Sharon J. Wayne

One‐Leg Balance Is an Important Predictor of Injurious Falls in Older Persons

OBJECTIVE: To test the hypothesis that one‐leg balance is a significant predictor of falls and injurious falls.

Impact of Subclinical Hypothyroidism on Serum Total Homocysteine Concentrations, the Prevalence of Coronary Heart Disease (CHD), and CHD Risk Factors in the New Mexico Elder Health Survey

The serum/plasma total homocysteine (tHcy) concentration, now recognized as an independent risk factor for accelerated atherosclerotic disease, is increased in overtly hypothyroid patients, and it decreases with thyroid replacement therapy. Whether or not individuals with subclinical hypothyroidism also increase their tHcy concentrations, and whether this elevation might help to explain the increased prevalence of the atherosclerotic diseases observed in this condition, remains unclear. If individuals with subclinical hypothyroidism have higher tHcy concentrations than euthyroid subjects, there would be added incentive to treat this condition earlier. In this cross-sectional study (New Mexico Elder Health Survey) of a randomly selected sample of Medicare recipients (age > or =65 years), no significant difference in serum tHcy concentrations could be detected between the 112 participants with subclinical hypothyroidism (Groups 2 and 3) and the 643 participants with thyrotropin (TSH) values < or =4.6 microU/mL (Group 1) after adjusting for differences in gender, ethnicity, age, and serum concentrations of folate, vitamin B(12), and creatinine. Only those participants with the highest TSH levels (>10 microU/mL) (Group 3) had a significantly higher prevalence of coronary heart disease (CHD) when compared against Group 1 participants (p = 0.007). No consistent significant differences in the prevalences of CHD or in the CHD risk factors examined were observed when all participants with subclinical hypothyroidism (Groups 2 and 3 combined) were compared against Group 1 participants.

Longitudinal prescribing patterns in a nursing home population.

This study documents the patient characteristics associated with prescribed medications on entry to a nursing home and the change in prescribing patterns after 3 months.

Cause or effect? The relationship between student perception of the medical school learning environment and academic performance on USMLE Step 1

Background: A schools learning environment is believed to influence academic performance yet few studies have evaluated this association controlling for prior academic ability, an important factor since students who do well in school tend to rate their schools environment more highly than students who are less academically strong. Aim: To evaluate the effect of student perception of the learning environment on their performance on a standardized licensing test while controlling for prior academic ability. Methods: We measured perception of the learning environment after the first year of medical school in 267 students from five consecutive classes and related that measure to performance on United States Medical Licensing Examination (USMLE) Step 1, taken approximately six months later. We controlled for prior academic performance by including Medical College Admission Test score and undergraduate grade point average in linear regression models. Results: Three of the five learning environment subscales were statistically associated with Step 1 performance (p < 0.05): meaningful learning environment, emotional climate, and student–student interaction. A one-point increase in the rating of the subscales (scale of 1–4) was associated with increases of 6.8, 6.6, and 4.8 points on the Step 1 exam. Conclusion: Our findings provide some evidence for the widely held assumption that a positively perceived learning environment contributes to better academic performance.

Impact of Psychosocial Factors on Health Outcomes in the Elderly A Prospective Study

One hundred and thirty-five initially healthy men and women older than 65 years of age were studied prospectively to identify factors associated with health outcomes. At study onset, measures of personality, social interaction, and health locus of control were obtained while participants were still healthy. A reliable health outcome measure was developed, based on the annual objective coding of morbidity. Correlations between variables showed significant associations between age, a less independent personality trait, and poor health outcomes. Anxiety and low levels of social interaction were associated with poor health after 8 years. Gender and health locus of control were not significantly related to health outcomes. A path analysis showed significant direct paths between age and trait anxiety and 8-year health outcomes, and indirect paths between anxiety and extroversion and 8-year health, by way of social interaction. There was no evidence that social interaction mediated the effects of either anxiety or extroversion on health. The structure of psychosocial characteristics of the healthy elderly sample was revealed in the pattern of correlations between personality, social interaction, and locus of control.

