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Biomedical subjects

C D Sherbourne

Publications and source records attributed to C D Sherbourne.

At least 55 records · Page 3Linked to original sources
PubMed1993

Recall of recommendations and adherence to advice among patients with chronic medical conditions.

BACKGROUND: Patient adherence to treatment regimens may be a critical mediator between physician recommendations and patient outcomes, but levels of adherence have not been compared across disease groups, and patient self-reports have not been well validated. METHODS: To determine recall of and adherence to physicians' recommendations among patients with chronic medical conditions and to measure the correspondence between self-reported adherence and disease activity, we analyzed data from the Medical Outcomes Study. A total of 1751 patients with diabetes mellitus, hypertension, and heart disease were identified among 20,223 patients visiting family physicians, general internists, cardiologists, and endocrinologists in 1986. Main outcome measures included recall of 15 disease-specific recommendations, self-reported general and specific adherence, and correlations between adherence and clinical measures of disease activity and control. RESULTS: Among patients in all three disease groups, the proportion recalling recommendations to take prescribed medications (> or = 90%) exceeded the fraction recalling recommendations to follow a restricted diet, exercise regularly, and perform various self-care activities (22% to 84%). Adherence to recalled recommendations was similar across conditions but varied markedly according to the nature of the recommendations; for example, 91% of diabetics took prescribed medications but 69% followed a diabetics diet and 19% engaged in regular exercise. Adherence to recommendations was correlated with reduced serum glucose (r = -.33) and glycohemoglobin (r = -.25) levels among insulin-dependent diabetics and with reduced diastolic blood pressure among patients with hypertension (r = -.15). CONCLUSIONS: The majority of chronically ill patients failed to recall elements of potentially important medical advice and did not always adhere to advice that was recalled. Self-reported adherence was correlated with clinical measures of disease activity and control. Additional research is needed not only to improve adherence to medical advice in patients with chronic illnesses but also to determine which life-style changes are truly beneficial for these patients.

Adult↗
PubMed1993

Prevalence of comorbid alcohol disorder and consumption in medically ill and depressed patients.

OBJECTIVE: To estimate the extent to which alcohol disorder co-occurs in patients with major medical and psychiatric conditions. DESIGN: Observational study. SETTING: Offices of general medical providers and mental health specialists in three US cities. PATIENTS: Adult patients (N = 2296) with hypertension, diabetes, heart disease (congestive heart failure or myocardial infarction), and/or current depressive disorder or subthreshold depressive symptoms. MAIN OUTCOME MEASURES: Current and lifetime alcohol disorder, alcohol consumption, current problem drinking, perceived need for help for alcohol or other drug problems, and unmet need. METHODS: Comparisons of the prevalence of alcohol comorbidity in medically ill nondepressed patients of general medical providers and in depressed patients of both provider types. RESULTS: Patients with chronic medical problems or depression had similar levels of lifetime alcohol disorder (14% to 19%) and current alcohol problems (18% to 29%), but depressed patients were more likely to report needing help for problems with alcohol or drugs. Current alcohol disorder was more prevalent among depressed patients in mental health specialty practices than in general medical practices. Many patients who perceived a need for care for alcohol and other drug problems reported that this need was unmet (37% to 84%). CONCLUSIONS: Clinicians who treat patients with major medical and psychiatric conditions need to be prepared to identify and treat comorbid alcohol disorder.

Adult↗
PubMed1993

The RAND 36-Item Health Survey 1.0.

Recently, Ware and Sherbourne published a new short-form health survey, the MOS 36-Item Short-Form Health Survey (SF-36), consisting of 36 items included in long-form measures developed for the Medical Outcomes Study. The SF-36 taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, general mental health, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. The SF-36 items and scoring rules are distributed by MOS Trust, Inc. Strict adherence to item wording and scoring recommendations is required in order to use the SF-36 trademark. The RAND 36-Item Health Survey 1.0 (distributed by RAND) includes the same items as those in the SF-36, but the recommended scoring algorithm is somewhat different from that of the SF-36. Scoring differences are discussed here and new T-scores are presented for the 8 multi-item scales and two factor analytically-derived physical and mental health composite scores.

