在健康与退休研究中照顾者提供的临床预防服务质量【外文翻译】.doc

1、本科毕业设计（论文）外文翻译原文QUALITYOFPREVENTIVECLINICALSERVICESAMONGCAREGIVERSINTHEHEALTHANDRETIREMENTSTUDYABSTRACTWEEXAMINEDTHEASSOCIATIONBETWEENCAREGIVINGFORASPOUSEANDPREVENTIVECLINICALSERVICESSELFREPORTEDINFLUENZAVACCINATION,CHOLESTEROLSCREENING,MAMMOGRAPHY,PAPSMEAR,ANDPROSTATECANCERSCREENINGOVER2YEARSANDMON

2、THLYSELFBREASTEXAMFORTHECAREGIVERINACROSSSECTIONALANALYSISOFTHEHEALTHANDRETIREMENTSTUDY,ANATIONALLYREPRESENTATIVESAMPLEOFUSADULTSAGED50YEARSN11,394SPOUSESENGAGEDIN0,114,OR14HOURSPERWEEKOFCAREGIVINGEACHSERVICEWASEXAMINEDINLOGISTICREGRESSIONMODELSADJUSTINGFORCAREGIVERCHARACTERISTICSAFTERADJUSTMENTFORC

3、OVARIATES,THEREWERENOSIGNIFICANTASSOCIATIONSBETWEENSPOUSALCAREGIVINGANDLIKELIHOODOFCAREGIVERRECEIPTOFPREVENTIVESERVICESKEYWORDSCAREGIVINGPREVENTIONMAMMOGRAPHYINFLUENZACHOLESTEROLOVER6MILLIONADULTSINTHEUNITEDSTATESPROVIDELONGTERM,UNPAIDCARETODISABLEDELDERLYPERSONSINTHEIRFAMILIES,PARTICULARLYELDERLYSP

4、OUSESTHESECAREGIVERSAREATINCREASEDRISKOFMORTALITYPOSSIBLEEXPLANATIONSINCLUDEHIGHERRATESOFNEGATIVEHEALTHBEHAVIORSANDHEALTHOUTCOMESAMONGCAREGIVERS,SUCHASNOTHAVINGENOUGHTIMETOEXERCISE,FORGETTINGTOTAKEPRESCRIPTIONMEDICATIONS,FATIGUE,DEPRESSION,ANDWORSEBLOODPRESSUREANDLIPIDCONTROLITISUNCLEARWHETHERTHEASS

5、OCIATIONBETWEENCAREGIVINGANDMORTALITYISALSOMEDIATEDTHROUGHPOORERQUALITYHEALTHCARETOTHECAREGIVERS,INCLUDINGDECREASEDDELIVERYOFPREVENTIVECLINICALSERVICESCAREGIVINGCONSUMESTIMEANDFINANCIALRESOURCESTHATMAYINTERFEREWITHPROPERPREVENTIVECAREINTHECAREGIVERHEALTHEFFECTSSTUDY,THEREWASNOASSOCIATIONBETWEENCAREG

6、IVINGANDCAREGIVERRECEIPTOFIMMUNIZATIONSANOTHERSTUDYOFCAREGIVINGFOUNDNOASSOCIATIONBETWEENCAREGIVINGANDMAMMOGRAPHY,COLONCANCERSCREENING,ORPAPSMEARPERFORMANCEINCONTRAST,ANOTHERSTUDYNOTEDTHATCAREGIVERSWEREACTUALLYMORELIKELYTHANNONCAREGIVERSTOGETFLUSHOTSANDRECEIVEPNEUMONIAVACCINESTHESESTUDIESMAYHAVECONFL

7、ICTINGRESULTSDUETODIFFERINGSTUDYPOPULATIONSANDTHESERVICESEXAMINEDSTUDIESFOCUSINGONHEALTHSERVICESDELIVEREDINTHEMEDICALOFFICEINVOLVEDSELECTPOPULATIONSFORSPECIFICSERVICESSUCHASINFLUENZAVACCINATION,CAREGIVINGCOULDPOSSIBLYPROVIDEINCREASEDOPPORTUNITIESTHROUGHDOCTORVISITSPROVIDEDFORTHECAREGIVINGRECIPIENTAL

