Oral health assessment in institutionalized elderly: a scoping review.

When elderly become frail and in need for complex care, they can no longer live independently at home and may be admitted to nursing homes. Various studies have shown that oral health in this population is remarkably poor, which may lead to distressing situations and impacts quality of life. A variety of definitions or descriptions for oral health is used. Without a uniform parameter, it is impossible to determine whether oral health in institutionalized elderly is actually improving or deteriorating over time, as well as the effect of (preventive) interventions. In search for an adequate and clinically applicable parameter to determine oral health in this specific patient group, this scoping review aims to give an overview of the currently used parameters for determining oral health in institutionalized elderly. Ninety different parameters were identified, and 50 parameters were solely used by one study. Only 4 parameters were frequently used (in > 20 studies). The relevance of these parameters for this specific patient group is discussed. To aid the planning and commissioning of future research and patient care, there is an urgent need for an adequate and uniform parameter for oral health determination in institutionalized elderly.

[General health, healthcare costs and dental care use of elderly with differing oral status]. / Algemene gezondheid, zorgkosten en tandartsbezoek van ouderen met verschillende orale status.

Cross-sectional studies have shown that elderly with a natural dentition or implant-retained overdenture have better general health outcomes than elderly with conventional dentures. It is not known whether these findings would be confirmed in longitudinal studies of such groups of elderly. Therefore, in this study a large group of elderly (aged 75 and over) with a natural dentition (n = 143,199), an implant-retained overdenture (n = 6,503) or conventional denture (n=18,420) were followed over a period of 8 years. Elderly with conventional dentures had chronic conditions more often, used more medication and had higher healthcare costs. Remarkably, the general health outcomes of elderly with an implant-retained overdenture declined over the period of 8 years. At the time the implant-retained overdenture was placed, their general health profile seemed comparable to that of elderly with a natural dentition, but as time progressed it declined to the level of elderly with conventional dentures.

Best practice recommendations for bladder management in spinal cord-afflicted patients in South Africa.

Recent research on the standard of care and related quality of life of the spinal cord-afflicted community in South Africa (SA) has revealed significant gaps in practice, and challenges regarding levels of care and access to services and supplies specifically related to the neurogenic bladder.

An online self-test added to colorectal cancer screening can increase the effectiveness of familial cancer risk assessment without increasing distress.

AIM: Most people who are at increased familial colorectal cancer (FCRC) risk are not identified, despite the need for enhanced surveillance colonoscopy for effective CRC prevention. An online self-test may enhance this identification. We assessed whether taking an online self-test to identify increased FCRC risk increases anxiety, distress or CRC risk perception in population-based CRC screening. METHOD: After the precolonoscopy consultation, patients who had a positive immunohistochemical occult faecal blood test (iFOBT+) in population-based CRC screening were invited by email to take an online self-test at home which returned details of family history. Anxiety (STAI-DY), distress (HADS) and CRC risk perception were assessed immediately before and after taking the online self-test and 2 weeks later. RESULTS: Of 250 participants invited, 177 (71%) completed the online self-test and psychological questionnaires and 153 (61%) completed questionnaires 2 weeks later. The median age was 65 years (range 61-75). The FCRC risk was increased in 17 participants (9.6%). Of these, 12 (6.8%) had a highly increased FCRC risk and may benefit from germline genetic testing for Lynch syndrome. In 7 of 17 participants (40%) the self-test obtained novel information on family history. Anxiety and distress levels were, and remained, below a clinically relevant level. Perception of CRC risk remained unchanged. Most participants (83%) would recommend the online self-test to others. CONCLUSION: Of those with a iFOBT+, 9.6% had a previously unidentified increasedFCRC risk and require an enhanced surveillance colonoscopy instead of iFOBT. As screening for this risk did not increase anxiety or distress, and was highly acceptable, we recommend adding the online self-test to population-based CRC screening.

Instruments Measuring Pain, Physical Function, or Patient's Global Assessment in Hand Osteoarthritis: A Systematic Literature Search.

