Biomedical subjects

William C Miller

Publications and source records attributed to William C Miller.

At least 37 records · Page 2Linked to original sources

PubMed2006

Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States.

BACKGROUND: Mood and anxiety disorders, particularly depression, and substance abuse (SA) commonly co-occur with HIV infection. Appropriate policy and program planning require accurate prevalence estimates. Yet most estimates are based on screening instruments, which are likely to overstate true prevalence. SETTING: Large academic medical center in Southeast. PARTICIPANTS: A total of 1,125 patients, representing 80% of HIV-positive patients seen over a 2.5-year period, completed the Substance Abuse-Mental Illness Symptoms Screener, a brief screening instrument for probable mood, anxiety, and SA disorders. Separately, 148 participants in a validation study completed the Substance Abuse-Mental Illness Symptoms Screener and a reference standard diagnostic tool, the Structured Clinical Interview for DSM-IV. METHODS: Using the validation study sample, we developed logistic regression models to predict any Structured Clinical Interview for DSM-IV mood/anxiety disorder, any SA, and certain specific diagnoses. Explanatory variables included sociodemographic and clinical information and responses to Substance Abuse-Mental Illness Symptoms Screener questions. We applied coefficients from these models to the full clinic sample to obtain 12-month clinic-wide diagnosis prevalence estimates. RESULTS: We estimate that in the preceding year, 39% of clinic patients had a mood/anxiety diagnosis and 21% had an SA diagnosis, including 8% with both. Of patients with a mood/anxiety diagnosis, 76% had clinically relevant depression and 11% had posttraumatic stress disorder. CONCLUSIONS: The burden of psychiatric disorders in this mixed urban and rural clinic population in the southeastern United States is comparable to that reported from other HIV-positive populations and significantly exceeds general population estimates. Because psychiatric disorders have important implications for clinical management of HIV/AIDS, these results suggest the potential benefit of routine integration of mental health identification and treatment into HIV service sites.

Adult↗

PubMed2006

High rates of HIV testing despite low perceived HIV risk among African-American sexually transmitted disease patients.

PURPOSE: In the current diagnosis-based, human immunodeficiency virus (HIV) prevention climate, previous testing among persons at elevated HIV risk has cost and efficacy implications, as it signals continued behavioral risk, limited HIV knowledge or overuse of services. This study sought to determine the proportion of African Americans newly seeking sexually transmitted disease (STD) diagnosis who previously had obtained HIV counseling and testing. METHODS: This was a clinic-based, cross-sectional survey of African-American adults (N=408) seeking STO diagnosis at a public STD clinic located in a high-HIV and STD prevalence city in the U.S. south. MAIN FINDINGS: Eighty-four percent of respondents had previously obtained HIV counseling and testing: 68% had previously obtained care at the clinic. Sixty-five percent of respondents perceived themselves as having low or no HIV risk. Seventy-two percent correctly answered > or = 3 of 4 HIV knowledge items. CONCLUSIONS: Although diagnosis-based HIV prevention initiatives promote HIV counseling and testing for both primary and secondary HIV prevention, these findings suggest that many African-American STD patients remain at risk following testing. Future research should explore how the counseling portion of standard HIV counseling and testing influences subsequent knowledge, attitudes, risk perceptions and behaviors.

AIDS Serodiagnosis↗

PubMed2005

Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients.

BACKGROUND: Substance abuse (SA) and mental illness (MI) commonly co-occur with HIV infection in the United States and have important implications for clinical management of HIV/AIDS. Yet SA/MI often go untreated due in part to a lack of practical, validated screening tools. SETTING: HIV clinic in academic medical center. METHODS: The 16-item SA/MI Symptoms Screener (SAMISS) targets SA/MI in HIV-positive patients. Consecutive consenting HIV-positive patients completed the SAMISS and then a reference standard diagnostic tool, SCID, the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: Twenty percent of participants (29/148) had an SA diagnosis and 41% (59/143) had an MI diagnosis in the past year on the SCID; 48% (68/143) had 1 or both. Thirty-seven percent (55/148) screened positive for SA and 69% (99/143) screened positive for MI on the SAMISS. The SAMISS had 86% (95% CI: 68%-96%) sensitivity and 75% (66%-82%) specificity for SA and 95% (86%-99%) sensitivity and 49% (38%-60%) specificity for MI. Patients with SA were likely to show up as false positives for MI and vice versa. CONCLUSION: The SAMISS functioned well as a first-line screening tool for SA/MI in this HIV clinic population. It missed few cases and was easily incorporated into a busy clinical setting. Persons screening positive require a more rigorous confirmatory psychiatric evaluation.

