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Biomedical subjects

D L Ronis

Publications and source records attributed to D L Ronis.

At least 37 records · Page 2Linked to original sources
PubMed1995

A comparison of multiple indicators--observations, supervisor report, and self-report as measures of workers' hearing protection use.

The purpose of this study was to compare multiple indicators of behavior and identify the most viable measure of blue-collar workers' use of hearing protection. Three measures of use were employed: observations, supervisor report, and self-report. Supervisor report was highly discrepant from both self-report and observed use; self-report and observations were highly correlated, and discrepancies between the two were slight. These results suggest that, for this type of measurement, self-report is an appropriate measure and may be the best choice when time and monetary resources restrict measurement to one indicator.

Administrative Personnel↗
PubMed1995

Predictors of hearing protection use among workers: implications for training programs.

In this study, we used the conceptual Health Promotion Model to identify predictors of hearing protection use among blue-collar workers (N = 504). The strongest predictors were self-efficacy, benefits, value, and barriers. Items in the barriers scale were most strongly correlated with use and had the greatest potential for change. Therefore, items from this scale are being used as the primary basis for development of a training intervention program.

Automobiles↗
PubMed1994

The relation of preventive dental behaviors to periodontal health status.

Current recommendations for periodontal health maintenance emphasize toothbrushing, flossing and periodic dental checkups. The purposes of this study were to examine (1) the effects of these practices on periodontal health and (2) the relationships of demographic and socioeconomic variables with these behaviors and with periodontal health. Adults (n = 319) in the Detroit, Michigan tri-county area were asked how frequently they performed the 3 preventive behaviors. Levels of plaque, gingivitis, calculus, and periodontal attachment were then assessed during in-home dental examinations. There were no statistically significant differences in these health measures between those with acceptable and unacceptable brushing behavior. About 20% of the subjects reported acceptable flossing behavior, and these individuals had significantly less plaque and calculus than other participants. Over 3/4 of subjects reported having a dental checkup at least 1 x a year, and these persons were found to have significantly less plaque, gingivitis, and calculus compared to less frequent attenders. Acceptable brushing behavior was not associated with any particular demographic or socio-economic characteristic, while differences in acceptable flossing behavior were found among age groups. Frequencies of yearly dental checkups varied significantly within every demographic and socioeconomic characteristic.

Adolescent↗
PubMed1994

Developing measures of patients' perceptions of orthognathic surgery.

Measurements of patients' perceptions of the benefits, costs, and risks of orthognathic treatment are needed to assess the utility of alternative treatments, and to assess and improve patient education to make informed decisions. A two-part study was conducted to develop and evaluate measures assessing patients' perceptions of the benefits and risks of orthognathic surgery in comparison to an orthodontics-only approach or no treatment. The first part of this study included 49 patients who had completed orthodontics and orthognathic surgery and 34 patients considering orthognathic surgery. All patients were asked to complete an open-ended telephone questionnaire about their perceptions of the benefits and risks of orthognathic surgery and of alternative options. Patients' answers were sorted into categories, and the second part of this study included a closed-form written questionnaire to assess the perceived likelihood of possible outcomes in each category. Reliability of the questionnaire was assessed using Cronbach's alpha coefficient of internal consistency reliability. Cronbach's alpha ranged from 0.74 to 0.91 when the instrument was used to assess either overall benefits or risks of orthognathic surgery, orthodontics only, or no treatment, indicating acceptable reliability for each of these uses. Subscales concerning more narrowly defined aspects of benefits and risks were less reliable than the overall scales.

Adult↗
PubMed1993

Tooth brushing, flossing, and preventive dental visits by Detroit-area residents in relation to demographic and socioeconomic factors.

A survey was conducted to identify (a) factors that influence preventive dental behaviors and (b) target groups for interventions. Data were collected in face-to-face interviews with a probability sample of 662 dentate adults living in the Detroit tricounty area. The interviews included questions about demographic and socioeconomic variables and about three preventive behaviors: brushing, flossing, and preventive dental visits. All behaviors were positively associated with socioeconomic status. Females were more likely than males to perform each of the behaviors at the recommended frequency. The behaviors were only weakly associated with age. Whites were more likely than nonwhites to make regular dental visits, but frequency of brushing and flossing did not vary substantially across racial groups. The impact of race on frequency of dental visits was reduced when socioeconomic status was statistically controlled. Findings suggest that socioeconomic status, race, and sex remain important considerations when planning dental health education or other interventions.

Adolescent↗
PubMed1992

Conditional health threats: health beliefs, decisions, and behaviors among adults.