8、TERNATIVELY,FORSERVICESTHATREQUIREANAPPOINTMENTSUCHASPAPSMEARS,CAREGIVINGCOULDREDUCETHETIMEAVAILABLEFORSUCHVISITSGIVENTHECONFLICTINGRESULTSOFPRIORSTUDIESOFCAREGIVINGSEFFECTONTHEUSEOFPREVENTIVECLINICALSERVICES,WEEXAMINEDTHEASSOCIATIONBETWEENANEXTENDEDLISTOFPREVENTIVECLINICALSERVICESANDSPOUSALCAREGIVI

9、NGINTHEHEALTHANDRETIREMENTSTUDYHRSTOOURKNOWLEDGE,THEHRSHASENROLLEDTHELARGESTNUMBEROFPARTICIPANTSINSTUDIESOFSPOUSALCAREGIVINGANDHEALTHSERVICESTODATEANDALSOHASDETAILEDCAREGIVINGDATAASWELLASCLINICALSERVICEINFORMATIONMETHODSDATASOURCESANDCOLLECTIONPROCEDURESTHEHRSISABIENNIALLONGITUDINALSURVEYOFANATIONAL

10、LYREPRESENTATIVECOHORTOFTHEUSPOPULATIONAGED50YEARSOROLDER13FORTHEPURPOSESOFTHISANALYSIS,WEANALYZEDYEAR2000INTERVIEWSBOTHSPOUSESWITHINMARRIEDHOUSEHOLDSRECEIVEDAFULLINTERVIEWOURSTUDYSAMPLEINCLUDED11,394MARRIEDINDIVIDUALSAGED50YEARSOROLDERWITHTWORESPONDENTSINTHEHOUSEHOLDWHOLIVEDINTHECOMMUNITYTHEMAINOUT

11、COMEVARIABLESWERECAREGIVERSELFREPORTEDRECEIPTOFPREVENTIVECLINICALSERVICESINCLUDINGINFLUENZAVACCINATIONS,PAPSMEARS,MAMMOGRAMS,CHOLESTEROLSCREENING,ANDPROSTATESCREENINGOVERTHEPAST2YEARSANDMONTHLYSELFBREASTEXAMTHEPRIMARYINDEPENDENTVARIABLEWASTHEAMOUNTOFINFORMALCAREGIVINGPROVIDEDRESPONDENTSWERECLASSIFIE

12、DASHAVINGRECEIVEDINFORMALHOMECAREIFTHEYRECEIVEDINHOMEASSISTANCEWITHANYACTIVITYOFDAILYLIVINGADL,SUCHASEATING,TRANSFERRING,TOILETING,DRESSING,BATHING,WALKINGACROSSAROOM,ORINSTRUMENTALACTIVITYOFDAILYLIVINGIADL,SUCHASPREPARINGMEALS,GROCERYSHOPPING,MAKINGTELEPHONECALLS,TAKINGMEDICATIONS,ORMANAGINGMONEYIN

13、THEPRIORMONTHFROMARELATIVEPAIDORNOTORUNPAIDNONRELATIVEWITHNOORGANIZATIONALAFFILIATION14RESPONDENTSWHODIDNOTNORMALLYPERFORMANIADL,SUCHASSHOPPING,WERENOTCLASSIFIEDASHAVINGANIADLIMPAIRMENTNORASHAVINGRECEIVEDHELPFORTHATIADLTHENUMBEROFWEEKLYHOURSOFINFORMALHOMECAREWASCALCULATEDUSINGTHEAVERAGENUMBEROFDAYSP

14、ERWEEKINTHEPRIORMONTH,ANDTHEAVERAGENUMBEROFHOURSPERDAYTHATRESPONDENTSREPORTEDRECEIVINGHELPFROMTHEIRSPOUSE15WECREATEDTERTILESOFTHENUMBEROFHOURSOFCAREGIVINGRECEIVED,ANDFROMTHISWEWEREABLETOCREATETHREECATEGORIESOFCAREGIVINGFORTHESPOUSESCAREGIVERSWEREGROUPEDINTOTHREECATEGORIESNOTPROVIDINGCARENONCAREGIVER

