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The purpose of this study was to describe the longitudinal trajectories and bidirectional relationships of the physical-social and emotional functioning (EF) dimensions of positive aging and to identify their baseline characteristics.
Women age 65 and older who enrolled in one or more Women's Health Initiative clinical trials (WHI CTs) and who had positive aging indicators measured at baseline and years 1, 3, 6, and 9 were included in these analyses (N = 2281). Analytic strategies included latent class growth modeling to identify longitudinal trajectories and multinomial logistic regression to examine the effects of baseline predictors on these trajectories.
A five-trajectory model was chosen to best represent the data. For Physical-Social Functioning (PSF), trajectory groups included Low Maintainer (8.3%), Mid-Low Improver (10.4%), Medium Decliner (10.7%), Mid-High Maintainer (31.2%), and High Maintainer (39.4%); for EF, trajectories included Low Maintainer (3%), Mid-Low Improver (9%), Medium Decliner (7.7%), Mid-High Maintainer (22.8%), and High Maintainer (57.5%). Cross-classification of the groups of trajectories demonstrated that the impact of a high and stable EF on PSF might be greater than the reverse. Low depression symptoms, low pain, and high social support were the most consistent predictors of high EF trajectories.
Aging women are heterogeneous in terms of positive aging indicators for up to 9 years of follow-up. Interventions aimed at promoting sustainable EF might have diffused effects on other domains of healthy aging.
The government has stated its commitment to provide equality of access to health care for all and has emphasized the need to take account of users' views. The aim of this review was to search for evidence of adolescents' perceived needs for and access to primary health care services and to evaluate and report on the evidence found. Methods used were systematic searching of data bases and direct contacting of health and related organizations. The main finding was that a substantial minority of teenagers has health-related problems which are not met by current services. The main barriers to accessing primary health care were a perceived lack of confidentiality, embarrassment and unsympathetic staff. Reported access to a school health nurse varied widely (between 5% and 83%). The conclusions were that the barriers to accessing services as identified by teenagers are amenable to staff training, and that taking account of users' views could act as a stimulus for such training.
New information on the phase diagrams of Ti-Fe-Si-O and Ti-Zr-Ni alloys near the quasicrystal and rational approximant compositions is presented. α(TiFeSiO), the 1/1 rational approximant, is shown to form in a peritectic mode from the liquid, indicating the possibility to produce single-crystal samples. Very long duration annealing studies demonstrate unambiguously that the TiZrNi i-phase and 1/1 approximant form at low temperatures by a solid-state transformation; their phase fields do not extend to the liquidus temperatures. The first undercooling measurements of electrostatically-levitated droplets of the Ti-Zr-Ni alloys are presented. These nucleation studies provide new information on the structural relations between polytetrahedral phases and the undercooled liquid, and on the phase transformation processes. The reduced undercooling for the polytetrahedral phases in these alloys is less than for crystal phases of a similar composition, demonstrating a low interfacial energy between the polytetrahedral phase and the liquid.
Economic evaluation of quality assurance programs is often called for but rarely reported. A study was designed to estimate the cost-utility of audit of thrombolysis in four U.K. district general hospitals, using the quality-adjusted life year. Although the results obtained were imprecise, the model used could be applied in future evaluations.
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