Search PubMed⌕ Search

Biomedical subjects

W E Broadhead

Publications and source records attributed to W E Broadhead.

At least 37 records · Page 2Linked to original sources
PubMed1994

Risk factors for violent behavior in elementary school boys: have you hugged your child today?

Seventeen Hispanic elementary schoolboys with violent behavior problems were compared with 27 matched control students who were not overtly violent at school. Violent boys were significantly more likely to not live with their fathers, to have unmarried parents, to have more siblings, and to have fathers who never show them affection. Parents of violent boys were more likely than those of matched control students to use spanking for discipline and to admit that they rarely express affection for their sons.

Adult↗
PubMed1993

The Duke Severity of Illness Checklist (DUSOI) for measurement of severity and comorbidity.

The Duke Severity of Illness Checklist (DUSOI) was evaluated on 414 primary care adult patients using data collected both by medical providers at the time of the patient visit and later by a chart auditor. Severity scores for individual diagnoses were determined by summing the ratings for four non-disease-specific parameters: symptom level, complications, prognosis without treatment, and expected response to treatment. Mean diagnosis severity scores (scale 0-100) among the 21 most prevalent diagnoses varied from a low of 13.9 for menopausal syndrome to a high of 43.0 for sprains and strains. An overall severity score was calculated by combining diagnosis severity scores and giving highest weights to the most severe diagnoses. Provider-generated overall severity scores (mean = 43.3) and auditor-generated overall severity scores (mean = 38.9) were significantly correlated (coefficient of agreement = 0.59, p < 0.0001). Diagnoses varied in their individual contribution to the overall severity score, from 8.9% for lipid disorder to 90.0% for sprains and strains. Separate comorbidity severity scores were calculated to measure the severity of all of each patient's health problems except the diagnosis under study. For example, patients with menopausal syndrome had co-existing health problems which generated a high mean comorbidity severity score of 43.2, while patients with sprains and strains had a low mean comorbidity score of 4.7. The DUSOI Checklist can be used in the clinical setting by both providers and auditors to produce quantitative severity scores (by diagnosis, overall, and for comorbidity) which are based entirely upon clinical judgment. This method should be useful in controlling for severity of illness in clinical studies and indicating the outcome of medical care in terms of reduction in severity of illness following medical interventions.

Adolescent↗
PubMed1993

Disease-specific versus generic measurement of health-related quality of life in insulin-dependent diabetic patients.

The health-related quality of life of 170 adult insulin-dependent diabetic patients was measured cross-sectionally to compare a disease-specific instrument, Diabetes Quality of Life (DQOL) questionnaire, and two generic instruments, the Duke Health Profile (DUKE) and the General Health Perceptions Questionnaire (GHP). The generic measures provided as much or more information about health-related quality of life as the disease-specific instrument. This was demonstrated both by comparison of the DQOL with the DUKE and GHP and by comparison of the disease-specific with the generic components of a modified version of the DQOL. Patients with the diabetic complication of nephropathy had increased worry over their health and lower general health perceptions. Neither the duration of diabetes nor the intensity of insulin therapy, however, was found to have a statistically significant effect on any of the health-related quality of life scores. Nondiabetic factors, such as the comorbidity, nondiabetic medications, marital status, social relationships, and family arguments were found to be predictors of health-related quality of life more often than the diabetic factors duration of diabetes, complications, and intensity of insulin therapy. These analyses suggest the clinical value of using generic questionnaires to measure health-related quality of life and psychosocial factors to identify nondiabetic problems that might respond to intervention, thereby potentially enhancing the effect of diabetes-specific therapy.

Adolescent↗
PubMed1993

Patient acceptance of two health status measures: the Medical Outcomes Study Short-form General Health Survey and the Duke Health Profile.

