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Biomedical subjects

N Breslau

Publications and source records attributed to N Breslau.

141 records · Page 8Linked to original sources
PubMed1978

Work settings and job satisfaction: a study of primary care physicians and paramedical personnel.

This paper examines job satisfaction of primary care physicians and paramedical personnel in traditional office practices and in modern medical organizations. A series of two-way analyses of variance using work settings and occupational level as independent variables showed consistent effects of setting on job satisfaction. In modern organizational settings satisfaction with the work activity, with coworkers, and with income was lower than in traditional practices. Only with respect to income, were physicians, on the average, more satisfied than paramedical workers. The relationships between job satisfaction and the variety and complexity of work as well as ownership of work settings are analyzed and discussed.

Allied Health Personnel↗
PubMed1977

The role of the nurse-practitioner in a pediatric team: patient definitions.

Patient conceptions and evaluations of the nurse-practitioner role were explored in a random sample of families who attended a pediatric office team comprising a pediatrician and a nurse-practitioner. Patients do not perceive the nurse to have expertise in an exclusive domain of health problems. Thus, the majority of patients do not consider her addition to the office to have improved on the doctor services. Although many patients took advantage of the opportunity to discuss with the nurse issues they regarded unworthy of the doctor's time, they did not value time spent with the nurse as meriting dispensing with some of the doctor time or the payment of an additional fee. The low value placed by patients on the diffuse area of "care" as opposed to the application of medical science hinders the prospects of public recognition of the nurse-practitioner. This applies particularly to the nurse-practitioner as a team member, where an explicit attempt is made to articulate the unique domains and boundaries of the various professionals.

Attitude↗
PubMed1976

Renal responses to PTH in patients with hormone-resistant (pseudo) hypoparathyroidism.

Five patients with pseudohypoparathyroidism were compared to normal subjects and patients with hypoparathyroidism in their ability to respond to the infusion of parathyroid hormone (PTH) by altering excretion of calcium, sodium, potassium, phosphate and bicarbonate. In patients with pseudohypoparathyroidism, impairment in renal responses to PTH was more generalized than has been recognized. The patterns of response varied from patient to patient. The most commonly observed abnormality, aside from lack of increase in urinary cyclic adenosine 5'-monophosphate (AMP) was failure to decrease the calcium to sodium clearance ratio, and indication of impaired renal calcium reabsorption. The responses which most closely approximated normal, including a normal decrease in the calcium to sodium clearance ratio, occurred in a patient (Case 1) who had the largest, although impaired, response in cyclic AMP excretion. Conversely, the most abnormal responses occurred in three patients (Cases 2, 4 and 5) who had the smallest increases in cyclic AMP excretion after the administration of PTH. The impaired renal reabsorption of calcium after the administration of PTH (lack of decrease in calcium to sodium clearance ratio) may, when present, be in part responsible for hypocalcemia.

Absorption↗
PubMed1976

The role of volume contraction in the hypocalciuric action of chlorothiazide.

Thiazide-induced hypocalciuria usually requires two to four days of drug treatment for its full expression. The present experiments were designed to test the possibility that an immediate hypocalciuria could be produced in subjects whose extracellular volumes were already contracted. In previously untreated subjects, chlorothiazide (2 g/day) did not produce hypocalciuria on the first day of treatment. Hypocalciuria occurred on the second day and was somewhat enhanced on the third and fourth days of treatment. In subjects pretreated with furosemide (40 mg two or three times a day for two days), chlorothiazide produced hypocalciuria on the first day of its use. Under the influence of chlorothiazide, there was a strong linear correlation between the changes in the excretion of calcium and sodium. The results are consistent with the idea that chlorothiazide enhances the ratio of calcium to sodium reabsorptions and that this tendency for absolute hypocalciuria can be overridden by a large natriuretic response to the drug. Volume contraction, which minimizes the natriretic response to diuretics, allows a more immediate and pronounced hypocalciuric response to thiazides.

Adult↗
PubMed1976

Service delivery structure and continuity of care: a case study of a pediatric practice in process of reorganization.

The effects of the reorganization of a medical practice on continuity of care were investigated in a case study of a changing pediatric practice. Continuity, which has often been conceptualized as one indicator of quality of care, was measured by an index of which the numerator was the number of visits with own pediatrician and the denominator was the total number of pediatric visits for the year. Increased number of pediatricians and incorporation of the practice into an academic setting resulted in a decline of continuity of care accompanied by a rise in the number of doctor visits for acute illness care. Patient satisfaction, although related in some of its aspects to continuity, was by and large unaffected by the change. The consequences of changes in practice size and goal complexity for interpersonal aspects of patient care and quality of care are discussed.