Adult↗

PubMed2005

Maternal-fetal microtransfusions and HIV-1 mother-to-child transmission in Malawi.

BACKGROUND: Between 25% and 35% of infants born to HIV-infected mothers become HIV-1 infected. One potential route of mother-to-child transmission (MTCT) could be through a breakdown in the placental barrier (i.e., maternal-fetal microtransfusions). METHODS AND FINDINGS: Placental alkaline phosphatase (PLAP) is a 130-kD maternal enzyme that cannot cross the intact placental barrier. We measured PLAP activity in umbilical vein serum as an indicator of maternal-fetal microtransfusion, and related this to the risk of HIV-1 MTCT. A case-cohort study was conducted of 149 women randomly selected from a cohort of HIV-1-infected pregnant Malawians; these women served as a reference group for 36 cases of in utero MTCT and 43 cases of intrapartum (IP) MTCT. Cord PLAP activity was measured with an immunocatalytic assay. Infant HIV status was determined by real-time PCR. The association between cord PLAP activity and HIV-1 MTCT was measured with logistic regression using generalized estimating equations. Among vaginal deliveries, PLAP was associated with IP MTCT (risk ratio, 2.25 per log10 ng/ml PLAP; 95% confidence interval, 0.95-5.32) but not in utero MTCT. In a multivariable model adjusted for HIV-1 RNA load, chorioamnionitis, and self-reported fever, the risk of IP MTCT almost tripled for every log10 increase in cord PLAP activity (risk ratio, 2.87; 95% confidence interval, 1.05-7.83). CONCLUSION: These results suggest that during vaginal deliveries, placental microtransfusions are a risk factor for IP HIV-1 MTCT. Future studies are needed to identify factors that increase the risk for microtransfusions in order to prevent IP HIV-1 MTCT.

Adult↗

PubMed2005

Effects of HIV-1 serostatus, HIV-1 RNA concentration, and CD4 cell count on the incidence of malaria infection in a cohort of adults in rural Malawi.

BACKGROUND: To assess the effects of human immunodeficiency virus (HIV) infection on susceptibility to malaria, we compared the incidence rates of malaria by HIV type 1 (HIV-1) serostatus, baseline blood HIV-1 RNA concentration, and baseline CD4 cell count, over the course of a malaria season. METHODS: We followed a cohort of 349 adults in Malawi. For the 224 HIV-1-seropositive adults (64% of the cohort), we measured HIV-1 RNA concentration (n=187) and CD4 cell count (n=184) at baseline. Parasitemia was defined as presence of asexual parasites on a thick film of blood and was treated with sulfadoxine/pyrimethamine (SP), in accordance with national policy. Hazard ratios (HRs) of parasitemia were estimated using Cox regression. Demographics were adjusted for. RESULTS: HIV-1 seropositivity was associated with parasitemia (adjusted HR, 1.8 [95% confidence interval {CI}, 1.2-2.7] for a first parasitemia episode; adjusted HR, 2.5 [95% CI, 1.5-4.2] for a second parasitemia episode [> 14 days after the first episode]; adjusted HR, 1.9 [95% CI, 1.4-2.6] for parasitemia overall). Treatment failure (parasitemia < or = 14 days after SP treatment) did not differ by HIV-1 serostatus (risk ratio, 1.3 [95% CI, 0.5-3.2]). HIV-1 RNA concentrations and CD4 cell counts were moderately but inconsistently associated with parasitemia. A high parasite density with fever was associated with HIV-1 seropositivity and low CD4 cell count. CONCLUSION: HIV-infected adults in malaria-endemic areas are at increased risk for malaria. Where possible, additional malaria prevention efforts should be targeted at this population.

Adolescent↗

PubMed2005

Accessing a new medication in Germany: a novel approach to assess a health insurance-related barrier.

