What Matters Most? Intersectional Correlates of Caregiver Burdens.

Increasing numbers of older adults require caregiver support from unpaid caregivers. Yet, there is limited research on caregiver burden type and interactions across race, gender, and other sociodemographic characteristics. This quantitative study uses an intersectional framework to examine associations between caregiving burden and sociodemographic factors. Using survey data from the National Survey of Caregiving the sample included unpaid caregivers (N = 1304) of older adult (65+) Medicare beneficiaries. Binary logistic regression analysis revealed that over 40% of the respondents reported emotional difficulties. Correlates to emotional difficulties included race, gender, age, and income with an age by income interaction. For physical difficulties, gender, age, work, and education mattered most, with an age by education interaction. Age and income predicted financial difficulties without interactions. Findings suggest that policymakers target emotional and physical difficulties, attend to age and socioeconomic status, and address the unique challenges faced in midlife by caregivers.

Assessment of Percheron infarction in images and clinical findings.

OBJECTIVE: To assess the imaging and clinical features of patients with an artery of Percheron infarction comprehensively. METHODS: Of 6539 patients with a first-ever stroke, 18 patients with a Percheron infarction were enrolled, and their images and clinical data were retrospectively investigated. RESULTS: All patients underwent neurological intensive care unit (NICU) management. The initial symptom of a Percheron infarction included dizziness, transient blurred vision, double vision, barylalia, cerebellar ataxia, drowsiness, and a coma. Subsequent symptoms differed for the three subtypes of Percheron infarction, and the three subtypes are bilateral paramedian thalamic infarction with midbrain involvement, bilateral paramedian thalamic infarction without midbrain involvement, and bilateral paramedian and anterior thalamic infarction without midbrain involvement. Between favorable and unfavorable outcomes, there was no significant difference in the following patient characteristics including current smoking, hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia, heart disease, time from stroke onset to medical care, and Glasgow Coma Scale score at admission (P>0.05), but there were significant differences in both the National Institute of Health stroke scale (NIHSS) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission (P<0.05). If the midbrain or larger infarct volume was involved or hemorrhagic transformation occurred, outcomes of a Percheron infarction were frequently unfavorable. CONCLUSION: The clinical presentation of patients with a Percheron infarction is variable; early recognition, image performance, NICU management, NIHSS, and APACHE II score would help in diagnosis, evaluation, and treatment.

[Impact of Macao Medical Voucher Program on health outcomes of the residents: changes of mortality from circulatory system diseases].

OBJECTIVE: To examine whether the implementation of Macao Medical Voucher Program has helped promote the health outcomes of the residents in the case of mortality from circulatory system diseases. METHODS: Based on 144 monthly observations of the mortality from circulatory system diseases in Macao during 2001-2012, we carried out a trend analysis of the time series to identify significant differences in the mortality data after the implementation of the Medical Voucher in Macao. This study was controlled for the compounding factors including medical resources (numbers of physicians, nurses and patient beds per thousand population and public healthcare expenditure), economic development level (GDP per capita), social human development level, population aging factor, natural seasonal effects and long-term trends. RESULTS: During 2010-2012 when the Medical Voucher Program in Macao was implemented, the annual mortality rates from circulatory system diseases were significantly lowered by 24% as compared with those recorded during 2001-2009 (P<0.01), which was equivalent to avoiding 123 deaths related of circulatory system diseases per year. CONCLUSION: Evidence in this study suggests a robust connection between the timing of the implementation of Macao Medical Voucher Program and a significant decrease in the mortality from circulatory system diseases in Macao, but their causal relationship awaits confirmation in further research.

Applicability of Community Periodontal Index teeth and random half-mouth examination to gingival bleeding assessment in untreated adult population in Beijing.

OBJECTIVE: To assess whether Community Periodontal Index (CPI) teeth and random half-mouth methods are representative of full-mouth method in gingival bleeding examination. METHODS: Data from 1000 untreated adults (age > 18) collected in Beijing from January 2000 to January 2001 were utilized in the analysis. Half of the subjects were examined by Gingival Bleeding Index (GBI) and the other half by Sulcus Bleeding Index (SBI). The data were sorted out and calculated according to CPI teeth and random half-mouth teeth methods. The results of the 2 methods were separately compared with those of full-mouth examination. RESULTS: There was a significant difference between CPI teeth method and full-mouth examination (P < 0.05) in both GBI and SBI. In contrast, compared with full-mouth examination, significant difference was not observed in diagonal or ipsilateral half-mouth results in SBI (P > 0.05), nor in diagonal half-mouth results in GBI (P > 0.05). CONCLUSIONS: The results of CPI teeth method on gingival bleeding could not reflect the full-mouth situation. Ipsilateral and diagonal half-mouth results can serve as a substitute for full-mouth results in SBI, while diagonal half-mouth results in GBI.