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Biomedical subjects

Alan J Christensen

Publications and source records attributed to Alan J Christensen.

15 recordsLinked to original sources
PubMed2006

Persistent posttreatment depressive symptoms in patients with head and neck cancer.

BACKGROUND: This study examined the prevalence and risk factors of persistent (versus short-term) depressive symptoms in patients with head and neck cancer. METHODS: Patients with 10+ and 18+ posttreatment Beck Depression Inventory scores for 6 or more months during their first year were identified. Regression analyses determined risk factors associated with persistently high scores. RESULTS: Of the 148 patients, 25.0% and 7.4% were persistently above the 10+ and 18+ cutoff scores, respectively (compared with 33.6% to 44.2% and 9.2% to 18.6% when measured at single points across this time period.) The strongest predictor of persistent posttreatment depressive symptoms was pretreatment depressive symptoms. CONCLUSIONS: The percentage of patients with persistently high levels of depressive symptoms, although considerable, is substantially lower when patients with transient mood disorders are omitted. A screening tool that determines high levels of pretreatment depressive symptoms could identify patients at high risk of experiencing posttreatment depression who would be good candidates for clinical intervention.

Aged↗
PubMed2006

The role of depression symptoms in dialysis withdrawal.

Among end-stage renal disease (ESRD) patients on hemodialysis, death from withdrawal from life-sustaining dialysis is increasingly common. The present study's objective was to examine depression as a potential risk factor for hemodialysis withdrawal. Two hundred forty ESRD hemodialysis (133 male and 107 female) patients were followed for an average of 4 years after depression symptom assessment. Of these, 18% withdrew from dialysis. Using multivariate survival analysis and after controlling for the effects of age (p < .001) and clinical variables, the authors found that level of depression symptoms was a unique and significant predictive risk factor for the subsequent decision to withdraw from dialysis (p < .05). The potential impact that depression may have on the decision to withdraw from hemodialysis should be considered by health care providers, patient families, and patients.

Adult↗
PubMed2005

Health locus of control and depression in chronic kidney disease: a dynamic perspective.

Participants in the present study were 207 patients with chronic kidney disease (CKD) who completed internal HLOC and depression measures at baseline and at an approximately 16-month follow-up period. Regression results indicated that after controlling for baseline level of depression, baseline internal HLOC was not a significant predictor of depression at follow-up. However, increases in internal HLOC over the 16-month follow-up were predictive of depression at follow-up. Furthermore, this relationship was qualified by an interaction between change in internal HLOC and disease progression. These results suggest that changes in internal HLOC over time may be a particularly important determinant of adjustment for individuals whose chronic illness progresses or becomes life threatening.

Depression↗
PubMed2004

Clinical significance of health status assessment measures in head and neck cancer: what do quality-of-life scores mean?

OBJECTIVES: To determine the magnitude of clinically significant differences in domain scores for a quality-of-life questionnaire specific to head and neck cancer; and to demonstrate a clinically relevant method of presenting head and neck cancer-specific quality-of-life data using cutoff scores and clinical anchors. DESIGN: Anchor-based and distribution-based techniques for determining clinically significant differences in health-related quality-of-life scores were used. SETTING: University-based tertiary care hospital. PATIENTS: A total of 421 patients with head and neck cancer enrolled in a longitudinal outcomes project. MAIN OUTCOME MEASURES: The Head and Neck Cancer Inventory; clinical anchor health status in the domains of speech, eating, and social disruption; and distribution-based clinically significant score differences. RESULTS: Clinical anchor health states representing incremental levels of dysfunction were significantly correlated with domain scores for eating, speech, and social disruption. The anchor-based clinically important difference magnitudes were consistent with the values obtained using distribution-based techniques. For mean domain scores (minimum, 0; maximum, 100), differences of approximately 4, 10, and 14 or greater represented small, intermediate, and large clinically significant differences, respectively. Stratifying mean domain scores into low (0-30), intermediate (31-69), and high (70-100) categories allowed presentation of the health-related quality-of-life data in a clinically relevant format. CONCLUSIONS: This study provides benchmarks for small, intermediate, and large clinically significant changes in scores and demonstrates the presentation of health-related quality-of-life data in a clinically useful format.