OBJECTIVE: Description of use and metric properties of instruments measuring pain, physical function, or patient's global assessment (PtGA) in hand osteoarthritis (OA). METHODS: Medical literature databases up to January 2014 were systematically reviewed for studies reporting on instruments measuring pain, physical function, or PtGA in hand OA. The frequency of the use of these instruments were described, as well as their metric properties, including discrimination (reliability, sensitivity to change), feasibility, and validity. RESULTS: In 66 included studies, various questionnaires and performance- or assessor-based instruments were applied for evaluation of pain, physical function, or PtGA. No major differences regarding metric properties were observed between the instruments, although the amount of supporting evidence varied. The most frequently evaluated questionnaires were the Australian/Canadian Hand OA Index (AUSCAN) pain subscale and visual analog scale (VAS) pain for pain assessment, and the AUSCAN function subscale and Functional Index for Hand OA (FIHOA) for physical function assessment. Excellent reliability was shown for the AUSCAN and FIHOA, and good sensitivity to change for all mentioned instruments; additionally, the FIHOA had good feasibility. Good construct validity was suggested for all mentioned questionnaires. The most commonly applied performance- or assessor-based instruments were the grip and pinch strength for the assessment of physical function, and the assessment of pain by palpation. For these measures, good sensitivity to change and construct validity were established. CONCLUSION: The AUSCAN, FIHOA, VAS pain, grip and pinch strength, and pain on palpation were most frequently used and provided most supporting evidence for good metric properties. More research has to be performed to compare the different instruments with each other.

Electronic portal image assisted reduction of systematic set-up errors in head and neck irradiation.

PURPOSE: To quantify systematic and random patient set-up errors in head and neck irradiation and to investigate the impact of an off-line correction protocol on the systematic errors. MATERIAL AND METHODS: Electronic portal images were obtained for 31 patients treated for primary supra-glottic larynx carcinoma who were immobilised using a polyvinyl chloride cast. The observed patient set-up errors were input to the shrinking action level (SAL) off-line decision protocol and appropriate set-up corrections were applied. To assess the impact of the protocol, the positioning accuracy without application of set-up corrections was reconstructed. RESULTS: The set-up errors obtained without set-up corrections (1 standard deviation (SD)=1.5-2mm for random and systematic errors) were comparable to those reported in other studies on similar fixation devices. On an average, six fractions per patient were imaged and the set-up of half the patients was changed due to the decision protocol. Most changes were detected during weekly check measurements, not during the first days of treatment. The application of the SAL protocol reduced the width of the distribution of systematic errors to 1mm (1 SD), as expected from simulations. A retrospective analysis showed that this accuracy should be attainable with only two measurements per patient using a different off-line correction protocol, which does not apply action levels. CONCLUSIONS: Off-line verification protocols can be particularly effective in head and neck patients due to the smallness of the random set-up errors. The excellent set-up reproducibility that can be achieved with such protocols enables accurate dose delivery in conformal treatments.

Patient education in Europe: united differences.

This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education is defined as all the educational activities directed to patients, including aspects of therapeutic education, health education and clinical health promotion. Five important factors are identified in the development of patient education: (1) research and evidence based standards; (2) the organization of care; (3) training and methodological support; (4) professional values; and (5) acknowledgment, funding and place of patient education in health policy. Several of the discussed common orientations and priorities in the patient education in the reviewed countries are highlighted in this issue. And finally, an example of the possible integrated international practice in patient education in the field of diabetes is described in this issue. Several conclusions are drawn concerning future development of communication in health care within the framework of patient education in Europe.

Inclusion of geometrical uncertainties in radiotherapy treatment planning by means of coverage probability.

PURPOSE: Following the ICRU-50 recommendations, geometrical uncertainties in tumor position during radiotherapy treatments are generally included in the treatment planning by adding a margin to the clinical target volume (CTV) to yield the planning target volume (PTV). We have developed a method for automatic calculation of this margin. METHODS AND MATERIALS: Geometrical uncertainties of a specific patient group can normally be characterized by the standard deviation of the distribution of systematic deviations in the patient group (Sigma) and by the average standard deviation of the distribution of random deviations (sigma). The CTV of a patient to be planned can be represented in a 3D matrix in the treatment room coordinate system with voxel values one inside and zero outside the CTV. Convolution of this matrix with the appropriate probability distributions for translations and rotations yields a matrix with coverage probabilities (CPs) which is defined as the probability for each point to be covered by the CTV. The PTV can then be chosen as a volume corresponding to a certain iso-probability level. Separate calculations are performed for systematic and random deviations. Iso-probability volumes are selected in such a way that a high percentage of the CTV volume (on average > 99%) receives a high dose (> 95%). The consequences of systematic deviations on the dose distribution in the CTV can be estimated by calculation of dose histograms of the CP matrix for systematic deviations, resulting in a so-called dose probability histogram (DPH). A DPH represents the average dose volume histogram (DVH) for all systematic deviations in the patient group. The consequences of random deviations can be calculated by convolution of the dose distribution with the probability distributions for random deviations. Using the convolved dose matrix in the DPH calculation yields full information about the influence of geometrical uncertainties on the dose in the CTV. RESULTS: The model is demonstrated to be fast and accurate for a prostate, cervix, and lung cancer case. A CTV-to-PTV margin size which ensures at least 95% dose to (on average) 99% of the CTV, appears to be equal to about 2Sigma + 0.7sigma for three all cases. Because rotational deviations are included, the resulting margins can be anisotropic, as shown for the prostate cancer case. CONCLUSION: A method has been developed for calculation of CTV-to-PTV margins based on the assumption that the CTV should be adequately irradiated with a high probability.

