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R M Kaplan

Publications and source records attributed to R M Kaplan.

At least 55 records · Page 3Linked to original sources
PubMed1999

If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness.

It is increasingly acknowledged that diabetes and other chronic illnesses are major public health problems. Medicare and many managed health care organizations have recognized the enormous personal and societal costs of uncontrolled diabetes in terms of complications, patient quality of life, and health care system resources. However, the current system of reactive acute-episode focused disease care practiced in many settings does not adequately address this public health problem. An alternative proactive, population-based approach to chronic illnesses such as diabetes is proposed and illustrated. This multilevel systems approach addresses supportive and inhibitory social-environmental factors at multiple levels (personal, family, health care team, work, neighborhood, community). Key disciplines contributing to a population-based approach to diabetes include epidemiology, behavioral science, health care services, public health, health economics, and quality of life professions. Current and potential contributions of each of these disciplines are illustrated and an integrative, population-based systems approach to diabetes management and prevention of complications is proposed. This approach is also seen as applicable to other chronic illnesses.

Chronic Disease↗
PubMed1999

Shared decision making in clinical medicine: past research and future directions.

CONTENT: Shared medical decision making is a process by which patients and providers consider outcome probabilities and patient preferences and reach a health care decision based on mutual agreement. Shared decision making is best used for problems involving medical uncertainty. During the process the provider-patient dyad considers treatment options and consequences and explores the fit of expected benefits and consequences of treatment with patient preferences for various outcomes. This paper reviews the literature on shared medical decision making. Several questions are considered. Although several studies suggest that patients do not want to be involved in decision making, these studies typically fail to separate decisions about technical aspects of treatment from preferences for outcomes. There is considerable evidence that patients want to be consulted about the impact of treatment. Studies on the acceptability of shared decision making for physicians have produced inconsistent results. Shared decision making is more acceptable to younger and better-educated patients. It remains unclear whether shared decision making requires expensive video presentations or whether the same results can be obtained with simpler methods, such as the decision board. We conclude that shared medical decision making is an important development in health care. More research is necessary to identify the effects of shared decision making on patient satisfaction and health outcomes. Further, more research is necessary in order to evaluate the most effective methods for engaging patients in decisions about their own health care.

Adult↗
PubMed1998

The psychosocial impact of macular degeneration.

BACKGROUND: Age-related macular degeneration (AMD), the leading cause of irreversible blindness and low vision among the elderly, has not been well studied with regard to its impact on daily life. This study was designed to demonstrate the impact of AMD on quality of life, emotional distress, and functional level. PARTICIPANTS: The study sample consisted of 86 elderly adults (average age, 79 years) with AMD who were legally blind in at least 1 eye. Participants completed a battery of measures that included the Quality of Well-being Scale, the Instrumental Activities of Daily Living index, self-rated general health status, and the Profile of Mood States. RESULTS: Persons with AMD experienced significant reductions in key aspects of daily life. Their ratings for quality of life (average Quality of Well-being Scale score=0.581) and emotional distress (average Profile of Mood States total score=65.36) were significantly worse than those for similarly aged community adults and were comparable with those reported by people with chronic illnesses (eg, arthritis, chronic obstructive pulmonary disease, acquired immunodeficiency syndrome, and bone marrow transplants). Patients with AMD were also more likely than a national sample of elderly individuals to need help with daily activities. Visual acuity was related to ability to carry out daily activities (Instrumental Activities of Daily Living, r=0.28, P=.008). Quality of life ratings were significantly related to the ability to carry out daily activities (r=-0.38, P=.001), self-rated general health status (r=-0.21, P=.05), and emotional distress (Profile of Mood States total score, r=-0.25, P=.02). Individuals with a shorter period of perceived vision loss were more likely to report high levels of emotional distress (r=-0.24, P=.03) than those with a longer period of perceived vision loss. Further, those who were blind in 1 eye were even more significantly distressed than those who were blind in both eyes. CONCLUSIONS: Elderly persons with AMD causing legal blindness in 1 or both eyes have significant emotional distress and profoundly reduced quality of life and need help with key daily activities.