15、S,PROVIDINGCAREFOR1TO14HOURSAWEEK,ANDPROVIDINGCAREFORMORETHAN14HOURSPERWEEKSTATISTICALANALYSISTOEXAMINETHEASSOCIATIONBETWEENTHEDEPENDENTVARIABLEOFCAREGIVERRECEIPTOFCLINICALSERVICEANDTHEINDEPENDENTVARIABLEOFCAREGIVING,WEEXAMINEDEACHCLINICALSERVICEINDIVIDUALLYUSINGLOGISTICREGRESSIONMODELSALLANALYSESWE

16、REWEIGHTEDFORDIFFERENTIALPROBABILITYOFSELECTIONANDADJUSTEDFORTHECOMPLEXSAMPLINGDESIGNOFTHEHRSWETESTEDFORSIGNIFICANTINTERACTIONSBETWEENALLCOVARIATES,ANDREGRESSIONDIAGNOSTICSWEREPERFORMEDTOCHECKFORMODELASSUMPTIONSALLCOVARIATESREFLECTCHARACTERISTICSOFTHECAREGIVER,NOTTHERECIPIENTOFCARE,EXCEPTFORTHEPRESE

17、NCEOFPAIDFORMALHOMECARETABLE1WEPERFORMEDSENSITIVITYANALYSESWHEREWEEXCLUDEDDATAOBTAINEDFROMPROXYRESPONDENTSN1,290BUTFOUNDLITTLECHANGEINTHERESULTSRESULTSNOTSHOWNANDTHEREFOREPRESENTTHERESULTSINCLUDINGTHESEDATADUETOTHEPOSSIBILITYTHATWEWEREOVERADJUSTINGBYINCLUDINGBOTHCAREGIVERCOMORBIDITIESANDCAREGIVERHEA

18、LTHSTATUSINTHEMODEL,WECONSTRUCTEDMODELSWITHANDWITHOUTCAREGIVERCHRONICMEDICALCONDITIONSBASEDONTHECHARLSONCOMORBIDITYINDEX16ANDCAREGIVERHEALTHSTATUSANDFOUNDLITTLEDIFFERENCERESULTSNOTSHOWNTHISFINDING,COMBINEDWITHOURRELIANCEONSELFREPORTFORCAREGIVERCOMORBIDITIES,LEDUSTOILLUSTRATEONLYMODELSWITHCAREGIVERHE

19、ALTHSTATUSDUETOCONCERNSTHATWEWEREOVERADJUSTINGBYINCLUDINGPRESENCEOFFORMALCAREANDCAREGIVERRECEIPTOFSPOUSALCARE,WECREATEDMODELSTHATDIDNOTADJUSTFORTHESEVARIABLES,BUTTHISHADLITTLEEFFECTONTHERESULTSRESULTSNOTSHOWNFINALLY,INSENSITIVITYANALYSES,WEALSOADJUSTEDFORCAREGIVERADLSANDIADLS,ADDITIONALCAREGIVINGFOR

20、DEPENDENTS,HOSPITALIZATIONS,LENGTHOFHOSPITALIZATIONS,ANDOUTPATIENTPHYSICIANVISITS,BUTADDITIONOFTHESEVARIABLESDIDNOTRESULTINDIFFERENTASSOCIATIONSBETWEENCAREGIVINGANDPERFORMANCEOFAPREVENTIVECLINICALSERVICE,ANDWERENOTINCLUDEDINTHEFINALMODELSNOINTERACTIONSWERESIGNIFICANT,INCLUDINGTHOSEBETWEENNETWORTHAND

