Objective. This analysis determines the importance of geography and spatial behavior as predisposing enabling factors in rural health care utilization, controlling for demographic, social, cultural, status factors. Data Sources. A survey 1,059 adults 12 Appalachian North Carolina counties. Study Design. cross‐sectional study used a three‐stage sampling design stratified by county ethnicity. Preliminary services utilization compared weighted proportions number visits previous months regular...

ABSTRACT: Context: Access to transportation transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access analyses of care utilization. Purpose: This analysis addresses association utilization region. Methods: Using survey data from sample 1,059 households located 12 western North Carolina counties, this tests relationship different measures while adjusting for effects personal characteristics,...

Although bone mineral density (BMD) testing to screen for osteoporosis (BMD T score, −2.50 or lower) is recommended women 65 years of age older, there are few data guide decisions about the interval between BMD tests.

Considering the increasing proportion of residents in long-term care who have dementia, and important influence that direct providers on resident quality life, this study explores dementia-related attitudes residential care/assisted living (RC/AL) nursing home staff, as well their work stress satisfaction.Data were derived from interviews with 154 31 RC/AL facilities 10 homes participated Collaborative Studies Long-Term Care.Stress was more often reported by had been working for 1 to 2 years...

"Activity space" has been used to examine how people's habitual movements interact with their environment, and can be accessibility healthcare opportunities. Traditionally, the standard deviational ellipse (SDE), a Euclidean measure, represent activity space. We describe construction application of SDE at one two deviations, three additional network-based measures space using common tools in GIS: road network buffer (RNB), 30-minute travel time polygon (STT), relative (RTT). compare...

Purpose: There are few empirical studies relating components of long-term care to quality life for residents with dementia. This study relates elements dementia in residential care/assisted living (RC/AL) facilities and nursing homes resident considers the guidance this information provides practice policy. Design Methods: We used a variety report observational measures structure process 11 standardized evaluate 421 35 RC/AL 10 four states. Data were collected cross sectionally on-site, we...

OBJECTIVES : To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults. DESIGN A randomized, controlled trial to determine effects clinical practice guideline implementation on provider attitudes behavior, patients' UI, health status, quality life, satisfaction with care. Baseline endpoint data were collected from patients via computer‐assisted telephone interviewing. SETTING Forty‐one nonacademic primary care practices (PCP) North Carolina....

OBJECTIVES: To determine whether high‐intensity ambient light in public areas of long‐term care facilities will improve sleeping patterns and circadian rhythms persons with dementia. DESIGN: A cluster‐unit crossover intervention trial involving four conditions: morning bright light, evening all‐day minimum standard light. SETTING: The common two geriatric units a psychiatric hospital dementia‐specific residential facility. PARTICIPANTS: Sixty‐six older adults INTERVENTION: Ambient...

Retinal telescreening for evaluation of diabetic retinopathy (DR) in the primary care setting may be useful reaching rural and underserved patients.To evaluate telemedicine retinal screenings patients with type 1 or 2 diabetes identify factors ophthalmology referral North Carolina Diabetic Retinopathy Telemedicine Network.A preimplementation postimplementation was conducted from January 6, 2014, to November 1, 2015, at 5 clinics serving populations among 1787 adult who received obtained...

OBJECTIVES: This study explored reasons why older adults with urinary incontinence (UI) do not initiate discussions or seek treatment for UI from their primary care provider. DESIGN: A randomized, prospective controlled trial involving 41 sites. SETTING: Primary practice PARTICIPANTS: 49 age 60 and previously screened by doctor. MEASUREMENTS: Demographic data, self‐reported bladder‐control information using questionnaires, health status. RESULTS: Adults who did discuss were older, had...

OBJECTIVE: To determine the point prevalence of agitated behaviors in a representative sample Alzheimer's disease Special Care Units, and to extent which agitation is associated with aspects treatment environment. DESIGN: A cross‐sectional study nonparticipant observers recorded 3723 observations resident 53 Units. Observational data were gathered on physical environment staff these settings, characteristics extracted from base developed states by Health Financing Agency. Analyses studied...