Activities of Daily Living↗
PubMed1993

Do depressed patients in different treatment settings have different levels of well-being and functioning?

Differences in the functioning and well-being of adult patients with current or past depressive disorder who visited clinicians of different specialties in health maintenance organizations, solo practices, or large multispecialty group practices were examined. For patients in different systems, there were no significant differences in functioning and well-being across 12 domains tested. Patients of mental health specialists had worse mental health and more limitations in social activities, whereas patients of medical clinicians had worse physical functioning, more pain, more physical/psychophysiologic symptoms, and worse health perceptions. Thus, each system of care had depressed patients with a similar functioning and well-being "burden" but specialty sectors had patients with slightly different functioning and well-being profiles, probably reflecting patient selection of type of provider.

Adaptation, Psychological↗
PubMed1993

Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study.

The influence of physicians' attributes and practice style on patients' adherence to treatment was examined in a 2-year longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 years later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise).

Adult↗
PubMed1992

Norepinephrine-induced increase in sympathetic neuron-derived prostaglandins is independent of neuronal release mechanisms.

The contribution of exocytosis to norepinephrine-stimulated prostaglandin release from sympathetic postganglionic neurons was evaluated in homogenates of adult rat superior cervical ganglia. Incubation of ganglion homogenates with norepinephrine (1 mM) for 30 min caused an increased release of prostaglandin E2 and prostaglandin I2 (measured as the stable metabolite, 6-keto-PGF1a). Neither tetrodotoxin (10 mM), K+ (120 mM), nor EDTA in Ca(2+)-free buffer affected prostaglandin generation under basal and norepinephrine-stimulated conditions. These results suggest that the increase in prostaglandin production by sympathetic neurons after norepinephrine administration is not through the release of previously synthesized intracellular stores. Instead, the increase in prostaglandins in response to norepinephrine appears to be explained by de novo synthesis.

Animals↗
PubMed1992

Social support and stressful life events: age differences in their effects on health-related quality of life among the chronically ill.

There is substantial evidence of individual variation in health-related quality of life measures that is not accounted for by age or disease condition. An understanding of factors that determine good health is necessary for maintained function and improved quality of life. This study examines the extent to which social support and stressful life events were more or less beneficial for the long-term physical functioning and emotional well-being of 1,402 chronically ill patients. Analyses, conducted separately in three age groups, showed that social support was beneficial for health over time regardless of age. In addition, low levels of support were particularly damaging for the physical functioning of older patients. Stressful life events impacted differentially on health-related quality of life; relationship events had an immediate effect on well-being which diminished with time; financial events had an immediate negative effect on functioning and well-being which persisted over time for middle-aged patients; bereavement had a delayed impact on quality of life, with the youngest patients especially vulnerable to its negative effects; work-related events had both negative and positive effects, depending on age group. Results reinforce the importance of identifying and dealing with psychosocial problems among patients with chronic disease.

Activities of Daily Living↗
PubMed1992

Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study.

A longitudinal study of patients with chronic medical diseases (hypertension, diabetes, heart disease) was conducted to identify antecedents of adherence to medical recommendations. Data are from 1198 patients in three health-care provision systems in Los Angeles, Chicago, and Boston. Nonadherence at the beginning of the study was the strongest predictor of nonadherence 2 years later. Other significant predictors varied by type of adherence outcome. Patients who were younger and who relied upon avoidant coping strategies tended to be less likely to follow their doctor's specific recommendations. Patients who were distressed about their health, used avoidant coping strategies, or who reported worse physical and role functioning were less likely to adhere in general. Patient satisfaction with two features of care (interpersonal quality and financial aspects) was positively related to adherence in some models, but satisfaction with the technical quality of care was negatively associated with adherence to specific recommendations among heart disease patients. Social support contributed to specific adherence among diabetic patients. Implications of the study for medical care providers are discussed.

