Changes in visual acuity in a population. The Beaver Dam Eye Study

PURPOSE: To describe the change in visual acuity over a 5-year period in persons participating in a large population-based study. METHODS: Best-corrected visual acuity was measured, after refraction, with logMAR charts using a modification of the Early Treatment Diabetic Retinopathy Study protocol in 3684 persons living in Beaver Dam, Wisconsin, who ranged in age from 43 to 86 years at the time of a baseline examination from 1988 to 1990, and at a follow-up examination from 1993 to 1995. RESULTS: The change in the number of letters read correctly over the 5-year period varied from 0.4 +/- 4.9 (mean +/- standard deviation) in people between 43 and 54 years of age to -5.2 +/- 15.4 in people 75 years of age or older at baseline. Over the 5-year period, vision became impaired (20/40 or worse in the better eye) in 2.9% of the population and severely impaired (20/200 or worse in the better eye) in 0.3%. The visual angle doubled in 1.7% of the population, and 2.4% had improved vision. People 75 years of age or older at baseline were 12.5 times (95% confidence interval [Cl], 8.6-18.2; P < 0.001) more likely to have impaired vision, 9.7 times (95% Cl, 5.9-16.0; P < 0.001) more likely to have doubling of the visual angle, and 78 times more likely (95% Cl, 9.9-614.1; P < 0.001) to have severe visual impairment than people younger than 75 years of age at baseline. People 75 years of age or older who were living in nursing homes or group homes were 3.8 times more likely to have impaired vision, 3.3 times more likely to have severely impaired vision, and 5.7 times more likely to have a doubling of the visual angle than those not residing in a nursing home or a group home. CONCLUSION: These data provide precise population-based estimates of incidence of visual loss over a wide spectrum of ages and show that decreased visual acuity in people 75 years of age is a common finding, especially in those who are in nursing homes or group homes.     

Heparan sulfate staining of the glomerular basement membrane in relation to circulating anti-DNA and anti-heparan sulfate reactivity: a longitudinal study in NZB/W F1 mice

BACKGROUND: Pyroglyphid mites are considered a major cause of house dust allergy. The occurrence and possible pathogenic role of other biologic components of house dust, in particular bacteria, has received less attention. OBJECTIVE: The aim of this study was to examine bacteria present in the samples of house dust from beds, in comparison to fungi and mites recovery. METHODS: Samples of bed dust were collected from 40 homes in Upper Silesia (Poland). Of these, 19 came from the homes of people with asthma caused by house dust and 21 from the homes of people without allergy. The concentrations of bacteria, fungi, mites, and endotoxin and species composition of microflora and acarofauna were determined. RESULTS: The overall mean concentrations of mesophilic bacteria, thermophilic bacteria and fungi, including yeasts, were, respectively, 1.6 x 10(6), 1.7 x 10(3), and 1.6 x 10(4) CFU/g. Samples contained an average of 8.4 mites/g and the ten samples assayed for bacterial endotoxin averaged 80.4 ng/mg. A total of 55 species of bacteria, 40 of fungi and 13 of mites were found. Gram-positive cocci (mostly Staphylococcus spp.) were the predominant mesophilic bacteria, followed by corynebacteria and Bacillus spp. Thermophilic bacteria were represented only by actinomycetes, with Thermoactinomyces vulgaris predominant. The most numerous fungi were Penicillium spp. and Aspergillus spp. followed by yeasts. The most abundant mites were Dermatophagoides spp. which formed > 85% of the total count. There were no significant differences between the homes of allergic and nonallergic people in the concentrations of total bacteria, fungi, and mites. Bacillus, Aspergillus and total filamentous fungi (molds), but not yeasts, were significantly more numerous in the homes of people with asthma caused by house dust. CONCLUSION: The results suggest that some species of bacteria and filamentous fungi should be considered potential causes of house dust allergy.     