Climacteric and menopause in seven South-east Asian countries.

The menopause is universal, but what about the climacteric? In an attempt to answer this question, a study was conducted in seven south-east Asian countries, namely, Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore and Taiwan. Samples of approximately 400 women in each country were questioned about a number of climacteric complaints, incontinence and dyspareunia, consultation of a physician, menopausal status and several background characteristics. Special care was taken to overcome linguistic and cultural problems, and the data collected were kept as objective as possible. From the results obtained we were able to show that the climacteric was indeed experienced in south-east Asian countries, although in a mild form. The prevalence of hot flushes and of sweating was lower than in western countries, but was nevertheless not negligible. The percentages of women who reported the more psychological types of complaint were similar to those in western countries. The occurrence of climacteric complaints affected perceived health status. A physician was consulted for climacteric complaints by 20% of the respondents, although this was most frequently associated with the occurrence of psychological complaints and less so with that of hot flushes and sweating. The median age at menopause (51.09) appeared to be within the ranges observed in western countries. Ethnic background and age at menarche were found to have a significant influence on age at menopause. The study clearly demonstrated that climacteric complaints occur in south-east Asia. The findings suggest, however, that vasomotor-complaint-related distress might be 'translated' into psychological complaints, which are more frequently considered to warrant consulting a physician.

Parental management of infants born following a cot-death victim who were monitored compared to infants who, despite similar histories, were not monitored: a controlled study.

We studied 93 families who had previously lost a baby to cot-death. Of these, 31 chose cardiorespiratory monitoring (CRM) for their next child and were compared to 62 families who, despite similar histories, decided not to monitor their subsequent infant. A control group consisted of 50 families without history of cot death. The three objectives of this retrospective study were: (1) to gain insight into psychological factors which differentiate between parents who insist on monitoring their infant and those who do not; (2) to explore how parents of both groups cope with their feelings of anxiety and stress and; (3) to examine the effect of psychological factors on parental reactions to monitor alarms. Infants of the monitor group and the nonmonitor group were matched to the age reached by the previous cot-death victims at the moment of death. Parents who had experienced cot-death (91%) and 37% of the control group parents completed the State-Trait Anxiety Inventory (STAI) and a questionnaire, consisting mainly of multiple-choice questions. Results show that monitor parents and nonmonitor parents differ greatly in their expectations of and attributions to the equipment and in the way they process information about monitoring. More monitor parents attribute a protective value to CRM. Monitor parents reported to have been more stressed during pregnancy. Postnatally, monitor parents and nonmonitor parents did not experience different anxiety levels. Nonmonitor parents experienced a slight decrease of feelings of happiness over time. Mothers with high state anxiety scores noted more false bradycardia alarms than mothers with low scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Sexuality, sexual behaviour and contraception in East Germany.

Social factors may influence sexual health and its related behaviour. The political changes in East Germany have revealed a positive attitude towards sexuality and the use of family planning methods. A study on sexual behaviour and the use of contraceptives was undertaken recently, at the end of the old regime and the beginning of the new one. The survey was performed among 3103 male and female respondents (pupils, students and workers) of between 16 and 48 years of age. The results show a decreased number of stable partner relationships among young people, however, love and sexuality are considered to be central values. Before the age of 19 years, the majority of girls (80%) and boys (68%) had had sexual intercourse for the first time, a rate which has not changed during the last decade. There is a tendency to postpone having a first child. Modern contraception is widely accepted and used. There is a growing number of condom users, however, the pill is still the most popular method. Family planning is much more advanced than in the other countries of Eastern Europe. Sex education and counselling should sustain this situation.

