Personal Health Problems Research Articles

Methodological and nutritional issues in assessing the oral health of aged subjects

Despite several serious methodological difficulties in epidemiological research on the oral health of elderly subjects, sufficient data are available to conclude that the prevalence of dental diseases is high in persons aged greater than 65 y in the US. An estimated 41% are completely edentulous, and dental caries, including root-surface caries, and destructive periodontal disease are widespread. Whether nutrition is related to the oral health problems of older persons is unclear: this question has received little research attention, and the results have generally been equivocal. There is some evidence that loss of teeth may be associated with suboptimal intake of nutrients and with changes in food preference.

Older persons' definitions of good health: implications for general practitioners.

General practitioners are the major providers of health-care services for the older population in Australia. Care that is provided for older persons within the general-practice setting remains crisis-orientated. Nevertheless, many of the disabling health problems of older persons neither can be "solved" nor cured. Therefore, the older population is a unique population in which to study what constitutes good health and ways in which good health can be maintained. This article describes the perceptions of a group of older persons about their health. They define good health in a remarkably non-medical way. General practitioners need to take into account this knowledge when considering ways to improve the health of these patients.

Health beliefs and adherence in chronic illness.

Nonadherence to recommended therapeutic regimens has been described as a major health problem for persons experiencing chronic illness. In this paper, the origins and concepts of the health belief model are described, and related methodological issues are discussed. Research into the relationship between health beliefs and adherence behavior in chronic illness is reviewed, and implications for nursing research and practice are suggested.

Alcoholism and Aging in the General Hospital

Alcoholism is one of the most under-recognized and poorly understood public health problems in elderly persons. Data comparing the frequency of alcohol dependence (DSM-III-R) found in a random sample of general hospital patients to actual discharge diagnoses of alcohol dependence suggest that alcoholism may be missed in as many as three of every four elderly patients admitted. Clinicians must face problems of recognition, diagnosis, neuropsychologic assessment, and treatment of elderly alcoholic patients.

Critical Public Health Problems Perceived by Urban Chinese Health Workers

This study surveyed a cross section of urban Chinese health workers' perception of problems, needs and priorities in health care delivery. Eleven categories of problems were identified by the health workers. When asked to prioritize what they perceived as critical public health problems in China, more respondents (25.9%) cited family planning and maternal child health as the most critical problem. However, in terms of response frequency, family planning and maternal child health ranked fifth (10.7%) behind disease prevention (18.4%), health education of the public (15.4%), health services administration (13.1%), and environmental health (12.1%). Other critical problems identified were medical education (10.0%). industrial health (5.3%), research (4.5%), nutrition and food sanitation (4.5%), young adults (3.6%), and the elderly (3.6%). Apparently, family planning is perceived as the most critical societal health problem affecting the welfare of the state, but heart disease, cancer, dysentery, hepatitis, and others were perceived as personal health problems critical to the individual and the public. The delineation suggests a distinction of state versus individual priorities. The Chinese health workers saw solutions to these critical problems more often in combined measures of health education, policy regulation, and medical care, than in single measures. They recognized the importance of an enlightened public and felt that educating the public must undergrid all health measures to reach the goal of Health for All by the Year 2000.

Screening for HTLV-III Antibodies: The Relation Between Prevalence and Positive Predictive Value and Its Social Consequences

To the Editor.— The article by Weiss et al 1 relative to the screening for human T-cell leukemia (lymphotropic) retrovirus type III (HTLV-III) antibodies in the Jan 11 issue strongly supports the recommendation that all blood donors be screened for evidence of HTLV-III antibody using the currently available enzyme-linked immunosorbent assay (ELISA) testing procedure. Unfortunately, neither this article nor the accompanying editorial 2 addresses the personal health or community health problems likely to be caused by universal implementation of this screening procedure for all blood donations. If we assume a sensitivity and specificity of the ELISA procedure in the range of 97% to 99%, this means that 1% to 3% of those likely to be harboring the HTLV-III virus are likely to be missed by the test, and 1% to 3% of those who are truly negative would generate a positive test result. Monroe County, New York, consists of the

Knowledge and attitudes toward sexuality and sex education of a select group of older people.

