Biomedical subjects

James E Rohrer

Publications and source records attributed to James E Rohrer.

At least 19 recordsLinked to original sources

PubMed2006

Risk of mistaken DNR orders.

A questionnaire study was carried out among attendants at a community cancer center to determine the subjects' preferences and understanding of the meaning of do-not-resuscitate (DNR). Only 34% correctly understood the meaning of DNR, and 66% thought that DNR was administered only to prolong life without realizing that a DNR decision would result in not being resuscitated even if the cause of the sudden death was potentially reversible. We then determined the subjects' preferences if they had developed a treatment complication needing resuscitation and be put on the ventilator machine temporarily. When the subject was not expected to be alive in 6 months, the preference for resuscitation was not related to correct understanding. However, when the chance of cure was 30%, a preference for resuscitation was related to an incorrect understanding of the meaning of DNR. About 70% of respondents who would accept ventilator care had an incorrect understanding of DNR. The adjusted odds for the correct understanding of DNR were less for respondents who preferred resuscitation. The adjusted odds ratio (AOR) was 0.58 (CI: 0.35-0.93) (p=0.02) after adjusting for age and 0.53 (CI: 0.32-0.86) (p=0.01) after adjusting for both age and treatment group. These results suggest that physicians should be open to the possibility that patients may not always understand what DNR means, and they may be placed on DNR by mistake.

Adult↗

PubMed2006

The relationship between obesity, hyperglycemia symptoms, and health-related quality of life among Hispanic and non-Hispanic white children and adolescents.

BACKGROUND: The current study was conducted to evaluate the effects of overweight, hyperglycemia symptoms, Hispanic ethnicity, and language barriers on health-related quality of life (HRQoL) among children and adolescents. METHODS: Parents'/guardians of a population based sample of 5530 children between ages 3 and 18 were administered the parents' version of the KINDL survey instrument to assess HRQoL in children and adolescents. Multiple linear regression analysis was used to assess relationships between HRQoL, body mass index, and hyperglycemia symptoms categories. RESULTS: The mean age of children was 10.6 (SD = 4.3). The mean KINDL total score was 79.7 (SD = 11.6) and the mean physical functioning score was 81.9 (SD = 20.3). Male children exhibited better physical health as compared to the female children (p < 0.001). Overweight children had lower overall HRQoL (p = 0.008). However, the association was not significant for the four of the six subscales including the physical health domain. Children with hyperglycemia symptoms and a family history of diabetes also had significantly lower overall and physical health HRQoL (p < 0.05). Children diagnosed with diabetes and in lower income strata also had significantly lower overall HRQoL (p < 0.05). No significant association between the Hispanic ethnicity and HRQoL was observed. However, those who reported mostly speaking Spanish exhibited significantly lower overall HRQoL (p = 0.001). CONCLUSION: Results suggest that overweight may reduce overall quality of life among children, though it does not directly influence physical functioning. However, hyperglycemia symptoms may affect both overall health and physical functioning. Findings also suggest the need for developing programs directed at overcoming language barriers that may face Spanish-speaking children or their parents. Furthermore, targeting children who have hyperglycemia symptoms with public information campaigns may be more appropriate than targeting overweight children.

Adolescent↗

PubMed2006

Gender-specific disparities in obesity.

Little prior research has investigated whether the correlates of obesity differ between men and women. The objective of this study was to examine gender-specific disparities in obesity by rurality of residence, race/ethnicity, and socioeconomic status. Particular emphasis was devoted to examining potential differences between residents of urban, suburban, and rural areas. Data from the adult version of the 2003 Behavioral Risk Factor Surveillance System (BRFSS) for the state of Texas were used to model the crude and adjusted odds of being obese as compared to normal weight. The findings showed that males of other race/ethnicity had lower adjusted odds of obesity than non-Hispanic whites, but other race/ethnicity was insignificant for females. Females who were Hispanic or black/African American had higher adjusted odds of obesity than non-Hispanic whites, but Hispanic ethnicity and black/African American race were insignificant for males. Men and women residing in non-metropolitan areas had higher adjusted odds of obesity than their counterparts in metropolitan areas. No economic disparities were revealed among men, but females with high household income had lower odds of obesity than those with low income. Educational status was insignificant for men and women. The findings suggest that programs and policies aimed at curbing obesity should target males and females residing in non-metropolitan localities. Other initiatives should focus on particular groups of women, including those who are Hispanic or black/African American and have low household income.

