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Lynda A Anderson

Publications and source records attributed to Lynda A Anderson.

At least 19 recordsLinked to original sources
PubMed2006

Further validation and reliability testing of the Attitudes and Beliefs about Living with Epilepsy (ABLE) components of the CDC Epilepsy Program Instrument on Stigma.

The aim of this study was to conduct additional validation and reliability testing of the Attitudes and Beliefs about Living with Epilepsy (ABLE) components of the CDC Epilepsy Program Instrument on Stigma. Thirteen items were tested using a representative sample of U.S. adults (n=4345). Confirmatory factor analyses confirmed two underlying constructs as hypothesized that accounted for 61% of the variance in the factor analysis: Negative Stereotypes (alpha=0.86) and Risk and Safety Concerns (alpha=0.88). As expected, participants differed on scale scores by demographic characteristics. Test-retest reliability was acceptable. The results of these analyses extend those from our previous study suggesting that the negative stereotypes and risk and safety concern scales demonstrate acceptable validity and reliability, and can be used to measure attitudes toward epilepsy related to these two domains.

Adolescent↗
PubMed2005

Using concept mapping to develop a logic model for the Prevention Research Centers Program.

INTRODUCTION: Concept mapping is a structured conceptualization process that provides a visual representation of relationships among ideas. Concept mapping was used to develop a logic model for the Centers for Disease Control and Prevention's Prevention Research Centers Program, which has a large and diverse group of stakeholders throughout the United States. No published studies have used concept mapping to develop a logic model for a national program. METHODS: Two logic models were constructed using the data from the concept mapping process and program documents: one for the national level and one for the local level. Concept mapping involved three phases: 1) developing questions to generate ideas about the program's purpose and function, 2) gathering input from 145 national stakeholders and 135 local stakeholders and sorting ideas into themes, and 3) using multivariate statistical analyses to generate concept maps. Logic models were refined using feedback received from stakeholders at regional meetings and conferences and from a structured feedback tool. RESULTS: The national concept map consisted of 9 clusters with 88 statements; the local concept map consisted of 11 clusters with 75 statements. Clusters were categorized into three logic model components: inputs, activities, and outcomes. Based on feedback, two draft logic models were combined and finalized into one for the Prevention Research Centers Program. CONCLUSION: Concept mapping provides a valuable data source, establishes a common view of a program, and identifies inputs, activities, and outcomes in a logic model. Our concept mapping process resulted in a logic model that is meaningful for stakeholders, incorporates input from the program's partners, and establishes important program expectations. Our methods may be beneficial for other programs that are developing logic models for evaluation planning.

Cluster Analysis↗
PubMed2005

The role of state public health agencies in addressing less prevalent chronic conditions.

INTRODUCTION: State-based chronic disease programs typically focus on the most prevalent chronic conditions, such as cancer, diabetes, and cardiovascular disease, but interest in less prevalent chronic conditions (LPCCs), such as epilepsy, is growing. In our study, we examined the perceived roles of state health departments in addressing LPCCs and used this information to develop recommendations for state health departments that are considering developing LPCCs programs. We also compared the identified state health department roles for LPCCs with roles related to healthy aging, as well as to the essential elements of existing state-based chronic disease programs, to determine whether future LPCCs programs would have any unique requirements. METHODS: Participants used concept-mapping techniques to generate a set of 100 statements on steps that state health departments could take to address LPCCs. The participants sorted and rated each statement according to importance and feasibility. We used a sequence of multivariate statistical analyses to generate a series of maps, or clusters, and rating graphics. We reviewed the findings and produced recommendations for state health departments. We used a similar process to examine roles of state health departments in addressing healthy aging. RESULTS: The participants grouped the LPCCs statements into nine clusters, which they rated as moderately feasible and important. The healthy aging statements were grouped into eight clusters. Clusters for LPCCs and healthy aging were similar. We also compared LPCCs clusters and the essential elements of existing state-based chronic disease programs and found that they were similar. CONCLUSION: The similarities between LPCCs clusters and essential elements of existing state-based chronic disease programs highlight an important point. State health departments that are considering establishing LPCCs programs should use strategies that have already been used by other public health agencies to develop chronic disease prevention and control programs.

Chronic Disease↗
PubMed2005

Aging and public health: partnerships that can affect cardiovascular health programs.