Benchmarking↗
PubMed2004

Technological and medical advances: implications for health psychology.

Behavioral telehealth, health informatics, organ and tissue transplantation, and genetics are among the areas that have been affected by advances in technology and medicine. These areas illustrate the opportunities and the challenges that new developments can pose to health psychologists. Each area is discussed with respect to implications for practice, research, public policy, and education and training: recommendations are provided.

Behavioral Medicine↗
PubMed2004

The role of perceived control and preference for control in adherence to a chronic medical regimen.

BACKGROUND: Poor patient adherence is a widespread problem among patients undergoing hemodialysis for end-stage renal disease. PURPOSE: The goal of this study was to examine the joint role of perceived restriction of control and individual differences in preference for control in predicting adherence to the hemodialysis regimen. METHODS: Participants were 49 patients recruited from five hemodialysis centers affiliated with the University of Iowa Hospitals and Clinics. Preference for control in the health care context was assessed using the Preference for Information and Preference for Behavioral Involvement subscales of the Krantz Health Opinion Survey, and perceived control was assessed using six items written for this study. Adherence was assessed by examining patients' interdialysis session weight gains (IWG). RESULTS: Hierarchical regression analysis indicated that the interaction between preference for information and perceived control over dialysis context explained a significant proportion of variance in IWG values, change in R2 =.09, F(1, 43) = 5.26, p <.05, standardized beta = -.32. Among patients with lower levels of perceived control in the dialysis setting, a higher preference for information concerning one's own health care was associated with increasingly poorer adherence. IWG levels in these individuals reflected clinically problematic nonadherence with fluid-intake restrictions. Among patients with a higher level of perceived control, preference for information had little effect on adherence. No main or interactive effects were found involving differences in patients' preference for behavioral involvement in their own health care or for the items reflecting perceived control outside the dialysis treatment setting. CONCLUSIONS: These data suggest that assessing and examining the interactive effects of patients' preferences for control and perceived control may, in some cases, be useful in identifying those individuals at risk for difficulty in adhering to the complex behavioral restrictions associated with chronic medical regimens.

Attitude to Health↗
PubMed2004

Patient preference for being informed of their DXA scan results.

Evidence suggests that patients diagnosed with osteoporosis are often undertreated. One potential solution to undertreatment is to enhance patient involvement in their osteoporosis care (a.k.a. patient activation) by having the dual-energy X-ray absorptiometry (DXA) center directly provide patients with their test results and educational material. However, little is known about patient interest in such an intervention. Consecutive patients presenting to an academic medical center DXA scanning unit were given a questionnaire to assess their preferences for being informed of their test results and interest in receiving their results plus educational material by mail from the testing center. Two hundred and two (202) of 206 (98%) of patients agreed to complete the survey. Fifty-one percent of participants preferred receiving their results by mail directly from the DXA center, followed by phone call (28%) and office visit (11%). Overall, 90% of patients reported interest in receiving results and educational material by mail. Younger patients were more interested in receiving their results by mail when compared with older patients, but this difference did not reach statistical significance (odds ratio [OR] = 2.40: 95% confidence interval [CI]: 0.91-6.31, p = 0.14). Patients undergoing DXA scanning were interested in receiving their scan results and educational material directly from the testing center. This might represent an effective intervention for improving care of patients with osteoporosis.

Absorptiometry, Photon↗
PubMed2003

Comprehensive head and neck oncology health status assessment.

BACKGROUND: This article presents the validation of the Head and Neck Cancer Inventory (HNCI), a health status assessment instrument with a small number of multiple-item domains that captures patients' ratings of functional status and attitude about that function. METHODS: The HNCI was administered to patients with upper aerodigestive tract carcinoma. An initial, cross-sectional study assessed feasibility and reliability. A subsequent, longitudinal study's factor analysis identified ineffective items and confirmed domain cohesiveness. Construct and criterion-related validity and sensitivity to detect change across time were evaluated. RESULTS: The HNCI was highly reliable. Criterion-related validity was demonstrated through comparisons with other HNC-specific instruments. Construct validity was demonstrated based on significant differences between patient groups (HNC/non-HNC, employment status, clinical stage, and type of treatment). Domain scores were sensitive to change across time. The domains' functional and attitudinal scores were significantly different. CONCLUSIONS: The HNCI is a reliable, valid instrument that evaluates the functional and attitudinal components of health status in HNC patients. This survey is recommended for self-reported health status evaluation in HNC clinical trials.

