Simple ADL staging is valid, demonstrating strong, clinically relevant associations with health states,
home-related challenges, and need. Both staging systems distinguish well among groups of community-dwelling older adults according to risk of mortality, NHU, or both. System selection should depend on the specific screening needs, MK2206 the outcomes being studied, and the resources available to collect information and assign stages. The slight loss of discrimination with the simple approach with respect to the more severe outcomes of NHU, death, or both, may be outweighed by its ease of use, especially in time-pressured clinical settings. The complex ADL staging approach may be more appropriate where increased discrimination is needed, particularly with respect to examining health care use and mortality, in research, or in the surveillance of large populations where measurement complexity is less of a barrier. In addition, since some ongoing surveys such as the Medicare Current Beneficiary Survey use
SCH772984 mouse 2-level ratings of difficulty, our study will help researchers who wish to apply ADL staging to studies using 2-level ADL difficulty responses. By improving our understanding of how patterns and severity of activity limitation influence needs and outcomes, staging can help clinicians design more appropriate interventions. In addition, stages may have utility as covariates in predictive models. Previous studies9 and 17 have found that both diagnoses and disability stages contribute independently to mortality prediction and NHU. There are also potential applications of staging
for population health surveillance of those with disabilities. This standardized, validated, meaningful approach to measuring disability could be used to achieve a greater understanding about how different patterns of disability may contribute to health disparities as called for in the PRKACG 2011 CDC disparity report.2 This in turn can help policymakers design more sound policies. Previous disability staging systems applied to hospital or institutionalized inpatients distinguish the effects of different rehabilitation therapy intensities and are powerful prognostic indicators of functional recovery and adverse outcomes.18, 19 and 20 The complex and simple ADL staging systems would primarily be appropriate for outpatient use and may help clinicians screen patients at risk for various adverse outcomes and with increasing needs for assistive devices or home modifications to allow them to maintain independence. a. SAS Institute Inc, 100 SAS Campus Dr, Cary, NC 27513. “
“The Editor would like to thank every reviewer who cooperated by evaluating the papers submitted to Oceanologia in 2010. We have received kind permission to print the following reviewers’ names: ■ Dr Pekka Alenius (Finnish Meteorological Institute, Helsinki, Finland) “
“Atmospheric aerosols are an important component of the atmosphere.