Data from the nationally representative US National Health and Nutrition Examination Survey (NHANES) III cohort were used to examine the hypothesis that socio-economic status is consistently and ...negatively associated with levels of biological risk, as measured by nine biological parameters known to predict health risks (diastolic and systolic blood pressure, pulse, HDL and total cholesterol, glycosylated hemoglobin, c-reactive protein, albumin and waist–hip ratio), resulting in greater cumulative burdens of biological risk among those of lower education and/or income. As hypothesized, consistent education and income gradients were seen for biological parameters reflecting cardiovascular, metabolic and inflammatory risk: those with lower education and income exhibiting greater prevalence of high-risk values for each of nine individual biological risk factors. Significant education and income gradients were also seen for summary indices reflecting cumulative burdens of cardiovascular, metabolic and inflammatory risks as well as overall total biological risks. Multivariable cumulative logistic regression models revealed that the education and income effects were each independently and negatively associated with cumulative biological risks, and that these effects remained significant independent of age, gender, ethnicity and lifestyle factors such as smoking and physical activity. There were no significant ethnic differences in the patterns of association between socio-economic status and biological risks, but older age was associated with significantly weaker education and income gradients.
Objectives:
To examine education differentials in screening, awareness, treatment and control of hypercholesterolemia overall and in 3 race/ethnic groups.
Methods:
We analyzed data for a nationally ...representative sample of 8,429 men and women ages 20 to 85 years, self-reported as white, black, Mexican American, or other race/ethnicity, who participated in the National Health and Nutrition Examination Survey from 1999–2002.
Results:
Participants with < high school education were 2.5 times less likely than participants with ≥ high school education to have been screened for hypercholesterolemia, after adjusting for age and gender (odds ratio: 0.4, 95 % confidence interval: 0.3–0.5, and similar across race/ethnic group). Multivariable models for awareness, treatment and control showed no significant trends associated with education after adjusting for age, gender, race and comorbidities.
Conclusions:
Higher education significantly increased the odds of being screened for hypercholesterolemia overall and within each race/ethnic group. Education differentials were strongest for hypercholesterolemia screening, and weak or no longer apparent for subsequent steps of awareness, treatment and control. Focusing public health policy on increasing screening for individuals with low education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent cardiovascular disease.
This article discusses the assessment of chronic pain in older patients. First, the epidemiology and impact of chronic pain in the elderly are addressed. Next, common barriers to pain assessment are ...reviewed. An effective approach to pain assessment in the older patient is described, including the important pearls of history-taking and the physical examination, as well as recommendations for the evaluation of functional status and psychosocial well-being. The article concludes with a review of multidimensional and unidimensional pain assessment tools, and a discussion of methods for pain assessment in the cognitively impaired.
Medical education in the United States develops many skills, but writing is not usually one of them. At the UCLA Multicampus Division of Geriatrics, we recently instituted a project that attempts to ...provide the opportunity for each of our Geriatric Medicine fellows to write and publish a review article. We report our experiences of the first 3 years of this program in an effort to share our successes, our shortcomings and our impressions.
This article will discuss the assessment of chronic pain in older patients. First, the epidemiology and impact of chronic pain in the elderly will be addressed. Next, common barriers to pain ...assessment will be reviewed. An effective approach to pain assessment in the older patient will then be described, including important pearls for history-taking and the physical examination, as well as recommendations for the evaluation of functional status and psychosocial well-being. The article will conclude with a review of multidimensional and unidimensional pain assessment tools and a discussion of methods for pain assessment in the cognitively impaired.
It is widely accepted that physical activity is beneficial to bone. However, the specific relationships of muscle strength to bone mineral density (BMD) are poorly understood. We examined strength ...and BMD in 59 women aged 18-31 years who ranged in exercise patterns from sedentary to active. Mineral density of the right proximal femur (hip) and spine (L2-4) was evaluated by dual-energy x-ray absorptiometry. BMD at the midradius was measured by single-photon absorptiometry. Dynamic strength (one repetition maximum) was measured for the following muscle groups: back, elbow flexors (biceps), leg extensors (quadriceps), and the hip flexors, extensors, adductors, and abductors. Isometric grip strength was assessed by dynamometry. Mineral density at the hip correlated independently with muscle strength and body weight, but not with age. Specifically, femoral neck BMD was significantly correlated with back strength and weight, whereas trochanter and overall hip mineral density were significantly related to biceps, back, and hip adductor strength. Hip mineral density was not related to strength of the quadriceps groups or to that of the hip flexors, extensors, or abductors. In addition, muscle strength was an independent predictor of lumbar spine and midradius mineral density. In stepwise multiple regression analysis, biceps strength proved the most robust predictor of hip BMD and grip strength best predicted bone density at the lumbar spine and radius. We conclude that muscle strength is an independent predictor of bone mineral density, accounting for 15-20% of the total variance in bone density of young women.
Bone bending stiffness (modulus of elasticity E x moment of inertia I), a measure of bone strength, is related to its mineral content (BMC) and geometry and may be influenced by exercise. We ...evaluated the relationship of habitual recreational exercise and muscle strength to ulnar EI, width, and BMC in 51 healthy men, 28-61 yr of age. BMC and width were measured by single photon absorptiometry and EI by mechanical resistance tissue analysis. Maximum biceps strength was determined dynamically (1-RM) and grip strength isometrically. Subjects were classified as sedentary (S) (N = 13), moderately (M) (N = 18), or highly active (H) (N = 20) and exercised 0.2 +/- 0.2; 2.2 +/- 1.3; and 6.8 +/- 2.3 h.wk-1 (P < 0.001). H had greater biceps (P < 0.0005) and grip strength (P < 0.05), ulnar BMC (P < 0.05), and ulnar EI (P = 0.01) than M or S, who were similar. Amount of activity correlated with grip and biceps strength (r = 0.47 and 0.49; P < 0.001), but not with bone measurements, whereas muscle strength correlated with both EI and BMC (r = 0.40-0.52, P < 0.005). EI also correlated significantly with both BMC and ulnar width (P < 0.0001). Ulnar width and biceps strength were the only independent predictors of EI (r2 = 0.67, P < 0.0001). We conclude that levels of physical activity sufficient to increase arm strength influence ulnar bending stiffness.
PDF