BACKGROUND: The Medical Outcomes Study Short-Form General Health Survey (MOS-SF) and the Duke Health Profile (DUKE) are brief, reliable, valid, and practical health status measures with potential applications in clinical research. We compared patient acceptance, ease of completion, and adequacy of capture (of the patient's self-perception of health) of these instruments in a primary care setting. METHODS: The MOS-SF, DUKE, and assessment questionnaires were administered to 79 patients in a university-based family practice. Patient acceptance of each instrument was assessed with Likert scale questions. Patients then compared the two instruments for relative ease of completion, preference, and completeness of capture. RESULTS: Both forms assessed each item well, but the DUKE scored statistically significantly better than the MOS-SF on four of six patient acceptance questions and both ease of completion items. There were no significant differences for capture items. CONCLUSIONS: Although both instruments are well accepted, investigators may favor the DUKE over the MOS-SF for situations in which patient acceptance or ease of completion is a key issue.

Adult↗
PubMed1993

Prevalence of depressive symptoms in primary care.

BACKGROUND: Depression is one of the most common medical disorders seen in primary care practice. The purpose of this study was to estimate the prevalence of depressive symptoms in primary care patients across the United States, and to describe patient characteristics that may be associated with an increased likelihood of those symptoms. METHODS: Survey data were obtained from a sample of 75,858 patients who visited one of 765 participating primary care physicians for any reason from February 1991 to September 1991. The outcome measurement used was the index score for presence of depressive symptoms on the Zung Self-rating Depression Scale. RESULTS: The overall prevalence of clinically significant depressive symptoms was found to be 20.9%, but the percentage of patients citing depression as a reason for visit (1.2%) was markedly lower. Patients who perceived their health as poor were more likely to have severe depressive symptoms than patients who perceived their health as excellent. Women, those in older age groups, and those with lower levels of education were more likely to have clinically significant depressive symptoms than men, those in younger age groups, and those with higher levels of education. When classified by marital status within each sex, married men and women were the least likely to have clinically significant depressive symptoms. CONCLUSIONS: Clinically significant depressive symptoms are highly prevalent in primary care patients; however, depression is an infrequent patient complaint. There are certain patient characteristics that may cue the physician to consider depression in the differential diagnosis, particularly the patient's self-perception of his or her overall health status. In addition, certain other subsets of patients are at increased risk of depression, such as women, those in older age groups, and those of lower socioeconomic status.

Adult↗
PubMed1993

Increasing compliance with mammography recommendations: health assessment forms.

BACKGROUND: Inexpensive reminder systems are needed to ensure that primary care physicians consistently provide health maintenance services to their patients. The purpose of this study was to determine the effectiveness of a simple, inexpensive health assessment form in place of the standard chart note to increase physician compliance with mammography recommendations. METHODS: A health assessment form with a reminder for screening mammography was implemented in a family practice in 1987 and was to be used as the official chart record for health maintenance visits. The charts of all women 50 years of age and older with two or more office visits during the years 1985 through 1988 were audited to determine how many mammograms were completed. Results were compared with mammography completion rates at a similar practice that did not use a health assessment form. RESULTS: The study group showed a significant increase in mammography completion after implementation of the form, with compliance increasing from 7.3% to 32.0% (P < .001). The comparison group had an increase in mammogram completion from 12.0% to 17.8% (P < .001). The difference between the changes in rates of mammography in the two practices was statistically significant (P < .001). Among women in the study group who had a scheduled health maintenance visit during the study period the average rate of mammography completion increased from 21.2% to 65.2% (P < .001). CONCLUSIONS: The addition of a health assessment form with a mammography reminder at the health maintenance visit is an effective and inexpensive method to increase compliance with mammography.

Adolescent↗
PubMed1992

Quality of life and functional health of primary care patients.

Quality of life and functional health were measured cross-sectionally for 314 adult ambulatory primary care patients in a rural clinic and found to be much better for patients with low severity of illness who required no confinement to home because of health problems, than for patients with high severity of illness who required confinement. Severity of illness was the strongest predictor for patient-reported physical health function and for patient quality of life when assessed by the health provider. Confinement was the strongest predictor for patient quality of life when assessed by the patient. There was very little agreement between patient-assessed and provider-assessed quality of life. Family stress was the strongest predictor of function in terms of mental health, social health, general health, self-esteem, anxiety, and depression. These data suggest that clinicians should direct increased attention to patient-assessed quality of life, patient-reported functional health status, and psychosocial factors such as family stress in an effort to improve medical outcomes.

Activities of Daily Living↗
PubMed1992

Prevalence of lifetime sexual victimization among female patients.