Cardiovascular health programs face a growing and not often recognized challenge--the aging of the American population. During this century, all states will experience a dramatic rise in the number of older adults. By 2030, approximately 20% of Americans will be over the age of 65. This article describes the prevalence of cardiovascular disease among older adults, the public health and aging services networks, selected results and recommendations from the Aging States Project, and examples of ongoing aging activities relevant to cardiovascular health programs being promoted by the U.S. Centers for Disease Control and Prevention (CDC). State health departments (SHDs) and state units on aging (SUAs) bring different resources, approaches, and partners to address older adult health but many aspects are complementary. The aging services network is extensive, and in one form or another, can reach older adults in virtually every community in the country. Based on a survey of SHDs and SUAs, which was part of the Aging States Project, respondents identified cardiovascular disease as the most common health concern (57% of SHDs and 55% of SUAs). However, fewer than half of those responding reported having cardiovascular health programs directed at older adults (37% of SHDs and 40% of SUAs). Initial activities are described in the arenas of strategic partnerships, data for action, and capacity building based on recommendations from the survey findings. These examples are provided as potential models for current and future state cardiovascular health programs wanting to enhance their reach to older adults.

Aging↗
PubMed2005

Development of public health priorities for end-of-life initiatives.

OBJECTIVE: Recently, end-of-life (EOL) issues have captured the attention of the public health community. This study reports a project to help state health departments better understand their potential role in addressing EOL issues and develop initial priorities for EOL activities. METHODS: The project involved two studies. Study 1 (October 2002 to September 2003) involved a concept mapping process to solicit and organize recommendations from key stakeholders. Concept mapping integrates qualitative group processes with multivariate statistical analysis to represent the ideas of stakeholders visually through maps. A key-informant approach was used to identify stakeholder participants with expertise in aging, cancer, public health, and EOL. In two meetings, stakeholders used the maps to develop short-, intermediate-, and long-term recommendations for EOL initiatives. Study 2 (October 2003 to September 2004) involved a modified Delphi process with three iterations to prioritize recommendations for initial action from among a group of short-term recommendations. RESULTS: Study 1 resulted in 103 recommendations for EOL initiatives across nine domains. Study 2 resulted in consensus on five initial recommendations from three domains: identifying an EOL point of contact in state health departments, collecting and analyzing data about EOL, incorporating EOL principles into state comprehensive cancer control plans, educating the public about hospice and palliative care, and educating the public about the importance of advance directives. CONCLUSIONS: Diverse perspectives of key public health stakeholders resulted in a series of short- and longer-term recommendations for EOL action. These recommendations can guide future efforts by state health departments and other public health agencies to address EOL issues.

Humans↗
PubMed2005

Improving services for sex partners of chlamydia-infected patients in an HMO.

OBJECTIVE: To improve services for sex partners of chlamydia-infected patients (ie, chlamydia partner services [CPS]) at an HMO. STUDY DESIGN: Assessment of current CPS policy, practices, and opinions in Kaiser Permanente Northwest Region (KPNW) and in local health departments, and design, implementation, and evaluation of 4 CPS interventions. METHODS: We reviewed KPNW policy documents, conducted focus groups with KPNW clinicians, and did phone interviews with KPNW chlamydia-infected patients and health department disease intervention specialists. We then implemented 3 informational interventions: CPS information was added to the after-visit summary given to patients tested for chlamydia; information on how to test, treat, and counsel chlamydia-infected patients was added to KPNW's electronic clinical-decision tool; and CPS information and a direct link to KPNW's chlamydia screening and treatment guidelines were added to KPNW's Web site. We also organized training for KPNW clinicians to review the roles of CPS and disease intervention specialists. We evaluated intervention uptake and impact by reviewing electronic medical charts, Web site "hits," and posttraining evaluations. RESULTS: Clinicians and disease intervention specialists reported that KPNW's CPS policy and the roles of disease intervention specialists regarding KPNW patients were unclear. Clinicians and patients wanted more CPS information. Clinicians commonly used the after-visit summary and Web-based CPS information and reported that training improved CPS knowledge. However, none used the clinical-decision tool. CONCLUSIONS: Several simple, centralized informational interventions to improve CPS were feasible and used by KPNW clinicians. These interventions could potentially be used in other settings structured like KPNW.