Purpose: This study's purpose was to better understand existing measures of quality life in dementia residents long-term care facilities. Design and Methods: We gathered data from 421 45 Analyses determined the psychometric properties each measure, estimated relationship between measures, identified extent which resident characteristics predicted scores. Results: Most instruments had good excellent dispersion interrater reliability, most scales internal consistency. Proxy tended correlate...

Abstract The generalized estimating equations (GEE) approach is commonly used to model incomplete longitudinal binary data. When drop‐outs are missing at random through dependence on observed responses (MAR), GEE may give biased parameter estimates in the for marginal means. A weighted gives consistent estimation under MAR when drop‐out mechanism correctly specified. In this approach, observations or person‐visits inversely proportional their probability of being observed. Using a simulation...

Journal Article Deletion diagnostics for generalised estimating equations Get access JOHN S. PREISSER, PREISSER 1Section on Biostatistics, Bowman Gray School of Medicine, Medical Center BoulevardWinston-Salem, North Carolina 27157–1063, U.S.A Search other works by this author on: Oxford Academic Google Scholar BAHJAT F. QAQISH 2Department Public Health University CarolinaChapel Hill, 27599–7400, Biometrika, Volume 83, Issue 3, September 1996, Pages 551–562,...

Purpose: The purpose of this study was to compare the sociodemographics, self-rated health, and involvement levels family caregivers residents with dementia in residential care/assisted living (RC/AL) versus nursing home settings. Design Methods: We conducted telephone interviews most involved 353 34 care 10 facilities. measured by caregiver self-report monthly out-of-pocket spending, burden ratings, frequency engaging eight specific activities. Open-ended questions elicited areas which...

Summary Mancl and DeRouen (2001, Biometrics 57, 126–134) Kauermann Carroll JASA 96, 1387–1398) proposed alternative bias‐corrected covariance estimators for generalized estimating equations parameter estimates of regression models marginal means. The finite sample properties these are compared to those the uncorrected sandwich estimator that underestimates variances in small samples. Although formula generally overestimates variances, it often leads coverage 95% confidence intervals near...

The goal of this study is to characterize the changes in 33 biomarkers within gingival crevicular fluid during 3-week induction and 4-week resolution stent-induced, biofilm overgrowth mediated, experimental gingivitis humans.Experimental was induced 25 subjects for 21 days followed by treatment with a sonic powered toothbrush 28 days. Clinical indices fluids were collected weekly biweekly resolution. Samples analysed using bead-based multiplexing analysis simultaneous measurements each...

A large body of evidence suggests that being diagnosed with and treated for cancer adversely affects functioning quality life, yet less is known about longer term outcomes. Therefore, this study aims to estimate the prevalence post-traumatic stress disorder (PTSD) symptoms in survivors adult non-Hodgkin's lymphoma (NHL) who are at least 2 years postdiagnosis identify risk factors associated PTSD symptoms, a focus on those amenable screening modifiable.A total 886 NHL identified from...

Levels of prostaglandin E 2 and the prostaglandin-endoperoxide synthase-2 ( PTGS2, or COX-2) increase in actively progressing periodontal lesions, but decrease chronic disease. We hypothesized that inflammation is associated with altered DNA methylation levels within PTGS2 promoter, effects on COX-2 mRNA expression. promoter from periodontally inflamed gingival biopsies showed a 5.06-fold as compared non-inflamed samples (p = 0.03), odds CpG site group 4.46 times higher than same 0.016). The...

Background: Tumor necrosis factor‐α (TNF‐α) plays a central role in the molecular pathogenesis of periodontal disease. However, epigenetic regulation attributable to microbial and inflammatory signals at biofilm–gingival interface are poorly understood. In this study, DNA methylation alteration within TNFA promoter human gingival biopsies from different stages disease is investigated regulatory mechanism transcription by explored. Methods: Gingival were obtained 17 patients with chronic...

Multifactorial etiological factors contribute to denture stomatitis (DS), a type of oral candidiasis; however, unlike other candidiasis, DS can occur in healthy person wearing denture. In this study, we therefore attempt explore the association between candida, denture, and mucosal tissue using (1) exfoliative cytology, (2) candidal levels present saliva, on tissues surfaces, (3) salivary flow rate xerostomic symptoms.A cross-sectional study enrolled 32 edentulous participants, 17 without as...