Adolescent↗

PubMed2006

Living near a trail is associated with increased odds of walking among patients using community clinics.

We tested the hypothesis that living near a walking or cycling trail was associated with greater odds of walking. This has been previously studied in healthy and unselected populations, but to our knowledge has not been studied in patients attending community clinics. A cross-sectional survey was completed by 1211 persons in five community clinics that serve poor populations. We performed univariate analysis and developed a multivariate logistic regression model for walking adjusting for 12 independent variables including self-rated health, frequent mental distress, lifestyle and demographic variables, and environmental characteristics of the neighborhood including perceived proximity to a walking or cycling trail. Compared to those who reported not living close to a trail, persons who reported living near a trail were more likely to meet recommended levels of walking of at least 30 minutes fives times per week (unadjusted odds ratio = 1.49, 95% confidence intervals = 1.04-2.13). In the multivariate model, male gender (unadjusted odds ratio = 1.63, 95% confidence intervals = 1.15-2.30), having three or more convenient destinations (unadjusted odds ratio = 1.78, 95% confidence intervals = 1.37-2.32), and living near a trail (unadjusted odds ratio = 1.45, 95% confidence intervals = 1.01-2.09) were positively associated with walking at statistically significant levels. The odds of walking were lower in non-Hispanic blacks (odds ratio = 0.59, 95% confidence intervals = 0.40-0.87) and current smokers (odds ratio = 0.66, 95% confidence intervals = 0.57-0.76). For patients attending community clinics, environmental strategies to encourage walking may include mixed-land-use neighborhoods and construction of trails.

Adult↗

PubMed2005

Patterns of alcohol drinking and its association with obesity: data from the Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: Recent reports suggest that alcohol use may have a protective effect on obesity. This study explores association between obesity and alcohol consumption in the non-smoking U.S. adult population. METHODS: We analyzed data on a total of 8,236 respondents who participated in the Third National Health and Nutrition Examination Survey. Body mass index (weight-kg/height-m2) was derived from measured height and weight data and categorized into: normal weight, overweight, and obese. Alcohol consumption was measured using following measures: history of drinking, binge drinking, quantity of drinks/day, frequency of drinking, and average volume of drinks/week. RESULTS: Mean body mass index in this sample of non-smokers was 26.4 (95% CI: 26.1, 26.7). Approximately 46% of respondents were classified as current drinkers. Current drinkers had lower odds of obesity (Adjusted odds ratio = 0.73, 95% CI: 0.55, 0.97) as compared to non-drinkers. The odds of overweight and obesity were significantly greater among binge drinkers and those consuming four or more drinks/day. However, those who reported drinking one or two drinks per day had 0.46 (95% CI: 0.34, 0.62) and 0.59 (95% CI: 0.41, 0.86) times the odds of obesity, respectively. Similarly, the odds of obesity were significantly lower among those who reported drinking frequently and consuming less than five drinks per week. The association between overweight and other alcohol measures was less pronounced. CONCLUSION: The results suggest further exploring the possible role of moderate alcohol drinking in controlling body weight in adults.

Adult↗

PubMed2005

A population-based study of asthma, quality of life, and occupation among elderly Hispanic and non-Hispanic whites: a cross-sectional investigation.

BACKGROUND: The U.S. population is aging and is expected to double by the year 2030. The current study evaluated the prevalence of asthma and its correlates in the elderly Hispanic and non-Hispanic white population. METHODS: Data from a sample of 3021 Hispanics and non-Hispanic White subjects, 65 years and older, interviewed as part of an ongoing cross-sectional study of the elderly in west Texas, were analyzed. The outcome variable was categorized into: no asthma (reference category), current asthma, and probable asthma. Polytomous logistic regression analysis was used to assess the relationship between the outcome variable and various socio-demographic measures, self-rated health, asthma symptoms, quality of life measures (SF-12), and various occupations. RESULTS: The estimated prevalence of current asthma and probable asthma were 6.3% (95%CI: 5.3-7.2) and 9.0% (95%CI: 7.8-10.1) respectively. The majority of subjects with current asthma (Mean SF-12 score 35.8, 95%CI: 34.2-37.4) or probable asthma (35.3, 34.0-36.6) had significantly worse physical health-related quality of life as compared to subjects without asthma (42.6, 42.1-43.1). In multiple logistic regression analyses, women had a 1.64 times greater odds of current asthma (95%CI: 1.12-2.38) as compared to men. Hay fever was a strong predictor of both current and probable asthma. The odds of current asthma were 1.78 times (95%CI: 1.24-2.55) greater among past smokers; whereas the odds of probable asthma were 2.73 times (95%CI: 1.77-4.21) greater among current smokers as compared to non-smokers. Similarly fair/poor self rated health and complaints of severe pain were independently associated with current and probable asthma. The odds of current and probable asthma were almost two fold greater for obesity. When stratified by gender, the odds were significantly greater among females (p-value for interaction term = 0.038). The odds of current asthma were significantly greater for farm-related occupations (adjusted OR = 2.09, 95%CI: 1.00-4.39); whereas the odds were significantly lower among those who reported teaching as their longest held occupation (adjusted OR = 0.36, 95%CI = 0.18-0.74). CONCLUSION: This study found that asthma is a common medical condition in the elderly and it significantly impacts quality of life and general health status. Results support adopting an integrated approach in identifying and controlling asthma in this population.

