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Biomedical subjects

David K Ahern

Publications and source records attributed to David K Ahern.

11 recordsLinked to original sources
PubMed2006

What is eHealth (6): perspectives on the evolution of eHealth research.

BACKGROUND: The field of eHealth holds promise for supporting and enabling health behavior change and the prevention and management of chronic disease. OBJECTIVE: In order to establish areas of congruence and controversy among contributors to the early development, evaluation, and dissemination of eHealth applications, as well as the desire to inform an evaluation research funding agenda, 38 semistructured, qualitative interviews were conducted among stakeholders in eHealth between May 2002 and September 2003. METHODS: Participants were asked about their perspectives on the credibility, value, and future potential of information technology for health behavior change and chronic disease management. Interviews were coded and analyzed for emergent themes using qualitative methods. RESULTS: Consistent themes were identified across stakeholder groups, with slight differences in emphasis. These topics included the following: (1) consensus and standardization-most stakeholders expressed a strong desire for a more coordinated, rigorous effort to define and integrate the field; (2) evaluation methods and challenges-demonstrating outcomes is required to establish eHealth quality and efficacy, but stakeholders were not satisfied with the sensitivity, validity, and reliability of existing outcome measures; (3) quality, value, and future potential-the intersection between eHealth's potential cost-effectiveness, efficiency, and improved clinical status among users generated a high degree of interest; and (4) health disparities-many stakeholders contended that traditionally underserved populations will particularly benefit from eHealth applications, although others argued that the underserved are also disadvantaged in terms of access to technology. CONCLUSIONS: Recommendations included the need for improvement and formalization of development and evaluation standards across private and public sectors, additional research on the technology needs and preferences of traditionally underserved populations, and long-term epidemiologic studies of the impact of eHealth on outcomes and cost-effectiveness.

Chronic Disease↗
PubMed2004

Cognitive behavior therapy for hypochondriasis: a randomized controlled trial.

CONTEXT: Hypochondriasis is a chronic, distressing, and disabling condition that is prevalent in ambulatory medical practice. Until recently, no specific treatment has been clearly demonstrated to be effective. OBJECTIVE: To assess the efficacy of a cognitive behavior therapy (CBT) for hypochondriasis. DESIGN: A randomized, usual care control group design, conducted between September 1997 and November 2001. The individual primary care physician was the unit of randomization, and all patients clustered within each physician's practice were assigned to the experimental treatment (individual CBT and a consultation letter to the primary care physician) or to the control condition. Subjects were assessed immediately before and 6 and 12 months after the completion of treatment. SETTING AND PARTICIPANTS: Participants were 80 patients from primary care practices and 107 volunteers responding to public announcements, all of whom exceeded a predetermined cutoff score on a hypochondriasis self-report questionnaire on 2 successive occasions. INTERVENTION: A scripted, 6-session, individual CBT intervention was compared with medical care as usual. The CBT was accompanied by a consultation letter sent to the patient's primary care physician. MAIN OUTCOME MEASURES: Hypochondriacal beliefs, fears, attitudes, and somatic symptoms; role function and impairment. RESULTS: A total of 102 individuals were assigned to CBT and 85 were assigned to medical care as usual. The sociodemographic and clinical characteristics of the 2 groups were similar at baseline. Using an intent-to-treat analytic strategy, a consistent pattern of statistically and clinically significant treatment effects was found at both 6- and 12-month follow-up, adjusting for baseline covariates that included educational level, generalized psychiatric distress, and participant status (patient vs volunteer). At 12-month follow-up, CBT patients had significantly lower levels of hypochondriacal symptoms, beliefs, and attitudes (P<.001) and health-related anxiety (P =.009). They also had significantly less impairment of social role functioning (P =.05) and intermediate activities of daily living (P<.001). Hypochondriacal somatic symptoms were not improved significantly by treatment. CONCLUSION: This brief, individual CBT intervention, developed specifically to alter hypochondriacal thinking and restructure hypochondriacal beliefs, appears to have significant beneficial long-term effects on the symptoms of hypochondriasis.

Adult↗
PubMed2004

Feasibility of incorporating computer-tailored health behaviour communications in primary care settings.