Adaptation, Psychological↗
PubMed1992

Quality of self-report data: a comparison of older and younger chronically ill patients.

This study examined age differences in the quality of self-report data in patients with chronic disease conditions (hypertension, diabetes, heart disease, depression). Data are from 2,304 patients in three health care systems in Los Angeles, Chicago, and Boston. Results support the idea that self-report health data can be gathered from older and younger patients without significant decrements in data quality. Specifically, results showed: (1) small decreases in the reliability of multi-item measures with age, primarily occurring in balanced scales; (2) little evidence of differences among age groups in response set or the tendency to respond "don't know" or "uncertain," although older patients had a greater tendency to respond in a socially desirable manner; (3) higher item nonresponse in older patients; (4) little variation in item nonresponse by type of question or question placement; (5) generally high panel retention in all age groups, supporting the value of repeated follow-up; and (6) similar known-groups validity across age groups.

Adolescent↗
PubMed1992

Adherence to cancer regimens: implications for treating the older patient.

Cancer presents unique challenges to the clinician who hopes to achieve patient adherence to medical recommendations. Preventive and treatment regimens, particularly those that involve lifestyle change, are often extremely difficult to carry out (eg, smoking cessation; following a low fat diet). Although research suggests that there is no clearcut relationship between a patient's age and his or her degree of adherence to medical treatment, older patients may have more difficulties than younger persons in understanding precisely the medical recommendations made to them and tend to be more passive recipients of care. The authors describe six factors that significantly affect adherence and clinical changes that are likely to be effective in enhancing the adherence behavior of older patients with cancer. Measurement of patient adherence in the Medical Outcomes Study is described. This paper also examines the difficulties and pressures faced by medical professionals in enhancing the adherence of their patients.

Adolescent↗
PubMed1992

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.

A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.

Activities of Daily Living↗
PubMed1991

Postnatal development of neurogenic inflammation in the rat.

We have studied the development in the rat of neurogenic inflammatory mechanisms that mediate cutaneous plasma extravasation. At birth and at postnatal day 10, intradermal injection of substance P, histamine, and bradykinin produced no significant plasma extravasation. At day 13 through adulthood (days 42-49), all test agents produced significant plasma extravasation which increased with increasing age. In the adult rat, pretreatment with 6-hydroxydopamine, to eliminate sympathetic postganglionic nerve terminals, attenuated the plasma extravasation elicited by substance P, histamine and bradykinin. The possible role of the sympathetic postganglionic neuron in the age-dependent changes in neurogenic inflammation is discussed.

Aging↗
PubMed1991

The MOS social support survey.

This paper describes the development and evaluation of a brief, multidimensional, self-administered, social support survey that was developed for patients in the Medical Outcomes Study (MOS), a two-year study of patients with chronic conditions. This survey was designed to be comprehensive in terms of recent thinking about the various dimensions of social support. In addition, it was designed to be distinct from other related measures. We present a summary of the major conceptual issues considered when choosing items for the social support battery, describe the items, and present findings based on data from 2987 patients (ages 18 and older). Multitrait scaling analyses supported the dimensionality of four functional support scales (emotional/informational, tangible, affectionate, and positive social interaction) and the construction of an overall functional social support index. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all Alphas greater than 0.91), and are fairly stable over time. Selected construct validity hypotheses were supported.

Adult↗
PubMed1991

Noradrenaline-induced prostaglandin production by sympathetic postganglionic neurons is mediated by alpha 2-adrenergic receptors.