The sexual knowledge and attitudes of adults age 65 and over has been a neglected area of research, due in part to the widespread belief that older people are neither sexually active nor interested in sexual expression. The purposes of this study were to: 1) develop an instrument to measure the sexual knowledge and attitudes of older adults, 2) collect data on the sexual knowledge and attitudes of a sample of older community residents, 3) determine whether there are significant differences between older men and women in this area, and 4) obtain older adults' perceptions about sex education programs. Study participants included 15 men and 17 women ages 65-74 years who were members of an organization of older people. All of the men and 41% of the women were currently married. Structured interviews consisting of knowledge and attitude items, demographic items, and open-ended questions prepared by sexology and gerontology experts were conducted. No significant differences were noted between male and female respondents in terms of overall knowledge or attitudes. Although respondents had significantly more formal education than their age cohort, they demonstrated a lack of knowledge about sexuality, especially about topics such as erection and impotence, drug effects, and alcohol. In terms of attitude, respondents were unanimous in recognizing the existence of sexuality needs in older adults. When asked to identify the concerns older people have about sex, respondents cited personal attitudes, impotence, health problems and inability to perform, unresolved questions, and the lack of an available partner. 75% identified health as the major deterrent to continued sexual expression. The majority did not consider themselves to be more knowledgeable about sex than younger adults, and 65% of the women and 75% of the men expressed a reluctance to ask questions about sex. 90% of respondents believed older people could benefit from sex education and suggested classes at community colleges, churches, and senior centers as well as handouts and pamphlets in public areas frequented by older adults. These results indicate that older adults need and desire information on sexuality, especially on physiosexual changes that occur with age, the impact of health changes on sexual expression, and the effects of medications on sexual function. An annotated bibliography of publications and media on sexuality and aging is included.

Employment, sense of well-being, and use of professional services among women.

Utilizing data from the National Health and Nutrition Examination Survey of 1971-1975 (NHANES I), comparisons were made of general well-being scores and utilization of professional services between employed and non-employed women. Employed women tend to have a higher sense of well-being and utilize fewer professional services to cope with personal and mental health problems than their non-employed counterparts. This tendency is more pronounced among non-married and less-educated women, with an indication of a counter-tendency among college-educated non-White women.

Minors' assent or dissent to medical treatment

Summary It is clear that competency to consent requires a number of attributes and develops in children over time. It can be accelerated by factors such as education, training, and experience. An inverse relationship exists between behavior and perception of vulnerability to health problems among persons with a high degree of perceived internal control. There is also an inverse relationship between perceived internal control and perception of vulnerability to health problems in persons for whom health is salient. 22 These correlates indicate that efforts to heighten a person's perceived internal control and concern for health could potentiate positive health behavior in adults by encouraging perceived internal control among the young. To increase the minor's perception of internal control, it may be the obligation of parents, as well as health providers, to establish a climate that encourages the development of those capabilities required for competency to consent and to grant autonomy to each minor individual with the attainment of those capabilities. During the minor's dependency and vulnerability theconsent process can be flagrantly abused through deception, undue inducement, or coercion. It is our responsibility to intervene in the minor's behalf in such instances. We must communicate with minors concerning medical needs in terms that can be understood. On the other hand, the psychological competencies that minors may possess are important determinants of their ability to conceptualize illness, to make decisions, and to act in their own behalf. Their capabilities and limitations should be borne in mind in relation to the informed consent process. Because of the wide variations in competence among individual children, it is important that a determination be made concerning the level of understanding and reasoning ability of each individual. Communication at that level will best enhance the minor's participation in decision making and the informed consent process. As competencies develop, their participation should increase. The developmental psychological approach will provide autonomy to those individuals capable of assuming it, without denying protection to those who cannot.

Guidelines for Providing Medical Care to Southeast Asian Refugees

Almost 500,000 Southeast Asian refugees have arrived in the United States since 1975. While these refugees have not presented substantial public health problems, they have important personal health problems frequently requiring medical attention. Medical care providers in this country need to be aware of disease patterns and prevalence among these refugees. As well, they need to be aware of the cultural and religious backgrounds and previous medical practices of this refugee population, particularly as these practice influence the refugees' ability to obtain and maintain medical services provided in this country. Historical, cultural, religious, ethical, and medical information is provided to help US health care facilities develop culturally appropriate medical care services for Southeast Asian refugees.

The epidemiology of genital colonization with Staphylococcus aureus.

