Factors associated with nursing-home entry for elders in Manitoba, Canada.

BACKGROUND: As the population ages, a greater demand for long-term care services and, in particular, nursing homes is expected. Policy analysts continue to search for alternative, less costly forms of care for the elderly and have attempted to develop programs to delay or prevent nursing-home entry. Health care administrators require information for planning the future demand for nursing-home services. This study assesses the relative importance of predisposing, enabling, and need characteristics in predicting and understanding nursing-home entry. METHODS: Proportional hazard models, incorporating changes in needs over time, are used to estimate the hazard of nursing-home entry over a 5-year period, using health and sociodemographic characteristics of a representative sample of elderly residents from Manitoba, Canada. RESULTS: After age, need factors have the greatest impact on nursing-home entry. Specific medical conditions have at least as great a contribution as functional limitations. The presence of a spouse significantly reduces the hazard of entry for males only. CONCLUSIONS: The results suggest that the greatest gains in preventing or delaying nursing-home entry can be achieved through intervention programs targeted at specific medical conditions such as Alzheimer's disease, musculoskeletal disorders, and stroke.

A profile of health care utilization of the disabled population in Manitoba.

OBJECTIVES: This study profiled health care utilization by disabled and nondisabled individuals in the Canadian province of Manitoba to evaluate the association between health care utilization and disability. METHODS: Age-standardized annualized utilization rates were calculated according to sex using longitudinal data on individual encounters with the Manitoba health care system from 1983 to 1990. Associations between severity of disability, number of prior chronic conditions, and prospective utilization were examined using multivariate regressions. RESULTS: Utilization patterns of the mildly disabled and the nondisabled differed only slightly. Severely disabled individuals had much higher rates of contact and consumed more resources, even after controlling for chronic conditions. The severely disabled accounted for 3% of the population and consumed 16% of hospital days and 7% of physician costs annually. CONCLUSIONS: The findings emphasize the importance of incorporating measures of disability in health services research. Both the severity of disability and the number of chronic conditions had independent value in predicting health care utilization. This has important implications for data collection and for the allocation of health care resources for research, which has traditionally been targeted toward fatal chronic conditions.

Health and gender differences between middle and senior managers in the Canadian Public Service.

Most studies of the relationship between socioeconomic status (SES) and health have concentrated on disparities between the richest and poorest men; few studies have examined such relationships for women due to difficulties in measuring SES for women. For the present study, data collected from Canadian Public Service middle and senior managers provided an opportunity to examine associations between SES and health within the upper end of the SES spectrum for both genders, since women managers can be assumed to have a relatively high SES. Demographic, health and lifestyle characteristics are compared for middle and senior managers for each gender separately to determine whether women experience the health benefits associated with higher SES that have been previously observed for men. The results support the hypothesis that achieving a higher SES through work is a more stressful process for women than for men and that women's upward mobility is restricted compared to that of men. Despite these findings, there is little evidence that women's health has been adversely affected. Compared to male managers, fewer female managers smoke or drink and fewer have high body mass index, high blood pressure or high cholesterol levels. Female managers are also more likely to report being in good health.

Variable-mode helical CT: imaging protocols.

Helical CT provides a rapidly acquired, accurately registered, two-dimensional data set during the phase of maximum vascular and parenchymal enhancement. The z-axis can be covered by using either a single acquisition, single breath-hold technique or by using multiple helical groups with intergroup delays for the patient's breathing. The latter approach, called variable-mode helical CT, allows large z-axis coverage of more than one anatomic region during injection of a single bolus of contrast material. We discuss helical scanning protocols, both single-acquisition and variable-mode, that we have developed for detection of disease involving major blood vessels (pulmonary arteries and aorta), perivascular tissue planes (neck, thorax, and pelvis), and abdominal viscera (liver, pancreas, and kidneys).

Magnetization transfer: a potential method to determine the age of multiple sclerosis lesions.

