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Biomedical subjects

J A Earp

Publications and source records attributed to J A Earp.

At least 55 records · Page 3Linked to original sources
PubMed1989

Accuracy of women's self-report of their last Pap smear.

We compared interview data and physician records on when women last had a Pap smear in a sample of 98 rural Black women. We found 20 per cent of women could not accurately report on whether a Pap smear had been done within three years (sensitivity = 0.95, specificity = 0.47). Source of gynecological care and perceived barriers to obtaining a Pap smear but not education were associated with inaccurate reports. Self-report may be a misleading measure of Pap smear screening in comparable groups of women.

Adolescent↗
PubMed1988

Reasons for patients' delay in response to symptoms of acute myocardial infarction.

Survival in the acute phase of myocardial infarction and the subsequent prognosis are critically dependent on the time between onset of symptoms and medical intervention. Studies have shown that the time that patients take to decide to seek help accounts for most of the delay. We documented the length of time from onset of symptoms to arrival in hospital for 201 patients consecutively admitted to one of four hospitals in the Regional Municipality of Ottawa-Carleton between October 1986 and February 1987 for suspected acute myocardial infarction. Of the 160 survivors 42% waited more than 4 hours (a critical time for effective thrombolytic therapy) before coming to hospital, and nearly a third did not arrive within 6 hours. On the basis of interviews conducted with 42 patients, sociodemographic factors, education, past experience with an acute myocardial infarction, a previous diagnosis of angina and a coronary-prone behaviour pattern did not explain the delay. How patients perceived the seriousness of their symptoms and how they used other illness-related coping strategies explained 46% of the variance in the delay. Interventions aimed at reducing the delay between onset of symptoms and treatment must focus on patients' preadmission behaviour.

Adaptation, Psychological↗
PubMed1988

Day care center illness: policy and practice in North Carolina.

We surveyed 62 North Carolina day care centers (DCCs) to determine their policies for excluding children. We found that the addition of a temperature of 100-101 degrees F to each of eight symptoms was associated with an increase in the percentage of DCCs choosing "immediate pick-up." Non-profit centers were more likely to send children home (70 per cent) than for-profit centers (48 per cent). Centers with and without written illness policies did not differ in their management of sick children.

Adult↗
PubMed1988

Day-care center exclusion of sick children: comparison of opinions of day-care staff, working mothers, and pediatricians.

Day-care center staff are often faced with the decision of whether to send sick children home. Some pediatricians may question the criteria used by day-care centers to exclude children who have mild infectious illnesses. To determine whether there is a consensus on illness policy, we asked day-care center staff, mothers, and pediatricians which sick children in day care should be excluded. Randomly selected day-care center staff, mothers, and pediatricians in three North Carolina counties completed self-administered questionnaires. We asked how combinations of temperature and symptoms that occur with common childhood infections should affect the staff's decisions to "call the parent for immediate pickup." Response rates were 302 of 347 staff (87%), 134 of 200 mothers (67%), and 69 of 80 pediatricians (86%). A temperature of 37.2 degrees to 37.7 degrees C (99 degrees to 99.9 degrees F) was considered a fever by 35% of staff, 24% of mothers, and 6% of pediatricians (P less than .01). At every level of elevated temperature from 37.2 degrees to 38.9 degrees C (99 degrees to 102 degrees F), day-care center staff were more likely to request immediate pickup than mothers or pediatricians (P less than .01). For each of eight symptoms and for all three groups of respondents, the addition of a temperature of 37.8 degrees C (100 degrees F) increased the proportion of children sent home (P less than .01). Day-care center staff, mothers, and pediatricians differ in their reported exclusionary practices for ill day-care children.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Day Care Centers↗
PubMed1988

Accuracy of chart diagnoses of alcoholism in patients with a history of psychosis.

At two psychiatric clinics, 76 patients with a history of psychosis were interviewed by a researcher blind to the presence or absence of a chart diagnosis of alcoholism. Another person blind to research diagnosis ascertained the chart diagnosis of alcoholism. The lifetime prevalence of alcoholism, according to a structured research interview, was 45% at a mental health center, and 29% at a teaching hospital clinic. When compared to the lifetime prevalence of alcoholism, as determined by the research interview, chart diagnoses had sensitivities of 21% and 20%, respectively; specificity was 100% at both sites. Psychiatric chart diagnoses are not sensitive indicators of psychiatric patients' alcoholism.

