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Biomedical subjects

R L Blake

Publications and source records attributed to R L Blake.

At least 55 records · Page 3Linked to original sources
PubMed1988

The association of health with stressful life changes, social supports, and coping.

Cross-sectional associations of social stressors, social supports, and coping strategies with health status were explored in a self-selected sample of 157 white adults. Using a mailed questionnaire, stressful life changes were assessed by a 40-item version of the Social Readjustment Rating Scale, social supports were measured by a 13-item index, and health status was assessed by the 63-item Duke-UNC Health Profile (DUHP). Responses to a recent stressful event were categorized by method of coping and by focus of coping. In a multivariate analysis controlling for the effects of age, gender, and education level, higher 12 month life change score was related to lower composite DUHP score. The use of active-cognitive coping was directly associated and the use of avoidance-coping was inversely associated with health status. When interaction terms were included in the multivariate analysis, avoidance-coping potentiated the adverse health effect of stressors and weak social supports potentiated the harmful effect of avoidance-coping on health. The findings suggest that the propensity to engage in avoidant behavior in response to a stressful experience is associated with health impairment, particularly when social supports are weak.

Adaptation, Psychological↗
PubMed1987

A randomized controlled evaluation of an educational program in adults with high psychosocial risk of morbidity.

This clinical trial tested the efficacy of a psychosocial intervention in a panel of white adults with a high level of recent stressful life changes and weak social supports. One hundred seventy users of three family practices were randomly assigned to receive a six-month educational program provided by a nurse practitioner or to a control group. Outcome variables were assessed over a 12-month follow-up period by mailed questionnaires and validated when possible by review of medical records. During the six months immediately following the intervention, recipients had a lower rate of restricted-activity days than controls. During the follow-up period, symptom experience, physical function, social function, and emotional function were similar in the two groups. While the overall improvement in social supports was not significantly better at the completion of the intervention for recipients than for controls, those recipients who developed strong supports had fewer restricted-activity days than those who continued to have weak supports. This educational program may provide temporary benefit to adults with high psychosocial risk for health impairment.

Adult↗
PubMed1986

A point-source epidemic of leptospirosis. Description of cases, cause, and prevention.

Leptospirosis is a zoonotic disease that consists of fever, headache, myalgias, and multiple organ involvement, has varying clinical severity and morbidity, and can occur in epidemic form. Diagnosis is based on culture or serologic demonstration of recent infection. There is evidence that doxycycline therapy started early in the course of the disease favorably affects duration and severity. Antibiotic therapy is often initiated because of a strong suspicion of the disease, before bacteriologic or serologic confirmation of the diagnosis is completed. Public health measures play an important role in minimizing the incidence of leptospirosis.

Adult↗
PubMed1986

Evaluation of a health status measure in adults with high psychosocial risk.

The 63-item Duke UNC Health Profile assesses four dimensions of health status: presence of symptoms, physical function, social function, and emotional function. This instrument was developed for use in primary care research. We have tested its value in a primary care setting among individuals with suspected increased risk of health problems. In a group of 65 white adults with high life changes and weak social supports, this scale produced relatively stable functional status scores over fifteen months. In addition, functional status scores derived from this instrument were strongly correlated with cumulative six-month self-reported morbidity. These findings suggest that the Duke-UNC Health Profile is an acceptably reliable and valid measure of health status for adults with high psychosocial risk of health impairment.

Adult↗
PubMed1986

Rational theophylline use in older asthmatics.

In the sick adult, the variability of clearance from patient to patient may be greater than 50%. A given dose of theophylline that is predicted to result in a serum concentration of 15 micrograms/ml may result in an actual range of serum concentrations from 6.6 to 33 micrograms/ml. Respiratory infections, both acute and chronic, seem to have an adverse effect on theophylline clearance. Studies in adults with acute viral upper respiratory infections, pneumonia, and chronic obstructive pulmonary disease show a significant decrease in clearance.

Absorption↗
PubMed1986

Health effects of relocation at work.