BACKGROUND: State and federal statistics describe a lower incidence of rape and child abuse than is suggested by community prevalence rates. Victims of sexual assault may experience numerous short-term and long-term effects on psychosocial and physical health. They tend to use medical services more than nonvictims and are also more likely to seek medical care than mental health services. This study seeks to determine the prevalence of sexual victimization in a family practice setting. METHODS: Women 18 years of age or older presenting to a combined family practice and university student health center for a routine Papanicolaou smear or a health maintenance visit voluntarily completed an anonymous sexual experiences questionnaire of 28 close-ended items. RESULTS: Of 416 consecutive women, 405 agreed to participate. Of 147 family practice patients, 47.6% reported some type of contact sexual victimization during their lifetimes; 25.2% reported rape or attempted rape. Of 258 student health service patients, 57% had experienced contact sexual victimization, and 28.7% reported rape or attempted rape. Of those who reported unwanted sexual contact, 30% of the family practice patients felt they would not be comfortable discussing the experience with medical personnel, and 44.9% of the student health service patients would not feel comfortable doing so. CONCLUSIONS: Women with a history of unwanted sexual contact may be common in family practice and student health settings. Although treatment can be beneficial, many of these patients are not comfortable discussing their experiences with medical personnel. These findings suggest that there is potential benefit in obtaining a sexual victimization history as part of routine care, but further research will be necessary to assess the clinical benefit of such an approach.

Adolescent↗
PubMed1991

Social support and the cancer patient. Implications for future research and clinical care.

This review assesses past progress, current practices, and future needs in research and clinical practice involving the social support needs of cancer patients. A review is given of the various conceptualizations of the social support/stress paradigm and of the state of the art of measuring social support. Then the current work in the field of social support and cancer is considered and an argument is made for the use of social support measures, which are relevant to the experiences of the cancer patient. Potential adaptations of an existing instrument (the Duke-UNC Functional Social Support Scale) are demonstrated, and a taxonomy of stages of cancer that would require additional types of social support measures and interventions is outlined. Interventions are discussed in terms of the traditional support groups as well as interventions by the oncologist and primary care physician. An argument is made for the inclusion of quality of life or functional measures as outcomes in clinical trials and the care of the cancer patient. Finally, the need to address the existential, philosophic, or religious issues surrounding cancer and its treatment is discussed.

Forecasting↗
PubMed1991

Development of the 17-item Duke Health Profile.

The 17-item Duke Health Profile (DUKE) was developed as a refined version of the 63-item Duke-UNC Health Profile (DUHP) using a methodology based upon a balanced clinical and statistical rationale. The result is a brief, valid functional health measure with 10 scales that compares well with the MOS Short-form and the COOP Charts. In addition to the five constructs (ambulation, emotional symptoms, activities with friends or relatives, health perception, and pain) which are measured by all three of the instruments, the DUKE quantitates cognition, social self-esteem, confinement, and somatic symptoms other than pain.

Adult↗
PubMed1991

Validation of the Duke Social Support and Stress Scale.

The Duke Social Support and Stress Scale (DUSOCS) was validated in 249 adult family practice patients using the Family Strengths, the Family Inventory of Life Events, and the Duke Health Profile (DUKE) as comparison instruments. Validity was supported in that the DUSOCS family support measure had the clinically expected positive associations with DUKE health measures (regression coefficients of +7.4 to +18.7) and negative associations with DUKE anxiety and depression measures (-2.0 to -17.2). DUSOCS family stress had negative associations with the health measures (-11.6 to -34.5) and positive associations with anxiety and depression (+18.9 to +32.1). Family and non-family stress contributed more than severity of illness to elevated levels of anxiety and depression and lowered levels of mental health, social health, and self-esteem, while these same stresses contributed only half as much as severity of illness to lowered physical health.

Adolescent↗
PubMed1991

Tricyclic antidepressant prescribing for nonpsychiatric disorders. An analysis based on data from the 1985 National Ambulatory Medical Care Survey.