Activities of Daily Living↗
PubMed2002

Patient personality and mortality: a 4-year prospective examination of chronic renal insufficiency.

The present study examined the role of personality as a predictor of mortality among patients with chronic renal insufficiency. A prospective evaluation of the influence of personality on patient survival was conducted over an average 49-month period. Cox regression was used to evaluate the effects of 5 dimensions of personality in a sample of 174 patients (100 male and 74 female). At follow-up, 49 patients had died. Significant demographic and clinical predictors of survival included age, diabetic status, and hemoglobin level. After these predictors were controlled for, 2 personality traits, conscientiousness and neuroticism, predicted patient mortality. Patients with high neuroticism scores had a 37.5% higher estimated mortality rate. Patients with low conscientiousness scores had a 36.4% increased mortality rate.

Adult↗
PubMed2002

Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis.

The present study examined the efficacy of a behavioral intervention designed to increase adherence to fluid-intake restrictions among hemodialysis patients. Twenty intervention-group patients were compared with 20 matched control patients on an indicator of fluid-intake adherence at 3 time points. The Group x Time interaction was significant, indicating that patients in the 2 groups exhibited a differential pattern of change in fluid-intake adherence across the follow-up period. The intervention and control groups did not differ significantly in terms of adherence at the initial postintervention period but did differ at the 8-week follow-up. The observed group differences were, in part, due to a trend toward increasingly better adherence in the intervention group and poorer adherence in the control group across the follow-up period.

Adult↗
PubMed2002

Effect of family environment and donor source on patient quality of life following renal transplantation.

The authors examined the degree to which the supportiveness of a patient's family environment predicts change in quality of life following renal transplantation. The sample consisted of 95 patients receiving renal grafts from either a living donor or a cadaveric donor. Patients were initially assessed prior to transplantation with follow-up assessment occurring an average of 5.5 months after transplantation. Among patients receiving a living-donor kidney, those reporting a more supportive family environment exhibited reduced depression, improved mobility, and improved social functioning. However, those living-donor recipients reporting less family support exhibited increased depression and diminished mobility and social functioning after transplantation. Patients receiving a kidney from a cadaveric donor showed modest improvements in quality of life regardless of the degree of family support.

Adaptation, Psychological↗
PubMed2002

Psychological factors in end-stage renal disease: an emerging context for behavioral medicine research.

End-stage renal disease (ESRD) is a chronic, life-threatening condition afflicting over 300,000 Americans. Patient nonadherence and psychological distress are highly prevalent among ESRD patients, and both have been found to contribute to greater morbidity and earlier mortality in this population. A range of factors have been examined as potential determinants of adherence and adjustment. Evidence suggests that adherence and adjustment are maximized when a patient's preferred style of coping is consistent with the contextual features or demands of the renal intervention the patient is undergoing. Challenges for future clinical research include refining methodologies for the assessment of depression and adherence, more clearly evaluating the efficacy of psychological interventions, and clarifying the role that depression and social support play in influencing patient mortality.

Adaptation, Psychological↗
PubMedDate not supplied

Behavioral and medical treatment of chronic polydipsia in a patient with schizophrenia and diabetes insipidus.

OBJECTIVE: This case report describes a novel outpatient behavioral treatment intervention for chronic polydipsia. The program was used in an effort to reduce excessive fluid intake in a woman with chronic paranoid-type schizophrenia who also had a diagnosis of diabetes insipidus. METHODS: The 12-session individual behavioral intervention incorporated self-monitoring, stimulus control, coping skills training, and reinforcement components. RESULTS: The patient engaged fully in the treatment program, and she successfully restricted her fluid intake. Her diabetes insipidus could therefore be treated with desmopressin, a medication that requires fluid restriction, and she experienced a concomitant reduction in polyuria and urinary incontinence. CONCLUSIONS: The outpatient behavioral intervention demonstrated promising outcomes in a chronically mentally ill patient whose polydipsia had underlying psychogenic and physiological components. This case highlights the efficacy of combining behavioral and medical interventions.

Ambulatory Care↗