Early Predictors of Physicians' Practice in Medically Underserved Communities: A 12-year Follow-up Study of University of New Mexico School of Medicine Graduates

Background Substantial numbers of people are medically underserved because of rural residence and/or economic circumstances. The mission of many medical schools is service to this group, so the ability to identify applicants likely to serve this population is valuable. Method In 2009, the authors asked graduates from their medical school, class of 1997 and forward, if they practiced in a medically underserved community in the past year. Variables obtained from medical school applications and scores from a survey of attitudes toward the underserved measured at matriculation were analyzed using logistic regression. Results Of 244 practitioners, 35% reported working in an underserved community. Rural background, older age (25+) at matriculation, and being a member of an underrepresented minority were independent, statistically significant predictors of practice in an underserved community. Conclusions Schools wanting to increase the number of practitioners caring for the underserved could consider older as well as rural and minority applicants.

Sampling issues in nursing home research.

It has been suggested that two common methods of sampling nursing home populations, cross‐sectional sampling and discharge sampling, result in samples with different characteristics and lengths of stay. Comparison of these samples to a sample of nursing home admissions has not been studied. This study compares characteristics and lengths of stay among cross‐sectional, discharge, and admission samples. All current residents of three nursing homes in February 1987 made up the cross‐sectional sample, all admissions in the following year made up the admission sample, and all discharges in the same year made up the discharge sample. The results of comparing these three sampling techniques show that the most striking differences occur between the cross‐sectional sample and the admission sample. Persons in the cross‐sectional sample tended to have longer nursing home stays as well as less social support and more behavioral and functional problems than persons in the admission sample, who tended to have shorter stays and more acute medical problems. The discharge sample was more similar to the admission sample than it was to the cross‐sectional sample; however, some differences were found between the discharge and admission samples. Based on the differences found among the three samples, appropriate uses for each sample are discussed.

A Resident-Led Institutional Patient Safety and Quality Improvement Process

The authors used a multipronged approach to gain resident involvement in institutional quality improvement over a 3-year period; the initiative included a survey, a retreat, workgroups, a resurvey, and another retreat. Survey results (from 2007 compared with those of 2010) demonstrated significant improvement in almost all the top issues concerning patient safety for residents—emergency department boarding and crowding, adequacy of patient flow through the institution, adequacy of nursing and technical support staffing, and laboratory specimen handling (initial overall mean concern level was 2.87, and final concern level was 2.19; P < .01). This perceived improvement in patient safety concerns for residents was associated with observable improvements in areas of high concern for hospital leaders. By surveying residents and students, prioritizing concerns, convening a hospital-wide retreat with key leaders, and implementing accountable plans, the authors have demonstrated that resident perceptions of quality and safety can help drive quality improvement and engage residents in improvement efforts at an institutional level.

Association between Alcohol Intake and Serum Sex Hormones and Peptides Differs by Tamoxifen Use in Breast Cancer Survivors

Objective: To measure the association between alcohol intake and 11 hormones and peptides in postmenopausal breast cancer survivors and to evaluate whether this association differs by tamoxifen use. Methods: Self-reported alcohol intake was assessed via food frequency questionnaire on average 30 months post-breast cancer diagnosis in 490 postmenopausal women from three western states. Concurrently, a fasting blood sample was obtained for assay of estrone, estradiol, free estradiol, testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), leptin, C-peptide, insulin-like growth factor-I (IGF-I), and IGF-binding protein-3. Adjusted means of these hormones and peptides were calculated for categories of alcohol intake, overall and stratified by tamoxifen use. Results: The association between alcohol intake and serum hormone and peptide levels differed by tamoxifen use. We found statistically significant inverse associations between alcohol intake and both leptin and SHBG values but only among tamoxifen users. In women not using tamoxifen, we found a positive association between alcohol intake and DHEAS but no association in tamoxifen users. Conclusion: Tamoxifen may modify the association between alcohol intake and serum hormones and peptides. The significant associations found for DHEAS and SHBG are in a direction considered unfavorable for breast cancer prognosis. Postmenopausal breast cancer survivors may benefit from decreasing their alcohol intake. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3224–32)

Bone Mineral in Southwest Native American Women

There is little, if any, information on bone mineral densities (BMD) in Native Americans. This information is valuable not only for assessing the risk of osteoporosis and fractures in this population, but with regard to estimating levels of obesity (%body fat), since bone mineral is a major factor influencing the density of the fat-free mass.1