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Introduction: Oral diseases and conditions affect the physical, social, and psychological well-being of an individual. The aim of this study was to determine the association between the severity of dental fluorosis and oral health related quality of life (OHRQoL) among 15-year-old school children residing in an endemic area for dental fluorosis in Sri Lanka. Design: A cross-sectional study was conducted among 989, 15-year-old school children who were lifetime residents of Kurunegala district. A validated Sinhala version of the Child Perception Questionnaire (CPQ 11-14) was used to assess OHRQoL. Dental fluorosis was assessed using the Thylstrup and Ferjeskov index (TF index) while dental caries and malocclusion were assessed using the WHO Basic Methods and Dental Aesthetics Index (DAI) respectively. In addition, information pertaining to parental level of education, type of toothpaste used, frequency of toothbrushing and use of dental services was also gathered. Results: The prevalence of dental fluorosis was 52%. The overall prevalence of impacts based on the CPQ was 38.2%. The severity of dental fluorosis was not significantly associated with the overall prevalence of impacts. However, the severity of dental fluorosis was significantly associated with three oral impacts namely "having pain in teeth, lips, jaws, or mouth", "felt irritable or frustrated" and "other children teased or called names". According to the multiple logistic regression analysis, use of dental services and moderate to severe malocclusion were significantly associated with poor OHRQoL but not dental fluorosis. Conclusion: The severity of dental fluorosis was not associated with OHRQoL of the participants.
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OBJECTIVE: This paper describes the results of a bi-level intervention, using a cognitive-behavioral theoretical approach, to improve the oral hygiene of older adults and the disabled in community-based low income senior housing. METHODS: The bi-level pilot intervention consisted of an on-site tailored adapted motivational interviewing (AMI) session and two oral health fairs, supported by a resident campaign committee, to change community norms. All materials were available in English and Spanish. Participants completed a survey consisting of 12 domains that provided the basis for tailoring the AMI and shaping the campaigns. The domains were activities of daily living (ADLs), access to oral health information, oral hygiene status, dental knowledge, hygiene behaviors, importance of oral hygiene, self-efficacy/locus of control, diet, intentions, self-management worries/fears, perceived risk and dry mouth. MAIN OUTCOME MEASURES: Each participant received clinical assessments consisting of full-mouth plaque score (PS) and gingival index (GI) before the intervention and at three months. RESULTS: Twenty-seven residents with at least one tooth completed all phases of the study. The mean number of domains requiring attention was 4.5 (SD 1.6) with a range of one to seven. Mean baseline PS was 83% (SD 16%) which improved significantly to 58% (SD 31%); mean baseline GI was 1.15 (SD 0.61) and improved significantly to 0.49 (SD 0.46). CONCLUSIONS: This pilot study supports the feasibility and acceptability of a tailored oral hygiene intervention among older and disabled adults living in low income senior housing. Although a small sample, the study demonstrated significant improvements in both plaque and gingival scores three months after the bi-level intervention.
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Personas con Discapacidad , Higiene Bucal/educación , Vivienda Popular , Acceso a la Información , Actividades Cotidianas , Anciano , Ansiedad/psicología , Información de Salud al Consumidor , Índice de Placa Dental , Estudios de Factibilidad , Conducta Alimentaria , Femenino , Estudios de Seguimiento , Conductas Relacionadas con la Salud , Educación en Salud Dental/métodos , Exposiciones Educacionales en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Intención , Control Interno-Externo , Masculino , Persona de Mediana Edad , Entrevista Motivacional/métodos , Índice Periodontal , Proyectos Piloto , Autoeficacia , Xerostomía/clasificaciónRESUMEN
Quality of life outcomes among patients receiving implants have been well studied, but little is known about the effects of bone augmentation in this therapy. The purpose of this paper was to assess quality of life changes among postmenopausal women receiving dental implants with bone augmentation during implant therapy. This was a prospective cohort study. 48 patients were recruited at the University of Connecticut Health Center and received one of three surgical augmentation methods: dehiscence repair; expansion alone; or expansion with dehiscence repair. The predictor variable was type of augmentation procedure. Quality of life measured by the Oral Health Impact Profile-14 (OHIP-14) was the outcome measure and was assessed prior to treatment, 1 week, 8 weeks and 9 months after surgery. Changes in OHIP-14 were evaluated by repeated measures analysis of variance. The mean initial OHIP-14 scores on total items checked were 4.6 (SD=3.0) and declined significantly to 2.0 (SD=2.0) at 9 months. The mean baseline severity score was 15.4 (SD=8.9) improving significantly to 7.5 (SD=7.6) at 9 months. Type of augmentation procedure did not affect quality of life. The participants' quality of life improved continuously from the pretreatment to the 9-month assessment, including improvements 1 week after implant placement.
