BackgroundHome care is integral to enabling older adults to delay or avoid long-term care (LTC) admission. To date, there is little population-based data about gender differences in home care users and their subsequent outcomes. Our objectives were to quantify differences between women and men who used home care in Ontario, Canada and to determine if there were subsequent differences in LTC admission.MethodsThis is a population-based retrospective cohort study. We identified all adults aged 76+ years living in Ontario and receiving home care on April 1, 2007 (baseline). Using the Resident Assessment Instrument – Home Care (RAI-HC) linked to other databases, we characterized the cohort by living condition, health and functioning, and identified all acute care and LTC use in the year following baseline.ResultsThe cohort consisted of 51,201 women and 20,102 men. Women were older, more likely to live alone, and more likely to rely on a child or child-in-law for caregiver support. Men most frequently identified a spouse as caregiver and their caregivers reported distress twice as often as women’s caregivers. Men had higher rates of most chronic conditions and were more likely to experience impairment. Men were more likely to be admitted to hospital, to have longer stays in hospital, and to be admitted to LTC.ConclusionsUnderstanding who uses home care and why is critical to ensuring that these programs effectively reduce LTC use. We found that women outnumbered men but that men presented with higher levels of need. This detailed gender analysis highlights how needs differ between older women, men, and their respective caregivers.

T he management of hypertension has traditionally been based on the measurement of blood pressure (BP) in the office using manual devices, such as the mercury sphygmoma-nometer. Manual BP measurement is associated with numerous sources of error, the most important of which relate to human behavior. In the office setting, many patients become anxious, health professionals frequently do not follow proper BP measurement technique, and the presence of a nurse or physician leads to conversation, which increases BP. Also, the phasing out of the mercury sphygmomanometer because of concerns about its potential adverse effects on the environment and human health provides further motivation to reexamine the role of manual BP in clinical practice. In recent years, the pre-eminence of office BP has been challenged by the widespread use of 24-hour ambulatory BP monitoring (ABPM) and self-measurement of BP in the home. The well documented advantages of ABPM 1 and home BP 2 in evaluating the benefits of antihypertensive therapy for individual patients has led to major changes in recent guidelines for the diagnosis of hypertension. ABPM and home BP have been advocated as the methods of choice for determining the BP status of patients, 3-5 whereas manual office BP is being replaced by electronic oscillometric sphygmomanom-eters, most of which are activated by the office staff. Although these semiautomated devices eliminate some of the errors associated with manual BP measurement, the presence of an observer may still provoke inaccurate BP readings. 6,7 This limitation of semiautomated devices has been overcome by the development of accurate oscillometric sphygmo-manometers specifically designed for professional use, which take multiple BP readings automatically with the patient resting quietly and alone, 8 now referred to as automated office BP (AOBP). Numerous studies comparing AOBP to awake ambulatory BP and home BP have shown that AOBP produces Abstract-The risk of cardiovascular events in relation to blood pressure is largely based on readings taken with a mercury sphygmomanometer in populations which differ from those of today in terms of hypertension severity and drug therapy. Given replacement of the mercury sphygmomanometer with electronic devices, we sought to determine the blood pressure threshold for a significant increase in cardiovascular risk using a fully automated device, which takes multiple readings with the subject resting quietly alone. Participants were 3627 community-dwelling residents aged >65 years untreated for hypertension. Automated office blood pressure readings were obtained in a community pharmacy with subjects seated and undisturbed. This method for recording blood pressure produces similar readings in different settings, including a pharmacy and family doctor's office providing the above procedures are followed. Subjects were followed for a mean (SD) of 4.9 (1.0) years for fatal and nonfatal cardiovascular events. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increme...

Recognition of the need for medical ophthalmologists has resulted in the Royal College of Ophthalmologists and Royal College of Physicians jointly establishing a professional training programme leading to accreditation and registration on the specialist register in the new subspecialty of medical ophthalmology-that is, a training for the ophthalmic physician. Currently, entry to the new training programme may be gained from a background in general medicine or general ophthalmology and the training programme appropriately tailored in line with a general template which ensures full exposure to the various aspects of medical ophthalmology. This training programme is in its infancy, but it is already clear that the route of entry to a medical ophthalmic training programme is less important than how we are going to provide training. Relevant postgraduate general medical training at some'stage, however, appears appropriate. When medical ophthalmology as a specialty has become sufficiently well established in the number of trained specialists, it will be in a better posi-782 on 11 April 2019 by guest. Protected by copyright.

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