21、HEALTHSERVICESORGENDERANDHEALTHSERVICESALLANALYSESWEREPERFORMEDUSINGSTATASTATISTICALSOFTWARE,RELEASE70STATACORPORATION,COLLEGESTATION,TEX2001RESULTSOFTHE11,394PARTICIPANTS,10,32891DIDNOTPROVIDECARETOTHEIRSPOUSES,6225PROVIDEDCARE1TO14HOURSPERWEEK,AND4444PROVIDEDMORETHAN14HOURSOFCAREPERWEEKCHARACTERIS

22、TICSOFPARTICIPANTSBYCAREGIVINGCATEGORYARESHOWNINTABLE1OLDERPERSONS75YEARSOFAGE,WOMEN,AFRICANAMERICANS,ANDPEOPLEWHOHADLOWEREDUCATION,NETWORTH,ANDEMPLOYMENTRATES,MORECOMORBIDITIES,ANDLOWERSELFREPORTEDCAREGIVERHEALTHSTATUSWEREMORELIKELYENGAGEDINSPOUSALCAREGIVINGRATESOFPREVENTIVESERVICEUSEACROSSCAREGIVI

23、NGCATEGORIESWERERELATIVELYHIGHTABLE1TABLE2SHOWSTHEUNADJUSTEDANDADJUSTEDODDSOFRECEIVINGAHEALTHCARESERVICEBYCAREGIVINGCATEGORYINUNADJUSTEDANALYSES,PROVISIONOFGREATERTHAN14HOURSOFCAREGIVINGPERWEEKWASASSOCIATEDWITHSIGNIFICANTLYHIGHERODDSOFTHECAREGIVERRECEIVINGINFLUENZAVACCINATIONANDSLIGHTLYLOWERODDSOFTH

24、ECAREGIVERRECEIVINGCHOLESTEROLSCREENING,MAMMOGRAPHY,PAPSMEAR,ANDPROSTATEEXAMINATION,ALTHOUGHONLYTHEASSOCIATIONBETWEENPAPSMEARSANDPROSTATEEXAMSWASSIGNIFICANTGREATERINTENSITYOFCAREGIVINGWASNOTASSOCIATEDWITHPERFORMANCEOFSELFBREASTEXAMAFTERADJUSTMENTFOROTHERCOVARIATESLISTEDINTABLE1,THEREWERENOSIGNIFICAN

25、TASSOCIATIONSBETWEENCAREGIVINGANDCAREGIVERRECEIPTOFHEALTHSERVICEMEASURESTABLE2DISCUSSIONDESPITELITERATURESUGGESTINGTHATCAREGIVERSFREQUENTLYSACRIFICETHEIROWNHEALTHANDWELLBEINGBECAUSEOFTHEDEMANDSOFPROVIDINGCARE,WEFOUNDNOEVIDENCETHATCAREGIVINGWASASSOCIATEDWITHHIGHERORLOWERRECEIPTOFPREVENTIVECLINICALSER

26、VICESFORTHECAREGIVERTHISSUGGESTSTHATTHEASSOCIATIONBETWEENCAREGIVINGANDINCREASEDMORTALITYISMEDIATEDTHROUGHOTHERPATHWAYSWARRANTINGFURTHERINVESTIGATIONOURRESULTSARECONSISTENTWITHPREVIOUSREPORTSTHATFOUNDLITTLEASSOCIATIONBETWEENCAREGIVINGANDPREVENTIVEHEALTHMEASURESFORTHECAREGIVER,EITHERTHOSECAREPRACTICES

27、PERFORMEDPRIMARILYOUTSIDETHEMEDICALOFFICEORINTHEOFFICEITISPOSSIBLETHATTHISOLDERGROUPOFPERSONSHASFIRMLYESTABLISHEDHEALTHROUTINESTHATAREMINIMALLYIMPACTEDBYRELATIVELYNEWDEMANDSSUCHASCAREGIVINGITISALSOPOSSIBLETHATANYCAREGIVINGDEMANDSAREBALANCEDBYINCREASEDCONTACTWITHTHEHEALTHCARESYSTEMTHROUGHVISITSFORTHE