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Huesos/cirugía , Implantes Dentales , Posmenopausia , Calidad de Vida , Anciano , Femenino , Humanos , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: To assess the relationship between African-American caregivers' and children's caries levels adjusting for sociodemographic factors. METHODS: A representative sample of 1021 children (0-5 years) and their caregivers were recruited using a stratified two-stage area probability sample of households in Detroit. The response rate was 73.7%. Caries was measured using the International Caries Detection and Assessment System. Caries was defined as D1S/d1s (noncavitated) or D2S/d2s (cavitated lesions) for both caregivers and children. Sociodemographic data included caregivers' employment status, sex, age, income and education. Negative binomial regression techniques were used for the multivariable analyses because of the highly skewed distribution of caries among the children. RESULTS: 48% of the children were male, 39% had employed caregivers, 46% had caregivers with less than a high school education and 44% had family incomes less than $10,000. A total of 47% of the children had at least one noncavitated lesion and 31% had a cavitated lesion. Younger children (ages 0-3 years) had lower caries rates with 24% having one or more noncavitated lesion,18% having a cavitated lesion and 31% with any lesion compared with 78%, 51% and 81%, respectively, among the 4- to 5-year olds. Because of these differences in prevalence in the age groups, subsequent analyses were conducted separately for the two age groups. Multivariable analyses found that the number of cavitated surfaces among the caregivers was significantly related to the number of cavitated and noncavitated lesions among their children for both age groups. The prevalence of children's caries increased with increasing caregivers' caries score when demographic characteristics of caregivers were controlled. Younger children with family incomes of less than $10,000 had a significantly increased risk of higher caries prevalence compared with children in families with incomes greater than or equal to $20,000. CONCLUSIONS: Caregivers' caries levels were modestly correlated with children's caries. However, higher caries prevalence among caregivers significantly increased the risk of caries prevalence among their children. Thus, efforts aimed at improving caregiver's oral health could result in reducing caries risk among their children, regardless of whether the mechanism was biologically or behaviorally based. Efforts also should be aimed directly at reducing caries risk among children by increasing fluoride exposure among children and improving access to preventive dental care. Finally, even the poorest of the poor experienced additional health disadvantages associated with income suggesting even small increases in family income raising families could have a significant effect on reducing caries risk among young children.
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Negro o Afroamericano/estadística & datos numéricos , Cuidadores/estadística & datos numéricos , Caries Dental/epidemiología , Adulto , Preescolar , Estudios Transversales , Escolaridad , Femenino , Humanos , Renta , Lactante , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Michigan/epidemiología , Prevalencia , Análisis de Regresión , Factores de Riesgo , Desempleo , Poblaciones VulnerablesRESUMEN
OBJECTIVE: To analyze factors associated with leaving employment among women with newly diagnosed rheumatoid arthritis (RA). METHODS: Women with RA were recruited from a national sample of rheumatologists in 1987 and 1998. Inclusion criteria were RA diagnosis <18 months earlier, age >or=18 years, and no other disabling health condition. The 1987 and 1998 cohorts comprised 48 and 91 women, respectively. Data were collected by telephone for 4 years. Survival analysis was conducted using Kaplan-Meier curves and a proportional hazards generalized linear model to assess whether the time to stopping work differed between the cohorts and to identify baseline predictors and time-varying covariates of leaving work. RESULTS: Most patients were age <50 years, married, had >12 years of education, and were white. Fifteen patients (31%) in the 1987 cohort and 24 patients (26%) in the 1998 cohort stopped working in the observation periods. Kaplan-Meier survival curves for each cohort were not significantly different. Multivariate analyses demonstrated that married women (P = 0.03) and those with joint deformities (P = 0.00) were more likely to stop working. A significant flares by cohort interaction (P = 0.01) indicated that, in comparison with patients in the 1998 cohort, those in the 1987 cohort with <2 disease flares had the lowest risk of stopping work and those with >or=2 flares had the greatest risk. CONCLUSION: Unexpectedly, the cumulative rate of stopping work among women in the 1998 study did not differ from that among women diagnosed >16 years earlier. However, disease flares greatly affected employment in the 1987 but not the 1998 cohort, possibly indicating that newer medications were effective in maintaining functional status among those with more severe disease activity, measured by number of flares, in the 1998 group.
