Dementia as a determinant of social and health service use in the last two years of life 1996-2003

<p>Abstract</p> <p>Background</p> <p>Dementia is one of the most common causes of death among old people in Finland and other countries with high life expectancies. Dementing illnesses are the most important disease group behind the need for long-term care and therefore place a considerable burden on the health and social care system. The aim of this study was to assess the effects of dementia and year of death (1998-2003) on health and social service use in the last two years of life among old people.</p> <p>Methods</p> <p>The data were derived from multiple national registers in Finland and comprise all those who died in 1998, 2002 or 2003 and 40% of those who died in 1999-2001 at the age of 70 or over (n = 145 944). We studied the use of hospitals, long-term care and home care in the last two years of life. Statistics were performed using binary logistic regression analyses and negative binomial regression analyses, adjusting for age, gender and comorbidity.</p> <p>Results</p> <p>The proportion of study participants with a dementia diagnosis was 23.5%. People with dementia diagnosis used long-term care more often (OR 9.30, 95% CI 8.60, 10.06) but hospital (OR 0.33, 95% CI 0.31, 0.35) and home care (OR 0.50, 95% CI 0.46, 0.54) less often than people without dementia. The likelihood of using university hospital and long-term care increased during the eight-year study period, while the number of days spent in university and general hospital among the users decreased. Differences in service use between people with and without dementia decreased during the study period.</p> <p>Conclusions</p> <p>Old people with dementia used long-term care to a much greater extent and hospital and home care to a lesser extent than those without dementia. This difference persisted even when controlling for age, gender and comorbidity. It is important that greater attention is paid to ensuring that old people with dementia have equitable access to care.</p

Adequacy of Diabetes Care for Older U.S. Rural Adults: A Cross-sectional Population Based Study Using 2009 BRFSS Data

Background: In the U.S. diabetes prevalence estimates for adults ≥ 65 years exceed 20%. Rural communities have higher proportions of older individuals and health disparities associated with rural residency place rural communities at risk for a higher burden from diabetes. This study examined the adequacy of care received by older rural adults for their diabetes to determine if older rural adults differed in the receipt of adequate diabetes care when compared to their non-rural counterparts. Methods: Cross-sectional data from the 2009 Behavioral Risk Factor Surveillance Survey were examined using bivariate and multivariate analytical techniques. Results: Logistic regression analysis revealed that older rural adults with diabetes were more likely to receive less than adequate care when compared to their non-rural counterparts (OR = 1.465, 95% CI: 1.454-1.475). Older rural adults receiving less than adequate care for their diabetes were more likely to be: male, non-Caucasian, less educated, unmarried, economically poorer, inactive, a smoker. They were also more likely to: have deferred medical care because of cost, not have a personal health care provider, and not have had a routine medical check-up within the last 12 months. Conclusion: There are gaps between what is recommended for diabetes management and the management that older individuals receive. Older adults with diabetes living in rural communities are at greater risk for less than adequate care when compared to their non-rural counterparts. These results suggest the need to develop strategies to improve diabetes care for older adults with diabetes and to target those at highest risk

Family social environment in childhood and self-rated health in young adulthood

<p>Abstract</p> <p>Background</p> <p>Family social support, as a form of social capital, contributes to social health disparities at different age of life. In a life-course epidemiological perspective, the aims of our study were to examine the association between self-reported family social environment during childhood and self-reported health in young adulthood and to assess the role of family functioning during childhood as a potential mediating factor in explaining the association between family breakup in childhood and self-reported health in young adulthood.</p> <p>Methods</p> <p>We analyzed data from the first wave of the Health, Inequalities and Social Ruptures Survey (SIRS), a longitudinal health and socio-epidemiological survey of a random sample of 3000 households initiated in the Paris metropolitan area in 2005. Sample-weighted logistic regression analyses were performed to determine the association between the quality of family social environment in childhood and self-rated health (overall health, physical health and psychological well-being) in young adults (n = 1006). We used structural equation model to explore the mediating role of the quality of family functioning in childhood in the association between family breakup in childhood and self-rated health in young adulthood.</p> <p>Results</p> <p>The multivariate results support an association between a negative family social environment in childhood and poor self-perceived health in adulthood. The association found between parental separation or divorce in childhood and poor self-perceived health in adulthood was mediated by parent-child relationships and by having witnessed interparental violence during childhood.</p> <p>Conclusion</p> <p>These results argue for interventions that enhance family cohesion, particularly after family disruptions during childhood, to promote health in young adulthood.</p