28、IMPAIREDFAMILYMEMBERCONTACTWITHTHEHEALTHSYSTEMCANINCREASEPERCEPTIONOFTHENEEDFORSERVICESSUCHASINFLUENZAVACCINATION,CHOLESTEROLSCREENING,MAMMOGRAPHY,PAPSMEARSCREENING,ANDPROSTATEEXAMINATIONSSUCHCONTACTCANALSOINCREASETHEOPPORTUNITIESFORSERVICESTHATARERELATIVELYEASYTOADMINISTER,SUCHASINFLUENZAVACCINATIO

29、NFINALLY,THOSEWHOCHOOSETOBECOMECAREGIVERSTOBEGINWITHMAYHAVEGREATERAWARENESSOFPROPERHEALTHBEHAVIORSANDNECESSARYSERVICESOURSTUDYHASSEVERALLIMITATIONSOURANALYSISWASCROSSSECTIONAL,ANDITISPOSSIBLETHATA“HEALTHYWORKER”EFFECTEXISTS,WHEREPERSONSWHOAREHEALTHIERAREMORELIKELYTOBECOMECAREGIVERSALTHOUGHTHEHRSSURV

30、EYISLONGITUDINAL,THEPREVIOUSANDSUBSEQUENTWAVESDROPPEDQUESTIONSPERTAININGEITHERTOINFORMALCAREFORSPOUSESORCLINICALSERVICES,LIMITINGOURABILITYTOEXAMINECAREGIVINGANDCLINICALSERVICEUSEOVERTIMETHEHRSRELIESONSELFREPORTEDINFORMATIONFORADLSANDIADLS,WHICHMAYDIFFERFROMPERFORMANCEBASEDMEASURESOFFUNCTIONINGSIMIL

31、ARLY,OURDATAONHEALTHSERVICEMEASURESWEREOBTAINEDBYSELFREPORT,WHICHMAYUNDERESTIMATEACTUALSERVICESPROVIDED,PARTICULARLYFORCHOLESTEROLSCREENINGFINALLY,OURCONCLUSIONSDONOTAPPLYTOOTHEROUTCOMESSUCHASQUALITYOFLIFE,STRESS,ANDDEPRESSIONOROTHERHEALTHBEHAVIORSSUCHASEXERCISE,SMOKING,ANDHEALTHYEATINGWECONCLUDETHA

32、TSPOUSALCAREGIVINGISNOTASSOCIATEDWITHLOWERPERFORMANCEOFPREVENTIVECLINICALSERVICESINTHECAREGIVERFUTUREINVESTIGATIONSSHOULDFOCUSONTHEASSOCIATIONBETWEENCAREGIVINGANDPROCESSESOFHEALTHCAREDELIVERYFORCAREGIVERCHRONICDISEASEMANAGEMENTANDQUALITYOFLIFEDRKIMWASSUPPORTEDBYANAMERICANDIABETESASSOCIATIONJUNIORFAC

33、ULTYAWARDDRLANGAWASSUPPORTEDBYACAREERDEVELOPMENTAWARDFROMTHENATIONALINSTITUTEONAGINGK08AG19180,ANEWINVESTIGATORRESEARCHGRANTFROMTHEALZHEIMERSASSOCIATION,ANDAPAULBEESONPHYSICIANFACULTYSCHOLARSINAGINGRESEARCHAWARDTHENATIONALINSTITUTEONAGINGPROVIDEDFUNDINGFORTHEHEALTHANDRETIREMENTSTUDYU01AG09740,DATAFR

34、OMWHICHWEREUSEDINTHISANALYSISSOURCECATHERINEKIM,MD,MPH,MOHAMMEDUKABETO,MS,ROBERTBWALLACE,MD,KENNETHMLANGA,MD,PHD，JGIM，2008，P875877译文在健康与退休研究中照顾者提供的临床预防服务质量摘要我们研究了配偶之间照顾和预防性医疗服务之间的关联（流感疫苗的自我报告，胆固醇筛检，乳房摄影，子宫颈抹片检查，超过2年的前列腺筛查，每月乳房自我检查）在健康与退休研究方面对被照顾者进行横向分析，一个具有民族性代表的美国成年人样本，年龄50岁11394例。配偶每星期花费0，114或者是大于