Comprehensive Health Care↗
PubMed1975

Continuity of care in a university-based practice.

Effects of changes in a pediatric practice--expansion of the number of pediatricians and incorporation into a university hospital setting--on continuity of care and utilization were examined by means of a longitudinal study of a sample of 63 families. Continuity of care was measured by the following index: the number of visits with own physician divided by the total number of pediatric visits per year. Although continuity of well-child visits remained unchanged at the university setting, the continuity of sick visits declined markedly. An increased use of doctor visits for illness care was observed; its relationship with the decline in continuity is analyzed and discussed. While continuity is inherent in a small partnership practice, it is not so in a larger medical organization, particularly when involvement in patient care is part time. In such an organization, deliberate arrangements that enable patients with acute needs to receive care from their own doctors are needed.

Child Health Services↗
PubMed1975

Comprehensive pediatric care: the patient viewpoint.

Two meanings of the term comprehensive care are delineated. The first refers to a wide scope of health services, the second to a humanistic approach to the patient. Findings from a sample of patients from one pediatric practice suggest that the two meanings constitute two independent variables with respect to patient expeciations. Patient responses to questions regarding their expectations of the pediatrician revealed a tendency to hold a traditional disease orientation. Comprehensive care as a broad scope of health services that include mother guidance in child rearing is not a common goal for mothers utilizing the pediatric practice under study. On the other hand, a comprehensive approach by the pediatrician is a standard shared by most respondents in the sample: high priority is accorded the pattern of the personal physician with whom a patient forms a continuous doctor-patient relationship which instills in the patient trust that the physician's recommendations are based on thorough knowledge of the patient as an individual.

Black or African American↗
PubMedDate not supplied

Migraine, physical health and psychiatric disorder: a prospective epidemiologic study in young adults.

In a prospective study of a random sample of 1,007 young adults, we examined the association between migraine and psychiatric disorder, physical complaints, indicators of functional impairment, and use of mental health services. A history of migraine was associated with increased lifetime rates of major depression, anxiety disorders, illicit drug use disorders, nicotine dependence, and suicide attempts. Compared with subjects without a history of migraine, those with such a history had significantly more physical symptoms and were more likely to report job absenteeism, assess their general health as fair or poor, and use mental health services. Follow-up data, gathered 14 months after the baseline interview, revealed that subjects with a history of migraine at the baseline had significantly increased rates of first incidence major depression and panic disorder during the interval period (odds ratio (OR) for major depression = 4.2, 95% confidence interval (CI) 2.0-9.2; and OR for panic disorder = 12.8, 95% CI 4.1-39.8). The risk for these psychiatric disorders in persons with prior history of migraine was unrelated to the recentness of their migraine attacks. These findings suggest that the link between migraine, major depression and anxiety might reflect a common predisposition.

Adult↗
PubMedDate not supplied

Investigations of causal pathways between PTSD and drug use disorders.

Although numerous studies have demonstrated an association between PTSD and substance use disorders, little is known about the causal nature of this relationship. In this article, we put forth and test major causal hypotheses. Specific hypotheses to be tested include self-medication of PTSD symptoms, substance users' high risk of exposure to traumatic events, and drug users' increased susceptibility to PTSD following a traumatic exposure. We also examine the possibility of an indirect pathway linking drug use disorders and PTSD via a shared vulnerability. Evidence for these causal hypotheses is evaluated using Hill's criteria for causal inference: strength, consistency, specificity, temporality, gradient, plausibility, coherence, experimental evidence, and analogy. We present data analytic strategies that exploit information about the temporal order of PTSD and drug use disorders to shed light on their causal relationship. Finally, we present findings on the PTSD/drug use disorder association from an epidemiologic study of young adults.

Adult↗
PubMedDate not supplied

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.

Adult↗
PubMedDate not supplied

Migraine, personality, and psychiatric comorbidity.

The purpose of this report is to examine the association between migraine and personality, taking into account history of co-occurring psychiatric disorders. Data came from an epidemiologic study of young adults in the Detroit, Michigan metropolitan area. Migraine, defined according to 1988 IHS criteria, and major depression and anxiety disorders were ascertained by a structured diagnostic interview. Migraine was associated with neuroticism, but not with extraversion or psychoticism, measured by the Eysenck's Personality Questionnaire. The association remained significant, when sex and history of major depression and anxiety disorders were controlled. An excess of 25% of persons with migraine alone, uncomplicated by psychiatric comorbidity, scored in the highest quartile of neuroticism. The results suggest that migraine sufferers might be more vulnerable to psychopathology and poor adjustment to their medical condition.

Adult↗