PURPOSE: Knowledge of the existence, position, and magnitude of barriers to equitable healthcare is an important consideration in shaping healthcare policies. METHODS: The authors developed a novel three-dimensional person-time-related hurdle model and followed a cohort of 7358 statutorily (SHI) and 457 privately health insured (PHI) patients with migraine headaches at 377 primary-care practices (MediPlus, IMS Health) in the second to fourth year of the HealthCare Structural Reform Act in Germany. RESULTS: For SHI compared with PHI migraine patients, there was a hurdle to receiving sumatriptan at all (2.4-fold lower hazard, 95% confidence interval, 1.8-3.2). Among patients who received sumatriptan, frequency and intensity of use differed only minimally between SHI and PHI patients. CONCLUSIONS: These findings have implications for healthcare researchers and healthcare policies. The framework extends traditional hurdle models and can serve as a model for quantifying barriers to receipt of services under different funding policies.

Adolescent↗

PubMed2005

Detection of acute infections during HIV testing in North Carolina.

BACKGROUND: North Carolina has added nucleic acid amplification testing for the human immunodeficiency virus (HIV) to standard HIV antibody tests to detect persons with acute HIV infection who are viremic but antibody-negative. METHODS: To determine the effect of nucleic acid amplification testing on the yield and accuracy of HIV detection in public health practice, we conducted a 12-month observational study of methods for state-funded HIV testing. We compared the diagnostic performance of standard HIV antibody tests (i.e., enzyme immunoassay and Western blot analysis) with an algorithm whereby serum samples that yielded negative results on standard antibody tests were tested again with the use of nucleic acid amplification. A surveillance algorithm with repeated sensitive-less-sensitive enzyme immunoassay tests was also evaluated. HIV infection was defined as a confirmed positive result on a nucleic acid amplification test or as HIV antibody seroconversion. RESULTS: Between November 1, 2002, and October 31, 2003, 109,250 persons at risk for HIV infection who had consented to HIV testing presented at state-funded sites. There were 606 HIV-positive results. Established infection, as identified by standard enzyme immunoassay or Western blot analysis, appeared in 583 participants; of these, 107 were identified, with the use of sensitive-less-sensitive enzyme immunoassay tests, as recent infections. A total of 23 acutely infected persons were identified only with the use of the nucleic acid amplification algorithm. With all detectable infections taken into account, the sensitivity of standard antibody testing was 0.962 (95 percent confidence interval, 0.944 to 0.976). There were two false positive results on nucleic acid amplification tests. The specificity and positive predictive value of the algorithm that included nucleic acid amplification testing were greater than 0.999 (95 percent confidence interval, 0.999 to >0.999) and 0.997 (95 percent confidence interval, 0.988 to >0.999), respectively. Of the 23 acute HIV infections, 16 were detected at sexually transmitted disease clinics. Emergency measures for HIV prevention protected 48 sex partners and one fetus from high-risk exposure to HIV. CONCLUSIONS: The addition of nucleic acid amplification testing to an HIV testing algorithm significantly increases the identification of cases of infection without impairing the performance of diagnostic testing. The detection of highly contagious, acutely infected persons creates new opportunities for HIV surveillance and prevention.

Acute Disease↗

PubMed2005

Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults.

The authors examined the relation between age at first vaginal intercourse and a positive nucleic acid amplification test for sexually transmitted infection (STI). A nationally representative sample of 9,844 respondents aged 18-26 years was tested for chlamydial infection, gonorrhea, and trichomoniasis in wave 3 (2001-2002) of the National Longitudinal Study of Adolescent Health. The authors used multiple logistic regression to assess the relation between age at first sexual intercourse and these STIs and to examine variation by current age, sex, race, and ethnicity. Younger ages at first intercourse were associated with higher odds of STI in comparison with older ages, but the effect diminished with increasing current age. For example, the odds of having an STI for an 18-year-old who first had intercourse at age 13 were more than twice those of an 18-year-old who first had intercourse at age 17 (prevalence odds ratio = 2.25, 95% confidence interval: 1.42, 3.59). In contrast, the odds of having an STI among 24-year-olds with first intercourse at age 13 versus those with first intercourse at age 17 were the same (prevalence odds ratio = 1.11, 95% confidence interval: 0.88, 1.39). Thus, earlier initiation of sexual intercourse is strongly associated with STIs for older adolescents but not for young adults over age 23 years.