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Artritis Reumatoide/fisiopatología , Personas con Discapacidad , Salud de la Mujer , Evaluación de Capacidad de Trabajo , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Análisis Multivariante , Esposos/estadística & datos numéricos , DesempleoRESUMEN
The purpose of this review is to summarize a systematic review evaluating the evidence regarding the association between the incidence and prevalence of dental caries and: 1) socioeconomic status; 2) tooth-brushing; and 3) the use of the baby bottle. Literature was drawn from two databases, Medline and EmBase. Because of limited resources, we did not conduct hand-searching or search unpublished studies. Three thousand one hundred thirty-eight abstracts were identified, 358 reviewed, and 272 papers included in the systematic review. There is fairly strong evidence for an inverse relationship between SES and the prevalence of caries among children less than twelve years of age. The evidence for this relationship is weaker for older children and for adults because of the relatively small number of studies and methodological limitations. There is weak evidence that tooth-brushing prevents dental caries, but it is uncertain whether the effects of tooth-brushing are due to use of a fluoride dentifrice or from mechanical removal of plaque. Finally, the evidence for the relationship between prolonged use of the baby bottle and dental caries is weak. More studies directly aimed at analyzing the relationship between SES and dental caries are needed to identify factors associated with SES that contribute to dental caries risk. Tooth-brushing should continue to be recommended as a measure to prevent dental caries, particularly using a fluoride dentifrice. Recommendations regarding bottle use should continue until clear evidence about the relationship between prolonged bottle use and dental caries can be obtained.
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Caries Dental/epidemiología , Adolescente , Adulto , Anciano , Alimentación con Biberón/efectos adversos , Niño , Preescolar , Caries Dental/etiología , Caries Dental/prevención & control , Humanos , Incidencia , Lactante , Persona de Mediana Edad , Pobreza , Prevalencia , Factores de Riesgo , Clase Social , Cepillado Dental/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the association of demographic, disease, workplace, social, and household factors with the ability of patients with rheumatoid arthritis (RA) to remain employed over time. METHODS: Four hundred seventy-two employed patients with RA recruited from a national sample of rheumatology practices were followed. Patients were interviewed once a year by telephone for 9 years and patients' physicians provided data on clinical aspects such as disease stage, joint deformity, and flares. A proportional hazards survival model based on stepwise variable selection was developed to investigate the association between continuance of work over a 9 year period and demographic, work, attitudinal, disease, and social support variables. RESULTS: In the univariate analysis, the significant factors associated with longer work survival were being younger, being self-employed, having a higher prestige occupation, working more hours per week, having higher education level, and missing fewer days of work during the baseline year. The final multivariate model included age, type of occupation and number of days missed from work as a time varying co-variate. CONCLUSION: Ability to remain employed over the 9 year study was more strongly associated with age, work characteristics, and time lost from work than with disease factors. The underlying mechanisms related to occupational prestige as a predictor of work survival should be investigated in order to develop interventions to reduce the risk of work disability.
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Artritis Reumatoide/fisiopatología , Empleo , Modelos de Riesgos Proporcionales , Evaluación de Capacidad de Trabajo , Anciano , Artritis Reumatoide/psicología , Femenino , Estudios de Seguimiento , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
This study examines whether the general level and rate of change of fatigue over time is different for those rheumatoid arthritis (RA) patients with and those without a history of affective disorder (AD). Four hundred fifteen RA patients from a national panel had yearly telephone interviews to obtain fatigue and distress reports, and a one-time semistructured assessment of the history of depression and generalized anxiety disorder Growth-curve analysis was used to capture variations in initial fatigue levels and changes in fatigue over 7 years for those with and without a history. RA patients with a history of major AD reported levels of fatigue that were 10% higher than those without a history in the 1st year of the study. Their fatigue reports remained elevated over 7 years. Further analysis showed that the effects of a history of AD on fatigue are fully mediated through current distress, although those with a history had a significantly smaller distress-fatigue slope. Thus, a history of AD leaves RA patients at risk for a 7-year trajectory of fatigue that is consistently higher than that of patients without a history. The elevation in fatigue reports is, at least in part, a function of enduring levels of distress.