BACKGROUND: We set out to investigate the feasibility of incorporating a computer-tailored health behaviour program into routine care in a group of primary care practices in Rhode Island. METHODS: Two existing computer programs (physical activity, smoking) that tailored text and graphical feedback to survey responses were combined and adapted for use in primary care directly by patients. Ten primary care practices were recruited and worked closely with project staff to develop a practice-specific plan for incorporating the program into the workflow and office routine. Feasibility was measured by the percentage of patients who used the program during the day of their visit. RESULTS: Only one of the ten offices was able to successfully incorporate the program into their office workflow and delivery of routine care. The main categories of barriers to incorporating the computer program into routine care included: the program was viewed overall as inconsistent with practice workflow, the staff was inexperienced with the program, technical problems with the computer and/or printer, the program placed an additional time burden on staff who already felt overworked. Suggestions for improving the program or the way that it was incorporated into routine care included: shortening the program, modifying the program's orientation to a target population (such as patients with hypertension) and incorporating decision-support feedback to help physicians manage the target condition, modifying the program to include other programs pertinent to primary care (for example, depression screening), selecting patients to use the program, rather than asking all patients to use it. CONCLUSIONS: After working closely with ten highly motivated primary care offices, we were unable to fully implement a point-of-care health behaviour computer system for patients and providers. Suggestions for disseminating computer-tailored health behaviour communications in primary care settings are discussed.

Feasibility Studies↗
PubMed1988

Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls.

According to myogenic models that relate abnormal EMG patterns to the experience of pain, lumbar paravertebral muscle activity has been considered to play an important role in chronic low back pain. In the present study, 40 chronic low back pain patients and 40 matched non-patient controls were compared on lumbar paravertebral EMG during mechanically stabilized static and dynamic postures. Differences between groups in lumbar curvature and spinal range of motion were determined using a dual goniometer technique. Although the two groups did not differ on absolute levels of EMG during quiet standing, significant differences were found for EMG patterns during dynamic postures. In addition, most patients did not show the flexion-relaxation response or the expected pattern of EMG responses during trunk rotation, most likely because of restricted range of motion and/or compensatory posturing. These findings provide support for the biomechanical model of chronic pain and indicate the need for further research pertaining to pain behavior and movement-related lumbar muscle activity.

Adult↗
PubMed1988

Expectancies and functional impairment in chronic low back pain.

Perceived self-efficacy [2] and pain response expectancies [13] were examined as correlates of movement limitations and impaired functioning in a sample of 40 patients with chronic low back pain. Self-efficacy was operationalized as patients' ratings of their ability to perform movements, while response expectancies were operationalized as ratings of the degree of pain expected to accompany the movements. Patients predicted their ability to perform 10 simple movements and the degree of pain that would accompany each movement; on a separate occasion, subjects' actual performance of the movements was assessed. In general, independent predictions of both movement ability and pain correlated significantly with performance of specific movements as rated from videotapes. Total movement scores correlated 0.55 and -0.54, respectively, with total self-efficacy and pain response expectancy ratings. Expectancy ratings were also predictive of average daily pain ratings and questionnaire ratings of physical impairment in everyday life. Multiple regression analyses, including causal modeling, indicated that actual performance was best predicted by self-efficacy ratings, which in turn appeared to be determined by pain response expectancies.

Aged↗
PubMed1985

The sickness impact profile: a global measure of disability in chronic low back pain.

This investigation examines the utility of the Sickness Impact Profile (SIP) for assessing disability associated with chronic pain and presents normative data on a sample of 107 patients experiencing chronic low back pain (CLBP). The results support the validity of the SIP as a measure of functional status with CLBP patients. Specifically, the psychosocial dimension was significantly correlated with the emotional distress categories of the MMPI and the physical dimension score was inversely associated with standing/walking and positively correlated with time spent lying down. In addition, the SIP appears to be a measure with sufficient sensitivity to detect pre-/post-treatment changes. Patients suffering from CLBP show significant impairment in physical, psychosocial, and work and recreational activities. The greatest impairment reported was in the area of work, but disability ratings for recreation, home management, social interaction, emotional behavior, and sleep and rest were also comparatively high. Based upon its reliability, validity, breadth of assessment, and ease of administration, the SIP appears to be well suited for the assessment of patients suffering from chronic pain and evaluating the efficacy of multidisciplinary pain units.