Chlamydia Infections↗
PubMed2004

Predicting reports of unmet expectations among rheumatology patients.

OBJECTIVE: Approximately 25% of patients report unmet expectations after their doctor visits. In a longitudinal study of rheumatology patients, we examined whether changes in health status could predict unmet expectations. METHODS: Arthritis patients (n = 177) responded to 2 surveys (baseline and 6-month followup). Both surveys contained questions on health status (functional status, pain, helplessness, psychological status) and visit duration. The followup survey contained questions on postvisit unmet expectations. Factors associated with unmet expectations were determined. RESULTS: Fifty-eight patients (33%) reported unmet expectations, most often for information (47%) and new medications (31%). Unmet expectations were more common among patients with greater baseline helplessness (odds ratio [OR] 1.9, 95% confidence interval [95% CI] 1.0-3.6) and short doctor visits at followup (OR 5.6, 95% CI 2.4-13.1). Unmet expectations were less common among those experiencing a decline in pain (OR 0.3, 95% CI 0.1-0.9). CONCLUSION: Attention to the patient's level of pain and helplessness and duration of the visit may limit reports of unmet expectations.

Adult↗
PubMed2004

Older adults' views of "successful aging"--how do they compare with researchers' definitions?

OBJECTIVES: To determine whether older adults have thought about aging and aging successfully and to compare their perceptions of successful aging with attributes of successful aging identified in the published literature. DESIGN: A cross-sectional, mailed survey. SETTING: King County, Washington. PARTICIPANTS: Nondemented participants from two cohorts. The first cohort, referred to as Kame, which means turtle, a symbol of longevity for Japanese, enrolled 1,985 Japanese Americans aged 65 and older and was established in 1992-94. The second cohort, Adult Changes in Thought, enrolled 2,581 white men and women aged 65 and older from a health maintenance organization and was established in 1994-96. MEASUREMENTS: Respondents were asked whether they had ever thought about aging and aging successfully and whether these thoughts had changed over the previous 20 years and about how important specific attributes, originating from the published literature, were in characterizing successful aging. RESULTS: Overall, 90% had previously thought about aging and aging successfully, and approximately 60% said their thoughts had changed over the previous 20 years. The Japanese-American group rated 13 attributes as important to successful aging; the white group rated the same 13 as important and added one additional attribute, learning new things. CONCLUSION: Older adults' definition of successful aging is multidimensional, encompassing physical, functional, psychological, and social health. In contrast, none of the published work describing attributes of successful aging includes all four dimensions. Future work would benefit from an expanded definition to adequately reflect the perceptions of older adults.

Adaptation, Psychological↗
PubMed2004

Mental health disorders and sexually transmitted diseases in a privately insured population.

OBJECTIVES: To consider whether patients who use mental health services in privately insured settings are also more likely to have received sexually transmitted disease (STD) or human immunodeficiency virus (HIV) diagnoses and whether this relationship extends to patients with milder mental health disorders. METHODS: Using frequency tables stratified by age and sex, a logistic regression model, and difference of means tests, we examined the relationship between mental health claims and STDs in a sample of 289 604 privately insured people across the United States. RESULTS: Patients with mental health claims were more than twice as likely as other patients to have an STD claim in the same year after controlling for confounding factors (odds ratio, 2.33; 95% confidence interval, 2.11-2.58). This relationship held for severe and milder mental health diagnoses, for male and female patients, and in each age category from 15 to 44 years. Among women, patients aged 20 to 24 years with a mental health claim had the highest predicted probability of STD diagnoses (3.0%); among men, patients aged 25 to 29 years with a mental health claim had the highest predicted probability of STD diagnoses (1.2%). CONCLUSIONS: In this population, patients with mental health claims were more likely to also have claims with diagnoses for STDs than patients without mental health claims, and this relationship applied to severe and milder mental health disorders. This suggests that people with mental health disorders in privately insured populations may benefit from routine STD risk assessments to identify high-risk patients for referral to cost-effective preventive services.

Adolescent↗
PubMed2003

Do physicians provide counseling with HIV and STD testing at physician offices or hospital outpatient departments?