The prevalence of genital colonization with Staphylococcus aureus, including strains that have been associated with toxic shock syndrome, was studied in 600 women. Nine percent of these women were colonized with S. aureus, 5% of whom had positive vaginal cultures, and 1% were colonized with toxin-producing strains. Black women were colonized with S. aureus, including toxin-producing strains, as frequently or more frequently than white women. The highest colonization rates occurred in postpartum women. Trends toward increasing colonization occurred in relation to decreasing age and socioeconomic status. There were no statistically significant relationships between genital colonization with S. aureus and the use of tampons, oral contraceptives, or a variety of other personal habits and health problems. Genital cultures taken in consecutive menstrual cycles indicated that 35% of women with S. aureus were persistent carriers, and the rest either intermittent or transient carriers. Toxin-producing S. aureus was also identified in family members of women carrying the same organism. This report defines the prevalence of genital colonization in a large population of women, characterizes the women with S. aureus, and describes epidemiologic features of genital carriage.

Mental Health and the Teacher

The emotional atmosphere in a classroom setting is important to the experiences of all students. That atmosphere is affeected by the emotional stability of the teacher. A teacher with personal mental health problems can have a detrimental effect upon all of those students who are associated with him or her. There are a variety of courses and contributing factors of mental health problems. Certain signs and symptoms, at times, can be identified that relate to emotional difficulties. It is important that measures be identified to help teachers with emotional problems. This is not always an easy task, yet it is necessary if the teaching-learning environment is to be of a positive nature. School administrators, teacher preparation programs, teaching peers, and self-analysis all should play a role in identifying one's teaching. This is a task that no one person or agency can accomplish alone. Though often felt to be an uncomfortable issue with which to deal, all educators must become increasingly aware of the problem and be willing to work toward greater emotional health of all teachers.

Who sees the doctor? A study of urban black adolescents.

Abstract By means of structured personal home interviews, health problems and physician care obtained for those problems were studied in an area probability sample of 562 non-Hispanic, black adolescents, drawn from a single health district in a major city in the Northeastern U.S. Physician care was represented by a ratio score: the number of health problems for which the adolescent had seen a physician divided by the total number of health problems he reported. On the basis of these scores, adolescents were separated into “high” and “low” physician care groups and compared with regard to: kinds of health problems, general health status, demographic and family background characteristics, health attitudes and behavior and psychosocial attitudes. Bivariate and then multivariate analyses were performed. A major finding indicated a relationship between lack of medical care and activity limitation or chronic impairment as early as the adolescent years. In multivariate analysis, the variable which accounted more than any other for the difference between black adolescents with “high” and “low” physician care scores was the combination of having a private physician and a mother born outside the southern U.S. Generally the findings supported the model of significant psycho-sociocultural influences, over and above need for care and availability of services, in explaining medical utilization.

Who sees the doctor? a study of urban black adolescents?

By means of structured personal home interviews, health problems and physician care obtained for those problems were studied in an area probability sample of 562 non-Hispanic, black adolescents, drawn from a single health district in a major city in the Northeastern U.S. Physician care was represented by a ratio score: the number of health problems for which the adolescent had seen a physician divided by the total number of health problems he reported. On the basis of these scores, adolescents were separated into “high” and “low” physician care groups and compared with regard to: kinds of health problems, general health status, demographic and family background characteristics, health attitudes and behavior and psychosocial attitudes. Bivariate and then multivariate analyses were performed. A major finding indicated a relationship between lack of medical care and activity limitation or chronic impairment as early as the adolescent years. In multivariate analysis, the variable which accounted more than any other for the difference between black adolescents with “high” and “low” physician care scores was the combination of having a private physician and a mother born outside the southern U.S. Generally the findings supported the model of significant psycho-sociocultural influences, over and above need for care and availability of services, in explaining medical utilization.