35、等于14小时来照顾。每项服务用逻辑复原模型检测来调整照顾者的特性。调整共变项后，夫妻之间看护与受到预防性服务可能性之间没有显著关联。关键词照顾；预防；乳房X光检查；流感；胆固醇超过600万的美国成年人提供长期，无偿地照顾老年人，残疾人及其家属,尤其是年老的配偶。这些照顾者处于高死亡的危险。可能的解释包括高频率的负面健康行为和其他因素作用于医护人员影响他们的健康，比如没有足够的时间去锻炼，忘了服用处方药物，疲惫，抑郁，更糟的是血压，血脂的不正常。目前还不清楚是否照顾和死亡率之间的关联也可以通过质量比较差的卫生保健的照顾者来实现，包括降低临床预防服务的介导。看护消耗时间和财政资源，可能会干扰正常预

36、防保健。在照顾者健康影响的研究中，照顾和照顾者与受到预防接种之间没有关联；另外关于护理研究发现乳房X检测，大肠直肠癌筛检，子宫颈抹片检查性能与照顾之间没有关联。与此相反，另一个研究表明，健康照顾者比那些不是照顾者更可能获得流感疫苗和接种肺炎疫苗。这些研究有冲突性结果归因于族群的矛盾和服务检查。研究以办公室提供的医疗服务为重点涉及到人口选择。对特殊的服务，如流感疫苗，照顾通过医生提供能够获得更多的机会。另外，对于如子宫颈抹片检查服务需要预约，有照顾可以减少类似于这种访问的时间。鉴于先前关于在预防性临床服务运用问题上出现的冲突，我们检测了预防性临床服务扩展列表和在健康与退休研究中配偶照顾的关联。据

37、我所知，到目前为止，健康退休研究中的配偶护理和保健服务在所有研究中参加人数最多，同时具有详细的照顾数据以及临床服务信息。方法数据源和采集程序健康退休研究是以美国老年人为代表的两年一度的国家纵向调查。年龄50岁的或者更大的，为了研究分析的宗旨，我们分析了2000个受访者。已经结婚的夫妇获得了全面的调查。我们研究的样本包括11394个年龄在50岁或者更大的已婚个人，他们居住在社区，两次受访。主要的结果变数为照顾者对流感疫苗的预防医疗服务，接种疫苗，子宫颈抹片检查，乳房X射线，胆固醇检查等方面自我报告，在过去的两年前列腺放射和乳房自我检查。主要的自变量是非正式照顾数额提供。受访者按照接受非正式家庭照

38、顾分类，如果他们接受家庭日常居住的服务，比如饮食，走动，如厕，穿衣，洗澡，走着穿过房间；或者日常生活活动能力，比如准备吃饭，超市购物，打电话，吃药；或者在前一月从亲戚那，或者不用偿还的非亲戚无从属组织那筹集钱。受访者不常执行的一个日常生活功能，如购物，不认为是日常生活障碍或得到日常起居的帮助。非正式家庭照顾的周照顾时间适用于一周平均几天，受访者回答从配偶那一天获得了多少小时的帮助来计算。我们得到了照顾获得的小时数，从这里我们能够把配偶的照顾分为3类。照顾者分为3种不提供护理，每周提供1到14小时护理，每周提供护理时间超过14小时。统计分析为了探讨照顾者获得的依赖变量和照顾者收到临床服务的独立变

39、量的关系，我们单独运用逻辑复原模型检测每个临床服务。所有分析用来加权微分选择概率和调整健康退休研究的复杂抽样设计。我们检测所有重大变项的相互作用，并分别用诊断学来检测模型的假设。所有变项反映照顾者的特性，除了在家中付费照顾外，没有获得照顾。（表一）我们进行了敏感性分析，我们排除代理受访者获得的数据（1290例），但是在结果中发现改变（结果未显示），因此在结果中包括这些数据。由于以上的可能性，我们的调整超过了模型中照顾者和照顾者的健康状况。在模型中，我们建造模型基于察尔森合并症和照顾者健康状况的医疗条件，发现差别不大。这一发现，与自我照顾者依赖并发症报告相结合，让我们举例说明照顾者健康状态。因为

