Planning for a statewide network of dementia assessment services: A survey of geriatric assessment services in Michigan

All 38 geriatric assessment service units identified in Michigan were surveyed and responded as a component of planning a statewide network of diagnostic and assessment services for patients with dementia. Most units were outpatient (71 percent), urban (71 percent), and hospital-based (82 percent). Some provided primarily geropsychiatric services (21 percent), while the rest provided general geriatric services. The staff included physicians (95 percent), nurses (100 percent), social workers (95 percent) and other professionals (SO percent) such as nutritionists, neuro psychologists or clinical pharmacists. Assessments performed by most units included physical (92 percent), psychosocial (95 percent), functional (95 percent), neurological (71 percent) mental (95 percent), and financial (89 percent). Patient referral sources were most frequently self/family, followed by physician, community agencies, and community mental health. Reasons for referral were most often confusion! memory loss, followed by behavior change, caregiver stress, depression, and evaluation for placement. Most patients seen were between 65 and 84 years of age (72 percent), lived within 25 miles of the unit (87 percent), and had dementia (62 percent). Urban sites assessed significantly more persons per month (19 percent) than non-urban sites (4 percent). Community-based services spent significantly more time per month on geriatric assessments (68 hours) than did hospital-based services (26 hours). These survey results will aid the development of a statewide network of dementia diagnostic and assessment services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67004/2/10.1177_153331759200700606.pd

学童の健康状況・生活習慣と生活習慣病予備軍のスクリーニング方法に関する研究(健康科学科)

小児生活習慣病予備軍のスクリーニング手法を開発することを目的に、学童の保護者1,619人を対象とした生活習慣実態調査及び肥満児等107人を対象とした健康教室を行った。その結果、肥満度と動脈硬化初期病変の血液指標との関連が認められたことから、肥満度と関連があった好ましくない生活習慣等13項目(不健康、BMI、家族の肥満、睡眠時間、就寝時刻、戸外遊び、保護者の悩みの食べすぎ・早食べ・噛み方・間食夜食・テレビをみる時間、多脂肪食品や野菜の摂取)をスクリーニング項目とした。更に、先行研究における肥満度との関連が認められている3項目(ジュース、甘い及び塩辛いおやつの摂取)を追加し、計16項目について有意水準をもとに傾斜配点を行った。更に、生活リズム及び排便の2項目は、肥満度との関連に関する先行研究はなかったが生活指導上重要な項目であると考え、結果的には未配点として追加し、最終的なスクリーニング票は18項目とした。18項目を用い、スクリーニング得点と血液検査にもとづく異常者数が一致した得点によって、傾斜配点したスクリーニング票を完成した。今後、スクリーニング票の活用によって、検診や健康教育の必要な子ども達を選択するための負担の軽減や生活習慣病に関する経費を節減できることが示唆された。To develop a screening checklist for future lifestyle-related diseases in children, a questionnaire survey of 1619 parents and training; for example, cooking and exercise education, of 107 obese children were conducted. A relationship between obesity level and a blood index indicating first stage arteriosclerosis was recognized. Thirteen undesirable items indicated in the questionnaire were selected for use in the checklist: 1) poor health, 2) a BMI of more than 22, 3) a family history of obesity, 4) short sleeping time, 5) sleeping late, 6) infrequent playing outdoors, 7) overeating, 8) speedy eating, 9) insufficient chewing, 10) frequent snacking during the day and night, 11) long hours of television watching, 12) overeating of greasy food, and 13) undereating of vegetables. An additional 3 items obtained in a previous study were also shown to be significantly correlated with the overweight index and daily lifestyles; namely, consumption of 14) sweet and fizzy drinks, and 15) sweet and 16) salty snacks. Consequently, 16 items were included in the checklist. Each was allotted a different point based on a significance level then total individual scores were calculated for 107 obese children. Two further items, 17) life rhythm and 18) bowel movement patterns, although they haven't been examined previously, were also deemed important and added to the checklist but without a screening score. The final checklist therefore consisted of 18 items. Use of the revised checklist was consequently examined. The results revealed that the screening scores correlated with blood test disorders. It was therefore suggested that the checklist could be used to help identify children in need of medical examination and health education, without the need for extensive testing, helping decrease the costs of life-style related diseases.原著Original国立情報学研究所で電子

Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health

Although self-rated health is proposed for use in public health monitoring, previous reports on US levels and trends in self-rated health have shown ambiguous results. This study presents a comprehensive comparative analysis of responses to a common self-rated health question in 4 national surveys from 1971 to 2007: the National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, and Current Population Survey. In addition to variation in the levels of self-rated health across surveys, striking discrepancies in time trends were observed. Whereas data from the Behavioral Risk Factor Surveillance System demonstrate that Americans were increasingly likely to report “fair” or “poor” health over the last decade, those from the Current Population Survey indicate the opposite trend. Subgroup analyses revealed that the greatest inconsistencies were among young respondents, Hispanics, and those without a high school education. Trends in “fair” or “poor” ratings were more inconsistent than trends in “excellent” ratings. The observed discrepancies elude simple explanations but suggest that self-rated health may be unsuitable for monitoring changes in population health over time. Analyses of socioeconomic disparities that use self-rated health may be particularly vulnerable to comparability problems, as inconsistencies are most pronounced among the lowest education group. More work is urgently needed on robust and comparable approaches to tracking population health

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Background: Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective: To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design: Prospective multicentre cohort study. Setting: Secondary care. Participants: A total of 381 patients referred with newly suspected GCA. Main outcome measures: Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results: We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations: There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion: We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work: Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding: he National Institute for Health Research Health Technology Assessment programme

Evaluation of the public health impacts of traffic congestion: a health risk assessment

Background: Traffic congestion is a significant issue in urban areas in the United States and around the world. Previous analyses have estimated the economic costs of congestion, related to fuel and time wasted, but few have quantified the public health impacts or determined how these impacts compare in magnitude to the economic costs. Moreover, the relative magnitudes of economic and public health impacts of congestion would be expected to vary significantly across urban areas, as a function of road infrastructure, population density, and atmospheric conditions influencing pollutant formation, but this variability has not been explored. Methods: In this study, we evaluate the public health impacts of ambient exposures to fine particulate matter (PM2.5) concentrations associated with a business-as-usual scenario of predicted traffic congestion. We evaluate 83 individual urban areas using traffic demand models to estimate the degree of congestion in each area from 2000 to 2030. We link traffic volume and speed data with the MOBILE6 model to characterize emissions of PM2.5 and particle precursors attributable to congestion, and we use a source-receptor matrix to evaluate the impact of these emissions on ambient PM2.5 concentrations. Marginal concentration changes are related to a concentration-response function for mortality, with a value of statistical life approach used to monetize the impacts. Results: We estimate that the monetized value of PM2.5-related mortality attributable to congestion in these 83 cities in 2000 was approximately $31 billion (2007 dollars), as compared with a value of time and fuel wasted of$60 billion. In future years, the economic impacts grow (to over $100 billion in 2030) while the public health impacts decrease to$13 billion in 2020 before increasing to $17 billion in 2030, given increasing population and congestion but lower emissions per vehicle. Across cities and years, the public health impacts range from more than an order of magnitude less to in excess of the economic impacts. Conclusions: Our analyses indicate that the public health impacts of congestion may be significant enough in magnitude, at least in some urban areas, to be considered in future evaluations of the benefits of policies to mitigate congestion