Mortality associated with HIV-1 infection over five years in a rural Ugandan population: cohort study

OBJECTIVE: To assess the impact of HIV-1 infection on mortality over five years in a rural Ugandan population. DESIGN: Longitudinal cohort study followed up annually by a house to house census and medical survey. SETTING: Rural population in south west Uganda. SUBJECTS: About 10,000 people from 15 villages who were enrolled in 1989-90 or later. MAIN OUTCOME MEASURES: Number of deaths from all causes, death rates, mortality fraction attributable to HIV-1 infection. RESULTS: Of 9777 people resident in the study area in 1989-90, 8833 (90%) had an unambiguous result on testing for HIV-1 antibody; throughout the period of follow up adult seroprevalence was about 8%. During 35,083 person years of follow up, 459 deaths occurred, 273 in seronegative subjects and 186 in seropositive subjects, corresponding to standardised death rates of 8.1 and 129.3 per 1000 person years. Standardised death rates for adults were 10.4 (95% confidence interval 9.0 to 11.8) and 114.0 (93.2 to 134.8) per 1000 person years respectively. The mortality fraction attributable to HIV-1 infection was 41% for adults and was in excess of 70% for men aged 25-44 and women aged 20-44 years. Median survival from time of enrollment was less than three years in subjects aged 55 years or more who were infected with HIV-1. Life expectancy from birth in the total population resident at any time was estimated to be 42.5 years (41.4 years in men; 43.5 years in women), which compares with 58.3 years (56.5 years in men; 60.5 years in women) in people known to be seronegative. CONCLUSIONS: These data confirm that in a rural African population HIV-1 infection is associated with high death rates and a substantial reduction in life expectancy.     

State- and sex-specific prevalence of selected characteristics--Behavioral Risk Factor Surveillance System, 1992 and 1993

PROBLEM/CONDITION: Much chronic disease and injury morbidity and mortality is associated with high-risk behaviors (e.g., cigarette smoking, excessive alcohol consumption, and physical inactivity) and with lack of preventive health care (e.g., screening for cancer). States use the Behavioral Risk Factor Surveillance System (BRFSS) to collect data about these modifiable health behaviors and to monitor trends and significant changes in their populations over time. REPORTING PERIOD: 1992 and 1993. DESCRIPTION OF SYSTEM: The BRFSS is a state-based telephone survey of the civilian, noninstitutionalized, adult (persons > or = 18 years of age) population. In 1992, 48 states and the District of Columbia participated in the BRFSS; in 1993, 49 states and the District of Columbia participated. Several questions were added to the BRFSS in 1993. RESULTS: As in previous years, state-specific variations occurred in the prevalence of high-risk behaviors, awareness of certain medical conditions, use of preventive health services, and health-care coverage. In 1993, 4.0% (range: 1.4% - 6.4%) of adults reported riding with a driver who had had too much alcohol to drink. The percentage of persons > or = 50 years of age who had ever had a proctoscopic examination ranged from 25.6% to 51.5% (median: 36.8%). Among adults > or = 65 years of age, 27.4% (range: 18.5 % - 40.0%) had ever had a pneumococcal vaccination, and 49.9% (range: 28.7% - 66.2%) had had an influenza vaccination within the past 1 year. INTERPRETATION: The variations in prevalence across states likely reflect socioeconomic differences, differences in state laws enacted to discourage risky behaviors, different levels of effort to screen for certain types of cancer or risk factors for other diseases, and other factors. ACTION TAKEN: States will continue to use the BRFSS to collect data about health behaviors. Analysis of these data will enable states to monitor factors that may affect the rate of chronic disease and injury mortality and morbidity and to develop public health policies to address these problems.     

Survey of lead exposure around a closed lead smelter

OBJECTIVE: To test the hypothesis that elevated lead in soil is positively correlated with blood lead (BPb) levels in children in an urban population surrounding a closed lead smelter, a US Environmental Protection Agency Superfund clean-up site was surveyed. METHOD: A total of 827 volunteers including 490 children under 6 years of age participated. A questionnaire was administered. Blood lead was determined as was lead content of samples of house dust, soil, paint, and water of the participants' homes. RESULTS: The arithmetic mean venous BPb in 490 children between 6 and 72 months of age was 6.9 micrograms/dL (0.33 mumol/L) range 0.7 to 40.2 micrograms/dL (0.03 to 1.94 mumol/L). The BPb of 78 (16%) children in this group was > or = 10 micrograms/dL (0.48 mumol/L). Based on multiple regression modeling, lead in house dust accounted for 18% of the variance in BPb. Lead in paint together with the condition of the house were the main contributors to the dust lead variance (26%) with soil lead accounting for an additional 6%. Lead in paint alone accounted for 3% of the BPb variance. Lead in paint together with the condition of the house accounted for 12% of BPb variance, and lead in soil accounted for an additional 3%. Factors other than environmental lead such as education of parents, household income, and behavior were associated with BPb levels. CONCLUSIONS: The mean BPb in children was below the present level of concern of the Centers for Disease Control and Prevention. Children with BPb of > or = 10 micrograms/L (0.48 mumol/L) tended to live in poorly maintained older houses. Based on these findings lead in soil and paint in well-maintained homes contributed little to the lead exposure of children.     

