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Biomedical subjects

T S Inui

Publications and source records attributed to T S Inui.

At least 73 records · Page 4Linked to original sources
PubMed1987

Risk of ulcerative colitis among former and current cigarette smokers.

We performed a case-control study of the effect of tobacco smoking on the risk of acquiring ulcerative colitis among the 304,000 members of a health maintenance organization. Smoking histories before the date of the onset of ulcerative colitis were compared in 212 cases and an equal number of controls matched for age and sex who were selected from the enrollment file of the health maintenance organization. The relative risk of ulcerative colitis among current cigarette smokers as compared with nonsmokers was 0.6 (95 percent confidence interval, 0.4 to 1.0); however, among former cigarette smokers it was 2.0 (95 percent confidence interval, 1.1 to 3.7). These values remained after adjustment for socioeconomic factors and for coffee and alcohol consumption. The higher risk among former smokers could not be explained by postulating that smokers gave up tobacco near the time of disease onset because of early symptoms of ulcerative colitis. The relative risk of ulcerative colitis among former smokers increased in proportion to the cumulative number of cigarettes smoked before the onset of disease, suggesting a causal relationship between this exposure and disease occurrence. No difference in risk was observed among current smokers according to cumulative amount smoked. We conclude that former and current tobacco use may have opposite effects on the risk of acquiring ulcerative colitis.

Adolescent↗
PubMed1986

The interaction of mental illness, criminal behavior and culture: native Alaskan mentally ill criminal offenders.

The rapid changes experienced by non-Western ethnic groups as they become "acculturated" to Western life-styles are frequently associated with disintegration of the traditional cultures and psychosocial dysfunction of the groups' members. How culture changes lead to maladaptation remains a mystery. As a first step in clarifying this relationship, this paper proposes a method for analyzing the interaction of cultural change and psychosocial maladjustment. It uses Native Alaskans as a paradigmatic example of a group that is undergoing rapid changes and describes in detail a maladjusted subgroup of Native Alaskans--mentally ill criminal offenders. It compares 567 Native Alaskan criminal offenders who were referred to mental health professionals (from 1977 thru 1981) to 939 White Alaskan offenders. We find that alcohol abuse, the dominant social problem for Native Alaskans, is not clearly associated with the degree of sociocultural change. Residence in larger communities and higher educational achievement are associated with greater psychosocial maladjustment. The region of residence (i.e., Native Corporation) has a stronger influence on the rate and type of maladjustment than the ethnic group (i.e., Eskimo, Indian, or Aleut) or the "ethnic density" of the community of residence (i.e., the proportion of Native Alaskans in the population). We emphasize the importance of using such quantitative findings to focus the questions that should be addressed by ethnographic research.

Acculturation↗
PubMed1986

The flu shot study: using multiattribute utility theory to design a vaccination intervention.

Differences between the multiattribute utility (MAU) profiles of participants who had previously gotten flu shots and those who had not done so were used to design an informational brochure urging influenza vaccination. The effectiveness of the MAU brochure was evaluated in a VA ambulatory care clinic with a long-standing influenza vaccination program. The target population for the intervention was high-risk clinic patients who had not gotten a shot the previous year. Participants received either a letter urging them to get a flu shot, or a letter plus the informational brochure. A significantly larger proportion of the patients who received the brochure got shots; 36% versus 23% for the letter only. While a 13 percentage point increase is modest, influenza and related complications (preventable through vaccination) are the fourth-leading killers of older persons. Adding a MAU-based brochure to an ongoing vaccination program is inexpensive and may save additional lives.

Aged↗
PubMed1986

Symptomatic depression in elderly medical outpatients. I. Prevalence, demography, and health service utilization.

The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty-four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1% reported receiving mental health treatment by a specialist. Self-reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.

Aged↗
PubMed1986

The Veterans Administration Northwest Regional Health Services Research and Development Field Program: organization, activities, and early outcomes.

In 1982, the Veterans Administration established Health Services Research field programs in each of the six VA regions. Herein, we describe the historical origins, organization, responsibilities, activities, and early accomplishments of one of these programs--the Northwest Regional HSR&D field program. Special reference is made to this program's commitment to health services research relevant to geriatrics and gerontology, including the development of a system-wide agenda for research, information syntheses in geriatrics-relevant health services research topics, and the conduct of funded projects pertinent to care of the elderly. The importance of a medical center location for the field programs is discussed, and early indications of institutional impact are described.

