Deborah A Chyun

Abstract

BACKGROUND:: Oral health contributes significantly to overall health. Finding a single item that can be used by primary care providers to screen elders who are in need of oral care is important. OBJECTIVES:: The objective of this article was to evaluate usefulness of the item: "Do you have regular dental checkups?" as a means to decide whether an oral health assessment or further referral is indicated. Answering no is postulated as a positive predictor of poor oral health and need for care. METHODS:: This study was a secondary analysis of a nutritional survey of 240 community-dwelling elders. Examiner-rated Kayser-Jones Brief Oral Health Status Examination; self-reported General Oral Health Assessment Index; number of remaining teeth; and pattern of checkups (regular vs. irregular) were evaluated by a trained gerontological nurse practitioner during an in-home assessment. RESULTS:: A dental visit within the past year for any reason was reported by 132 subjects (55.0%), but only 81 (33.8%) reported some sort of regular dental checkups. For dentate elders (n ≤ 147), an irregular checkup was associated with lower educational level, Protestant faith, and Black race. People with irregular checkups scored significantly lower on all three oral indices. The negative predictive values and likelihood ratio negative values ranged 98.7-100.0% and 0.00-0.98, respectively, indicating that this item of interest is valid for ruling-out dentate subjects with good oral health. For edentulous elders (n ≤ 93), the item was less effective. DISCUSSION:: A single item, "Do you have regular dental checkups?" can be used effectively to rule out dentate elders with good oral health and identify those who are in need of further oral health assessment or referrals.

Abstract

The validity of baseline dietary intake data in women participating in a culturally competent intervention study for black women with type 2 diabetes was assessed. The relationship of sociodemographic and physiologic factors with underreporting of dietary intake was determined. Criterion validity of dietary intake, which had been assessed using the Nutritionist Five Collection Form, a combination of a standard 2-day dietary recall and a modified, culturally appropriate food frequency questionnaire, was determined. Data were analyzed using First Data Bank Nutritionist Five (version 2.3, 2000, First Data Bank, San Bruno, CA) software. Validation of baseline dietary data in 109 women was performed by calculating the ratio of energy intake to resting metabolic rate. χ2 and t tests were used to assess relationships between underreporting and sociodemographic and physiologic factors. Mean ratio of energy intake to resting metabolic rate was 1.46 (±0.4). Using a lower limit of 1.35, the prevalence of underreporting was 46.8%. Underreporting was significantly associated with body mass index (P≤0.001) and waist circumference (P<0.001). Use of this combined dietary recall and modified food frequency questionnaire might, therefore, provide more accurate dietary assessment in this population. Additional modification and validity testing is warranted in this and other populations.

Abstract

The objective of this study was to determine the relationship of sociodemographics; diabetes-related factors, including diabetes-related microvascular complications; cardiac risk factors; and psychological factors with quality of life (QOL). Participants enrolled at three sites in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study were invited to participate in this ancillary study. Questionnaires assessing psychological factors were completed by participants, and the remainder of the data was obtained as part of the DIAD study. Many participants had elevated levels of anxiety (n = 91; 82%), depressive symptoms (n = 16; 14%), anger (n = 38; 34%), and hostility (n = 17; 17%). Results of multivariate analyses conducted for each of the eight domains on the Medical Outcomes Study Short Form-36 and two Diabetes Quality of Life domains demonstrated that in the majority of models (42% to 68% of the variance explained), female sex, peripheral or autonomic neuropathy, physical inactivity, higher body mass index, and the presence of depressive symptoms and anxiety were associated with poorer QOL (p =.0001). These findings demonstrate that anxiety, depressive symptoms, and neuropathy are prevalent in older adults with type 2 diabetes. In addition, potentially important correlations were demonstrated between psychological factors, neuropathy, body mass index, and physical inactivity.

Abstract

Although short- and long-term outcomes in individuals with DM following ACS, PCI, and CABG have improved over the past decade, CVD continues to be an important cause of morbidity and mortality in this population. Nursing has a critical role in the prevention of CVD, and in the early detection of symptomatic and asymptomatic CHD. Following ACS, PCI, or CABG, ongoing assessment for new ischemia, HF, or renal insufficiency, and specific complications of ACS or revascularization is crucial. Long-term prevention of recurrent ischemia, ACS, HF, and death necessitates multifactorial CHD risk factor reduction, along with aggressive glucose control, in all individuals with DM.

Abstract

Purpose: The purpose of this descriptive study was to describe attainment of glucose and coronary heart disease (CHD) risk factor goals and to identify factors that were associated with successful goal achievement. Methods: A cross-sectional survey enrolled 110 subjects with type 2 diabetes undergoing screening for asymptomatic myocardial ischemia. Results: Many participants had HbA1c levels ≥7% (45%), and 46% to 79% were not meeting goals for CHD risk reduction. Individual factors of age, gender, and anxiety; the illness-related factor of lipid-lowering therapy; and the family-related factor of living alone were independently associated with 1 of the 7 outcomes under study. Illness-related factors of a longer duration of diabetes were strongly associated with glucose and blood pressure control, insulin use with glucose control and waist circumference, and antihypertensive use with blood pressure, triglycerides, and body mass index. Family-related factors of higher income were significantly associated with poorer glucose control and higher body mass index, while higher levels of perceived support by family and friends were associated with a lower risk of not meeting lipid goals. However, individual factors, represented by several aspects of personal model beliefs (exercising regularly, testing glucose, and checking one's feet) and physical activity, were consistently related to lipid and weight control. Conclusions: A variety of factors were associated with control of blood glucose and CHD risk factors, suggesting that a one-size-fits-all approach to multiple risk factor reduction efforts may not result in goal attainment.