A 3- to 6-year follow-up of former long-stay psychiatric patients in Northern Ireland

Little is known about the first patients who left hospital before and during the official implementation of the hospital discharge policy in Northern Ireland. This study describes patterns of residential provision for former long-stay patients (approximately two-thirds of whom had an ICD-9 diagnosis of schizophrenia) discharged from the six major psychiatric hospitals in Northern Ireland between 1987 and 1990 (n = 321). It also employs several instruments within a retrospective survey design to examine outcomes for a 35% sample of people (112/321) discharged between 1997 and 1990 and followed up in 1993. Almost two-thirds (61%) had been discharged to independent living or low-staffed statutory settings. None of the group was homeless, one person was in prison and three people had committed suicide during the first 2 years after discharged. Almost one-third had to be re-admitted at some stage during the 6-year period and 13% had died. 'Moderate' to 'major problems' with most daily living skills were reported for less than 25% of people, while 15% or less had problem behaviour. Approximately 90% or more were satisfied with most aspects of their new homes and most also reported feeling happier (77%), healthier (63%) and more independent (78%) since discharge. However, social, recreational and occupational opportunities were limited. Purchasers, providers and practitioners need to review ways in which former long-stay patients might be empowered to live more meaningful and integrated lives in the community, particularly as the current government strategy for health and social well-being (1997-2002) in Northern Ireland points to the closure of existing psychiatric hospitals.     

Effect of the National Resident Assessment Instrument on selected health conditions and problems

OBJECTIVE: To evaluate the effect of the implementation of the National Resident Assessment Instrument (RAI) system on selected conditions representing outcomes for nursing home residents. DESIGN: Quasi-experimental, pre-/post-design, with assessments at baseline and 6-month follow-up. SAMPLE: Two thousand one hundred twenty-eight residents from 268 nursing homes in 10 states before RAI implementation, and 2,088 from 254 of the same nursing homes after implementation. MEASURES: From the full RAI Minimum Data Set, measures of dehydration, falls, decubitus, vision problems, stasis ulcer, pain, dental status (poor teeth), and malnutrition were examined at baseline and 6 months later. Poor nutrition was evaluated using a body mass index score below 20 and vision using a 4-level scale; other conditions were represented by their presence or absence. Decline and improvement were computed as the changes in level between baseline and follow-up, limiting the sample to those who could manifest each such change. MAIN RESULTS: Of eight health conditions representing poorer health status, dehydration and stasis ulcer had significantly lower prevalence after the implementation of the RAI (1993) compared with 1990. At the same time, there was an increase in the prevalence of daily pain. Fewer residents declined over 6 months in nutrition and vision after implementation. Although for these two conditions there were also significantly reduced rates of improvement, the net was an overall reduction in the 6-month rate of decline for all residents. Pain also demonstrated a decline in the postimplementation rate of improvement. The combined eight conditions showed reductions in the rates of both decline and improvement. CONCLUSIONS: Several outcomes for nursing home residents improved after implementation of the RAI. Of the four conditions for which there are significant declines in prevalence or outcome changes, three are specifically addressed in the care planning guidelines incorporated the RAI system (all except stasis ulcer, although there is a RAP for decubitus ulcer). Pain, the only other condition with a significant result --an increase in baseline prevalence--also has no RAP. Although the changes might be ascribed otherwise, they support the premise that the RAI has directly contributed to improved outcomes for nursing home residents.     

Matching faces to photographs: Poor performance in eyewitness memory (without the memory).