The health effects of a work-related stressor over a six-month period in 355 employees at a university medical center were prospectively measured. Subjects were assigned to cohorts determined by whether they experienced a move from their office or laboratory during a time of building construction and renovation. After controlling for demographic factors, preexisting health status, prior physician utilization, and bed-disability, movers had a higher rate of bed-disability (P = .05). They were also more likely to report a deterioration in their health (P less than .05). Movers with high support at work and high total social support were more likely to report increased physician utilization. The findings suggest that a work-related stressor can adversely affect health, but this study does not support the hypothesis that such effects are moderated by social supports. Family physicians should be sensitive to the potential adverse health effects of work-related stressors on their patients.

Adult↗
PubMed1986

The reliability and validity of a ten-item measure of functional status.

The accurate assessment of functional status is an important clinical activity in family practice. Many of the measures of function developed for research purposes, however, have questionable applicability to primary care practices. The Duke-UNC Health Profile (DUHP) is a 63-item instrument that assesses four dimensions of function: symptom experiences, physical function, social function, and emotional function. The reliability and validity of a ten-item subset (the mini-DUHP) of the DUHP was examined for 71 white adults with a profile of high stressful life changes and weak social supports. These subjects completed the DUHP on two occasions and provided personal morbidity data by monthly mailed questionnaire for an intervening six-month period. On both administrations of the instrument, mini-DUHP scores were strongly correlated with composite DUHP scores (r = .81 and .84) and moderately correlated with each of the four functional dimension scores. The mini-DUHP demonstrated good temporal stability (r = .58). Mini-DUHP scores, determined both before and after the six-month period, were correlated with cumulative self-reported hospital days, bed disability days, restricted activity days, and physician utilization. Responses to the mini-DUHP strongly predicted bed disability, restricted activity, and physician visits after controlling for the effects of sociodemographic characteristics by multivariate analysis. This ten-item scale may be useful and practical in the assessment and monitoring of function in a primary care setting.

Adult↗
PubMed1985

Physician's knowledge and treatment of primary dysmenorrhea.

Recent advances in knowledge have increased understanding of the etiology of primary dysmenorrhea and provided new approaches to the treatment of this disorder. Primary care physicians in Missouri have been surveyed to determine the extent to which new knowledge about primary dysmenorrhea has been utilized in patient care. The majority of physicians who responded to a mailed questionnaire were aware of the role of prostaglandins in the pathogenesis of dysmenorrhea and used prostaglandin inhibitors in management. Congenital cervical stenosis, neurosis, and physical inactivity were also frequently cited as causal factors of this disorder. Older physicians and osteopathic physicians were less likely to prescribe prostaglandin synthetase inhibitors for this condition. The reported prevalence of dysmenorrhea in the respondent's practice was lower than that estimated in the literature. The findings suggest that the condition is underdiagnosed and that effective pharmacotherapy may be underutilized.

Adult↗
PubMed1985

Social supports and stress as predictors of illness.

The incidence and pattern of self-reported illness were studied over a six-month period in panels of 292 women and 188 men categorized by their experience of stressful life changes and their perceived supportive relationships. Men and women with more than average stressful changes had a risk of illness 1.6 and 1.8 times that reported by those with below-average changes. Analysis of the interaction of stressful changes with social supports showed that women with a combination of high changes and low supports experienced 2.5 times the rate of illness as those with low changes and high supports. This interaction was not found for men. A monthly rating of perceived life stress was correlated with subsequently recalled life changes for both men and women. The findings for women are consistent with the hypothesis that the interaction of stress with degree of social support is an important predictor of illness experience.

Adult↗
PubMed1985

An assessment of the practice of preventive cardiology in an academic health center.

There is evidence that attention to cardiovascular risk factors will decrease the mortality of atherosclerotic disease. The objective of this study was to ascertain how often cardiovascular risk factors were assessed and modified in inpatients and newly seen outpatients aged 10 to 50 years at the University of Missouri-Columbia Hospital and Clinics. A total of 461 randomly selected inpatient and outpatient charts were reviewed from three departments: family practice, internal medicine, and pediatrics. Each record was assessed for history of smoking, exercise, diet, stress, and familial heart disease, for blood pressure measurement, and for serum lipid profile and glucose determination. With the exception of blood pressure, the risk factors were infrequently assessed in outpatients. Again excepting hypertension, there was little evidence of any attempt to modify those risk factors identified in inpatients or outpatients. Therefore, an educational program in risk factor recognition and modification is needed for primary care physicians.

Adolescent↗