THE EFECT OF CITRULLINE MALATE SUPPLEMENTATION ON OVERHEAD SQUAT PERFORMANCE IN RECREATIONALLY TRAINED MALES

Morgan Maleske1, Macy Kate Bynum1, Annika Marie Pschorr1, Taylor Carrico1, Matthew Hermes1, & Brenda Reeves1 1Murray State University, Murray, Kentucky Citrulline malate (CM) is a recognized supplement to improve performance due to its potential to enhance blood flow and nutrient delivery. Various studies have focused on the effect of CM on anaerobic performance in trained athletes with differing results in power output due to variations in methodology. The benefits of acute CM supplementation on high intensity aerobic/anaerobic performance in novice CrossFit® participants is unknown. PURPOSE: To examine the effects of acute CM vs. placebo (PL) supplementation on repeated-bout overhead squat (OH) performance in novice Nancy CrossFit® participants. METHODS: Eight recreationally trained males (X ± SD; age = 20.8 ± 2.3 yrs, height = 180.0 ± 6.0 cm, body fat 9.5 ± 5.1%, VO2max = 49.3 ± 6.4 ml/kg/min, 1RM = 59.5 ± 19.7 kg, MET.min = 701.2 ± 230.5) were randomized in a double-blind, crossover design. Participants completed two sessions of the Nancy separated by a 7-day washout period. In each session, participants consumed 4 oz of orange juice with either 8 g of CM or PL. After 60 min, participants completed the Nancy (5 bouts of a 400-meter run on a treadmill followed by 15 OH using a 20 kg barbell) as quickly as possible. Mean concentric power (MP) and mean concentric velocity (MV) in OH performance was measured with a linear position transducer. A 2x2 (condition x set) repeated measures ANOVA with Bonferroni adjustments was used to assess changes in MP and MV between the first and last set between conditions. An additional 2x2 repeated measures ANOVA (trial x set) was used to compare Nancy performance between the first and second sessions to test for a potential practice effect independent of supplementation. RESULTS: Two-way interactions between supplementation condition and set were not significant for MV (p = .63, = .04) or MP (p = .65, = .03). Main effects for condition and set were not different for MV (p = .28 - .54, = .06 - .16) or MP (p = .29 - .53, = .06 - .16). When collapsing across sets, MV (1.05 ± 18 vs. 101.1 ± 16 m/s) and MP (205.0 ± 35.8 vs. 198.5 ± 31.6 W) for CM and PL, respectively, were not different (p = .28 -.29, = .16). In addition, no practice effect was found between the first and second session for MV (p = .17 - .80, = .01 - .25) or MP (p = .16 - .83, = .07 - .26). CONCLUSION: These data suggest that acute CM supplementation before the Nancy did not improve OH performance

THE EFFECTS OF CITRULLINE MALATE ON MULTIPLE BOUT, HIGH-INTENSITY AEROBIC EXERCISE: A PILOT STUDY

Macy Kate Bynum1, Annika Marie Pschorr1, Taylor Carrico1, Morgan Maleske1, Matthew Hermes1, & Brenda Reeves1 1Murray State University, Murray, Kentucky Citrulline malate (CM) is suggested to improve performance and post-exercise recovery. There is limited research on the effect of CM on short duration, high-intensity aerobic exercise with ambiguous results. The effects of acute CM supplementation on combined aerobic/anaerobic performance in novice CrossFit® participants is unknown. PURPOSE: To examine the effects of acute CM vs. placebo (PL) supplementation on multiple-bout, high intensity aerobic performance in novice Nancy CrossFit® participants. METHODS: Eight recreationally trained males (X±SD; age = 20.8 ± 2.3 yrs, height = 180.0 ± 6.0 cm, body fat 9.5 ± 5.1%, VO2max = 49.3 ± 6.4 ml/kg/min, 1RM = 59.5 ± 19.7 kg, MET.min = 701.2 ± 230.5) were randomized in a double-blind, crossover design. Participants completed two Nancy workouts separated by a 7-day washout period. In each session, participants consumed 4 oz of orange juice with either 8g of CM or PL. After 60 min, participants completed the Nancy (5 bouts of a 400-meter run on a treadmill followed by 15 overhead squats with a 20 kg barbell), and a 20-min recovery. Speed, heart rate reserve (HRR), rate of perceived exertion (RPE), blood pressure (BP), and lactate (LA) were measured. Separate 2x5 repeated measures ANOVAs assessed differences in speed, HRR, and RPE between conditions and bouts. A 2x6 repeated measures ANOVA assessed differences in LA between conditions at the following timepoints: pre-exercise and 2, 5-, 10-, 15-, and 20-min post exercise. A 2x3 repeated measures ANOVAs assessed the influence of CM on systolic (SBP) and diastolic (DBP) blood pressure before, immediately after, and 20 min after exercise. To assess if a learning effect was present, speed between trials 1 and 2 were compared. RESULTS: For LA, a 2-way interaction was noted (p = .03, = .29), indicating at 10 min (9.98 ± 2.14 vs 11.10 ± 1.97 mmol/L, p = .04, g = .84) and 20 min (6.04 ± 1.92 vs 7.30 ± 2.25 mmol/L, p = .01, g = 1.14) LA was lower for PL as compared to CM. All other timepoints were not different between conditions (p = .11 - 0.81, g = .08 - .62). RPE, HRR, speed, DBP and SBP were not different between conditions (p \u3e .05, \u3c .001 - .19). In addition, a learning effect was not found between trials 1 and 2 (p = .76, = .01). CONCLUSION: These data suggest that acute CM supplementation before the Nancy did not improve aerobic performance