Aged↗

PubMed2005

Rural residence is not a risk factor for frequent mental distress: a behavioral risk factor surveillance survey.

BACKGROUND: Residents of rural areas may be at increased risk of mental health problems. If so, public health programs aimed at preventing poor mental health may have to be customized for delivery to rural areas. The purpose of this study was to examine the relationship between residing in a rural area and frequent mental distress, which is one indicator of poor mental health. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) survey for the state of Texas was the source of information about obesity, demographic characteristics, and frequent mental distress (FMD). FMD was defined as poor self-rated mental health during at least half of the days in the last month. Adjusted odds for FMD were computed for rural and suburban respondents relative to urban respondents. RESULTS: FMD was found to be independently associated with lower education, being younger, being non-Hispanic, being unmarried, and being female. FMD also was associated with being obese or underweight and suburban residence (relative to metro-central city). FMD was not more common among rural respondents than in the metro-central city. CONCLUSION: Rural respondents were not at greater risk of frequent mental distress than urban respondents in this sample. Programs seeking to improve community mental health should target persons with less education and extremes in body weight, along with women and single persons, regardless of whether they live in rural or urban areas.

Adolescent↗

PubMed2005

Race and satisfaction in general OB/GYN clinics.

BACKGROUND: The purpose of this study was to test the hypothesis that racial differences in satisfaction can be found among OB/GYN patients on a US naval base. METHODS: Cross-sectional surveys assessing satisfaction with services were obtained from 838 patients who were seen in one of the two general OB/GYN clinics (455 in the base hospital clinic and 391 in a satellite clinic). Multiple logistic regression analysis was used to identify subgroups of patients who were not very satisfied with care received. RESULTS: When the patients seen in the base hospital were analyzed separately, Asian respondents had significantly lower odds of being very satisfied relative to non-Hispanic white respondents (AOR = .33, p < .01). CONCLUSION: Asian patients may be less satisfied than others when treated at a larger facility. Patients treated at a satellite clinic tended to be more satisfied than patients seen at the base hospital.

Journal Article↗

PubMed2005

Frequency of alcohol use and obesity in community medicine patients.

BACKGROUND: Obesity is an important public health problem. However, the effects of alcohol use on the risk for obesity have not been thoroughly explored. This study focuses on how frequency of alcohol use is related to the risk of obesity in a community medicine clinic population. METHODS: This study used a cross-sectional survey to test the hypothesis that obesity (BMI > 30) is associated with alcohol use. The convenience sample was drawn from three clinics that primarily serve low-income populations. Independent variables included frequency of alcohol use, frequency of binge drinking, demographic characteristics, health behaviors and health status. RESULTS: In comparison to non-drinkers, people who consumed alcohol 3 or more days per month had lower odds of being obese (Adjusted Odds Ratio = .49, p < .04). As expected, there was a significant association between watching eight or more hours of television per day and obesity (AOR = 2.34, p < .01). CONCLUSION: More frequent drinking and less television time are independently associated with reduced odds of obesity in this sample of community medicine patients. Additional research is needed to isolate casual mechanisms.

Adult↗

PubMed2005

Lifestyle and mental health.

STUDY OBJECTIVE: To examine the relationship between healthy lifestyles and self-rated mental health. DESIGN: A cross-section telephone survey involving multiple callbacks. Using a Behavioral Risk Factor Surveillance Survey, information about lifestyle, demographic characteristics, and self-rated mental health was collected. SETTING: Amarillo, Texas, a city of approximately 170,000 in the Panhandle of Texas. PARTICIPANTS: Six hundred and twenty-one adults. MAIN RESULTS: Good mental health was independently associated with physical activity, being male, and being married. Poor mental health was associated with obesity, daily smoking, being Hispanic, and being non-Hispanic White. CONCLUSIONS: Programs targeting risk factors for poor physical health also may improve mental health in the community.