Adolescent↗

PubMed2005

Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke.

PURPOSE: To examine the reliability and validity of the Activities-specific Balance Confidence (ABC) scale among individuals with stroke. METHOD: Descriptive measurement study using a 4-week test-retest design. Data were collected at a tertiary rehabilitation centre form a community-dwelling sample of ambulatory older adults who sustained one stroke at least 1 year prior to the study. During the first measurement session, the total sample (n = 77) completed the ABC as well as the Berg Balance Scale (BBS) and gait speed. The reliability sample (n = 24), a subset of the larger data set, completed the ABC again 4 weeks later. RESULTS: Internal consistency of the ABC was 0.94 and test-retest reliability was ICC = 0.85 (95% CI, 0.68, 0.93). A moderate significant positive, linear correlation with both the BBS (rho = 0.36, P < 0.001) and gait speed (rho = 0.48, P < 0.001) was observed. A factor analysis using principal component analysis indicated that the ABC measures two components of balance self-efficacy (component 1 = perceived low-risk activities; component 2 = perceived high-risk activities). CONCLUSION: The ABC has acceptable measurement properties as demonstrated in this sample of individuals with stroke. This study provides further support for the use of the scale.

Aged↗

PubMed2005

A randomized trial of practice-based education to improve delivery systems for anticipatory guidance.

BACKGROUND: Communication between physicians and patients is an important component of medical encounters and has been identified by the Institute of Medicine as a point of intervention to increase quality of care. In pediatric health maintenance visits, substantial recommended communication, in the form of anticipatory guidance, is not provided. OBJECTIVE: To examine the effectiveness of an intervention of continuing medical education and process improvement methods to implement "office systems" to improve the delivery of anticipatory guidance for parents of young children. METHODS: We performed a randomized controlled trial of a practice-based quality improvement intervention among 44 pediatric practices in North Carolina. In the 22 intervention practices, project staff coached practice staff in auditing performance and identifying, testing, and implementing new care processes to improve delivery of anticipatory guidance. We surveyed parents of 1-month-olds and 6-month-olds regarding their recollection of anticipatory guidance as well as parent knowledge and parent behaviors and used cluster analysis to determine the effects of the intervention. RESULTS: The proportion of parents of 1-month-olds who reported that they received all age-appropriate anticipatory guidance changed from 15.9% (95% confidence interval [CI], 8.9%-26.7%) to 10.0% (95% CI, 5.1%-18.8%) in the control practices and from 7.3% (4.1%-12.9%) to 24.0% (95% CI, 14.6%-36.9%) in the intervention practices (difference between 2 differences, P = .002). The proportion of parents of 6-month-olds who reported that they received all age-appropriate anticipatory guidance changed from 8.2% (95% CI, 3.6%-17.8%) to 5.4% (95% CI, 2.8%-10.2%) in the control practices and from 2.2% (95% CI, 0.8%-5.9%) to 18.1% (95% CI, 10.3%-29.9%) in the intervention practices (difference between 2 differences, P = .001). There were no differences in self-reported parent knowledge and parent behavior. CONCLUSION: An office system intervention improved parent reports of quantity of anticipatory guidance but did not change parent knowledge or parent behavior. Future research should examine how to use systems improvement methods to improve the impact of anticipatory guidance.

Adult↗

PubMed2005

Predicting adolescents' longitudinal risk for sexually transmitted infection: results from the National Longitudinal Study of Adolescent Health.

