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Biomedical subjects

D Quade

Publications and source records attributed to D Quade.

At least 19 recordsLinked to original sources
PubMed1998

Statistical methodology for screening studies with qualitative/quantitative mixtures.

A statistical method for designing screening studies involving several experimental treatments compared to a standard treatment is developed. The screening study identifies the most promising experimental treatments, which then undergo more rigorous evaluation in a future, larger study. The technique is especially relevant for biopharmaceutical research and development in which phase II clinical trials are conducted to identify the most promising drug regimens, which then move on to phase III of clinical development. It is assumed that the underlying distribution of the primary efficacy random variable is a qualitative/quantitative mixture. The proposed methodology involves calculating the probability of accepting each experimental treatment compared to the standard treatment, where the criterion for acceptance is based on the proportion of qualitative observations and a measure of their location. The probability of acceptance is displayed in two dimensions using operating characteristic contour plots. The techniques are illustrated with some practical examples and some extensions are indicated.

Algorithms↗
PubMed1995

Obtaining telephone numbers for a rural Medicaid population: issues for outreach and research.

This study examined the accuracy and costs of determining whether rural, low-income Medicaid recipients did or did not have a phone, and of obtaining phone numbers for those who did. For a random sample of 209 families, we compared phone information obtained from phone books and directory assistance with information obtained from department of social services (DSS) records. DSS records identified 51% of the sample as having phones, compared with 19%-25% for phone books and directory assistance. For identifying families as having no home phone or a phone with a number that matched the one in the DSS record, phone books or directory assistance corresponded with DSS records in 52%-57% of the sample. Using phone books or directory assistance was up to 3.2 times more costly than using DSS records. The study highlighted the need to establish policies to promote the exchange of information between social services and public health agencies and researchers.

Community Health Planning↗
PubMed1995

Diversity in the rural poor: differences between households with and without telephones.

Differences between households with and without phones in the United States as a whole are well documented, but these differences, and their implications for nursing practice and research, have received little attention in nursing publications. This article 1) reviews findings from national studies of these differences and 2) reports on a nursing study that examined such differences specifically in a random sample (N = 2,053) of low-income families having children eligible for but not using the well-child services of the Medicaid program in rural North Carolina. The study was part of a randomized trial of nursing interventions to encourage parents to use these services. The analyses reported herein focus on how families with and without phones differed in health-related characteristics and in responses to the interventions. The findings have relevance for public health nurses conducting outreach or research with similar low-income families, even when the outreach or research methods do not involve phone contact.

Adult↗
PubMed1995

Increasing Medicaid child health screenings: the effectiveness of mailed pamphlets, phone calls, and home visits.

OBJECTIVES: A randomized controlled trial was conducted to test the effectiveness and cost effectiveness of three outreach interventions to promote well-child screening for children on Medicaid. METHODS: In rural North Carolina, a random sample of 2053 families with children due or overdue for screening was stratified according to the presence of a home phone. Families were randomly assigned to receive a mailed pamphlet and letter, a phone call, or a home visit outreach intervention, or the usual (control) method of informing at Medicaid intake. RESULTS: All interventions produced more screenings than the control method, but increases were significant only for families with phones. Among families with phones, a home visit was the most effective intervention but a phone call was the most cost-effective. However, absolute rates of effectiveness were low, and incremental costs per effect were high. CONCLUSIONS: Pamphlets, phone calls, and home visits by nurses were minimally effective for increasing well-child screenings. Alternate outreach methods are needed, especially for families without phones.

Adult↗
PubMed1993

Increasing mammography utilization: a controlled study.

