Transportation for an Aging Population: Promoting Mobility and Equity for Low-Income Seniors

This study explores the travel patterns, needs, and mobility problems faced by diverse low-income, inner-city older adults in Los Angeles in order to identify solutions to their mobility challenges. The study draws information from: (1) a systematic literature review of the travel patterns of older adults; (2) a review of municipal policies and services geared toward older adult mobility in six cities; (3) a quantitative analysis of the mobility patterns of older adults in California using the California Household Travel Survey; and (4) empirical work with 81 older adults residing in and around Los Angeles’ inner-city Westlake neighborhood, who participated in focus groups, interviews, and walkabouts around their neighborhood

The Effect of Patients’ Met Expectations on Consultation Outcomes. A Study with Family Medicine Residents

OBJECTIVES: To know the patients’ expectations and the fulfillment of these at family medicine consultations by resident doctors and to assess their effect on some consultation outcomes. DESIGN: A prospective cohort study. PARTICIPANTS: Patients attending family medicine consultations held by 38 resident doctors: 1,301 eligible patients, 702 filled in all questionnaires. MEASUREMENTS: Before each visit, the patients’ expectations about that particular consultation were registered. Right after the visit was over, their perception of several aspects of the communicative interaction with the doctor was measured. Later, patients were interviewed on the phone to know how their expectations had been fulfilled, how satisfied they were about the consultation, how they had followed the doctor’s suggestions, if they were going to seek further care for the same cause later, and the evolution of their clinical problem. Logistic regression was the main analysis used. RESULTS: The most common expectations were the doctor showing interest and listening (30.5%), getting some information about the diagnosis (16.3%), and sharing problems and doubts (11.1%). The rate of main expectations that were met was 76.5%. Satisfaction with the encounter was associated with the clinical evolution [odds ratio (OR) 2.23; confidence interval (CI): 1.32–3.75], and the fulfilling of the patients’ main or two main expectations was significantly related to all the measured outcomes (satisfaction OR 3.51, CI: 1.73–7.8; adherence OR 1.80, CI: 1.11–2.92; clinical evolution OR 1.54, CI: 1.01–2.35; and seeking further care later OR 0.54, CI:0.36–0.81) CONCLUSIONS: Patients prioritize expectations of a more general sort when they attend primary care consultations and residents fulfill these acceptably. The fulfillment of expectations seems to affect the studied outcomes more than other factors

Ice-margin and meltwater dynamics during the mid-Holocene in the Kangerlussuaq area of west Greenland

Land-terminating parts of the west Greenland ice sheet have exhibited highly dynamic meltwater regimes over the last few decades including episodes of extremely intense runoff driven by ice surface ablation, ponding of meltwater in an increasing number and size of lakes, and sudden outburst floods, or 'jökulhlaups', from these lakes. However, whether this meltwater runoff regime is unusual in a Holocene context has not been questioned. This study assembled high-resolution topographical data, geological and landcover data, and produced a glacial geomorphological map covering ~1200 km2. Digital analysis of the landforms reveals a mid-Holocene land-terminating ice margin that was predominantly cold-based. This ice margin underwent sustained active retreat but with multiple minor advances. Over c. 1000 years meltwater runoff became impounded within numerous and extensive proglacial lakes and there were temporary connections between some of these lakes via spillways. The ice-dams of some of these lakes had several quasi-stable thicknesses. Meltwater was apparently predominantly from supraglacial sources although some distributary palaeochannel networks and some larger bedrock palaeochannels most likely relate to mid-Holocene subglacial hydrology. In comparison to the geomorphological record at other Northern Hemisphere ice-sheet margins the depositional landforms in this study area are few in number and variety and small in scale, most likely due to a restricted sediment supply. They include perched fans and deltas and perched braidplain terraces. Overall, meltwater sourcing, routing and the proglacial runoff regime during the mid-Holocene in this land-terminating part of the ice sheet was spatiotemporally variable, but in a manner very similar to that of the present day

Sociodemographic gradients in breast and cervical cancer screening in Korea: the Korean National Cancer Screening Survey (KNCSS) 2005-2009

<p>Abstract</p> <p>Background</p> <p>Cancer screening rates in Korea for five cancer types have increased steadily since 2002. With regard to the life-time cancer screening rates in 2009 according to cancer sites, the second highest was breast cancer (78.1%) and the third highest was cervical cancer (76.1%). Despite overall increases in the screening rate, disparities in breast and cervical cancer screening, based on sociodemographic characteristics, still exist.</p> <p>Methods</p> <p>Data from 4,139 women aged 40 to74 years from the 2005 to 2009 Korea National Cancer Screening Survey were used to analyze the relationship between sociodemographic characteristics and receiving mammograms and Pap smears. The main outcome measures were ever having had a mammogram and ever having had a Pap smear. Using these items of information, we classified women into those who had had both types of screening, only one screening type, and neither screening type. We used logistic regression to investigate relationships between screening history and sociodemographic characteristics of the women.</p> <p>Results</p> <p>Being married, having a higher education, a rural residence, and private health insurance were significantly associated with higher rates of breast and cervical cancer screening after adjusting for age and sociodemographic factors. Household income was not significantly associated with mammograms or Pap smears after adjusting for age and sociodemographic factors.</p> <p>Conclusions</p> <p>Disparities in breast and cervical cancer screening associated with low sociodemographic status persist in Korea.</p

Client and clinical staff perceptions of barriers to and enablers of the uptake and delivery of behavioural interventions for urinary incontinence: qualitative evidence synthesis

Aim: To evaluate factors influencing uptake and delivery of behavioural interventions for urinary incontinence from the perspective of clients and clinical staff. Background: Behavioural interventions are recommended as first-line therapy for the management of urinary incontinence. Barriers to and enablers of uptake and delivery of behavioural interventions have not been reviewed. Design: Systematic narrative review. Data sources: MEDLINE, EMBASE, CINAHL, PsychInfo, AMED (inception to May 2013); Proceedings of the International Continence Society (ICS) (2006-13). Review methods: ENTREQ reporting guidelines were followed. Studies where data were collected from clients or staff about their experiences or perceptions of behavioural interventions were included. Two reviewers independently screened records on title and abstract. Full-text papers were obtained for records identified as potentially relevant by either reviewer. Two reviewers independently filtered all full-text papers for inclusion, extracted findings and critically appraised studies. Results: Seven studies involving 200 participants identified clients’ views. Findings identified from at least one study of moderate quality included increased fear of accidents and convenience of treatment. Factors enabling participation included realistic goals and gaining control. Six studies involving 427 participants identified staff views. Findings identified from at least one study of moderate quality included staff education and perceptions of treatment effectiveness. Enabling factors included teamwork and experience of success. Conclusion: There is little detailed exploration of clients’ experiences of, and responses to, behavioural interventions. Evidence for staff relates predominantly to prompted voiding in long-term residential care. Studies of the uptake and delivery of other behavioural interventions in other settings are warranted

Characteristics of a Widespread Community Cluster of H275Y Oseltamivir-Resistant A(H1N1)pdm09 Influenza in Australia

Background. Oseltamivir resistance in A(H1N1)pdm09 influenza is rare, particularly in untreated community cases. Sustained community transmission has not previously been reported