Activities of Daily Living↗
PubMed1998

Por La Vida model intervention enhances use of cancer screening tests among Latinas.

OBJECTIVE: To describe the short-term impact of the intervention known as Por La Vida (PLV) on cancer screening for Latinas in San Diego, California. METHODS: Thirty-six lay community workers (consejeras) were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program. The consejeras were randomly assigned to either a twelve-week cancer screening intervention group or a control group in which they participated in an equally engaging program entitled "Community Living Skills." Pre- and post-intervention self-report information was obtained from project participants on the use of cancer screening examinations. Outcome measures were changes in the percentages of women who had breast and cervical cancer screening test within the past year before and after the intervention occurred. Experimental and control groups were compared using t-tests. Analyses were conducted using both consejeras and participants as the unit of analysis. RESULTS: The increase in the use of the cancer screening test was higher in the PLV cancer intervention group in comparison to women in the community living skills control group. CONCLUSIONS: Key to the PLV intervention model is the identification of natural helpers in the Latino community and their subsequent training in intervention based on social learning theory using culturally appropriate educational materials. The model is an effective and viable approach for increasing the use of cancer screening tests in Latinas of low socioeconomic level and low level of acculturation.

Adult↗
PubMed1998

Comparison of the Quality of Well-being Scale and the SF-36 results among two samples of ill adults: AIDS and other illnesses.

PURPOSE: To compare results of using the SF-36 Short Form 36 (SF-36) and the Quality of Well-being Scale (QWB) in characterizing health outcomes over time in patients having serious illnesses, including cancer and AIDS. BACKGROUND: The SF-36 and the QWB are alternative measures of health-related quality of life. The SF-36 is a morbidity measure that features a profile of nine dimensions. The QWB is a preference-based measure that combines morbidity and mortality into a single number. However, the QWB can also be scored and used as a profile. We compare SF-36 and QWB scores with different scoring methods to assess validity and sensitivity to change over time in health outcomes for adult patients with HIV infection, cancer, and other serious illnesses. SUBJECTS: 201 adults with serious illnesses, including 99 with AIDS and 102 with cancer or other illnesses. PROCEDURE: All subjects received both measures at baseline and at 6-month intervals thereafter, over a period of 21/2 years. RESULTS: In the profile mode, the QWB captured outcomes that characterize the AIDS syndrome. The SF-36 differentiated between the AIDS and other illnesses patients on some scales, but without consistent direction. However, the overall QWB showed a decrease in quality of life over time for both the AIDS and other illnesses patients while the SF-36 did not. This is because many patients died and these were counted as outcomes by the QWB and as missing data by the SF-36. CONCLUSIONS: The QWB appears to be better able to capture outcomes of serious illness over time than does the SF-36.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prenatal screening for cystic fibrosis carriers: an economic evaluation.

The cloning of the CFTR gene has made it technically possible to avert the unwanted birth of a child with cystic fibrosis (CF). Several large trials offering prenatal CF carrier screening suggest that such screening is practical and that identified carriers generally use the information obtained. Therefore, a critical question is whether the cost of such screening is justified. Decision analysis was performed that used information about choices that pregnant women were observed to make at each stage in the Rochester prenatal carrier-screening trial. The cost of screening per CF birth voluntarily averted was estimated to be $1,320,000-$1,400,000. However, the lifetime medical cost of the care of a CF child in today's dollars was estimated to be slightly>$1,000,000. Therefore, despite both the high cost of carrier testing and the relative infrequency of CF conceptions in the general population, the averted medical-care cost resulting from choices freely made are estimated to offset approximately 74%-78% of the costs of a screening program. At present, if it is assumed that a pregnancy terminated because of CF is replaced, the marginal cost for prenatal CF carrier screening is estimated to be $8,290 per quality-adjusted life-year. This value compares favorably with that of many accepted medical services. The cost of prenatal CF carrier screening could fall to equal the averted costs of CF patient care if the cost of carrier testing were to fall to $100.