We combined the health belief model with the theory of subjective expected utility to derive hypotheses about the relations among health beliefs and preventive decisions. The central implication of this combination of theories is the importance of conceptualizing, measuring, and communicating about health threats in ways that are clearly conditional on action. It is important to distinguish, for example, between how susceptible to a disease a person thinks he or she would be if that person were and were not to take a preventive action. An experimental study of judgments about a hypothetical preventive action was conducted to test many of the theoretically derived hypotheses. A correlation study of dental flossing behavior was conducted to test the hypotheses as they apply to overt behavior rather than to judgment. Results of both studies supported most of the tested hypotheses, especially those related to the conditional conceptualization of health threats. Implications for theory, research methods, and practical applications are discussed.

Adult↗
PubMed1990

Reliability and validity of utilization review criteria. Appropriateness Evaluation Protocol, Standardized Medreview Instrument, and Intensity-Severity-Discharge criteria.

A study was conducted to assess the reliability and validity of the Appropriateness Evaluation Protocol (AEP), the Standardized Medreview Instrument (SMI) and the Intensity-Severity-Discharge criteria set (ISD), three utilization review instruments used to determine whether inpatient care is required. Reliability and validity were assessed for retrospective application of these instruments to charts of a sample of 119 medical cases from 21 hospitals in the state of Michigan. The reliability of each instrument was determined by having the instrument applied by two different nurse reviewers to each hospital record. Results indicated that the AEP and ISD were moderately reliable, while the SMI had low reliability. The validity of each instrument was tested by comparing the judgments of nurse reviewers using the instruments with the judgment of a panel of physicians. The AEP and ISD were found to be moderately valid and the SMI was found to have low validity. Results suggested that the SMI should not be used. The modest level of validity of the other two instruments suggests that payment should never be denied on the basis of the instrument alone. Payment should be denied only if a physician confirms the judgment based on the instrument that inpatient care was not required.

Health Maintenance Organizations↗
PubMed1989

Focused utilization review strategies.

Researchers from the Michigan Health Care Education and Research Foundation, a research affiliate of Blue Cross and Blue Shield of Michigan, compared three focused utilization review (UR) strategies to determine which method most effectively and efficiently identifies nonacute inpatient hospital admissions. Intensity, Severity, Discharge-Appropriateness (ISD-A) criteria were used to identify nonacute admissions in 8,973 cases in 73 Michigan hospitals. Significant proportions of nonacute admissions were found in medical, psychiatric, and substance abuse cases; surgical admissions had the lowest rates. Strategies involving the concentration ratio were most effective at indicating potential efficiency gains. Focused UR on Diagnosis-Related Groups (DRGs) with nonacute rates greater than 15% captured 41% of admissions and accounted for 85% of nonacute admissions, 85% of nonacute days, and 80% of potential dollar savings. This suggests that UR efforts focused primarily on DRGs with high nonacute rates would significantly improve the efficiency and effectiveness of the overall UR process.

Acute Disease↗
PubMed1989

Efficiency gains in utilization review.

A study was conducted to determine which Major Diagnostic Categories (MDCs) accounted for most of the nonessential hospital admissions in 73 Michigan hospitals in 1986. The Intensity, Severity, Discharge-Appropriateness (ISD-A) criteria set was used to identify nonessential admissions. Large concentrations of nonessential admissions were found in medical, psychiatric, and substance abuse cases; surgical admissions had low rates of nonessential hospitalization. Focusing utilization review on MDCs with nonessential rates exceeding 15% results in an examination of 44% of admissions, while capturing 77% of nonessential admissions and 73% of potential dollar savings. Implications for UR activities are discussed.

Age Factors↗
PubMed1989

The triple option choice: self-selection bias in traditional coverage, HMOs, and PPOs.

Health care costs and utilization by salaried employees and their dependents at a large self-insured midwestern industrial manufacturing corporation were analyzed for the year before employees were first offered a triple option choice. Members had the option of retaining traditional Blue Cross and Blue Shield of Michigan (BCBSM) coverage or switching to either a number of health maintenance organizations (HMOs) or a number of preferred provider organizations (PPOs). Members who switched to HMOs or PPOs were generally younger and had lower average expenses and utilization rates than those who retained the traditional BCBSM plan. The results suggest that a selection bias does occur in this population, as lower cost members were more attracted to the HMOs and PPOs than were more expensive members. Implications for the corporation as well as for the drive toward managed care alternatives are discussed.

Age Factors↗
PubMed1988

Statistical interactions in studies of physician utilization. Promise and pitfalls.