Alcoholism↗
PubMed1987

Sick child care options: what do working mothers prefer?

More than half of all mothers with children under age 6 are in the labor force. Working mothers must take off anywhere from 5.6 days to 28.8 days per employee per year to care for their sick children. In a survey of 134 working mothers with children in day care centers, 70% expressed an interest in sick child care options outside the home, especially a sick room at the child's regular day care center or an infirmary at the parent's workplace. Mothers who chose "out-of home care" were more likely to: be minority (p less than 0.01); be single parents (p = 0.06); earn less than $10,000 annually (p = 0.03); want their children with temperatures of 100-100.9 F to remain in school until the end of the day (p less than 0.01). Communities and day care centers serving especially lower income, minority or single-parent working mothers should consider investigating these out-of-home sick child care options; the savings to employers could be $2 to $12 billion per year, not to speak of the personal savings to the mothers themselves.

Absenteeism↗
PubMed1985

Seat belt use laws: the influence of data on public opinion.

Motor vehicle crashes are a major public health problem. Mandatory seat belt use laws capable of lessening the highway death and injury toll have recently received a great deal of public attention. Public opinions toward such laws were assessed in a representative sample of 410 North Carolina drivers. In our experimental design, subjects were randomly assigned to receive one of six types of data expressing the effectiveness of the proposed mandatory and the current voluntary policies. A comparison group received no data. Exposure to data about the effectiveness of the proposed seat belt law was strongly predictive of policy preferences, though the specific type of data did not appear to have an influence. Additional characteristics predictive of policy preferences included attitudes toward other government regulations, beliefs about the effectiveness of seat belts, and personal seat belt use. The findings suggest that health educators need to continue to provide the public with data about potential safety regulations. Furthermore, health educators, to be more effective, should target information toward certain critical beliefs such as those about the relative effectiveness of a particular policy.

Humans↗
PubMed1985

Epidemiologic evidence and motor vehicle policy making.

After being randomly assigned to receive policy effectiveness information expressed as attributable benefit, attributable risk, or relative risk, 318 graduate students were asked to indicate their preferences for the current voluntary seat belt use policy, a mandatory seat belt policy, or mandatory passive restraints. A control group received no data. Exposure to effectiveness information (any type) was significantly associated with favoring either mandatory seat belts or passive restraints over the current policy. Those exposed to attributable benefit or risk data were more apt to make proregulatory choices than subjects exposed to relative risk data. Attitudes toward government regulation and specific views about personal freedom and policy effectiveness were also found to be significant predictors of policy preference.

Accidents, Traffic↗
PubMed1984

Measuring the continuity and coordination of medical care in a system involving multiple providers.

Patients often receive medical care from many different providers. Consequently, the various episodes of care may not be integrated into a meaningful whole, and the quality of care may suffer. Before this possibility can be evaluated, it is necessary to develop a measure of the integrating process. The authors studied the continuity and coordination of care for 197 patients attending the General Medicine Practice within a large teaching hospital. Each patient had one internist as primary physician; however, a broad array of special services were available at the hospital and were often required. Of 1,768 total visits to the hospital, 62.2% were scheduled to the practice, whereas 92.9% were with the primary physician. For visits outside the practice, coordination (defined as the percent of visits for which the primary and other physicians were aware of each other's contact with shared patients) was 35.2%. Only 74.4% of all visits were either continuous or coordinated. Continuity with a single provider may be determined by patients' needs for services by others. A combined measure of continuity with coordination, such as the one used in this study, is more appropriate for a setting with multiple providers.

Continuity of Patient Care↗
PubMed1984

The effect of mothers' social support and life changes on the stimulation of their children in the home.

The relationship between mothers' life changes, social support, and the preschool home environment of their children was analyzed three years after all study children were discharged from a neonatal intensive care unit. The number of reported life changes occurring to mothers since the births of the children in the group was not related to the amount of home stimulation mothers provided their children; however, mothers reporting more social support provided a more stimulating home environment unrelated to the number of life changes.

Child, Preschool↗
PubMed1984

Attitudes of internal medicine subspecialty fellows toward primary care.