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Trastornos de Ansiedad/complicaciones , Artritis Reumatoide/psicología , Fatiga/psicología , Anamnesis , Trastornos del Humor/complicaciones , Artritis Reumatoide/diagnóstico , Fatiga/etiología , Femenino , Humanos , Análisis de los Mínimos Cuadrados , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVES: The personality trait of negative affectivity (NA) is associated with reports of worse physical health, more symptoms and worse health-related quality of life but its associations with oral quality of life (OQOL) are unexplored. In this study we examined the association of NA with OQOL. METHODS: We drew on data from two samples of older men: The VA Dental Longitudinal Study (DLS; n=177) and the Veterans Health Study (VHS; n=514), which included three measures of oral quality of life: the Oral Health-Related Quality of Life Measure (OHQOL), the Oral Health Impact Profile (OHIP), and the Geriatric Oral Health Assessment Instrument (GOHAI). For each OQOL measure, and the GOHAI and OHIP subscales, two regression models were estimated to examine the marginal change in variance due to NA: the first model included age, number of teeth, and self-rated oral health, and the second added NA. RESULTS: In both bivariate and multivariate analyses, higher NA was consistently associated with worse scores on the OQOL measures. In the regression analyses, NA explained an additional.01 to 18% of the variance in OQOL, explaining the most variance in the OHIP and the least in the OHQOL. The addition of NA explained more variance in the more subjective, psychologically oriented GOHAI and OHIP subscales than it did in the more objective, physical function oriented subscales. CONCLUSIONS: Psychosocial factors such as personality are significantly associated with quality of life ratings. Such associations should be taken into account when OQOL measurements are used and interpreted.
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Actitud Frente a la Salud , Trastornos del Humor/psicología , Salud Bucal , Calidad de Vida , Actividades Cotidianas , Factores de Edad , Anciano , Dentición , Evaluación Geriátrica , Estado de Salud , Humanos , Análisis de los Mínimos Cuadrados , Estudios Longitudinales , Masculino , Masticación/fisiología , Persona de Mediana Edad , Análisis Multivariante , Dolor/psicología , Personalidad , Análisis de Regresión , Autoimagen , Ajuste Social , Conducta Social , Estadística como Asunto , VeteranosRESUMEN
This article presents findings about the mammography screening experience of Medicare members of a health maintenance organization (HMO). Based on a mail survey of 309 women, we assessed factors that may be facilitators or barriers to this service for older women. The results indicate that these respondents generally are receiving timely mammograms; over three-quarters (79 percent) reported having a mammogram in the past 2 years. Multivariate analysis showed that women who were younger (under 75 years of age), believed in the importance of screening, had been told by a physician to obtain a mammogram, and were more satisfied with their physician and more likely to report mammography use.
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Neoplasias de la Mama/diagnóstico por imagen , Sistemas Prepagos de Salud/estadística & datos numéricos , Mamografía/estadística & datos numéricos , Anciano , Neoplasias de la Mama/prevención & control , Connecticut , Demografía , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Estado de Salud , Humanos , Medicare , Análisis Multivariante , Aceptación de la Atención de Salud , Encuestas y Cuestionarios , Salud de la MujerRESUMEN
This paper describes a comparative analysis of (ADL) and (IADL) items administered to two samples, 4,430 persons representative of older Americans, and 605 persons representative of patients with rheumatoid arthrisit (RA). Responses are scored separately using both Likert and Rasch measurement models. While Likert scoring seems to provide information similar to Rasch, the descriptive statistics are often contrary if not contradictory, and estimates of reliability from Likert are inflated. The test characteristic curves derived from Rasch are similar despite differences between the levels of disability with the two samples. Correlations of Rasch item calibrations across three samples were .71, .76, and .80. The fit between the items and the samples, indicating the compatibility between the test and subjects, is seen much more clearly with Rasch with more than half of the general population measuring the extremes. Since research on disability depends on measures with known properties, the superiority of Rasch over Likert is evident.
