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PubMed2026

Healthcare Access and Safety Training Gaps Among H-2 A Visa Agricultural Workers in Georgia.

The H-2 A Temporary Agricultural Workers Program, which supplies seasonal labor essential to U.S. food security, has grown over 230% in the past decade but is excluded from the National Agricultural Workers Survey. Although safety training is federally mandated and H-2 A workers are eligible for Affordable Care Act (ACA) marketplace coverage, compliance and healthcare access among these workers remain poorly documented. The aim of this pilot study was to assess workplace safety training, heat acclimatization practices, health insurance awareness and enrollment, and healthcare utilization among H-2 A workers in Georgia. In summer 2024, bilingual research assistants orally administered a cross-sectional Spanish-language survey to 51 H-2 A workers at a South Georgia laundromat, in partnership with the Latino Community Fund Georgia. The survey assessed demographics, occupational characteristics, safety training, heat acclimatization, health insurance awareness and enrollment, and healthcare utilization. Findings are self-reported. Among participants, 41% reported not receiving federally mandated pesticide safety training, and 59% received heat illness prevention training. Heat acclimatization was inadequate for 53% (29% received none). Additionally, 53% did not know the nearest hospital, 43% reported having health insurance, and 25% were unsure of their health insurance status. Overall, 71% had never visited a doctor's office, and of 22 insured workers, only 1 (2%) had used benefits this season. Substantial gaps in workplace safety training, heat acclimatization, and healthcare access were observed in this pilot study, consistent with prior evidence of persistent disparities in this population. Community-based outreach, bilingual health navigation, and market-based labor accountability models warrant further investigation to improve protections for H-2 A workers.

Agricultural workers↗
PubMed2003

A propensity analysis of late versus early nephrologist referral and mortality on dialysis.

Previous studies have analyzed the association between late versus early nephrologist referral (LR, ER) and poor clinical outcomes in patients with end-stage renal disease. We sought to determine whether these poor outcomes were causally related to LR, or whether LR was a proxy for poorer access to health care in general. An inception cohort of incident dialysis patients enrolled in the New Jersey Medicare or Medicaid programs was identified. Using a large number of demographic, clinical, and health care utilization covariates, propensity scores (PS) were then calculated to predict whether a given patient had been seen by a nephrologist at 90 d before first dialysis. Cox proportional hazards models were then built to test the association between timing of nephrologist referral and mortality during the first year of dialysis, using PS adjustment and matching to determine whether this association was confounded by other measures of reduced healthcare utilization. Neither adjustment for PS (HR = 1.31; 95% CI, 1.17 to 1.47) nor matching (HR = 1.40; 95% CI, 1.23 to 1.59) materially changed the initial 36% excess mortality in LR compared with ER patients (HR = 1.36; 95% CI, 1.22 to 1.51). Excess mortality among LR was limited to the first 3 mo of dialysis (HR = 1.75; 95% CI, 1.48 to 2.08) but not present thereafter (HR = 1.03; 95% CI, 0.84 to 1.25). Late nephrologist referral is an independent risk factor for early death on dialysis, even after controlling for other indicators of healthcare utilization. Further research is needed to identify patients at particular risk so that interventions to prevent early deaths on dialysis in LR patients can be developed and tested.

Aged↗
PubMed2003

Approach to the Patient with Severe, Refractory Irritable Bowel Syndrome.

Defining which patients with irritable bowel syndrome (IBS) are "refractory" is a highly subjective undertaking. Duration of symptoms, severity of symptoms, type of symptoms, and a host of other medical, epidemiologic, and psychosocial variables all play a role in this determination. It is safe to say that a long duration of disease per se does not constitute a refractory patient. A number of studies have given us some suggestion of what constitutes refractoriness in IBS. Patients who have a predominant pain complaint as opposed to those who are mainly concerned about their bowel habit (either diarrhea or constipation) are more likely to be disabled by their IBS. However, at a clinical level, patients who are considered refractory are usually seen as individuals who fail to improve on a variety of drug therapies or who have high healthcare utilization despite aggressive treatment of their IBS. Finally, patients who are unhappy about their care and/or are assertive in their request to "be cured" can also be seen as refractory because of unrealistic expectations they set for both themselves and the physician. The key to effectively dealing with patients with "refractory" IBS is to understand that their behaviors most often have correlates and underlying issues that need to be dealt with in order to effectively address the patient's concerns. Unfortunately, most patients who fall into this category are quickly identified as "difficult," "unpleasant," or even "crazy" and are not infrequently dismissed by their treating physician. This leads to an ever-enlarging circle of healthcare utilization, with patients seeking out physicians and other practitioners looking for the elusive cure. A key component of this process is an increasing frustration and cynicism regarding the healthcare system and physicians in particular, which does no good for anyone involved. It is clearly critical for the physician dealing with a patient with IBS and a history of poor response to treatment to understand these correlates. Failure to do so creates a continuation of the cycle of treatment failure and frustration that so often characterizes these patients' care.