Aged↗
PubMed1986

The effectiveness and cost of home care: an information synthesis.

The effect of home care on patient outcomes and costs of care has been controversial. This information synthesis summarizes results from studies of home care using experimental or quasi-experimental designs, explicitly including judgments of methodologic soundness in weighing the results. In 12 studies of programs targeted at chronically ill populations, home care services appear to have no impact on mortality, patient functioning, or nursing home placements. Across studies, these services either have no effect on hospitalization or tend to increase the number of hospital days; ambulatory care utilization may be increased by 40 percent. The cost of care either is not affected or is actually increased by 15 percent. The critical need at present is for better-designed studies to test the effects of different types of home care, targeted at various types of patients, on the outcomes assessed in the existing studies, as well as on other important outcomes such as family finances, quality of life, and quality of care.

Ambulatory Care↗
PubMed1986

Risk factors for acquiring pneumococcal infections.

To identify risk factors for developing pneumococcal infections, we carried out a case-controlled study on a retrospectively constituted cohort of 3074 clinic patients in a presumed high-risk population. Culture-proved pneumococcal infections were identified in 63 men over a period of 5.5 years, yielding an estimated incidence of 6.3 cases per 1000 person-years. By comparing these patients with 130 uninfected control patients, the relative risk of pneumococcal infections related to various exposures was calculated by logistic regression analysis. Statistically significant independent risk factors (and their relative risks) were as follows: dementia (5.82), seizure disorders (4.38), current cigarette smoking (4.00), congestive heart failure (3.83), cerebrovascular disease (3.82), institutionalization (3.13), and chronic obstructive pulmonary disease (2.38). Risk was increased with age and previous hospitalizations, and, to a nonsignificant degree, by hotel residence (3.93), lung cancer (2.24), previous smoking (2.14), corticosteroid use (1.81), and alcoholism (1.35); but not by diabetes mellitus (0.99), nonlung malignancies (0.93), nonwhite race (0.89), or ischemic heart disease (0.58).

Aged↗
PubMed1986

Developing and testing a decision model for predicting influenza vaccination compliance.

Influenza vaccination has long been recommended for elderly high-risk patients, yet national surveys indicate that vaccination compliance rates are remarkably low (20 percent). We conducted a study to model prospectively the flu shot decisions and subsequent behavior of an elderly and/or chronically diseased (at high risk for complications of influenza) ambulatory care population at the Seattle VA Medical Center. Prior to the 1980-81 flu shot season, a random (stratified by disease) sample of 63 patients, drawn from the total population of high-risk patients in the general medicine clinic, was interviewed to identify patient-defined concerns regarding flu shots. Six potential consequences of influenza and nine of vaccination were emphasized by patients and provided the content for a weighted hierarchical utility model questionnaire. The utility model provides an operational framework for (1) obtaining subjective value and relative importance judgments from patients; (2) combining these judgments to obtain a prediction of behavioral intention and behavior for each patient; and, if the model is valid (predictive of behavior), (3) identifying those factors which are most salient to patient's decisions and subsequent behavior. Prior to the 1981-82 flu season, the decision model questionnaire was administered to 350 other high-risk patients from the same general medicine clinic population. The decision model correctly predicted behavioral intention for 87 percent and vaccination behavior for 82 percent of this population and, more importantly, differentiated shot "takers" and "nontakers" along several attitudinal dimensions that suggest specific content areas for clinical compliance intervention strategies.

Adult↗
PubMed1985

The relationship of attitude changes to compliance with influenza immunization. A prospective study.

In a longitudinal, prospective study of patient's decisions about influenza vaccination, the stability of attitudes about the flu and flu shots, the stability of flu shot decisions, and the relationship of attitude shifts to compliance were studied. In both 1981 and 1982 for 216 patients at high risk for complications of influenza, attitudes about 15 issues in the decision to obtain a flu shot were measured and each patient's behavioral intention and flu shot behavior ascertained. From one year to the other, 53% of patients had at least two substantial attitude shifts, yet 91% of patients expressed the same behavioral intention, and 85% of patients had the same flu shot behavior. Reversals in flu shot decisions were closely related to shifts in attitudes concerning side effects of the flu shot, an association that was supported by other findings, including a marked difference in prevalence of previous side effects in shot takers (11%) versus nontakers (60%). The results suggest: intention reversals were less frequent than attitude shifts because only specific attitude changes about flu shots were associated with reversals, and interventions that induce positive attitude changes, especially about the side effects of flu shots, should be effective in improving flu shot compliance.