PIP: In 1990, the Central Institute for Youth Research in Leipzig, Germany, conducted the Partner Study III which consisted of 3103 pupils, students, and factory workers in the former East Germany, 16-48 years old, to determine society's influence on partner relationships, sexuality, sexual behavior, and family planning use. Just 25% of 16-year-old males and 50% of 16 year-old-females had a stable partner relationship compared to 75% and 93%, respectively, for 16-year-olds in earlier studies. Almost everyone (99%) had premarital sexual intercourse. Mean age at first intercourse was 17, which usually occurred in a stable partnership (77% of males and 85% of females). 67% of 16-18 year old couples had agreed on contraception, especially oral contraceptives (OCs) and condoms (75% and 32%, respectively), before first intercourse. Most respondents considered love and sexuality to be central aspects of their lives. Respondents had sexual intercourse 8-9 days/month. Most women (91%) had had a recent orgasm. Most people wanted to marry, but later than they did previously, and to have children (87% and 99%, respectively). Yet, many East Germans were delaying childbearing. 99% favored contraception. Most people considered contraception to be the responsibility of both men and women. Acceptance of contraception did not include acceptance of abortion as a birth control method. Yet, few wanted to make the liberal abortion law more restrictive. The most commonly used contraceptive methods were OCs (66%) and condoms (62% vs. 35% in 1980). Overall, the sample had a good knowledge of contraceptive methods. More than 90% favored OCs. More than 80% accepted the condom. They considered it to be morally sound to carry a condom due to the threat of AIDS. Yet, few used a condom for each act of coitus. Safe contraception was a prerequisite for sexual intercourse for 79% of youth. Youth in East Germany tended to have a serious attitude of responsibility towards one's partner, contraception, and sexuality.

A study on the use of medication for climacteric complaints in western Europe--II.

Samples of about 300 women aged 40-69 were interviewed in Denmark and the Netherlands about consultations with a physician for climacteric complaints, awareness regarding the menopause and hormone replacement therapy (HRT), and use of medication. Twenty percent of Danish and 13% of Dutch respondents had consulted a physician. Fifty percent of Danish and 16% of Dutch respondents were informed about the menopause, and 46% of Danish and 10% of Dutch respondents were informed about HRT, the mass media being the most important information source. In Denmark and the Netherlands HRT use rates were 12% and 4%, respectively, those for non-hormonal treatment being 6% and 2%, and for tranquillizers 11% and 7%. Pooling of the data with those from a similar study conducted in Italy, the United Kingdom, West Germany and France [6] revealed that consultation for climacteric complaints was a universal phenomenon in all six countries which correlated mainly with perimenopausal status. Awareness of the menopause and HRT, and actual use of HRT were predominantly associated with the individual countries. These findings suggest that HRT prescription and use for climacteric complaints depend greatly on country-specific reservations about HRT among both physicians and women. Surprisingly, these appeared more prevalent in the countries where GPs played a predominant role in climacteric counselling.

Practice, attitudes and knowledge of Czech and Slovak gynaecologists concerning contraception.

PIP: 155 Czech and Slovak gynecologists completed questionnaires during the National Gynecological Congress held during November 4-6, 1992. Information was solicited on experience in family planning and practice, knowledge, and attitudes concerning contraception. The average age was 42.8 years, 33% were women, and 52% had practiced as gynecologists for 6-20 years. 93% rejected abortion as a method of birth control, while 10% stated that abstinence is more detrimental to health than abortion. The combined pill and the IUD were prescribed always (80%) or very often (60%). Over 90% perceived OCs, the IUD, and male or female sterilization as very reliable. Also, 75-90% perceived vaginal douche, rhythm, withdrawal, and the cervical mucus methods as rather reliable. Fewer gynecologists working in outpatient clinics perceived the OC as completely reliable (31%) as compared to hospital staff gynecologists (61%). Younger gynecologists also tended to be more positive about OCs than older ones. Regarding safety, only 8% mentioned the IUD, and 10% mentioned injectables and implants. 85% of gynecologists living in Prague perceived condoms as very safe compared to 50% of their colleagues elsewhere. Gynecologists working in hospitals, those with postgraduate training, over 40 years of age, and with more than 10 years of experience were less positive about the safety of the IUD. The perceived safety of OCs and of the IUD influences prescription rates. IUDs, OCs, injectables and implants, female and male sterilization, condoms, diaphragms, and rhythm method were perceived as most convenient. Convenience was significantly correlated with the prescription rate of IUDs. The attitude concerning the suitability of contraceptives for women under 35 years of age was correlated with the prescription rate of OCs, IUDs, and condoms. 51% of the physicians were familiar with the action of hormonal contraception. Only 45% knew that OCs were also safe for smokers below 35 years. The perceived side effects and benefits of OCs and IUDs were also evaluated.^ieng

Attitudes of Czech and Slovak gynecologists toward family planning.