OBJECTIVES: To estimate the frequency of HIV/sexually transmitted disease (STD) counseling among patients tested for HIV or STD infection at physician offices and hospital outpatient departments and to describe the factors associated with HIV/STD counseling in private settings in the USA. DESIGN: Cross-sectional study of patients served by physicians in private settings in the USA. METHODS: We analyzed 1997-1998 data from two representative national surveys of ambulatory care visits in private settings by persons aged 18-64 years. RESULTS: During 1997-1998, 12.7 million ambulatory care visits included HIV or STD testing. HIV/STD counseling was documented in 35% of all visits and in 28% of visits by pregnant women at the time HIV or STD tests were done. Counseling was less common when only HIV tests (21%) or STD tests (37%) alone were carried out than when both HIV and STD tests (50%) were performed. Counseling was more common (65%) if the patient's reason for visit was related to HIV, STD, or genitourinary complaints than if the visit was for other reasons. CONCLUSIONS: Private physicians often counseled about HIV/STD when testing patients with symptoms. The proportion of other visits in which counseling accompanied HIV or STD tests was variable. This suggests the need for a better understanding of the reasons why clinicians in private settings decide whether to counsel patients about HIV and STD when they order testing, barriers to offering counseling, and interventions to increase counseling when appropriate.

Adolescent↗
PubMed2003

Use of the Trust in Physician Scale in patients with rheumatic disease: psychometric properties and correlates of trust in the rheumatologist.

OBJECTIVES: To assess the psychometric properties of the Trust in Physician Scale and to identify variables associated with patients' trust in their rheumatologist. METHODS: Analyses of self reported data from 713 patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia. Study variables included the Trust in Physician Scale, a decision-making question, a medical skepticism measure, and demographic and health-related measures. Internal consistency and construct validity were assessed using correlational analyses and factor analysis. A regression analysis was conducted to identify factors associated with trust in the rheumatologist. RESULTS: Internal consistency of the scale was high (Cronbach's alpha = 0.87). Scale items also loaded on a single factor. Construct validity was supported by inverse correlations between higher trust scores and both skepticism and independent decision making. Decreased trust was associated with older age, minority status, higher education, diagnosis of fibromyalgia or osteoarthritis, and poorer health. CONCLUSION: The Trust in Physician Scale is appropriate for patients with rheumatic disease. Several patient characteristics appear to be associated with lower trust in the rheumatologist.

Aged↗
PubMed2003

Validity of self-reported mammography: examining recall and covariates among older women in a Health Maintenance Organization.

Self-reports of screening are frequently used in place of chart abstraction, particularly in outpatient settings, because they are generally less expensive and frequently provide the only information available. The authors expanded the literature on validation of self-reported mammography by including the validity of recall and by assessing covariates in a setting where women were examined more than once. In 1995, this study validated mammography use in a sample of 949 women aged 50-80 years who were members of a health maintenance organization with centralized automated records of mammographic examinations. The majority of women had had a mammogram within the previous 2 years according to self-reports and records, but self-reported rates exceeded record rates by 8.2%. Sensitivity was high (93.8%), whereas specificity was low (53.6%). The overall agreement between self-reports and records was 82.7%. The kappa value was 0.52, indicating fair agreement beyond chance. Modeling with logistic regression revealed that being a college graduate and having a first-degree relative with breast cancer were significantly associated with accurate recall. Comparison of actual time interval data revealed that disagreements consisted largely of women's underestimates of time since their last screening. These results add to knowledge about the validity of self-reported mammographic screening data in settings where women are screened more than once.

Aged↗
PubMed2003

Differences in access to health care services among adults in rural America by rural classification categories and age.

OBJECTIVE: To study differences in excess to health care services between different population groups in rural areas of the United States. DESIGN: Using data from the 1994 National Health Interview Survey and the 1991 Area Resource File, we examined the differences in excess with seven measures: having a regular source of care, having a usual place of care, having health insurance coverage, delaying medical care because of cost for all rural residents; number of doctor visits, number of hospital discharges and length of hospital stay per discharge for those who reported their health as being either poor or fair. Rural residents were classified by ages and grouped into four rural classification categories that were characterised along two dimensions: adjacent to a metropolitan statistical area (MSA) (yes/no) and inclusion of a city of at least 10,000 people (yes/no). SETTING: Rural areas. SUBJECTS: Rural populations. RESULTS: Residents aged 18-24 years had the worst access to services and the residents aged 65 years and over had the best access to services when measured by regular source of care, a usual place of care and health insurance status. Compared to those aged 50-64 years, residents aged 25-49 years were less likely to report having health insurance and more likely to report delaying seeking medical care because of costs. Rural residents who lived in a county adjacent to an MSA generally were less limited in access than those who lived in a county not adjacent to an MSA. CONCLUSIONS: Rural America is not a homogeneous entity in many aspects of the access to health care services.