Abortion, Eugenic↗
PubMed1998

The Quality of Well-Being Scale: critical similarities and differences with SF-36.

PURPOSE: To summarize the development and application of a generic measure of health-related quality of life known as the Quality of Well-Being Scale (QWB). BACKGROUND: The QWB is part of a general health policy model. The measure includes functional components for mobility, physical activity, and social activity. In addition, it includes a comprehensive list of symptoms and problems. QWB scoring allows placement of each individual on a continuum of wellness ranging from 0 (for dead) to 1.0 for asymptomatic full function. The General Health Policy Model combines this point in time measure with information on prognosis and mortality to estimate quality-adjusted life-years (QALYs). Forming a ratio of program costs to QALYs yields estimates of cost per quality-adjusted life year. Evidence supports the validity of the QWB for a wide variety of applications in population monitoring, descriptive studies of patient populations, and clinical trials. We offer a variety of comparisons between the QWB and Medical Outcomes Study Short Form 36 (SF-36). MAIN FINDINGS: In comparison with the SF-36, the QWB provides less information on health profiles, but has the advantage of providing a metric that can be used for cost-utility or cost-effectiveness analysis. Although ceiling effects are common for some SF-36 subscales, perfect scores on the QWB are very rare. The QWB has an approximately normal distribution for populations of adults. Although, often criticized for not including a mental health component, we present evidence documenting the validity of the QWB for patients with psychological and psychiatric diagnoses. CONCLUSIONS: The QWB and SF-36 are alternative comprehensive measures of health outcomes.

Health Policy↗
PubMed1998

Performance of a self-administered mailed version of the Quality of Well-Being (QWB-SA) questionnaire among older adults.

OBJECTIVES: The Quality of Well-Being questionnaire is a measure of health-related quality of life (HRQoL) that has several desirable properties. Its widespread use has been hindered because it is difficult to administer. To overcome this limitation, a new self-administered form has recently been developed. This study examined the feasibility of using the Quality of Well-Being-Self-Administered (QWB-SA) questionnaire in an older population. METHODS: The Quality of Well-Being-Self-Administered questionnaire was sent to 430 community-dwelling individuals aged 65 years and older who were randomly selected from primary care physicians' offices. Response patterns, scaling distributions, and the acceptability of the survey were examined for all respondents. The results of the QWB-SA questionnaire were compared to the Sickness Impact Profile (SIP) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) for those individuals who also had completed the latter two surveys approximately 10 months earlier and whose health had not changed substantially in the meantime. RESULTS: Three hundred and one older adults (70%) responded. The mean QWB-SA questionnaire score was 0.7035. The scores were not skewed, and there were no floor or ceiling effects. The mean time to complete the QWB-SA questionnaire was 14.2 minutes, which was significantly shorter than for the SIP (19.3 minutes) but significantly longer than for the SF-36 (12.5 minutes). Subjects rated their satisfaction with the QWB-SA questionnaire somewhat lower than for the SIP and similar to SF-36. Correlations between the QWB-SA questionnaire and the SIP and SF-36 were moderate and were generally stronger for measures of physical health than for other domains such as mental health. CONCLUSIONS: The self-administered QWB questionnaire was acceptable to older respondents, and it correlated with other measures of health-related quality of life. It can be considered as a candidate for some research applications among older adults.

Aged↗
PubMed1998

Validity of the Quality of Well-Being Scale for patients with Alzheimer's disease.

The Quality of Well-Being (QWB) Scale is a utility-weighted measure of health-related quality of life that can be used in clinical trials, population studies, and cost/utility analyses. This article reports evidence for the validity of the QWB in patients with Alzheimer's disease. The subjects were 211 patient-spouse dyads and control dyads recruited from the University of California, San Diego, Alzheimer's Disease Research Center (ADRC) and from community referrals. Among these, three quarters were patients, and one quarter were age- and gender-matched controls. Patient data were obtained by caregiver proxy. Analyses demonstrated that the QWB was strongly associated with dementia ratings and behavioral problems. Caretakers of patients with low QWB scores also reported using more respite time. The authors conclude that the general QWB score allows data from Alzheimer's disease studies to be used in comparative cost/utility analysis.