Subspecialists deliver a substantial proportion of primary care but little is known about how their training affects their attitudes toward this role. We surveyed a department of medicine to determine fellows' (N = 34) attitudes toward primary care and how these compared with the attitudes of house staff (N = 45) and faculty (N = 66). Continuous, coordinated, and accessible care as departmental policy was almost unanimously endorsed by all physicians. In contrast, fellows less often supported the provision of such care for their own patients in actual clinical situations. Fellows were also less likely than either house staff or faculty to endorse primary care attributes for their own patients. Departments of medicine should examine how negative attitudes toward primary care develop in subspecialty fellows and whether these attitudes persist after fellowship.

Academic Medical Centers↗
PubMed1983

Patients' priorities for medical care.

Relatively little research has been done on the importance patients attach to various aspects of their medical care when their options are constrained. We studied priorities for care among 225 patients attending the medical clinics of a university teaching hospital. Eight attributes of medical care were considered: continuity, coordination, comprehensiveness, availability, convenience, cost, expertise, and compassion. Priorities were established by the method of paired comparisons. Continuity of care was the highest priority for these patients, while cost and convenience were lowest. Priorities varied in subgroups of patients defined by demographic, illness, and utilization characteristics. Patients with acute problems preferred coordination and expertise, while those with chronic problems ranked continuity higher. Patients younger than 30 years old valued coordination most; older patients preferred continuity and comprehensiveness. Since all aspects of medical care cannot be provided to all people, and choices are necessary, patients' priorities should be considered when planning health services.

Adolescent↗
PubMed1983

The determinants of dropping out of care among hypertensive patients receiving a behavioral intervention.

Predictors of dropping out of care were examined for 171 treated hypertensive patients enrolled in a randomized trial of social support strategies designed to improve compliance and blood pressure control. Control patients who continued to receive routine care were more than twice as likely to drop out as patients who received routine care and periodic home visits by nurses or pharmacists (odds ratio [OR] = 2.7). The combination of home visits and a second intervention, having family members monitor patients' blood pressure and compliance behavior, was no more effective than home visits alone (OR = 1.1). The home visits intervention was one of six variables identified by a stepwise regression as significant predictors of dropping out. Patients with four or more high-risk characteristics constituted 15% of the sample but contributed almost half (46%) of the dropouts. Targeting support strategies at high-risk patients may be a cost-effective means of reducing uncontrolled hypertension.

Adult↗
PubMed1982

Manual ability as a marker of dependency in geriatric women.

Little is known about the factors responsible for the institutionalization of the elderly. This study's objective was to discover markers associated with nursing home placement. Fifty-six white ambulatory women over 63 yrs of age were selected from 3 settings encompassing a range of dependency: 20 women from nursing homes; 16 women who lived in their own homes but requiring social assistance and 20 totally independent women. Each woman was examined for factors that might be associated with her state of dependency: age, socioeconomic status, morale, education, strength of social network, number and type of medications, mental status, manual ability, medical problems and abnormalities on physical examination. The time required to perform any of 27 manual skills discriminated the 3 groups better than any other factor (P less than 0.0001). Three manual skills predicted group membership with 92% accuracy. Manual ability may be the best marker of dependency in elderly women and should be measured in studies concerned with geriatric health status.

Activities of Daily Living↗
PubMed1982

The effects of family involvement and practitioner home visits on the control of hypertension.

The effectiveness of two social support strategies designed to lower hypertensive patients' blood pressure were compared to each other and to a control group (N = 63) receiving routine care in a randomized clinical trial extending over a period of two years. Group 1 (N = 99) received visits and had family members actively participate in their care through home blood pressure monitoring; Group 2 (N = 56) received home visits from nurses and pharmacists. All groups were predominantly Black. After the first year of the trial, the proportion of patients with uncontrolled diastolic blood pressure (greater than or equal to 95mm Hg) had declined significantly for all three groups; no group showed a statistically significant advantage. However, during the last six months of the second year (after visiting had ended), both Groups 1 and 2 demonstrated clear superiority in DBP control over Group 3, achieving borderline statistical significance (p = .07) when multivariable analysis was performed to control for potential confounders. Supplementing routine care with periodic home visits produced an additional 21 per cent of patients with well-controlled DBP, while involving family members plus visits produced a 17 per cent improvement in the percentage of patients with DBP less than 95mm Hg. However, neither support strategy was clearly more effective than the other over time. The efficacy of the interventions is discussed with respect to cost and feasibility of implementation.

Allied Health Personnel↗