Biomedical subjects
L R Schultz
Publications and source records attributed to L R Schultz.
The role of exploratory laparotomy for chronic abdominal pain in children.
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The cost and effectiveness of an education program for adults who have asthma.
STUDY OBJECTIVE: To determine whether a self-management training program decreases emergency department visits and reduces costs for patients with asthma. DESIGN: Randomized controlled trial of an educational program. SETTING: Two sites--an urban emergency room and a suburban emergency room. PATIENTS: 241 asthma patients between the ages of 18 and 70 years. Of the 119 patients in the intervention group and the 122 in the control group, 185 (76%) were available for follow-up. INTERVENTION: All patients seen in the emergency departments were given usual medical care and follow-up. Patients in the intervention group were asked to attend three educational sessions on asthma conducted by a specially trained RN. The program stressed importance of medication compliance, methods to control and prevent attacks, effects of drugs and rationale for their use, relaxation exercises, and smoking cessation. MEASUREMENT AND MAIN RESULTS: All patients received telephone interviews four, eight, and 12 months after entry into the study. Reports based on hospital admissions and emergency room utilization were verified by billing records. Three patients died during the study, none from asthma-related problems. The intervention group had significantly fewer asthma-related emergency visits (16 visits per 100 persons) than did the control group (39 per 100 persons); p = 0.0005 for the 12 months of follow-up. The effect of the intervention on asthma-related emergency department visits was strongest during the initial four months postintervention (68 per 100 persons versus 220 per 100 persons, p = 0.003). The financial analysis showed that the $85/person cost for the educational sessions was offset by the $628/person reduction in emergency room charges. CONCLUSION: Education enables patients with asthma to decrease utilization of emergency services.
Joint 1994 Wolff Award Presentation. Migraine and major depression: a longitudinal study.
UNLABELLED: Recent epidemiologic studies have reported an association between migraine and major depression. Little is known about the mechanisms that link the two disorders, or the natural history of their co-occurrence. We examined the association between migraine and major depression in a sample of young adults, using longitudinal data. METHOD: A random sample of 1,007 young adults (21-30 years of age) members of a large HMO in Southeast Michigan was interviewed in 1989; 97% of the sample were reinterviewed 3.5 years later, in 1992. A structured diagnostic interview was used to elicit information on DSM-III-R major depression and IHS migraine in lifetime (in the 1989 interview) and during the 3.5 year follow-up interval (in the 1992 interview). Using Cox-proportional hazards models with time-dependent covariates, we estimated the relative risk for major depression associated with prior migraine and the relative risk for migraine associated with prior major depression. RESULTS: In this sample of young adults, the incidence of migraine per 1,000 person years, based on the prospectively gathered data, was 5.0 in males and 22.0 in females. The estimated relative risk for major depression associated with prior migraine, adjusted for sex and education, was 3.2 (95% CI 2.3-4.6). The adjusted relative risk for migraine associated with prior major depression was 3.1 (95% CI 2.0-5.0). CONCLUSIONS: The study provides the first body of evidence that the previously observed cross-sectional association between migraine and major depression can result from bidirectional influences, with each disorder increasing the risk for first onset of the other. The explanation that major depression in persons with migraine represents a psychologic response to migraine attacks would have been more plausible had we found an influence only from migraine to depression. By diminishing the plausibility of a simple causal explanation for the migraine-depression comorbidity, the findings favor the shared mechanisms explanation.