PURPOSE: To determine whether magnetization transfer contrast can differentiate acute from chronic lesions in multiple sclerosis. METHODS: Thirteen patients with multiple sclerosis and eight healthy patients were studied with MR using a 0.1-T system. Relatively T2-weighted spin-echo images were obtained without and with magnetization transfer contrast. The magnetization transfer effect of multiple sclerosis lesions was calculated and compared with the ages of the lesions. The magnetization transfer effect of normal-appearing white matter in patients with multiple sclerosis was calculated and compared with the magnetization transfer effect of white matter in healthy volunteers. Statistical analysis was performed. RESULTS: White matter in the healthy volunteers had values from 0.40 to 0.45. Normal-appearing white matter in the patients with multiple sclerosis had magnetization transfer effect values ranging from 0.41 to 0.45. Multiple sclerosis plaques of less than 1 year's duration had magnetization transfer effect values ranging from 0.05 to 0.26; older plaques had values from 0.25 to 0.41. The difference in the distributions of these values for acute and chronic multiple sclerosis plaques is statistically significant. CONCLUSION: Current imaging modalities do not differentiate acute multiple sclerosis lesions from chronic ones. Our data on magnetization transfer show a statistically significant difference in magnetization transfer effect values between lesions of less than 1 year's duration and older lesions. The different values may correspond to the histologic changes of multiple sclerosis plaques over time. Magnetization transfer may be a reliable method for determining the age of multiple sclerosis lesions.

Intravascular stents in the management of acute superior vena cava obstruction of benign etiology.

The purpose of our study was to report our experience with percutaneous placement of intravascular stents to relieve venous occlusion in patients with acute superior vena cava syndrome resulting from benign etiologies. Six patients ranging in age from 39 to 66 years received thrombolysis followed by placement of stents within the superior vena cava or received stent placement alone as emergency treatment for symptoms of acute superior vena cava obstruction. Treatment was successful in all patients, with establishment of a patent lumen angiographically, and patients experienced prompt symptomatic relief. Follow-up examination at intervals of 5 months to 2 years has demonstrated no evidence of reocclusion. Three patients have subsequently had central lines placed across the stented vena cava for vascular access. Percutaneous placement of intravascular stents to treat acute occlusion offered a safe and effective method of treatment in patients with superior vena cava syndrome resulting from benign causes.

[Supracondylar fracture of the humerus in children with concomitant fracture of the ipsilateral forearm]. / Zlamania nadklykciowe kosci ramiennej u dzieci z jednoczasowym zlamaniem przedramienia tej samej konczyny.

The mode of treatment used in 6 cases of combined supracondylar fracture of the humerus and ipsilateral forearm fracture is presented. Results were rated good, fair and poor according to both functional and radiological assessments. Three cases were good and 3 fair. One stage reduction of both fractures with plaster of Paris immobilization or olecranon traction has been performed. The results achieved are corresponding with those presented in the bibliography.

Career earnings and death: a longitudinal analysis of older Canadian men.

There is widespread interest in disparities in health status across income groups and other classifications of socioeconomic status. In Canada, as in many other countries, there is considerable evidence showing such disparities. This study reports an analysis of male mortality at ages 65 to 74 in relation to socioeconomic characteristics, specifically employment and self-employment earnings histories during the 10 to 20 years prior to age 65, marital status, disability, and age at retirement. The analysis is based on administrative data from the Canada Pension Plan covering more than 500,000 individuals. Significant mortality gradients are found throughout the earnings spectrum. These gradients are also clearly evident in a multivariate context. The results illustrate the major potential of administrative data for research. Substantively, the results cast doubt on the primacy of causal explanations such as "reverse causality" and "health selection" and raise important questions regarding pension and health policy.

Use of CT for diagnosis of traumatic rupture of the thoracic aorta.

CT imaging of traumatic aortic rupture has been both advocated and disparaged in the current literature as a reliable diagnostic modality. In a retrospective review of blunt chest trauma patients at our institution evaluated by both thoracic CT and arteriography, we found a 17% false negative rate and a 39% false positive rate. Although we feel CT is not sufficiently sensitive at present to evaluate traumatic rupture of the aorta directly, it is an invaluable adjunctive imaging modality for stable blunt chest trauma patients with equivocal chest radiographs or arteriograms.

Risk factors for hypertension as measured by the Canada Health Survey.

This paper examines the association between hypertension and demographic, genetic, personal, and socio-economic risk factors. Logistic regression models were fitted to data from the 1978-79 Canada Health Survey. The analysis showed that age, sex, genetic history, and body mass index were important factors in predicting high blood pressure. For males, blood cholesterol and exercise were other contributing factors; for females, hypertension also had significant associations with marital status, geographical region, and economic family income.

The consistency of various high blood pressure indicators based on questionnaire and physical measures data from the Canada Health Survey.

Several indicators of the presence of high blood pressure, taken from different parts of Canada Health Survey data, are compared at the individual respondent level to determine their consistency and their usefulness, alone or in combination, in measuring the prevalence of hypertension. The results demonstrate some systematic and substantial discrepancies among various high blood pressure indicators derived from questionnaire data, and between questionnaire data and physically measured blood pressure status.