Adult↗

PubMed2005

Patient gender preferences in a large military teaching hospital.

OBJECTIVE: To quantify preferences for female providers among obstetric-gynecology patients in a large military teaching hospital in California. METHODS: A questionnaire regarding patient preferences for female provider was distributed to and collected from 1,544 obstetric-gynecology patients over a two-month period. Responses were tabulated overall and for several demographic subgroups. RESULTS: Sixty percent of respondents indicated they had no provider gender preference or they preferred a male. Significant ethnic preferences were noted among Asian, Pacific Islander, and Native-American women. Junior officers, wives, and daughters of service members also showed a greater preference for a female physician provider. CONCLUSION: The majority of obstetric-gynecology patients surveyed had no strong preferences for female providers. In the interest of patient satisfaction, where strong gender preferences exist, attempts to accommodate could be made without overburdening female staff. LEVEL OF EVIDENCE: III.

Adult↗

PubMed2004

Psychosocial risk factors for obesity among women in a family planning clinic.

BACKGROUND: The epidemiology of obesity in primary care populations has not been thoroughly explored. This study contributes to filling this gap by investigating the relationship between obesity and different sources of personal stress, mental health, exercise, and demographic characteristics. METHODS: A cross-sectional survey using a convenience sample. Five hundred women who attended family planning clinics were surveyed and 274 provided completed answers to all of the questions analyzed in this study. Exercise, self-rated mental health, stress, social support, and demographic variables were included in the survey. Multiple logistic regression analysis was performed. RESULTS: After adjusting for mental health, exercise, and demographic characteristics of subjects, analysis of the data indicated that that being having a large family and receiving no support from parents were related to obesity in this relatively young low-income primary care sample, but self-reported stress and most types of social support were not significant. CONCLUSION: Obesity control programs in primary care centers directed at low-income women should target women who have large families and who are not receiving support from their parents.

Adult↗

PubMed2004

Self-esteem, stress and self-rated health in family planning clinic patients.

BACKGROUND: The independent effects of stress on the health of primary care patients might be different for different types of clinic populations. This study examines these relationships in a low-income female population of patients attending a family planning clinic. METHODS: This study investigated the relevance of different sources of personal stress and social support to self-rated health, adjusting for mental health, health behavior and demographic characteristics of subjects. Five hundred women who attended family planning clinics were surveyed and 345 completed the form for a response rate of 72 percent. RESULTS: Multiple logistic regression analysis revealed that liking oneself was related to good self-rated health (Odds ratio = 7.11), but stress or support from children, parents, friends, churches or spouses were not significant. White non-Hispanic and non-white non-Hispanic respondents had lower odds of reporting good self-rated health than Hispanic respondents (odds ratios were 2.87 and 2.81, respectively). Exercising five or more days per week also was related to good self-rated health. Smoking 20 or more cigarettes per day, and obese III were negatively related to good self-rated health (odds ratios were.19 and.22, respectively with corresponding p-values equal to.0043 and.0332). CONCLUSIONS: Among younger low-income women, addressing low self-esteem might improve health status.

Adult↗

PubMed2004

Medical care usage and self-rated mental health.

BACKGROUND: Population studies frequently employ a single item dependent variable for overall health. Self-rated mental health has been the focus of attention less often. The purpose of this project was to investigate the relationship between use of medical care and poor mental health in an elderly population. METHODS: This study involved a cross-sectional telephone survey of persons over 65 years of age in West Texas, a sparsely-populated 108-county region. Independent variables included number of medical visits, race/ethnicity, age, gender and ability to pay for care. Mental health was measured by asking subjects how often they felt downhearted or blue. RESULTS: Multiple logistic regression analysis revealed that more medical visits were made by persons who were downhearted or blue. Females, persons who had difficulty paying for care, Hispanic respondents, and older persons were more likely to report poor mental health. CONCLUSIONS: Elderly persons in this region who use more medical care are at greater risk of being in poor mental health. Public health agencies that are planning population-based approaches to improving mental health should consider targeting persons who are high users of medical care as well as those of limited means, women, persons of Hispanic ethnicity, and people who are of greater age.

Aged↗

PubMed2004

Healthy skepticism.