Aged↗
PubMed1998

Validation of a new dyspnea measure: the UCSD Shortness of Breath Questionnaire. University of California, San Diego.

OBJECTIVE: Evaluate the reliability and validity of a new version of the University of California, San Diego Shortness of Breath Questionnaire (SOBQ), a 24-item measure that assesses self-reported shortness of breath while performing a variety of activities of daily living. DESIGN: PATIENTS enrolled in a pulmonary rehabilitation program were asked to complete the SOBQ, the Quality of Well-Being Scale, the Center for Epidemiologic Studies Depression Scale, and a 6-min walk with modified Borg scale ratings of perceived breathlessness following the walk. SETTING: University medical center pulmonary rehabilitation program. PATIENTS: Thirty-two male subjects and 22 female subjects with a variety of pulmonary diagnoses: COPD (n=28), cystic fibrosis (n=9), and postlung transplant (n=17). MEASUREMENTS AND RESULTS: The current version of the SOBQ was compared with the previous version, the format of which often resulted in a significant number of "not applicable" answers. The results demonstrated that the SOBQ had excellent internal consistency (alpha=0.96). The SOBQ was also significantly correlated with all validity criteria. CONCLUSIONS: The SOBQ is a valuable assessment tool in both clinical practice and research in patients with moderate-to-severe lung disease.

Activities of Daily Living↗
PubMed1997

Health-related quality of life in older patients with schizophrenia and other psychoses: relationships among psychosocial and psychiatric factors.

OBJECTIVE: Few multivariate studies relating psychosocial factors to symptoms of psychosis among older patients exist. We assessed environmental stressors, satisfaction with emotional support, coping responses and psychiatric symptoms, and sought to relate these factors to quality of well-being among older patients with schizophrenia and other psychoses. METHOD: Subjects were 70 psychosis patients with a mean age of 58. Predictors included measures of stressors (number of negative life events), satisfaction with emotional support, coping responses, positive and negative symptoms, depressive symptoms, social adjustment and a general quality of well-being (QWB) score. RESULTS: A conceptual model was tested and modified using path analytic techniques. Preliminary analyses suggested that psychosocial environment (life events, coping and emotional support) was primarily a product of psychiatric symptoms. Therefore, psychiatric symptoms preceded psychosocial environment variables in the proposed model. Further results suggested that depression mediated all of the effects of psychotic symptoms on social maladjustment, but not all of their effects on well-being. CONCLUSIONS: In older patients with schizophrenia and other psychoses, health-related quality of well-being is influenced by symptoms of psychoses, psychosocial factors and social maladjustment.

Adaptation, Psychological↗
PubMed1997

The effects of social support and education interventions on health care costs.

OBJECTIVE: To determine whether experimentally developed social support and education about appropriate use of the health care system decrease health care costs without negatively affecting health status. METHOD: Three hundred sixty-three health maintenance organization members with osteoarthritis were randomly assigned to 1 of 3 intervention groups or to a control group. Health status and health care use were assessed upon entering the study, and after 1 year and 2 years. RESULTS: A savings of $1,156/participant/year was obtained when health care costs of the experimental groups were compared with those of the control group. Production or implementation costs were least for the social support intervention. The nearly equal effects of the 3 interventions on health care costs make implementation costs the primary focus when deciding which intervention to use. CONCLUSION: We believe that the social support treatment is the most cost-effective intervention.

Aged↗
PubMed1997

Cigarette smoking predicts development of depressive symptoms among U.S. adolescents.