BACKGROUND: Influencing adolescents' sexual behaviors has the potential to influence trajectories of risk for sexually transmitted infections (STIs) among young adults. OBJECTIVE: To determine whether family, school, and individual factors associated with increased duration of virginity also protect against STIs in young adulthood. DESIGN: Prospective cohort study. Wave I of the National Longitudinal Study of Adolescent Health occurred in 1995 when participants were in grades 7 through 12. Six years later, all wave I participants who could be located were invited to participate in wave III and provide a urine specimen for STI testing. SETTING: In-home interviews in the continental United States, Alaska, and Hawaii. PARTICIPANTS: Population-based sample. Of 18,924 participants in the nationally representative weighted wave I sample, 14,322 (75.7%) were located and participated in wave III. Test results for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were available for 11,594 (81.0%) of wave III participants. MAIN OUTCOME MEASURE: Positive test result for C. trachomatis, N. gonorrhoeae, or T. vaginalis. RESULTS: Controlling for biological sex, age, race/ethnicity, family structure, and maternal education, adolescents who perceived that their parents more strongly disapproved of their having sex during adolescence were less likely to have STIs 6 years later (adjusted odds ratio, 0.89; 95% confidence interval, 0.81-0.99). Those with a higher grade point average during adolescence were also less likely to acquire STIs (adjusted odds ratio, 0.84; 95% confidence interval, 0.71-0.99). Stratified analyses confirmed these findings among female, but not male, adolescents. Feelings of connection to family or school, reported importance of religion, attending a parochial school, and pledges of virginity during adolescence did not predict STI status 6 years later. CONCLUSIONS: Perceived parental disapproval of sexual intercourse and higher grades in school during adolescence have protective influences on the trajectory of risk for acquiring STIs, primarily among female adolescents. Most factors associated with increased duration of virginity in adolescence do not influence the trajectory of STI risk.

Adolescent↗

PubMed2005

Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain.

OBJECTIVE: We sought to describe irritable bowel syndrome (IBS) treatment among women with chronic pelvic pain. STUDY DESIGN: We performed a cross-sectional study of new chronic pelvic pain patients between 1993 and 2000 (n = 987). IBS was defined by Rome I criteria. IBS treatment was defined as lower gastrointestinal drugs or referral. Analyses were descriptive and multivariable. RESULTS: IBS occurred in 35% of patients. In the highest quartile of pain, women with IBS were not more likely to have IBS treatment initiated. In the lowest three quarters of pain, women with IBS were 5.08 times more likely to have IBS treatment initiated. IBS was not diagnosed 40% of the time. IBS treatments were not recommended to 67% of patients with IBS. More than 35% of patients were prescribed narcotics. CONCLUSION: IBS is not consistently diagnosed and treated even in a pelvic pain clinic. Yet, treatment of IBS may reduce the overall abdominal pain of these patients.

Adult↗

PubMed2005

The epidemiology of threatened preterm labor: a prospective cohort study.

OBJECTIVE: The purpose of this study was to describe the occurrence, timing, and outcomes of hospital-based diagnoses of preterm labor. STUDY DESIGN: Administrative records identified hospital admissions for preterm labor among 2534 women in an ongoing cohort study. Factors that were considered risks for prematurity were examined by logistic regression for an association with any preterm labor diagnosis, a preterm labor diagnosis <33 weeks of gestation, or > or =33 weeks of gestation. RESULTS: Of 234 women (9%) who experienced hospitalization for preterm labor, 90 women (38%) were delivered in the first episode. Previous preterm birth consistently was associated with a diagnosis of preterm labor. Reporting a sexually transmitted infection (odds ratio, 1.8; 95% CI, 1.1-3.0) or bacterial vaginosis (odds ratio, 2.6; 95% CI, 1.7-4.1) early in pregnancy was associated with hospitalization for preterm labor between 24 and 32 weeks of gestation. CONCLUSION: The incidence of first-time hospitalization for preterm labor was 9%, with most episodes not resulting in preterm birth. Previous preterm birth was associated therefore with a preterm labor diagnosis.

Adolescent↗

PubMed2005

Epidemiology of chlamydial infection, gonorrhea, and trichomoniasis in the United States--2005.

The prevalence and incidence of chlamydial infection, gonorrhea, and trichomoniasis are unacceptably high in the United States. The prevalence of gonorrhea is substantially lower than chlamydial infection and trichomoniasis; in part, this is presumably due to the greater frequency of symptomatic disease. The disparity between racial/ethnic groups is considerable for each of these infections. Greater effort must be devoted to reducing this disparity and to understanding the underlying mechanisms of disease persistence in the United States.

Adolescent↗

PubMed2005

The relationship between the location of pediatric intensive care unit facilities and child death from trauma: a county-level ecologic study.