Adult↗
PubMed1984

High blood glucose level on hospital admission and poor neurological recovery after cardiac arrest.

To evaluate the relationship between blood glucose and neurological recovery after cardiac arrest, we retrospectively reviewed our experience with 430 consecutive patients resuscitated after out-of-hospital cardiac arrest. All these patients had received variable amounts of intravenous 5% glucose solutions before admission. Awakening patients, those following commands or having comprehensible speech, were classified as to whether they suffered persistent neurological deficits. The mean blood glucose level on hospital admission was higher in 154 patients who never awakened than in 276 who did awaken (mean, 341 versus 262 mg per 100 milliliters; p less than 0.0005). Among the 276 who awakened, 90 patients with persistent neurological deficits had higher mean glucose levels on admission than did 186 without deficits (286 versus 251 mg per 100 milliliters; p less than 0.02). These significant differences persisted after excluding all patients whose glucose levels were higher than 500 mg per 100 milliliters and after controlling for potentially confounding variables using multiple regression analysis.

Blood Glucose↗
PubMed1984

Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men?

To determine whether the results of voided urine cultures in men are affected by meatal cleansing, midstream sampling, or circumcision status, 308 paired (initial and midstream) specimens were collected from 254 urology clinic patients. Half of the patients cleansed their urethral meatus with povidone-iodine prior to voiding. The circumcision status of all patients was noted. The rates of true bacteriuria (growth of 10(4) or greater colony-forming units/ml urine with a single predominant species) and contamination (growth of 10(3) or greater colony-forming units/ml urine with two or more colonial types) were compared in the various collection technique subgroups. Neither the bacteriuria nor contamination rates were significantly different (p greater than 0.05) in circumcised and uncircumcised patients, or in those who cleansed their meatus and those who did not. Contamination, but not bacteriuria, rates were higher in initial as compared with midstream specimens. These data suggest that the clean-catch midstream void procedure is unnecessary for obtaining routine voided urine culture specimens from men.

Bacteriuria↗
PubMed1984

Fulfillment of patient requests in a general medicine clinic.

For initial visits to a longitudinal-care internal medicine clinic, we elicited patients' requests for problems to be addressed, measured patients' assessments of request fulfillment, and determined correlates of request fulfillment. Patients rated all requests as fulfilled in 62 of 71 cases (87 per cent). Fewer pre-encounter patient-reported problems, discretionary features of the doctor-patient encounter including more time spent eliciting history of present illness, and greater completeness of laboratory testing were associated with request fulfillment.

Consumer Behavior↗
PubMed1984

Pediatric clinicians' support for parents makes a difference: an outcome-based analysis of clinician-parent interaction.

Pediatric clinicians frequently must offer support (eg, reassurance) to anxious, stressed parents. Supportive clinician behaviors were studied to determine their impact on parents. Forty initial health supervision visits to a pediatric clinic were videotaped through a one-way mirror. Mothers were interviewed immediately before and 1 week after the visits to ascertain changes in concerns, opinions of clinicians, perceptions of infants, and self-confidence. Mothers also completed a postvisit satisfaction questionnaire. Coders blinded to these outcomes identified and enumerated three supportive clinician behaviors: encouragement, reassurance, and empathy. Analyses compared visit outcomes according to high and low levels of maternal exposure to clinician support. Mothers exposed to high levels of encouragement had significant improvement in their opinions of clinicians and higher satisfaction (P = .02). Mothers exposed to high levels of empathy had higher satisfaction and greater reduction in concerns (P less than .05). No significant differences in outcome were found for exposure to reassurance. Differences in visit outcomes were not related to either maternal demographic factors or clinician type (pediatricians v pediatric nurse practitioners). These results suggest that pediatric clinicians' support for parents makes a difference. Additional outcome-based analyses are needed to identify the full range of effective pediatric communication.

Adolescent↗