Eyewitness memory is known to be fallible. We describe 3 experiments that aim to establish baseline performance for recognition of unfamiliar faces. In Experiment 1, viewers were shown live actors or photos (targets), and then immediately presented with arrays of 10 faces (test items). Asked whether the target was present among the test items, and if so to identify the person, participants showed poor performance levels (roughly 70% accurate). Furthermore, there was no difference between immediate memory for a live person and photograph. In Experiment 2, the same targets and test items were presented simultaneously, and participants were asked to perform a matching task. Again, performance was poor (roughly 68% accurate), with no difference between matching photos and live people. In the final experiment, viewers were asked to match a live person to a single photograph. Even under these conditions, performance was poor (c. 85%), with no advantage over matching 2 photographs. We suggest that problems of eyewitness identification may involve difficulties in initial encoding of unfamiliar faces, in addition to problems of memory for an event. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking at home: The impact of smoking cessation on nonsmokers' exposure to environmental tobacco smoke.

Nonsmokers who live with smokers are at increased risk for chronic disease. This study evaluated the impact of eliminating smoking in the home on nonsmokers' environmental tobacco smoke (ETS) exposure. Nonsmokers participated in measurements of their ETS exposure before and after the smoker in their home quit smoking. A matched comparison group of nonsmokers from nonsmoking homes was also included. ETS exposure was assessed using passive nicotine monitors, an exposure diary, and a questionnaire. Nonsmokers from smoking homes had significantly higher exposure to ETS than those from nonsmoking homes. There was a 60% reduction in nicotine levels following smoking cessation by the household smoker. However, there were still detectable levels of nicotine measured at posttest. These results have important implications for individual risk reduction and public health policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neighborhood deterioration and self-rated health in later life.

This study examined the relationship between the physical living environment and self-rated health in later life. It is hypothesized that older adults who reside in deteriorated neighborhoods will report more physical health problems than elderly people who live in better physical environments. However, it is further predicted that these effects will only emerge in the most dilapidated living conditions. Data from a nationwide survey of older adults provide support for this complex nonlinear relationship. Further analyses reveal that part of the effect can be attributed to friendship strains that arise in deteriorated neighborhood environments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The health project Ebeltoft: health check ups and discussions in general practice. Basic data from a 5-year, prospective, randomized, controlled population study

A study was carried out to investigate people's interest in participating in health check-up and in discussions about health with their own general practitioner, participants' health status, the proportion who received health advice following health check-up, and the lifestyle goals they set following discussion with their general practitioner. This study reports the baseline data from a five-year randomized, controlled, prospective, population-based study in general practices in Ebeltoft, Denmark. All general practitioners from the four practices in Ebeltoft and a random sample of 2,000 people aged between 30 and 50 years were invited to participate. Participants were randomly divided into three groups-one control group and two intervention groups. One intervention group was given a health check-up which included a range og tests (Table 2 and 3); this group received written feedback from the general practitioner. The other intervention group was also given a health check-up and written feedback, in addition, they were given the opportunity to attend their general practitioner to discuss health-promoting measures. A total of 1370 people participated in the study (69% response rate). Health advice was given to 76% of 905 participants following health check-up. Almost all of the 456 participants (96%) who were offered the opportunity of discussing their health with their general practitioner took up the offer: 64% of the 456 participants reported that they had decided to undertake lifestyle changes. Eleven of those who discussed their health with the doctor were referred to a specialist (2%). There was considerable interest in participating in health promotion. Three out of four of those who had a health check-up were given health advice. Two out of three of those who were offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes. Longterm follow up is needed to determine effects and side effects of health check-up and health talks.     

Beliefs about the helpfulness of interventions for mental disorders: a comparison of general practitioners, psychiatrists and clinical psychologists

OBJECTIVE: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders. METHOD: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful. CONCLUSIONS: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.     

