Policy change to improve access to safe abortion care in federal Nepal.

In Nepal's constitution, safe abortion care is recognized as an essential component of a comprehensive approach to fulfill individuals' sexual and reproductive health and rights. In the current context of transition to a three-level governance (federal, provincial, and local), there are opportunities to accelerate decentralization and devolution of decision-making power, increase access to and coverage of safe abortion services, and improve health outcomes. This article documents the processes and results of the policy change undertaken by the Ministry of Health and Population in collaboration with development partners to decentralize the approval process of safe abortion sites and providers with the objective to increase access to and coverage of safe abortion services.

Mental health and psychosocial support after the tsunami: observations across affected nations.

The countries affected by the tsunami responded to the natural disaster promptly but with different results and outcomes. The reasons for this varied response were many. The outcome depended upon a number of factors, including the extent of the damage to property and lives, accessibility of the areas and existing disaster plans.

Alzheimer disease and mortality: a 15-year epidemiological study.

Background: Alzheimer disease (AD) is considered a leading cause of death, but few studies have examined the contribution of AD to mortality based on follow-up of representative US cohorts.

Objective: To examine mortality rates, duration of survival, causes of death, and the contribution of AD to the risk of mortality in an aging community-based cohort, controlling for other predictors.

Design: Fifteen-year prospective epidemiological study.

Gambling participation and social support among older adults: a longitudinal community study.

The purpose of this preliminary study was to examine associations between leaving home to engage in bingo or gambling activity and indices of physical and mental health and social support among a representative community cohort of 1016 elderly people. Cross-sectional and longitudinal data gathered from a prospective epidemiological study in a rural, low socio-economic status, area of Pennsylvania was employed. The cohort had a mean age of 78.

Detection and management of cognitive impairment in primary care: The Steel Valley Seniors Survey.

Objectives: To identify characteristics of older primary care patients who were cognitively impaired and who underwent mental status testing by their physicians.

Design: Cross-sectional and retrospective analysis.

Setting: Seven small-town primary care practices.

Hemoglobin levels and Alzheimer disease: an epidemiologic study in India.

Objective: Anemia is common in developing countries, where populations are aging rapidly. The authors explored the cross-sectional relationship between hemoglobin concentration and Alzheimer disease (AD) in a rural elderly sample in Ballabgarh, India.

Methods: A clinical diagnostic evaluation for dementia and a hemoglobin estimation were performed in 605 persons selected by screening a larger community-based sample age 55+ years.

Exercise level and cognitive decline: the MoVIES project.

Growing evidence suggests that physical exercise may be protective against cognitive impairment and decline. A prospective study of a representative rural community sample (N = 1,146) aged 65+ years examined self-reported exercise habits and measured global cognitive function using the Mini-Mental State Examination (MMSE). A composite variable "exercise level" combining type, frequency, and duration of exercise was created with three levels: "high exercise" (aerobic exercise of > or = 30 minute duration > or = 3 times a week), "low exercise" (all other exercise groups), and "no exercise.

Medical and cognitive correlates of denture wearing in older community-dwelling adults.

Objectives: To examine the association between denture wearing and use of dental services, oral function limitations, and medical and cognitive status in a community-based cohort of rural older adults enrolled in an epidemiological study.

Design: This cross-sectional study was part of a larger cohort study, the Monongahela Valley Independent Elders Survey. Dental data were collected during the fifth wave of assessments (10 years after the start of the study in 1987).

Predictors of nursing facility admission: a 12-year epidemiological study in the United States.

Objectives: To identify predictors of institutionalization in a community-based cohort of older adults.

Design: Prospective, longitudinal. After initial assessment at study entry, surviving participants were reassessed in a series of approximately biennial waves until October 2001; baseline for the current analysis was Wave 2 (1989-91).

Blood pressure and cognitive impairment in India and the United States: a cross-national epidemiological study.

Objective: To evaluate the relationship between blood pressure (BP) and cognitive impairment in elderly populations in India and the United States in a cross-national epidemiological study.

Design: Cross-sectional comparisons, using standardized cognitive screening and BP measurements.

Participants: We examined 4810 subjects 55 years and older, of whom 595 were 75 years and older, from Ballabgarh, India, and 636 subjects 75 years and older from the Monongahela Valley, Pennsylvania.

Functional transitions and active life expectancy associated with Alzheimer disease.

Context: The concept of active life expectancy, the number of years a person can expect to live without disability, is used for the first time, to our knowledge, to examine the effect of Alzheimer disease (AD) on total life expectancy with different degrees of disability.

Objectives: To estimate and compare total life expectancy and average duration lived with different degrees of disability, between persons with and without AD.

Design: Ten-year prospective epidemiologic study.

Data management and quality assurance for an International project: the Indo-US Cross-National Dementia Epidemiology Study.

Background: Data management and quality assurance play a vital but often neglected role in ensuring high quality research, particularly in collaborative and international studies.

Objective: A data management and quality assurance program was set up for a cross-national epidemiological study of Alzheimer's disease, with centers in India and the United States.

Methods: The study involved (a) the development of instruments for the assessment of elderly illiterate Hindi-speaking individuals; and (b) the use of those instruments to carry out an epidemiological study in a population-based cohort of over 5000 persons.

Sensitivity and specificity of cognitive and functional screening instruments for dementia: the Indo-U.S. Dementia Epidemiology Study.

There is a shortage of adequate screening instruments for dementia in poorly educated populations and non-English-speaking groups. An epidemiological survey was conducted in a population-based, largely illiterate, sample of 5,126 individuals aged 55 and older in 28 villages in the rural community of Ballabgarh in northern India. All participants were administered a general mental status test, the Hindi Mental State Examination (HMSE), and a brief battery of neuropsychological tests.