OBJECTIVES: To describe the relationship between the location of Pediatric Intensive Care Unit (PICU) facilities and county-level child death from trauma in the contiguous USA. STUDY DESIGN: We conducted a cross-sectional ecologic study using county-level data on death due to trauma in children 0 to 14 years of age from 1996 to 1998. These data were linked to 1997 county-level data on availability of PICU facilities. RESULTS: In 1997, PICU facilities were present in 9% of USA counties. There were 18,337 childhood deaths from trauma in the study period. The presence of PICU facilities in a county was associated with lower mortality from trauma (incidence rate ratio [IRR] = 0.72; 95% CI 0.67-0.78) compared to counties without PICU facilities. After controlling for residence in rural and low-income counties, and the presence of adult medicosurgical intensive care units, the presence of PICU facilities in a county remained associated with lower rates of death from trauma (IRR = 0.82; 95% CI 0.75-0.89). CONCLUSION: The presence of PICU facilities is related to lower mortality rates due to traumatic injuries at the county level. This finding may reflect the concentration of pediatric subspecialty care in counties with PICUs. This association merits further study with individual-level observations.

Adolescent↗

PubMed2005

The prevalence of trichomoniasis in young adults in the United States.

BACKGROUND AND OBJECTIVES: The prevalence of trichomoniasis in the general population of the United States is unknown. This study provides the first population-based prevalence estimates of trichomoniasis among young adults in the United States. METHODS: The National Longitudinal Study of Adolescent Health (Add Health) is an ongoing prospective cohort study. In a cross-sectional analysis of Wave III of Add Health (N = 12,449), we determined the prevalence of trichomoniasis using a polymerase chain reaction assay. RESULTS: The estimated overall prevalence of trichomoniasis in U.S. young adults was 2.3% (95% confidence interval [CI], 1.8-2.7%). The prevalence was slightly higher among women (2.8%; 95% CI, 2.2-3.6%) than men (1.7%; 95% CI, 1.3-2.2%). The prevalence increased with age and varied by region, with the south having the highest prevalence (2.8%; 95% CI, 2.2-3.5%). The prevalence was highest among black women (10.5%; 95% CI, 8.3-13.3%) and lowest among white women (1.1%; 95% CI, 0.8-1.6%). Among men, the prevalence was highest among Native Americans (4.1%; 95% CI, 0.4-29.3%) and blacks (3.3%; 95% CI, 2.2-4.9%), and lowest among white men (1.3%; 95% CI, 0.9-1.8%). CONCLUSIONS: Trichomoniasis is moderately prevalent among the general U.S. population of young adults and disturbingly high among certain racial/ethnic groups.

Adolescent↗

PubMed2005

A randomized, controlled trial of acupuncture for chronic daily headache.

BACKGROUND: Approximately 4% of adults experience headaches nearly every day. Nonpharmacologic interventions for frequent headaches may be appropriate because medical management alone is often ineffective. OBJECTIVE: To assess the efficacy of acupuncture as an adjunct to medical management for chronic daily headache (CDH). METHODS: We conducted a randomized, controlled trial of 74 patients with CDH that compared medical management provided by neurologists to medical management plus 10 acupuncture treatments. Primary outcome measures were daily pain severity and headache-related quality of life (QoL). RESULTS: Patients who received only medical management did not demonstrate improvement in any of the standardized measures. Daily pain severity scores trended downward but did not differ between treatment groups (P= .60). Relative to medical management only, medical management plus acupuncture was associated with an improvement of 3.0 points (95% CI, 1.0 to 4.9) on the Headache Impact Test and an increase of 8 or more points on the role limitations due to physical problems, social functioning, and general mental health domains of the Short Form 36 Health Survey. Patients who received acupuncture were 3.7 times more likely (CI, 1.7 to 8.1) to report less suffering from headaches at 6 weeks (absolute risk reduction 46%; number needed to treat 2). CONCLUSION: Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population. Supplementing medical management with acupuncture, however, resulted in improvements in health-related QoL and the perception by patients that they suffered less from headaches.

Acupuncture Therapy↗

PubMed2005

Perceptions of power mobility use and safety within residential facilities.

BACKGROUND: Power wheelchairs enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities. PURPOSE: As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use. METHOD: In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members. RESULTS: A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions. PRACTICE IMPLICATIONS: Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.

Adult↗