A survey was held among 155 gynecologists of the former Czech and Slovak Federal Republic (CSFR) who visited a national gynecological congress. The sample was fairly comparable to the total group of Czech and Slovak gynecologists concerning sex, age and county. Questions were asked on personal and professional characteristics, experience with the provision of contraception, attitudes toward family planning and knowledge about contraception. Almost all gynecologists rejected abortion as a birth control method and mentioned the lack of sex education, non-use of contraception and the widespread use of traditional contraceptive methods as main reasons for the high prevalence of abortion. About 60% of the physicians thought that at least some women would rather have an abortion than use contraception. According to the physicians, special family planning services should be developed and delivered by gynecologists. Opinions on proper services for teenagers varied. Only a few physicians felt that patients should pay the full price of contraceptives. Physicians' knowledge about the pill was found to be insufficient. The physicians overestimated the knowledge of their female patients about the pill. Apart from books and journals, colleagues and pharmaceutical firms were reported as important information sources. Overall, the present survey showed that introduction of well structured pre- and postgraduate courses in family planning should be encouraged.

Family planning in Russia: experience and attitudes of gynecologists.

A survey was made of 375 Russian gynecologists. The questionnaire on family planning and contraceptives was distributed at the beginning of three local educational symposia. Almost all participants filled in the questionnaire on attitudes, knowledge and experience with family planning. The sample consisted of departmental specialists and heads of departments/clinics, working mainly at in- or out-patient women's health clinics. The mean age was 37 years; 83% were women, living in medium-sized or large cities (80%). Half of them had been working as a gynecologist for more than 10 years. Only 55% had been trained in family planning. The main reasons mentioned for the high abortion rate in Russia were the lack of education, non-involvement of male partner, and lack of modern contraceptives. Most of the gynecologists were in favor of special family planning clinics with special attention to services for the users. About half of the physicians knew how the pill works and estimated that 41% of women know that the pill contains estrogens. Sixty-two percent found that patients are badly informed about available contraception. Main sources of information on contraception were journals/books, colleagues and mass media. The majority reported having a directive style of patient counseling, and stated that parents should be informed of their teenagers' sexual experiences. The more experienced physicians with a training in family planning were better informed on contraception and showed a more patient-concerned attitude. It is concluded that health care providers should be the main target group of training and education in family planning, and need the support of Western European family planning organizations.

Has the climacteric been medicalized? A study on the use of medication for climacteric complaints in four countries.

In order to compare the use of hormone replacement therapy (HRT), non-hormonal treatment for the menopause, and tranquillizers, samples of about 300 women aged over 40 were interviewed in France, the United Kingdom, the former West Germany and Italy. The proportion of women in the samples using HRT varied from 3% in Italy to 25% in Germany. The figures for non-hormonal treatment ranged from 2-13%, and for tranquillizers from 5-28%. The use of both HRT and non-hormonal treatment was found to be related to the perimenopause and the corresponding age groups and that of HRT to higher educational level. Tranquillizer use was related to the postmenopause and lower educational level. After controlling for potential confounding effects of menopausal status, educational level, gainful employment and civil status, it emerged that HRT use rates varied significantly between the countries surveyed. It is concluded that cultural differences exist between these countries as to the prescription and acceptance of HRT.

[Nursing home admission; a study among elderly applicants]. / Verpleeghuisopname; een onderzoek bij op te nemen ouderen.

This article describes the care needs, social network, housing conditions, utilization of care and diagnoses of 157 elderly applicants to nursing homes in Maastricht. The study was conducted during the period of February 1987 to July 1988. Possible differences in these characteristics in relation to the goal of the admission (rehabilitation versus continuous support) and in relation to prior living arrangements (home versus hospital) were investigated. In addition, the question to what extent substitution of care is possible is discussed. Within the group of nursing home applicants, a fairly clear distinction could be made between a number of subgroups, although care needs, social network (with the exception of the number of visits paid), and demographic characteristics showed no differences in relation to admission goals and prior living arrangements. The distinction was based particularly on the nature of the disorders (psychogeriatric versus somatic and chronic versus more or less acute), which was reflected not only in the main diagnosis itself, but also in differences in housing conditions, numbers of visits paid to others, and utilization of care prior to admission. Under the proposed policies for substitution, about a quarter of the applicants would be eligible for substitution. However, the major care needs, and the levels of formal and informal care prior to admission, as well as the shortage of alternative services, would seem to indicate that the actual possibilities for substitution are more limited.