In this study we have demonstrated that noradrenaline increases the levels of prostaglandin E2 and prostaglandin I2 (detected as the stable metabolite 6-keto-prostaglandin F1 alpha) synthesized by homogenates of superior cervical ganglia from the adult rat. This noradrenaline-induced prostaglandin production was further characterized: (a) Selective destruction of adrenergic sympathetic postganglionic neurons in the ganglia using 6-hydroxydopamine abolished both basal and stimulated prostaglandin production. (b) Elimination of preganglionic cholinergic sympathetic nerve terminals in the ganglia had no effect. (c) Mepacrine (a phospholipase inhibitor) and indomethacin (a cyclooxygenase inhibitor) attenuated both basal and stimulated prostaglandin production. (d) Yohimbine, but not prazosin, suppressed the noradrenaline dose-response curve for prostaglandin production. The results of these experiments show that, in vitro, noradrenaline stimulates de novo synthesis of prostaglandin E2 and prostaglandin I2 by sympathetic postganglionic neurons. This stimulation by noradrenaline appears to result from action at an alpha 2-adrenergic receptor.

6-Ketoprostaglandin F1 alpha↗
PubMed1990

The synthesis and molecular dynamics of phospholipids having hydroxylated fatty acids at the sn-2 position.

We have devised a general method for the synthesis of phospholipids containing hydroxylated fatty acids and have utilized this methodology to synthesize two naturally occurring hydroxylated lecithins (i.e. 1-palmitoyl-2-[15(S)-hydroxy-5E, 8E,11E,13Z-eicosatetraenoyl]-sn-glycero-3-phosph ocholine (1-palm-2-15HETE PC) and 1-palmitoyl-2-[5-hydroxy-6Z,8E,11E, 14E-eicosatetraenoyl]-sn-glycero-3-phosphocholine (1-palm-2-5HETE PC]. After protection of the hydroxylated fatty acid as its t-butyldimethylsilyl derivative, the anhydride of the protected fatty acid was formed utilizing dicyclohexylcarbodiimide and subsequently was condensed with a regiospecific lysolecithin utilizing pyrrolidinopyridine as catalyst to form the protected hydroxylated lecithin. Finally, hydroxylated lecithins were formed after removal of the t-butyldimethylsilyl group with acetic acid. Electron spin resonance spectroscopy was utilized to interrogate the molecular dynamics of lipid bilayers comprised of mixtures of these hydroxylated lecithins and naturally occurring lecithins. Remarkably, the molecular dynamics of spin-labeled phospholipids in liposomes comprised of cholesterol and phosphatidylcholine were altered substantially after addition of only 3.5 mol% 1-palm-2-15HETE PC as assessed by the order parameter of 16-doxylstearoyl phosphatidylcholine.

Chemical Phenomena↗
PubMed1990

Marital status, social support, and health transitions in chronic disease patients.

Married persons tend to be healthier, both physically and mentally, than unmarried persons. We tested the hypothesis that being married results in better physical and mental health outcomes for chronic disease patients (N = 1,817) by increasing social support. We modeled health outcomes one year later, controlling for initial health status. Cross-validation studies of two random halves of the sample supported an indirect effect of marital status on mental health through social support, but did not support a relationship, direct or indirect, of either marital status or social support with physical health outcomes. In addition, specific types of functional support were not differentially predictive of mental health status.

Adaptation, Psychological↗
PubMed1988

The role of social support and life stress events in use of mental health services.

This study examined the role of social supports and life stress events in use of mental health services. Data were derived from a 3-5 year longitudinal study of a general population of adults (ages 14 and older) enrolled in the RAND Health Insurance Experiment. The sample used in this analyses included those enrollees who participated for a full year in the second (N = 1979) and third (N = 2601) years of the experiment. Included were 4580 person-years of data. Statistical methods used probit regression models which controlled for a number of covariates including insurance plan, site, sociodemographic variables, physical and mental health. Results supported the following conclusions: (1) the more life events experienced, the more likely one is to use mental health services, (2) chronic types of life events are more important than acute events in predicting use of mental health services, (3) when defined as social contacts, social support does not predict use; however, when defined as social resources, the more support one has the less likely is one to use mental health services, and (4) neither social contacts nor social resources buffer the impact of life stress events on use of services.

Adolescent↗