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Actividades Cotidianas , Artritis Reumatoide/fisiopatología , Evaluación de la Discapacidad , Modelos Estadísticos , Anciano , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Proyectos de InvestigaciónRESUMEN
OBJECTIVES: This study assessed the perceived impact of oral health conditions, and the relationship of two measures of self-reported outcome, the RAND SF-36 and the Oral Health Impact Profile (OHIP), to clinical indicators of oral health among inner-city adolescents. METHODS: A convenience sample of 93 minority adolescents completed the RAND SF-36 and the OHIP and 76 of them completed a clinical dental examination assessing DMFS. RESULTS: Participants averaged 14.4 (SD = 1.2) years old; 52 percent were female; and 86 percent were African-American. The mean DMFS was 8.8 (SD = 6.3). Participants reported relatively poor general health on the SF-36 as well as poor oral health on the OHIP. None of the SF-36 subscales were significantly related to DMFS. OHIP subscales were consistently related to DMFS--those with worse oral health reported more impacts. With the exception of the bodily pain subscale of the SF-36, the SF-36 and OHIP subscales were significantly correlated with Pearson's correlations ranging from -.21 to -.57 (P < .05). CONCLUSIONS: Although the SF-36 and the OHIP were correlated, the OHIP appears to be more highly associated with the impacts of oral health conditions than the SF-36 among inner-city adolescents who reported low general and oral health quality of life.
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Actitud Frente a la Salud , Estado de Salud , Grupos Minoritarios , Salud Bucal , Actividades Cotidianas , Adolescente , Negro o Afroamericano , Análisis de Varianza , Niño , Índice CPO , Caries Dental/clasificación , Emociones , Femenino , Salud , Hispánicos o Latinos , Humanos , Relaciones Interpersonales , Masculino , Dimensión del Dolor , Calidad de Vida , Autoevaluación (Psicología) , Pérdida de Diente/clasificación , Salud UrbanaRESUMEN
OBJECTIVE: A 10-year study of rheumatoid arthritis (RA) patients was conducted to identify characteristics associated with continued participation in a long-term research project. METHODS: Nine hundred eighty-eight RA patients were recruited from 56 private rheumatology practices. Over the course of the study, 45 patients died and were eliminated from the analysis. Patients were interviewed by phone each year for 10 years, and their physicians provided clinical data. Variables measured included demographic characteristics, perceived health status, employment status, family responsibilities, social support, and clinical health status. RESULTS: Forty-six percent of patients remained in the study after 10 years. Survival analysis using Cox regression techniques assessed baseline factors that significantly predicted characteristics of patients who remained in the study. The multivariate analysis found that more educated patients, female patients, those with moderate to high levels of social support, patients having fewer joint groups with flares, and employed patients were more likely to remain in the study. Disease characteristics of stage of disease, level of pain, self-reported level of physical disability, and duration of RA were not significantly associated with continued study participation. CONCLUSION: The results suggest that psychosocial and socioeconomic factors are more important determinants of continued participation in long-term research studies than are most clinical disease characteristics. Among clinical variables, only the active disease characteristic of joint flares predicted continued study participation. Overall disease characteristics such as disease stage or duration did not predict subject attrition.
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Artritis Reumatoide/psicología , Ensayos Clínicos como Asunto/estadística & datos numéricos , Pacientes Desistentes del Tratamiento/psicología , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Adulto , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Tremendous strides have been made in reducing the incidence of tooth decay, periodontal diseases, and associated loss of teeth in adults and children since the inception of community water fluoridation programs. Yet the disadvantaged and poor have not fully shared in the benefits. Other challenges to oral health remain. Oral cancer and related smoking and smokeless tobacco use remain major public health problems. Access to preventive and therapeutic dental care is far from universal. Public health programs similar in commitment to the approach of community water fluoridation programs initiated in the 1950s and 1960s are needed to address neglected oral health needs of underserved and high-risk populations in the United States.