Adolescent↗
PubMed2003

Adherence to CDC STD guideline recommendations for the treatment of Chlamydia trachomatis infection in two managed care organizations.

BACKGROUND: The extent of adherence to the Centers for Disease Control and Prevention (CDC) STD guidelines by clinicians practicing in managed care settings is unknown. GOAL The goal was to assess adherence to the CDC guideline recommendations for the treatment of genital chlamydial infection, by clinicians at two group model managed care organizations. DESIGN: Retrospective cohort study of men and women with laboratory-confirmed chlamydial infection. Patients were members of either the Kaiser Permanente Foundation Health Plan of Colorado or HealthPartners of Minneapolis/St. Paul who had tested positive for cervical or urethral chlamydial infection during the period from January 1, 1998, through June 30, 1999. RESULTS: During the study period, 1,078 patients with positive tests for genital Chlamydia trachomatis were identified. More than 97% of men and nonpregnant women and more than 98% of pregnant women were prescribed treatment, consistent with current CDC guidelines. CONCLUSION: Adherence to CDC-recommended therapy was high for patients with genital chlamydial infections at these two managed care organizations.

Adolescent↗
PubMed2003

Georgia prenatal care providers' perceptions of barriers to sexually transmitted disease screening.

BACKGROUND: Evidence suggests that sexually transmitted disease (STD) screening during pregnancy is not optimal. No published studies have systematically examined barriers that hinder routine STD screening. This study examines prenatal care providers' perceptions about barriers to routine STD screening of pregnant women. METHODS: Using a conceptual framework, four a priori barrier categories were developed: provider, patient, organizational, and structural. Responses to a question on barriers to STD screening in a 1998 mail survey of Georgia prenatal care providers were qualitatively classified into one of these categories. RESULTS: Of the 293 providers who responded, 71% identified structural barriers, with 52% citing inadequate reimbursement. These respondents were most likely to name barriers categorized as structural, not patient, provider, or organization issues. CONCLUSION: Efforts to improve STD screening of pregnant women should include a focus on structural level interventions, such as instituting health care policies that provide adequate reimbursement for routine STD screening during pregnancy.

Female↗
PubMed2003

A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes.

OBJECTIVE: To compare a simple meal plan emphasizing healthy food choices with a traditional exchange-based meal plan in reducing HbA(1c) levels in urban African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 648 patients with type 2 diabetes were randomized to receive instruction in either a healthy food choices meal plan (HFC) or an exchange-based meal plan (EXCH) to compare the impact on glycemic control, weight loss, serum lipids, and blood pressure at 6 months of follow-up. Dietary practices were assessed with food frequency questionnaires. RESULTS: At presentation, the HFC and EXCH groups were comparable in age (52 years), sex (65% women), weight (94 kg), BMI (33.5), duration of diabetes (4.8 years), fasting plasma glucose (10.5 mmol/l), and HbA(1c) (9.4%). Improvements in glycemic control over 6 months were significant (P < 0.0001) but similar in both groups: HbA(1c) decreased from 9.7 to 7.8% with the HFC and from 9.6 to 7.7% with the EXCH. Improvements in HDL cholesterol and triglycerides were comparable in both groups, whereas other lipids and blood pressure were not altered. The HFC and EXCH groups exhibited similar improvement in dietary practices with respect to intake of fats and sugar sweetened foods. Among obese patients, average weight change, the percentage of patients losing weight, and the distribution of weight lost were comparable with the two approaches. CONCLUSIONS: Medical nutrition therapy is effective in urban African Americans with type 2 diabetes. Either a meal plan emphasizing guidelines for healthy food choices or a low literacy exchange method is equally effective as a meal planning approach. Because the HFC meal plan may be easier to teach and easier for patients to understand, it may be preferable for low-literacy patient populations.

Black or African American↗