Falls, injuries due to falls, and the risk of admission to a nursing home

BACKGROUND: Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable. METHODS: We conducted a prospective study of a probability sample of 1103 people over 71 years of age who were living in the community. Data on demographic and medical characteristics, use of health care, and cognitive, functional, psychological, and social functioning were obtained at base line and one year later during assessments in the participants' homes. The primary outcome studied was the number of days from the initial assessment to a first long-term admission to a skilled-nursing facility during three years of follow-up. Patients were assigned to four categories during follow-up: those who had no falls, those who had one fall without serious injury, those who had two or more falls without serious injury, and those who had at least one fall causing serious injury. RESULTS: A total of 133 participants (12.1 percent) had long-term admissions to nursing homes. In an unadjusted model, the risk of admission increased progressively, as compared with that for the patients with no falls, for those with a single noninjurious fall (relative risk, 4.9; 95 percent confidence interval, 3.2 to 7.5), those with multiple noninjurious falls (relative risk, 8.5; 95 percent confidence interval, 3.4 to 21.2), and those with at least one fall causing serious injury (relative risk, 19.9; 95 percent confidence interval, 12.2 to 32.6). Adjustment for other risk factors lowered these ratios to 3.1 (95 percent confidence interval, 1.9 to 4.9) for one noninjurious fall, 5.5 (95 percent confidence interval, 2.1 to 14.2) for two or more noninjurious falls, and 10.2 (95 percent confidence interval, 5.8 to 17.9) for at least one fall causing serious injury, but the association between falls and admission to a nursing home remained strong and significant. The population attributable risk of long-term admission to a nursing home for these three groups (the proportion of admissions directly attributable to the three categories of falls) was 13 percent, 3 percent, and 10 percent, respectively. CONCLUSIONS: Among older people living in the community falls are a strong predictor of placement in a skilled-nursing facility; interventions that prevent falls and their sequelae may therefore delay or reduce the frequency of nursing home admissions.     

Madness and mayhem: the place of people with dementia in a mental health setting

Demographic predictions indicate that there will be between 174,300 and 194,200 people in Australia experiencing dementia of the Alzheimer's type by the year 2006. At present, 60% of those who make up the resident population in nursing homes and aged-care units in psychiatric hospitals suffer from dementia. To explore the place of people with dementia in a mental health setting, a comprehensive review of the literature was undertaken and the results compared with the outcomes of an ethnographic study of a unit for confused older people.     

How Changes in Population Demographics Will Impact Health Psychology: Incorporating a Broader Notion of Cultural Competence Into the Field.

U.S. population demographics are undergoing striking changes that will impact health care and the research and practice of health psychology. An increase in the number of people who are older; belong to an ethnic minority group; have disabilities; identify as lesbian, gay, bisexual, or transgendered; or live in poverty will influence definitions of aging, health, and illness, and will challenge current psychological and medical treatment models. The authors argue that health psychologists need to become context competent for the field to be relevant and viable over the course of this new century. Health psychologists need to become aware of the multiple, overlapping contexts in which people live and apply this knowledge on a regular basis to research, practice, education and training, and policy in health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of interior design elements in human responses to crowding.

The role of interior design elements in mitigating the negative relationship between residential crowding and psychological health was investigated. Residents of crowded homes with greater architectural depth (the number of spaces one must pass through to get from one room in the house to another) are less likely to socially withdraw or to be psychologically distressed than residents in crowded homes with relatively low depth. Additional analyses suggest that greater depth buffers the association between residential crowding and psychological distress because it reduces social withdrawal among residents of crowded homes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acknowledgement of handicap as a tactic in social interaction.

Nonhandicapped people often report discomfort and uncertainty when interacting with handicapped individuals. Three studies, using a total of 160 nonhandicapped undergraduates, investigated a possible tactic that handicapped people could use to reduce a fellow interactant's discomfort and uncertainty. Ss watched 2 videotapes of handicapped individuals being interviewed. Ss then chose the handicapped person with whom they would prefer to work on a cooperative task. Results of all 3 studies support the hypothesis that a handicapped person who acknowledges the handicap will be preferred to a handicapped person who does not. In Study 1, Ss significantly preferred a handicapped person who acknowledged the handicap to a handicapped person who did not disclose anything personal. In Study 2, Ss significantly preferred an acknowledging person over one who made a personal disclosure other than about the handicap. In Study 3, Ss preferred the individual acknowledging a handicap over one who disclosed something else personal even when the acknowledging individual was clearly nervous about doing so. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developmental trajectories of delinquency symptoms in childhood: The role of marital conflict and autonomic nervous system activity.