BACKGROUND: Primary care physicians often do not document a psychiatric diagnosis when prescribing psychotropic medications. Recent literature suggests the potential benefit of tricyclic antidepressants (TCAs) in a number of nonpsychiatric conditions (low back pain, peptic disease, fibrositis, headache, peripheral neuropathy, rheumatoid disease, and irritable colon). METHODS: Data from the 1985 National Ambulatory Medical Care Survey (NAMCS) were used to categorize the primary diagnoses given during office visits in which tricyclic antidepressants were prescribed. Comparisons were made across specialties. RESULTS: Primary care physicians prescribed tricyclic antidepressants in 1% of all visits (an estimated 2,892,000 visits per year). Whereas 50% of these visits at which TCAs were prescribed were for documented psychiatric illnesses or conditions, 15% were for nonpsychiatric TCA-responsive conditions. The majority of visits by patients with these disorders were to primary care physicians. The pattern of TCA prescribing for these disorders by primary care physicians parallels that of other medical specialties except that primary care physicians prescribed TCAs for nonpsychiatric TCA-responsive disorders less frequently than did other medical specialists. CONCLUSIONS: When nonpsychiatric TCA-responsive disorders are included, primary care physicians document with appropriate diagnoses 15% more of their TCA prescriptions than previous studies have indicated. An understanding of the 35% of TCA prescriptions that do not show proper documentation will require further study and information not available from the NAMCS:

Adolescent↗
PubMed1990

Depression, disability days, and days lost from work in a prospective epidemiologic survey.

We describe the relationship of depression and depressive symptoms to disability days and days lost from work in 2980 participants in the Epidemiologic Catchment Area Study in North Carolina after 1 year of follow-up. Compared with asymptomatic individuals, persons with major depression had a 4.78 times greater risk of disability (95% confidence interval, 1.64 to 13.88), and persons with minor depression with mood disturbance, but not major depression, had a 1.55 times greater risk (95% confidence interval, 1.00 to 2.40). Because of its prevalence, individuals with minor depression were associated with 51% more disability days in the community than persons with major depression. This group was also at increased risk of having a concomitant anxiety disorder or developing major depression within 1 year. We conclude that the threshold for identifying clinically significant depression may need to be reevaluated to include persons with fewer symptoms but measurable morbidity. Only by changing our nosology can the societal impact of depression be adequately addressed.

Absenteeism↗
PubMed1990

The health status and life satisfaction of first-year medical students.

The self-reported health status and life satisfaction of 286 first-year Duke University medical students in four consecutive classes were measured at the beginning and end of the school year and compared statistically with relevant sociodemographic and behavioral factors. Health status, quantitated in terms of Duke Health Profile scores, was generally lower for women than for men. Although there was a definite trend of worsening along all parameters of health and satisfaction during the year for both women and men, the most marked change was the increase in depressive symptoms. The students who were very satisfied with life had fewer symptoms of depression and anxiety; higher self-esteem, better physical, mental, and social health; stronger social ties; more physical activity; more sleep; and fewer stressful life events. Strong social ties was the factor most positively related to better health and life satisfaction.

Depressive Disorder↗
PubMed1990

The Duke Health Profile. A 17-item measure of health and dysfunction.

The Duke Health Profile (DUKE) is a 17-item generic self-report instrument containing six health measures (physical, mental, social, general, perceived health, and self-esteem), and four dysfunction measures (anxiety, depression, pain, and disability). Items were derived from the 63-item Duke-UNC Health Profile, based upon face validity and item-remainder correlations. The study population included 683 primary care adult patients. Reliability was supported by Cronbach's alphas (0.55 to 0.78) and test-retest correlations (0.30 to 0.78). Convergent and discriminant validity were demonstrated by score correlations between the DUKE and the Sickness Impact Profile, the Tennessee Self-Concept Scale, and the Zung Self-Rating Depression Scale. Clinical validity was supported by differences between the health scores of patients with clinically different health problems. Patients with painful physical problems had a DUKE physical health mean score of 58.1, while patients with only health maintenance problems had a mean score of 83.9 (scale: 0.0 = poorest health and 100.0 = best health). Patients with mental health problems had a DUKE mental health mean score of 49.2, in contrast to 75.7 for patients with painful physical problems and 79.2 for those with health maintenance. The DUKE is presented as a brief technique for measuring health as an outcome of medical intervention and health promotion.

Adolescent↗