BACKGROUND: Despite the effectiveness of breast cancer screening for women older than 50 years of age, only about one third of these women in the United States receive annual mammography. PURPOSE: This study was designed to determine if a community-wide intervention could increase use of mammography screening for breast cancer. Secondary end points were determination of changes in women's knowledge and attitudes toward mammography and physicians' self-reported screening practices. METHODS: We conducted a controlled study from January 1987 through January 1990 in two eastern North Carolina communities--New Hanover County (the experimental community) and Pitt County (the control community). Before development and implementation of the intervention program in New Hanover County and after the program had been in operation for 1 year, 500 women of ages 50-74 years and all primary-care physicians in each community were interviewed by telephone. In these interviews, we determined the use of mammography for breast cancer screening and the knowledge and attitudes about it. We also established the number of screening mammograms performed in 1987 and 1989 in each county and reviewed medical records to determine the percentage of women the physicians had referred for mammograms. RESULTS: The percentage of women who reported receiving a mammogram in the previous year increased from 35% to 55% in the experimental community and from 30% to 40% in the control community (difference of differences, 10%; P = .03 after adjustment for race, education, age, and having a regular doctor; 95% confidence interval, 1%-18%). Increases were greater in New Hanover County regardless of age, race, income, and education. However, the increase was less for Black women than for White women, both overall and in most demographic subgroups. The total number of mammograms performed increased 89% in the experimental community and 45% in the control community. Women's knowledge about mammography changed little, but the intention to get a mammogram increased 30% in New Hanover County, compared with a 17% increase in Pitt County--a statistically significant difference (P < .01). Physician reports and medical record reviews in the two communities showed similar increases in the number of mammograms ordered. CONCLUSIONS: A community-wide effort to increase use of breast cancer screening was successful, but more work must be done to reach the National Cancer Institute's goal of annual mammograms for 80% of women of ages 50-74.

Age Factors↗
PubMed1992

Panic, suicide, and agitation: independent correlates of the TSH response to TRH in depression.

We investigated the relationship between suicidality, agitation, panic attacks, and the thyrotropin-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH), and tested the hypothesis that panic would account for the association between a reduced TSH response and the other conditions. Twenty-seven euthyroid primary unipolar depressed inpatient women received a TRH test and systematic psychiatric assessment. Panic attacks were insufficient to explain the link between the TSH response and suicidal intent, lethality, and agitation; each condition was independently associated with a lower TSH response. In an additive fashion, copresence of conditions further reduced TSH response. The symptom constellation of panic, agitation, and suicidality in depression may correlate with the greatest reduction in TSH response.

Adolescent↗
PubMed1992

Circulating natural killer cell phenotypes in men and women with major depression. Relation to cytotoxic activity and severity of depression.

The effects of major depression on peripheral blood natural killer cell phenotypes and natural killer cell activity were studied by comparing depressed and normal control subjects. Depressed subjects exhibited (1) significant reductions in Leu-11 (CD16) natural killer effector cells and natural killer cell activity and (2) a dissociation of the normal positive correlation between the percentage of Leu-11 cells and natural killer cell activity. These findings suggest that alterations in the availability and the killing capacity of circulating Leu-11 natural killer cells appear to be responsible for depression-related reductions in natural killer cell activity. Moreover, men with major depression showed marked reductions in Leu-11 cells, natural killer cell activity, and Leu-7 (HNK-1) lymphocytes compared with normal control men. By contrast, depressed women did not differ significantly from normal control women on any of these three immune function measures. Severity of depression as assessed by Hamilton Rating Scale for Depression scores was not associated with natural killer cell activity or Leu-7 lymphocyte levels in either men or women with major depression. Hamilton Rating Scale for Depression severity ratings were, however, strongly inversely correlated with Leu-11 lymphocyte counts among men, but not women, with major depression. These data begin to elucidate the immunological mechanisms by which natural killer cell activity is altered in depression and suggest that some measures of immunity may be differentially affected in male and female subjects with the syndrome of major depression.

Adolescent↗
PubMed1992

Relationship of object loss during development to hypothalamic-pituitary-adrenal axis function during major affective illness later in life.