Dentistry as a profession

The question confronting many young individuals of today is what to choose fo r their life ’s work. Selecting a career that will utilize their own abilities and inclinations and also be of the greatest service to their coun­ try is usually not a simple problem. Indeed, the question is a weighty one, for upon the answer depends much of the happiness to be found in life and the happiness of others. These young people like to be where things are moving, where immense changes are in view, and w here they them selves can help bring about these improvements; and those who have im agination enough to see into the fu ture of their work and make progress toward it might well inves­ tigate and decide to make dentistry their profession. It is a work of ser­ vice to the people and to their coun­ try w hereby general health can be im proved, and thus greater happi­ ness can be brought to all. The most common diseases of mankind are those occurring in the teeth and their surrounding bone and soft tissues. Constant care is necessary if these diseases are to be prevented, controlled, and cured. The public is coming to understand what good dental care means to them , and their interest in it is in­ creasing. The dental profession must carry on this hum ane work of preven­ tion and healing so that people in all walks of life may be free from pain and loss of health because of bad teeth. It is a great task to undertake, but if ideals are kept high and above reproach, it can be done success­ fully and thus a great service can be done fo r our nation. One hears much these days about m aintenance of health and preven­ tion of disease. The schools are do­ ing much to educate the children and parents in the need for care of the teeth. The dentist plays a large part in this since many give freely and un­ selfishly of their tim e to lecture and bring about a better knowledge of w hat is needed to preserve teeth and health. M any people visit the dentist periodically and through his frequent exam inations and instructions on care of the teeth, he helps his patients to maintain their teeth and gingiva in sound condition. Pride is justly due the dentist for his service to children. Dental disease in children often continues through­ out life; therefore, when this is con­ trolled during childhood these future citizens have a better chance for the health and happiness they deserve. Through the correction of malaligned teeth, the dentist brings joy to many a youth who would otherwise go through life with an unsightly facial appearance. The physician and the dentist are mutually engaged in phases of health service to the people of their com ­ munities. It is necessary at times for these two professionals to work to­ gether for the proper treatm ent of patients. An invaluable service is giv­ en to patients by the dentist who is able to detect signs of cancer in the mouth or of diseases in other parts of the body. W hen these are in evi­ dence, he advises the patient to con­ sult a physician. Thus the dentist and the physician guard health on two fronts. Many public health departm ents have found that dentists are indis­ pensable to well-developed health plans. Dentists often serve on boards of public health, and many public health programs now provide for cer­ tain types of dental service for all groups of people. In this work den­ tists and physicians cooperate in planning and caring for the health problems of persons in the com m un­ ity, state, and nation. Many dentists engage in such ac­ tivities as teaching in dental schools, carrying on research in dentally re­ lated problems, and serving on state boards of dental exam iners. It may be noted that dentists have many things to do in caring fo r patients and car­ rying on their profession in such a way as to improve their service and maintain it on a level of which they can be proud. Dentistry as a profession requires men with special qualifications. The dentist must possess a fine charac­ ter, professional com petence, and integrity. Constructive ability, both imaginative and practical, is a nec­ essary requirem ent. In all of the den­

Reviews : YOU, YOUR HEALTH, YOUR COMMUNITY. A Guide to Personal and Communal Health Problems throughout the World, For 6th Form Students and Teachers. By Sonya Leff. London: Heine mann Medical Books Ltd. 1970. Pp. 127. Price 90p

Reviews : YOU, YOUR HEALTH, YOUR COMMUNITY. A Guide to Personal and Communal Health Problems throughout the World, For 6th Form Students and Teachers. By Sonya Leff. London: Heine mann Medical Books Ltd. 1970. Pp. 127. Price 90p

TEXTBOOK OF HEALTHFUL LIVING

Some areas of interest or emphasis are new. Recent discoveries in genetics, advances in dental health, prevention and treatment of atherosclerosis, problems of air pollution including radioactivity, and extensions in life and life expectancy are among those topics treated. In general, illustrations and references are recent and reliable. They support the health areas of interest and concern to college students. Material of general common knowledge is left out. Daily personal and community health problems are covered authoritatively. Despite the reference to them in the Foreword, no questions or exercises appear at the end of each chapter. Further, in Chapter 12 the authors need to update the description of activities of some agencies. MOREY R. FIELDS

Multiple screening in evaluation of entering college and university students.

Multiple screening as applied to entering students consists of a battery of tests, including a questionnaire, that can be administered to about 100 students per hour. It supplies a base line of health data on all new students and yields a preliminary classification for the department of physical education within the first few days of the quarter. It spares all students the indignity of a cursory physical examination rendered in public, sorts out those who are most likely to profit by an individual physical examination, and enables the physicians to interview the students later, if necessary, under much more favorable conditions. The advantages of this method were compared with those of the customary complete physical examination by applying both methods to each of 3,523 entering students. The results were studied as to their cost in time and money and also as to the frequency with which serious trouble either was mistakenly inferred or escaped detection. Both methods occasionally failed to detect serious defects or disease existing at the time of entrance, but the screening enabled the health service to learn with dispatch the prevalence of personal or public health problems among new students on the campus. The out-of-pocket cost of multiple screening was less than two-thirds that of the conventional examination technique. It calls for substantial planning, but both staff and students who were qualified to make comparisons favored it.

Personal Health Problems for Teachers

Personal Health Problems for Teachers