OBJECTIVE: To investigate the relationship between medical skepticism and overall self-rated health and to identify disparities in health for vulnerable subgroups among the elderly. DESIGN: A cross-sectional telephone survey involving multiple callbacks. Independent variables included three measures of medical skepticism and disparities variables (low income, low education, race/ethnicity, gender, rural residence) along with several control variables (body weight, marital status, employment, insurance coverage, number of medical visits). SETTING: West Texas, a sparsely populated 108-county region. PARTICIPANTS: Five thousand six persons aged 65 and over. MAIN RESULTS: Multiple logistic regression analysis revealed that medical skepticism (believing that one can overcome illnesses without the help of a medical professional) was independently related to better self-rated overall health. Disparities in health were found for income, race/ethnicity, and low education but not for residents of rural or frontier areas (vs. urban residents). CONCLUSIONS: Belief in one's own ability to manage most illnesses may or may not be causally related to better health. However, the association is promising and deserves further investigation. Programs promoting self-care among groups facing health disparities should be considered.

Aged↗

PubMed2004

Hispanic ethnicity, rural residence, and regular source of care.

This study assessed whether Hispanic ethnicity and rural residence were related to usual source-of-care. We studied 3,689 persons over age 65 who lived in their own homes in a 108-county area in West Texas. A telephone interview in two waves was used to collect information. Usual source-of-care was measured in two ways: by asking if the subject had a usual place to go and by asking if the subject had a personal physician or nurse. In a logistic regression analysis, Hispanic ethnicity was independently associated with both having a usual place of care (OR = .511, CI = .32-.82) and a usual provider (OR = .629, CI = .45-.88). Rural residence was not associated with either measure. Efforts to promote usual source-of-care should be targeted at Hispanic seniors in this region of the southwestern United States.

Aged↗

PubMed2004

Older persons' evaluations of health care: the effects of medical skepticism and worry about health.

OBJECTIVE: To describe how skepticism about medical care and other individual differences, including worry about health status, are associated with evaluations of health care among the noninstitutionalized elderly. DATA SOURCES/STUDY SETTING: Data were collected through a survey of approximately 5,000 community-dwelling elders (aged 65 and older) in a southwestern region of the United States. STUDY DESIGN: Global evaluations of health care were measured with two items from the Consumer Assessment of Health Plans Study (CAHPS) instrument, an overall care rating (OCR) and a personal doctor rating (PDR). Multivariate ordered logit regression models were tested to examine how medical skepticism and other factors were associated with ratings of 0-7, 8-9, and 10. PRINCIPAL FINDINGS: Consumers who were skeptical of prescription drugs relative to home remedies, who held attitudes that they understand their health better than most doctors, and who worried about their health had worse OCR and PDR. Those who held attitudes that individual behavior determines how soon one gets better when sick had better PDR and OCR. CONCLUSIONS: Health policymakers, managers, and providers may need to consider the degree to which they should attempt to satisfy skeptical consumers, many of whom may never rate their care highly. Alternatively, they may need to target skeptical consumers with educational efforts explaining the benefits of medical care.

Age Factors↗

PubMed2004

Correlates of physician visits among children and adolescents in west Texas: effects of hyperglycemia symptoms.

CONTEXT: Health care services use by children varies tremendously. Because of the increasing prevalence of diabetes in children and adolscents, one of the major concerns is access to physician care among children with diabetes and diabetes symptoms. PURPOSE: This population-based cross-sectional study examines correlates of physician visit among children and adolescents living in west Texas. METHODS: A telephone survey was administered in 2002 to a random sample of households in 106 counties of West Texas. The sample included 5,462 respondents with children aged between 3 and 18 years. Proportional odds ordered logistic regression analysis was used to determine correlates of physician visits in the previous 12 months. FINDINGS: Hispanic children were less likely than non-Hispanic whites to have a recent physician visit; there were no significant rural-urban differences. Children with insurance (adjusted odds ratio= 2.21, 95% CI = 1.89-2.59) were more likely to visit physicians. Almost 16% of children in this study did not have any health insurance coverage. Children reporting 3 or more hyperglycemia symptoms and those with a family history of diabetes had 1.81 times and 1.20 times the odds of visiting the physician. CONCLUSIONS: Presence of health insurance and increasing symptoms of diabetes were found to influence the utilization of physician services. Since most of the cases of diabetes that have recently been diagnosed among Texas youth are type 2 diabetes, it is important that adolescents and their parents are educated about the risk factors and how to recognize them.

Adolescent↗