It has been suggested that use of interactive statistical models would greatly increase the proportion of variance accounted for by studies of physician utilization. The purpose of this paper is to evaluate and describe the benefits and pitfalls of using interactive statistical models of physician utilization. The paper presents Monte Carlo simulation data and real world data to determine how much more of the variance in physician utilization can be accounted for by interactive regression models. Results indicate that adding interaction terms is unlikely to produce large increases in variance accounted for. The usefulness of interactive models is particularly low when there is substantial measurement error in the predictor variables. Other advantages and disadvantages of interactive models are discussed, including 1) improved understanding, 2) inflation of alpha, 3) sensitivity to transformations and scale of measurement, and 4) confounding of interaction effects with nonlinear effects.

Computer Simulation↗
PubMedDate not supplied

Early adolescents' sexual behaviors.

The purpose of this study was to analyze changes in early adolescents' intimate behaviors and the initiation of sexual intercourse over a one-year time period. The changes are interpreted within the context of recent progress in understanding the development of early adolescents. Public school students in sixth and ninth grades of selected schools in a midwestern industrial city were studied in two waves of data collection. A total of 106 students provided data for the second year, allowing comparisons of their Time 2 with their Time 1 responses. Five of eight intimate behaviors studied increased in frequency during the year. Also, the adolescents' perceived benefits of having sexual intercourse increased and perceived costs decreased during the follow-up year. Increases in the frequency of intimate behaviors but not changes in their perceptions of the benefits and costs predicted whether or not students had initiated sexual intercourse during the follow-up period. These findings support current understanding of early adolescence as a time of incremental learning about intimacy and about sexual relationships. The findings suggest that preventing early sexual intercourse may require understanding the specific behavioral competencies related to healthful development of intimacy. Pediatric nurses can be leaders in providing the necessary counseling and education to young adolescents, their families, and their communities.

Adolescent↗
PubMedDate not supplied

Attention and symptom distress in women with and without breast cancer.

BACKGROUND: The cognitive capacity to direct attention (CDA) is essential for self-care and independent functioning. Older women may be more vulnerable to fatigue-related losses in CDA following surgery for breast cancer. Normal functional variations in CDA associated with aging might affect attentional responses in older women newly diagnosed with breast cancer, and factors such as extent of surgery or symptom distress might influence CDA over time. OBJECTIVES: To examine (a) differences in CDA and symptom distress in older women newly diagnosed with breast cancer as compared to a control group of older women without breast cancer; (b) the pattern of change in CDA and symptom distress from the pretreatment period to 3 months after surgery; and (c) to examine the relationship of CDA with symptom distress and extent of surgery over time. METHODS: Women, 55 to 79 years of age, newly diagnosed with breast cancer (N = 47), were assessed with measures of CDA and symptom distress: (a) before surgery, (b) at 2 weeks postsurgery, and (c) 3 months postsurgery. To account for normal variations associated with aging, 48 women of similar age without breast cancer were assessed following a routine screening mammogram and 3 months later. RESULTS: Before treatment, the breast cancer group scored significantly lower than the control group (p < .05) on measures of CDA and higher on symptom distress. Repeated measures ANOVA showed significant main effects of group, but not time, for the measures of CDA and symptom distress with the breast cancer group having worse status than the control group. For CDA only, there was a significant group by time interaction effect (p = .005) so that the breast cancer group showed a gradual gain in CDA over time. CONCLUSIONS: Reduced performance in a cognitive function was observed before treatment and found to persist over an extended interval in older women newly diagnosed with breast cancer.

Aged↗
PubMedDate not supplied

Predictors of adherence to nutrition recommendations in people with non-insulin-dependent diabetes mellitus.

The purpose of this study was to determine how the components of psychosocial adjustment to diabetes predict adherence to nutrition recommendations based on self-reported successful completion of contingency contracts. The relationships between the components of psychosocial adjustment and adherence to nutrition recommendations were examined in a convenience sample of patients with non-insulin-dependent diabetes mellitus participating in a contingency contracting intervention with nurses. Patients completed a standardized instrument, the Diabetes Care Profile, at the time they were enrolled into this randomized clinical trial. High and low levels of adherence to nutrition recommendations were identified by a median split of the number of contingency contracts completed for adherence to nutrition recommendations. Subjects who reported higher regimen adherence and a higher support ratio (received more diabetes-specific social support than desired) were significantly less likely to engage in contingency contracting for adherence to nutrition recommendations.

Adaptation, Psychological↗
PubMedDate not supplied

Applying the health promotion model to development of a worksite intervention.

INTRODUCTION: Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. PURPOSE: The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. SUBJECTS/SETTING: Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. DESIGN: Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. MEASURES: All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). RESULTS: Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. CONCLUSION: Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.

Adult↗