Trajectories of delinquency symptoms across middle and late childhood were examined through latent growth modeling, with a focus on the role of interactions among parental marital conflict, child sex, and multiple indices (baseline, reactivity) of either parasympathetic nervous system activity, indexed by respiratory sinus arrhythmia (RSA), or sympathetic nervous system activity, indexed by skin conductance level (SCL), as predictors of growth. At Time 1, 128 girls and 123 boys (mean age = 8.23 yrs ± 0.73) and their parents participated. The sample comprised 64% European American and 36% African American children. Families participated in second and third waves of data collection with a 1-year lag between each wave. Interactions among marital conflict, sex, baseline RSA, and RSA reactivity from baseline to a frustrating lab task were significant predictors of growth in delinquent behavior from age 8 to age 10, with overall patterns indicating increasing symptoms for boys who lived in high-conflict homes and had an RSA response profile comprising lower RSA during the baseline and RSA augmentation (increase from baseline to the frustrating task). Furthermore, increases in delinquency symptoms over time were observed for children from high-conflict homes and with an SCL profile characterized by higher baseline levels and lower reactivity (less pronounced SCL increases from baseline) to the frustrating task. Findings highlight the importance of contemporaneous assessments of resting and reactivity levels when examining relations among the environment, physiological functioning, and psychopathology. Results are discussed in the context of interactions between biology and environment as relevant to the development of psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In vitro toothbrush-dentifrice abrasion of resin-modified glass ionomers

OBJECTIVES: The three purposes of this study are to: (1) describe the relationship between the prevalence of coronal caries and root caries; (2) describe the relationship between the three-year incidence of coronal caries and root caries; and (3) if the two conditions are associated, develop a multiple regression model that identifies characteristics distinguishing people who had increments of both root caries and coronal caries from people who had increments of either coronal caries or root caries, or who had no new caries. METHODS: Dental examinations and interviews were conducted in the homes of a randomly selected, stratified sample of people over the age of 65 years in five North Carolina counties. The relationships between coronal and root D and DF were analyzed through contingency table analyses, and ordinal logistic regression was used to identify characteristics that differentiated people who had both coronal and root D over the three years from people who had either coronal or root D and people who had no new disease. RESULTS: Evidence of root and coronal caries in whites was much more likely to be in the form of fillings, while for blacks, it was more likely to be in the form of untreated decay. Prevalence rates of coronal and root D and DF were significantly associated for both blacks and whites. Incidence rates based on DF indicated that root and coronal caries were not associated in whites, but were associated in blacks. People more likely to experience both types of caries had more gingival recession at baseline, greater average attachment loss over the three years, and lactobacilli at baseline. In addition, the presence of Porphymonas gingivalis at three years was important for whites. CONCLUSIONS: It appears that coronal and root caries do tend to appear together in the same individuals, but fillings attenuate that relationship. The impact of dental treatment on the epidemiology of dental caries appears to be considerable and calls into question whether the F component of the caries index is related to disease as defined by epidemiologic criteria.     

A patient-centred study of the consequences of stroke

OBJECTIVE: To explore subjective accounts of the consequences of stroke. DESIGN: Qualitative methods using depth interviews. PARTICIPANTS AND SETTING: Forty people sampled ten months post stroke from a hospital stroke register which was established in two adjacent health districts in North Thames Regional Health Authority. RESULTS: Interviewees reported a number of ways in which the stroke had affected their daily lives, including difficulty with leaving the house, doing the housework, pursuing former leisure activities, inability to walk in the way they wanted, problems with communicating, washing, bathing and dressing, and with confusion and deteriorating memory. In all these areas people described the loss of social contact that accompanied these changes, and the loss of valued roles which had been embedded in the everyday functions they had previously performed. In general, people over the age of 70 were more seriously affected. CONCLUSION: The type of changes which people reported would not easily have been captured using standardized outcome measures, pointing to the value of qualitative methods in providing subjective accounts. In terms of clinical practice, there is a need to reduce people's isolation after stroke by providing home visits after discharge, particularly to those living alone, and also by reducing disability through rehabilitation and by tackling the environmental obstacles which can imprison people in their homes. The findings suggest that many people with stroke would benefit from being able to talk about the changes which have occurred. Imaginative proposals are needed to develop ways to help replace the loss of activities, social contacts and social roles, particularly among older people with stroke.