Activities of Daily Living↗
PubMed1984

Evaluation of a daily activity diary for chronic pain patients.

The present study examined the reliability and validity of a daily activity diary for chronic pain patients. The diary assesses various postures and activities including time spent lying, sitting, or standing/walking, the use of pain relief devices, time spent in pain relief activities, and the use of analgesic medications. The methodology compared patient self-report on the daily activity diary to spouse observations of the same activities. In addition, patient self-report of uptime/downtime was compared to the objective assessment of uptime/downtime by an automated electromechanical device. Reliability coefficients for the daily activity diary categories were all positive and statistically reliable as were correlations between patient and spouse ratings on lying down time, time spent standing/walking, and pain intensity. Also, patient self-report of medication use correlated significantly with spouse pill count. Finally, the correlation between patient report of lying down time and downtime as measured by the electromechanical monitor was also positive and highly significant. These results indicate that the daily activity diary is a reliable and valid instrument for the assessment of daily activity patterns of chronic pain patients in their natural environment. These results are discussed in relation to other research and the use of daily diaries for assessment and treatment outcome research with this population.

Activities of Daily Living↗
PubMedDate not supplied

Mapping the road from childhood trauma to adult somatization: the role of attachment.

OBJECTIVE: This study tested whether insecure attachment mediates the link between childhood trauma and adult somatization. METHODS: A community sample of 101 couples completed self-report measures, including the Relationship Scales Questionnaire, the Childhood Trauma Questionnaire, the Somatic Symptom Inventory, the Beck Depression Inventory, and the Conflict Tactics Scale. RESULTS: Childhood trauma was associated with higher levels of somatization and insecure attachment. Insecure attachment style was also associated with higher levels of somatization. Controlling for age, income, and recent intimate partner violence, analyses showed that fearful attachment fully mediated the link between childhood trauma and somatization for women. For men, there was no such mediation, but both childhood trauma and insecure attachment styles made independent contributions to predicting levels of somatization. CONCLUSIONS: Findings are consistent with the hypothesis that, for women, childhood trauma influences adult levels of somatization by fostering insecure adult attachment. For men, findings suggest that trauma and attachment are both important independent predictors of adult somatization. Study results support the idea that childhood trauma shapes patients' styles of relating to others in times of need, and these styles, in turn, influence the somatization process and how patients respond to providers. Screening for attachment style may provide information that could allow health care providers to tailor treatment more effectively.

Adolescent↗
PubMedDate not supplied

Patients' perceptions of cholesterol, cardiovascular disease risk, and risk communication strategies.

PURPOSE: Despite some recent improvement in knowledge about cholesterol in the United States, patient adherence to cholesterol treatment recommendations remains suboptimal. We undertook a qualitative study that explored patients' perceptions of cholesterol and cardiovascular disease (CVD) risk and their reactions to 3 strategies for communicating CVD risk. METHODS: We conducted 7 focus groups in New England using open-ended questions and visual risk communication prompts. The multidisciplinary study team performed qualitative content analysis through immersion/crystallization processes and analyzing coded reports using NVivo qualitative coding software. RESULTS: All participants were aware that "high cholesterol" levels adversely affect health. Many had, however, inadequate knowledge about hypercholesterolemia and CVD risk, and few knew their cholesterol numbers. Many assumed they had been tested and their cholesterol concentrations were healthy, even if their physicians had not mentioned it. Standard visual representations showing statistical probabilities of risk were assessed as confusing and uninspiring. A strategy that provides a cardiovascular risk-adjusted age was evaluated as clear, memorable, relevant, and potentially capable of motivating people to make healthful changes. A few participants in each focus group were concerned that a cardiovascular risk-adjusted age that was greater than chronological age would frighten patients. CONCLUSIONS: Complex explanations about cholesterol and CVD risk appear to be insufficient for motivating behavior change. A cardiovascular risk-adjusted age calculator is one strategy that may engage patients in recognizing their CVD risk and, when accompanied by information about risk reduction, may be helpful in communicating risk to patients.

Adult↗