted to receive higher amounts and an increased frequency of providing services targeted at those predicted to be less likely to receive them. The outcomes of the changes deserve further study.


Assuntos
Acessibilidade aos Serviços de Saúde/economia , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Reabilitação/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Instituições Privadas de Saúde/economia , Humanos , Funções Verossimilhança , Modelos Logísticos , Masculino , Medicaid , Medicare/legislação & jurisprudência , Pessoa de Meia-Idade , Ohio , Admissão do Paciente/estatística & dados numéricos , Reabilitação/economia
18.
J Invest Dermatol ; 125(4): 659-64, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16185263

RESUMO

This study's aim was to determine the relationship between Dermatology Life Quality Index (DLQI) scores and a Global Question (GQ) concerning patients' views of the overall impairment of their skin-related quality of life (QoL), and to express this relationship by identifying bands of DLQI scores equivalent to each GQ descriptor. A DLQI questionnaire and the GQ were mailed to 3834 adult general dermatology outpatients. There were 1993 (52%) responses: male 841; female 1152. Mean DLQI score = 4.86 (range 0-30, standard deviation (SD) = 5.83). Mean GQ score = 1.22 (range 0-4, SD = 1.20). The mean, mode, and median of the GQ scores for each DLQI score were used to devise several sets of bands of DLQI scores, and kappa coefficients of agreement calculated. The set proposed for adoption is: DLQI scores 0-1 = no effect on patient's life (GQ = 0, n = 754); DLQI scores 2-5 = small effect on patient's life (GQ = 1, n = 611); DLQI scores 6-10 = moderate effect on patient's life (GQ = 2, n = 327); DLQI scores 11-20 = very large effect on patient's life (GQ = 3, n = 242); DLQI scores 21-30 = extremely large effect on patient's life (GQ = 4, n = 59); kappa coefficient 0.489. Banding of the DLQI will aid the clinical interpretation of an individual's DLQI score and allow DLQI scores to inform clinical decisions.


Assuntos
Qualidade de Vida , Dermatopatias/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Arch Phys Med Rehabil ; 86(5): 876-80, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15895331

RESUMO

OBJECTIVE: To examine the effect of stroke rehabilitation in the nursing home on community discharge rates and functional status among patients stratified by propensity to receive rehabilitation. DESIGN: Retrospective cohort. SETTING: Medicaid-certified nursing homes (N=945) in Ohio. PARTICIPANTS: Patients with stroke (N=2013) admitted to an Ohio nursing home. INTERVENTION: Rehabilitation therapy services. MAIN OUTCOME MEASURES: The propensity to receive rehabilitation, used to adjust for selection bias, was calculated for each patient by using a logistic regression model. Community discharge and change in functional status, measured by using a crosswalk to the FIM instrument, were determined 3 months after admission. RESULTS: By 3 months after admission, 36.9% of the patients were discharged to the community, 16.6% had died, and 46.5% remained in the nursing home. The overall effect of rehabilitation on community discharge (relative risk [RR]=1.58; 95% confidence interval [CI], 1.33-1.85) was not homogeneous across subgroups stratified by propensity to receive rehabilitation. Patients less likely to receive rehabilitation, as measured by a lower propensity score, had a significant benefit in terms of community discharge (RR=1.65; 95% CI, 1.35-1.97), but those more likely to receive services did not (RR=1.21; 95% CI, 0.87-1.56). Among long-term nursing home residents, rehabilitation services were not associated with improved functional status. CONCLUSIONS: With respect to community discharge, patients who were less likely to receive rehabilitation therapy appear to receive greater benefit from rehabilitation services than those who were more likely to receive rehabilitation. This finding raises concerns about current selection practices for rehabilitation services. Research is needed to identify the patients most likely to benefit, especially in the present fiscally constrained reimbursement environment.


Assuntos
Casas de Saúde , Seleção de Pacientes , Reabilitação do Acidente Vascular Cerebral , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Modelos Logísticos , Masculino , Alta do Paciente/estatística & dados numéricos , Recuperação de Função Fisiológica , Estatísticas não Paramétricas , Resultado do Tratamento
20.
Chest ; 126(6): 1897-904, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15596690

RESUMO

STUDY OBJECTIVE: To use an existing database from a large cohort study with follow-up as long as 5.5 years to assess the extended prognosis of patients who survived their hospitalizations for severe acute respiratory failure (ARF). DESIGN, SETTING, AND PATIENTS: Secondary analysis of an inception cohort of 1,722 patients with ARF requiring mechanical ventilation from five major medical centers who were entered into the prospective Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. The 1,075 patients (62.4%) who survived hospitalization had systematic follow-up of vital status for a median time of 662 days (interquartile range, 327 to 1,049 days; range, 2 to 2,014 days). Interviews performed a median of 5 months after hospital discharge assessed functional capacity and quality of life (QOL). The main outcome measure was survival after hospital discharge. Secondary measures were functional status and QOL. Cox proportional hazard regression identified factors influencing posthospital survival. RESULTS: The median survival time after hospital discharge for ARF was > 5.3 years. The posthospital survival time was shorter for those with older age, male gender, several preexisting comorbid conditions, worse prehospital functional status, greater acute physiologic derangement, and a do-not-resuscitate order while in the hospital, and for those discharged to a location other than home. Five months after hospital discharge, 48% of survivors needed help with at least one activity of daily living, and 27% rated their QOL as poor or fair. However, most of these impairments were present before respiratory failure occurred. CONCLUSIONS: Extended survival is common among patients with ARF who require mechanical ventilation and who survive hospitalization. Among these patients, only a small fraction of the impairment in activity and QOL can be considered to be a sequela of the respiratory failure or its therapy. These findings are relevant to the care decisions for such critically ill patients.


Assuntos
Respiração Artificial , Insuficiência Respiratória/terapia , Atividades Cotidianas , Doença Aguda , Idoso , Feminino , Seguimentos , Custos Hospitalares , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Modelos de Riscos Proporcionais , Qualidade de Vida , Insuficiência Respiratória/economia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Taxa de Sobrevida
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