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Caries Dental/epidemiología , Caries Dental/prevención & control , Fluoruración , Salud Bucal , Enfermedades Periodontales/epidemiología , Enfermedades Periodontales/prevención & control , Pérdida de Diente/epidemiología , Pérdida de Diente/prevención & control , Adolescente , Adulto , Niño , Preescolar , Atención Odontológica/organización & administración , Encuestas de Salud Bucal , Fluoruración/estadística & datos numéricos , Fluoruración/tendencias , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Evaluación de Necesidades , Odontología en Salud Pública/organización & administración , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: This study examined the within-person relations between transitory changes in mood, asthma symptoms, and peak expiratory flow rate (PEFR). METHODS: Thrice-daily for 21 consecutive days, 48 adults with moderate to severe asthma entered information in palm-top computers about their mood and asthma symptoms. A multidimensional model of mood, ie, the mood circumplex, informed the assessment of mood arousal and mood pleasantness. At each observation, participants also recorded their PEFR with peak flow meters that stored blinded data. Albuterol doses were also monitored electronically. Before and after the 21-day study, spirometric measures of airways obstruction were taken under controlled conditions. RESULTS: Random effects regression models revealed a significant, but weak, within-person relation between symptoms and PEFR. Changes in mood vectors with an arousal component were significantly related to PEFR changes, whereas changes in mood vectors with a pleasantness component tracked changes in asthma symptom reports, even after adjustment for contemporaneous PEFR and after controlling for time of day and albuterol dosing. Comparison of spirometric assessments with unsupervised PEFR suggested that part of the relation between mood arousal and PEFR may be attributable to the "effort-dependence" of peak flow self-monitoring. CONCLUSIONS: Different dimensions of mood were associated with transitory changes in asthma symptoms and PEFR. This may be one reason why individuals with asthma misperceive the severity of their symptoms in relation to underlying airways obstruction.
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Afecto/fisiología , Asma/diagnóstico , Asma/psicología , Adulto , Albuterol/uso terapéutico , Nivel de Alerta/fisiología , Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Procesamiento Automatizado de Datos/métodos , Femenino , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Ápice del Flujo Espiratorio/fisiología , Índice de Severidad de la EnfermedadRESUMEN
This paper describes a comparative analysis of (ADL) and (IADL) items administered to two samples, 4,430 persons representative of older Americans, and 605 persons representative of patients with rheumatoid arthrisit (RA). Responses are scored separately using both Likert and Rasch measurement models. While Likert scoring seems to provide information similar to Rasch, the descriptive statistics are often contrary if not contradictory, and estimates of reliability from Likert are inflated. The test characteristic curves derived from Rasch are similar despite differences between the levels of disability with the two samples. Correlations of Rasch item calibrations across three samples were .71, .76, and .80. The fit between the items and the samples, indicating the compatibility between the test and subjects, is seen much more clearly with Rasch with more than half of the general population measuring the extremes. Since research on disability depends on measures with known properties, the superiority of Rasch over Likert is evident.
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Actividades Cotidianas/clasificación , Evaluación de la Discapacidad , Modelos Estadísticos , Anciano , Envejecimiento/fisiología , Artritis Reumatoide/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
BACKGROUND: Although health-related quality of life (HRQL) in asthma is strongly influenced by disease severity, demographic and socioeconomic variables may also be important factors. OBJECTIVE: We related demographics, asthma severity, and socioeconomic factors to HRQL. METHODS: We interviewed 50 patients with moderate or severe asthma recruited from outpatient health center-based clinics to determine demographics, socioeconomic status, asthma severity, medication use, and HRQL. For HRQL, the mean total score of the Asthma Quality of Life Questionnaire (AQLQ) and the Medical Outcomes Study Short-Form 36 questionnaires physical and mental component summary scores (PCS and MCS, respectively) were used. RESULTS: The mean patient age was 46 +/- 14 years, and the FEV1 was 75% +/- 21% of predicted value. Twenty-nine subjects had been hospitalized for asthma, 29 belonged to a minority racial/ethnic group, and 16 had less than 12 years of education. The mean total AQLQ score was 4.12 +/- 1.42, the PCS was 37 +/- 10, and the MCS was 45 +/- 13. In univariate analyses, severity (nighttime awakenings, prednisone use, and a history of emergency department visits), racial/ethnic group (African American, white, or Hispanic), and socioeconomic status (low educational level, unemployed, family income under $20,000, public assistance, or no health insurance) were related to HRQL. These factors explained 67% of the variance of AQLQ and 48% of the variance of the PCS. Much of the quality of life variance was shared among these variables. Explanatory variables were not related to MCS in multivariate analysis. CONCLUSION: Socioeconomic status is an additional important independent factor influencing HRQL in asthma. In this study it was difficult to separate out the unique effects of socioeconomic status and race/ethnicity.
