Mortality from lower respiratory infection in nursing home residents. A pilot prospective community-based study.

BACKGROUND: Lower respiratory infections (LRI) are an important cause of morbidity, mortality, and hospitalization of nursing home residents, yet treatment recommendations have primarily been based on the minority who are hospitalized. We sought to prospectively evaluate risk factors for mortality from LRI in community nursing home residents. METHODS: We studied residents of 10 central Missouri nursing homes (910 beds) from January 1994 to September 1994. Attending physicians authorized nurse evaluations of ill residents who showed symptoms of an LRI. Those residents who met the study definition of LRI received a more detailed assessment and follow ups at 30 and 90 days. RESULTS: The 231 evaluations identified 141 LRIs in 121 individuals. Sixteen (11%) residents died within 30 days of evaluation. The most important univariate predictor of 30-day mortality was severe activities of daily living (ADL) dependency (relative risk = 8.8, 95% confidence interval, 2.55-30.1). Several other clinical and laboratory findings were also significant predictors. In multivariable logistic regression, ADL dependency, respiratory rate, and pneumonia on chest radiograph independently predicted mortality; the model showed good discriminating ability (c = .83). CONCLUSIONS: For nursing home residents with LRI, ADL dependency is an important mortality predictor. Further research with a larger sample should lead to a useful prediction rule for outcome from nursing home-acquired LRI.

Efficacy of an intervention to promote use of hearing protection devices by firefighters.

Numerous cases of hearing loss consistent with noise-induced damage were noted among firefighters in the city of Columbia, MO. A survey of firefighting vehicles in operation showed that the firefighters were exposed to excessive noise levels and put at risk for noise-induced hearing loss (NIHL). Audiologic evaluation showed that 36 percent of the firefighters had moderate or severe hearing loss (a threshold of 40 decibels (dB) or more at 3,000, 4,000, or 6,000 hertz (Hz) in either ear). An educational program on NIHL was then carried out to increase the use of hearing protection devices (HPDs) by firefighters, followed by an evaluation of the intervention. The educational intervention successfully increased knowledge of NIHL, positive attitudes toward HPDs, and resulted in more frequent use of HPDs. After the intervention, 85 percent of firefighters regularly used HPDs compared with 20 percent before the intervention. Recommendations are made for fire departments to reduce the risk of NIHL.

Gender and the attribution of the nurse practitioner and physician status.

The purpose of this study was to discover whether sex-role sterotypes were used to identify members of two professions, nurse practitioners and physicians. Participants reported whether they believed a videotaped health care provider was a physician or a nurse practitioner. Results showed that male providers tended to be identified as physicians, whereas female providers tended to be identified as nurse practitioners. Findings indicate that understanding and enactment of the nurse practitioner and physician roles are still affected by gender issues and that both physicians and nurse practitioners remain subject to the force of sex-role stereotypes.