To examine whether adolescent cigarette smoking predicts the development of depressive symptoms, we used a longitudinal follow-up survey of 6,863 adolescents ages 12 to 18 in the U.S. who did not report notable depressive symptoms at baseline. This study used a self-report measure of six depressive symptoms experienced within the past twelve months at follow-up as the outcome of interest. Results indicated that 11.5% developed notable depressive symptoms at follow-up. There were marked gender differences with 15.3% of girls developing notable depressive symptoms compared to 8.1% of boys. Gender differences in depressive symptoms were consistent across all age groups and were apparent by the age of twelve. For both genders, smoking status was the most significant predictor of developing notable depressive symptoms. Several other risk factors including involvement in organized athletics, availability of social support, and personality characteristics were also found to be associated with development of depressive symptoms. Adolescent cigarette smoking may have marked health consequences in terms of depressive symptoms. The reduction of cigarette smoking among adolescents should be a focus of depression prevention interventions. In addition, the development of gender-specific components of prevention interventions may be warranted.

Adolescent↗
PubMed1997

The prevalence of Fasciola hepatica in its snail intermediate host determined by DNA probe assay.

Accurate snail intermediate host infection prevalence data have the potential to be extremely useful in determining seasonal transmission dynamics of Fasciola hepatica. Because the microscopic techniques currently used lack the sensitivity and specificity necessary to obtain meaningful infection prevalence data, we developed a highly accurate and efficient DNA probe assay. The assay has a sensitivity of 100%, a specificity of > 99%, easily detects a single miracidia and does not cross-hybridize with DNA of Fascioloides magna, Paramphistomum liorchis or Heterobilharzia americana, trematodes that share the same intermediate host and enzootic range as Fasciola hepatica. Using this assay, we determined the prevalence of F. hepatica in its snail intermediate host, Fossaria cubensis, during the second year of a 2-year study on the epizootiology of Fasciola hepatica in Florida. The overall infection prevalence of snails assayed in this study (n = 5246) was 1.5% and ranged from 0.1% to 3.1% for individual cattle ranches. Additionally, infection prevalence differed significantly for successive size groupings of snails, varying from 0% for 1-mm snails to 18.5% for 9- and 10-mm snails. The accuracy and efficiency of the DNA probe assay reported here for determining snail infection prevalence offers an inexpensive alternative to tracer animal studies for determining the epizootiology of F. hepatica.

Animals↗
PubMed1997

Cross-sectional study of quality of life and symptoms in chronic renal disease patients: the Modification of Diet in Renal Disease Study.

The purposes of this study were to measure health-related quality of life in the Modification of Diet in Renal Disease clinical trial; correlate quality of life measures with demographic, medical, and laboratory variables; and compare quality of life in various chronic diseases. The 1,284 patients enrolled in the baseline period of the Modification of Diet in Renal Disease study who completed at least one measurement of quality of life or symptoms served as the subjects of this study. The Quality of Well-Being (QWB) scale, which was a general health-related quality of life index, the Symptom Checklist-90R (SCL-90R), which provided a global measure of mental health, and the Patient Symptom Form, which assessed the frequency of symptoms specific to this population, were used as measurements. The mean +/- SD QWB score was 0.74 +/- 0.09. Using multivariate analysis, there was a significant negative correlation between the overall QWB score and age and female gender, and a significant positive correlation between the QWB and level of education, income, and glomerular filtration rate (GFR). For the SCL-90R subscores, the mean normalized Global Symptom Index was 49.7 +/- 9.6, the Positive Symptom Total was 47.9 +/- 10.4, and the mean Positive Symptom Distress Index was 51.3 +/- 12.6. Using multivariate analysis, significant inverse relationships were seen between each of the SCL-90R subscores and income, serum albumin level, and GFR. The most commonly reported medical symptoms in this cohort included tiring easily, weakness, lack of pep or energy, difficulty sleeping, and abdominal bloating or gas. Symptoms in which the severity index score had a negative correlation with GFR included tiring easily, weakness, lack of pep and energy, muscle cramps, easy bruising or bleeding, bad taste in mouth, and hiccoughs. In conclusions, patients with moderate to advanced renal insufficiency have a reduced quality of life and an increased frequency and severity of both symptoms and psychological distress, with the magnitude of these changes negatively correlated with GFR.

Chronic Disease↗