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Asma/psicología , Calidad de Vida , Adulto , Análisis de Varianza , Asma/economía , Asma/epidemiología , Humanos , Persona de Mediana Edad , Análisis Multivariante , Índice de Severidad de la Enfermedad , Factores SocioeconómicosRESUMEN
Results from a 3-year longitudinal study on the oral manifestations of AIDS (OMA) among seropositive children and their siblings indicated poor adherence with recommendations for dental treatment (Broder, Catalanotto, Reisine, & Variagiannis, 1996). The purposes of this study were to (a) to examine oral health behaviors, attitudes, and perceived barriers to care among caregivers of children with HIV and their siblings who were referred for dental care, and (b) develop and evaluate a 5-week summer pilot program to increase adherence with referral for dental treatment. Telephone interviews with caregivers were conducted to identify barriers to care and to implement services to increase attendance in the dental clinic for their children. Interviews were completed with 28 of the 38 (74%) caregivers recruited from the OMA study (previously cited) who had children referred for dental treatment at the final (sixth) oral health research exam. Twelve of their 58 children (21%) had obtained dental care privately, 25 (62.5%) initiated treatment and 2 (6.3%) completed treatment at the referred dental school during the 5-week pilot program. Although caregivers of children with HIV and their siblings were responsive to the initial efforts of the program's service coordinators, follow-up data from the coordinators' records and chart abstraction revealed that the majority of the participants did not appear for their second or third appointments. The interview reports suggested that caregivers expect dental treatment, such as restorations, at each appointment and do not regard exams/treatment planning as treatment. Personal/family and health care delivery system factors were expressed barriers to dental care. Implications for future programs and investigations are discussed.
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Cuidadores/psicología , Atención Dental para Niños/psicología , Atención Dental para Enfermos Crónicos/psicología , Seropositividad para VIH/psicología , VIH-1/inmunología , Conocimientos, Actitudes y Práctica en Salud , Salud Bucal , Aceptación de la Atención de Salud/psicología , Derivación y Consulta/estadística & datos numéricos , Adulto , Cuidadores/estadística & datos numéricos , Niño , Atención Dental para Niños/estadística & datos numéricos , Atención Dental para Enfermos Crónicos/estadística & datos numéricos , Femenino , Humanos , Entrevistas como Asunto/métodos , Estudios Longitudinales , Masculino , New Jersey , Aceptación de la Atención de Salud/estadística & datos numéricos , Proyectos Piloto , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To determine whether a previous episode of major depression leaves a "scar" that places previously depressed patients with rheumatoid arthritis (RA) at risk for experiencing high levels of pain, fatigue, and disability. METHODS: A cohort of 203 patients with RA was randomly selected from a national panel and interviewed by phone about pain, fatigue, depressive symptoms, disability, and history of major depression. RESULTS: Excluding patients who met the criteria for current major depression, patients with both a history of depression and many depressive symptoms at the time of the interview (dysphoria) reported more pain than those without current dysphoria, irrespective of whether they had a history of depression. Dysphoria alone was not reliably related to pain reports. CONCLUSION: An episode of major depression, even if it occurs prior to the onset of RA, leaves patients at risk for higher levels of pain when depressive symptoms persist, even years after the depressive episode.
Asunto(s)
Artritis Reumatoide/fisiopatología , Artritis Reumatoide/psicología , Depresión/complicaciones , Evaluación de la Discapacidad , Fatiga/epidemiología , Dolor/epidemiología , Humanos , Metotrexato/uso terapéutico , Dolor/tratamiento farmacológico , Dolor/etiología , Prednisona/uso terapéutico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate the effect of employment on health outcomes in a sample of women with rheumatoid arthritis (RA) and to test the hypothesis that employment confers a health benefit to women. METHODS: Seven hundred sixty women with a diagnosis of RA were recruited from a national random sample of private rheumatology practices in 1988, and 416 remained in the study after 7 years of followup in 1994. Women were interviewed each year by telephone to collect data on demographic variables, health status, and employment status. Clinical data were provided by referring physicians. RESULTS: Most women (175, 42%) were not employed outside the home 1988-94, although 96 of those women (23% of the sample) had been employed previously. Twenty-seven percent (n = 112) were employed all 7 years and 31% (n = 129) had been employed between one and 6 years. Women who were employed had significantly better health outcomes measured by pain, disability, role functioning, and clinical status compared to those who were never employed and those who had been employed before the study. Women who were previously employed, but not employed during the study period experienced the worst health outcomes. This difference in health status, however, appeared before entry into this study. CONCLUSION: Employed women with RA had better health status than women who were not employed outside the home. Previously employed women had worse health outcomes than both working women and women who were never employed, suggesting that loss of employment is associated with worse health. Further research is needed to investigate underlying factors contributing to worse health status among unemployed women and to better health among employed women.