Although many studies have attempted to determine whether early object loss influences the risk of developing major affective illness in adulthood, there are few empirical data relating early loss to subsequent hypothalamic-pituitary-adrenal (HPA) axis dysfunction in adulthood. Forty-five psychiatric inpatients admitted for an active major affective illness, all of whom had a previous history of a significant permanent object loss (by death only), were studied retrospectively in this preliminary investigation to examine whether the type and timing of object loss experienced earlier in life would discriminate affectively ill patients who exhibit HPA dysfunction. Several loss variables were found to be statistically significant predictors of cortisol responses following glucocorticoid challenge. A median split of the distribution was used to classify patients into early loss (< or = 19 years) and late loss (> or = 20 years) groups. Analyses for all subjects, early and late loss combined, showed that late loss was associated with higher 11 p.m. cortisol levels. Within the early loss group, however, age of first loss was the most significant predictor of 4 p.m. cortisol levels after dexamethasone challenge. Consistent with the hypothesis that childhood object loss may be associated with long-term alterations in HPA axis function, younger age of loss correlated significantly with higher 4 p.m. cortisol responses. These preliminary data suggest that future prospective investigation of the neurobiological as well as psychosocial consequences of various types of early loss warrant further study.

Adult↗
PubMed1992

Evidence for normal feedback inhibition of triiodothyronine on the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) in abstinent male alcoholics.

Disturbances in the hypothalamic-pituitary-thyroid (HPT) axis have been reported in abstinent, noncirrhotic alcoholics, including a reduction in thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) and reductions in triiodothyronine (T3). Some evidence has suggested that a portion of alcoholics may also exhibit a disturbance in the feedback inhibition of thyroid hormone on TSH release. To evaluate the function of the HPT axis negative feedback system in abstinent, noncirrhotic alcoholic men we compared the TSH response with TRH before and after a standard suppressive dose of T3. Ten alcoholic subjects were studied and compared with four control subjects from a previous study and to literature values. The mean percent reduction in TSH response in the alcoholic subjects of 74 +/- 7% was almost identical to the 71 +/- 9% reduction observed in normal subjects. The present findings indicate that noncirrhotic, abstinent alcoholic men exhibit normal suppression of the TSH response to TRH following T3.

Adult↗
PubMed1992

Abnormal diurnal variation in circulating natural killer cell phenotypes and cytotoxic activity in major depression.

This investigation tested the hypothesis that depressed patients have abnormal diurnal variation of natural killer (NK) cell measures. The diurnal variation of levels of Leu-11 NK cells and NK cytotoxic activity was significantly less in 24 patients with major depression than in 24 normal comparison subjects. These findings provide evidence that aspects of immune, as well as neural and endocrine, chronobiology are abnormal in depression.

Adult↗
PubMed1992

Measuring the use of mammography: two methods compared.

Population studies often estimate mammography use using women's self-reports. In one North Carolina county, we compared self-report surveys with a second method--counting mammograms per population--for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.

Aged↗
PubMed1991

Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling.

Smokers requesting self-help materials for smoking cessation (N = 2,021) were randomized to receive (a) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (b) the same self-quitting guide with a support guide for the quitter's family and friends, (c) self-quitting and support guides along with four brief counselor calls, or (d) a control guide providing motivational and quit tips and referral to locally available guides and programs. Subjects were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control subjects achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-month quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates.

Behavior Therapy↗
PubMed1991

Specialty roles in community health nursing: a national survey of educational needs.

This study identified population groups, health conditions, and employment settings considered appropriate for graduate-level community health nursing (CHN) practice and employment, and described the relative importance of each of these areas as assessed by CHN leaders. According to 588 leaders in CHN service and education, (1) the population groups most in need of graduate-prepared CHNs are the elderly, persons of low socioeconomic status, the homeless, adolescents, and the unemployed; and (2) the health conditions most in need of CHN services are AIDS, pregnancy and prenatal problems, low birth weight and infant mortality, stress-related illness, and Alzheimer's and other chronic diseases of the elderly. Among the many employment settings rated as having a great need for CHNs are state and local health departments and home health agencies. The findings provide the direction and justification for developing specialty options within CHN that correspond to these identified and changing needs. This article provides suggestions and possible alternatives for initiating educational change to prepare graduate-level CHNs for these various specialties and for the settings in which the specialties will be applied.