40、关心，我们调整已经超过包括正式护理和配偶照顾。我们创建的模型没有调整这些变量，但对结果影响不大（结果未显示）。最后，在敏感性分析中，我们还调整照顾者的日常起居，包括更多的照顾家属，住院，长期住医院，门诊医生的拜访，但是除了这些变量，没有造成护理和预防的临床服务的不同，不包括最终的模型。相互作用不显著，包括净资产和健康服务或者性别和健康服务。所有分析运用史塔特执行统计软件70版（史塔特的公司，大学城，德州，2001年）。结果在11394名参加者中，10128（91）对他们的配偶没提供照顾，622（5）每星期提供1到14小时的照顾，444（4）每星期提供超过14小时的照顾。参加者的特征通过照顾分类

41、在表1中有所显示。老年人（大于75岁），女人，非裔美国人和低教育者，净资产和就业率更多的并发症，低的自我健康照顾的人更可能受到配偶的照顾。跨类别的预防性护理服务的使用率相对较高。（表1）表2显示调节和未调节，通过照顾分类获得卫生保健的平衡。在未调节的分析中，每周多于14小时更高的可能性接受流行性感冒的疫苗，很少的可能性获得胆固醇放映，早期胸部X放射，子宫颈抹片检查和前列腺检测，虽然只有子宫颈之间的关联涂片和前列腺测试也是有意义的。健康保健的强度与自我检测没有关系。根据表1其他变项的调整，在看护和照顾者收到的卫生服务措施没有明显关系（表2）讨论虽然文艺著作表明照顾者因为提供保健的需要频繁地牺牲他

42、们的健康和幸福，但是我们没能找到证据表明照顾与预防性医疗服务有着或高或低的关系，这个结论，需要进一步调查，照顾和死亡之间的关系。我们的报告与早些的研究是一致的，没有发现照顾和为照顾者提供预防健康是有关联的，这些照顾在医疗室里进行或者不在医疗室里进行。这个可能是老年人长期建立的常规，对新的照顾需求影响小。这个也可能是照顾的需求通过家庭成员的探访增加联系被平衡。联系与卫生系统可以增加知觉对服务的需求，比如流行性感冒的疫苗，胆固醇筛选乳房X摄影，子宫颈抹片检查，前列腺检查等这些联系可以增加服务机会，相对容易管理，如流感疫苗注射。最后，这些谁选择成为照顾者的人开始会有正确的认识和必要的服务。我们的研究

43、受到许多限制，我们的分析是跨部门的，它可能是一个“健康工人”的效果存在，那里的人谁更健康更有可能成为照顾者。虽然健康退休研究调查是纵向的，先前的和后来的研究发现非正式照顾对配偶或者临床服务是有关系的，随着时间的推移限制我们的能力去研究和对临时性服务的使用。健康退休研究运用自我报告信息，可能不同于运作业绩为基础的措施。同样，我们在健康服务措施上的数据，获得了自我报告，这个报告可能低估了实际提供的服务，特别是胆固醇筛选。最后，我们的结论并不适用于其他结果，如生命，压力和抑郁，或者另外的健康行为如运动，吸烟和健康的饮食质量。我们得出来的结论是配偶的照顾与低水平的预防性临时服务无关。将来的研究应把重点放在健康护理和照顾慢性疾病管理过程之间的关联关系。金博士被授予由美国糖尿病协会颁发的青年教师奖。博士郎获得了职业生涯发展奖由国家老化研究所颁发（K08AG19180），国家老化研究所是新的调查研究资助的老年痴呆症协会，保罗比森医学院老化研究学者奖。国家老化研究所提供的健康与退休研究（U01AG09740），其中得到的数据应用于此篇文章分析中。出处凯瑟琳金,医学博士,公共卫生硕士,穆罕默德美国阿贝托,硕士,罗伯特B华莱士,医师,肯尼思米郎加，医学博士,哲学博士,中华普通内科，2008，P875877