Community Health Nursing↗
PubMed1991

The detection of depression by patient self-report in women with gynecologic cancer.

We examined the utility of patient self-report forms in identifying those gynecologic oncology patients who would be diagnosed by an experienced consultation-liaison psychiatrist as suffering from major depression. Sixty-five women with gynecologic tumors were evaluated by a consultation-liaison psychiatrist, using standardized (DSM-III) criteria. Each patient also completed a Carroll Rating Scale for Depression (CRS). The CRS demonstrated sensitivity and specificity of 87 percent and 58 percent, respectively. Used as a screening instrument to rule out depression, the CRS yielded a negative predictive value of 94 percent. We identified a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of gynecologic tumors, and compared the performance of this non-cancer related symptoms subscale (NCSG) to that of the CRS. The NCSG did not significantly outperform the CRS; its sensitivity and specificity were 87 percent and 62 percent, respectively. Because our study population was relatively homogeneous (i.e., non-ovarian gynecologic oncology patients without severe debilitation who were not receiving chemotherapy, radiation therapy, or other invasive procedures), the findings should not be generalized to other oncologic populations at this time. Our results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression.

Adult↗
PubMed1990

Statistical analysis of repeated measures in psychiatric research.

We examined the statistical methods applied to research studies that used parallel-groups repeated measures designs. Sixty-three of the 343 articles that were published in four major psychiatry research journals during a 6-month period contained data of this type. Seven (11%) of the 63 articles applied a multivariate analysis of variance. Four (6%) used a univariate analysis of variance with an adjustment for correlated measures. Ten (16%) used a univariate analysis of variance without an adjustment for correlated measures. Twenty (32%) either reduced their repeated measurements to a single value, such as a maximum-change score in each group, or carried out multiple tests at several time points. Twenty-two (35%) of the reports did not provide enough information to allow readers to determine the type of analysis that was applied. We discuss the appropriate selection of analytical techniques for repeated measures designs.

Humans↗
PubMed1990

A hospital quit-smoking consult service: clinical report and intervention guidelines.

A minimal-contact quit-smoking consult service was established to treat hospital inpatients and outpatients referred for behavioral smoking cessation treatment. Sixty-two consecutively referred patients were evaluated and triaged to one of three standardized quitting protocols: motivational counseling; standard behavioral abstinence counseling; or abstinence counseling plus nicotine fading. Consultations included personalized self-quit materials and planned telephone follow-up to enhance compliance. Triage differentiated patients with different levels of quitting readiness and nicotine dependence. Six months after treatment, 27% of patients had quit smoking (informant-verified). Predictors of quit attempts were shorter smoking history and lower nicotine dependence. Variables predicting cessation or substantial reductions in estimated daily nicotine intake included higher educational level, stronger beliefs in smoking health harms, higher trait anxiety, a greater desire to quit and quitting self-efficacy, and the recall of direct quitting advice from the referring physician. Results compare favorably with those of more intensive treatments with similar patient groups. Recommendations are presented for controlled follow-up research to explore promising findings in this clinical report.

Adult↗
PubMed1990

Public health nursing interventions to improve the use of a health service: using a pilot study to guide research.

This article demonstrates how a pilot study can provide useful direction for a research project. In planning a study to improve the use of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for Medicaid-eligible children, we tested our research methods and interventions (mailed pamphlets, telephone calls, home visits) on a small scale (N = 100) prior to implementing a large-scale (N greater than 2000) project. The issues and obstacles included obtaining cooperation from many agencies involved in administering the Medicaid program, addressing informed consent, assessing feasibility of methods for random sampling and random assignment, identifying sources of Medicaid data, designing and assessing validity and reliability of research tools, and testing the feasibility of implementing interventions in the field. Our experience may be particularly helpful for public health nurses who plan to investigate approaches to improve the use of services in federally mandated health programs where cooperation from federal, state, and local agencies is required.

Adolescent↗