Journal Article↗
PubMed2004

Pregnancy and economic outcomes in patients treated for recurrent preterm labor.

OBJECTIVE: To compare clinical and cost-effectiveness of treating recurrent preterm labor (RPTL) with oral nifedipine versus continuous subcutaneous terbutaline infusion (SQT). STUDY DESIGN: Women with singleton gestations prescribed nifedipine for tocolysis following first diagnosis of preterm labor were identified. Women hospitalized with RPTL at <34 weeks were matched by gestational age (GA) after resuming nifedipine (NIF group) with women prescribed SQT (SQT group) after stabilization. Healthcare utilization costs were modeled and compared. RESULTS: This study analyzed 142 matched pairs. GA at RPTL (matched variable) was 30.4+/-2.6 weeks. GA at delivery was earlier in the NIF group versus the SQT group (35.7+/-3.1 weeks versus 36.6+/-2.1 weeks, p=0.004). Overall, infants from the NIF group had lower birth weights and higher nursery days than infants from the SQT group. Healthcare utilization costs were greater in the NIF group versus the SQT group (37,040+/-47,518 US dollars versus 26,546+/-25,386 US dollars, p=0.014). CONCLUSION: Treating RPTL with SQT versus oral nifedipine resulted in a later GA at delivery, improved neonatal outcome, and increased cost-effectiveness.

Administration, Oral↗
PubMed2000

Dually incontinent nursing home residents: clinical characteristics and treatment differences.

OBJECTIVE: Previous studies have described urinary and fecal incontinence in nursing homes and their separate effects on healthcare utilization. However, little is known about those who are incontinent of both. DESIGN: Retrospective chart review. SETTINGS: Twenty sites in three states PARTICIPANTS: A total of 413 nursing home residents were categorized as having neither fecal nor urinary incontinence (C, n = 114), urinary incontinence only (UI, n = 53), fecal incontinence only (FI, n = 9), or were dually incontinent (DI, n = 237). MEASUREMENTS: Charts were abstracted for sociodemographic information and health status information as well as utilization for the year before the date of abstraction. We then compared these characteristics across groups using ANOVA with pairwise comparisons and multiply adjusted regression. RESULTS: Almost all patients with DI were cognitively and mobility impaired. However, there were no significant differences between the groups with respect to age and number of diagnoses. A diagnosis of stroke was also more common among those with DI compared with C. When examining healthcare utilization in multiply adjusted regression, dually incontinent residents received significantly fewer days of hospital care than those with UI. CONCLUSIONS: Dual incontinence in NH residents is likely to have an important functional component. These residents seem to be treated less aggressively with respect to hospitalization compared with those with UI alone. The reasons for these differences need to be explored further.

Aged↗
PubMed2002

Challenges encountered in measuring outcome for a rural psychiatric residential program.

Evaluation of outcome measures can provide policymakers with valuable information on the effectiveness of psychiatric rehabilitation. Two specific challenges in collecting outcome measures for psychiatric rehabilitation programs are heterogeneity of outcomes and difficulty with follow-up. These two challenges were illustrated in the process of evaluating Rose Hill Center, a rural residential psychiatric rehabilitation program. The original design was to conduct interviews with former residents and family members and verify healthcare utilization. The difficulty of locating people and their reluctance to participate conspired to lower the follow-up rates. The design was modified to improve the follow-up rate but decrease the details of specific outcomes. The results showed a high but biased follow-up rate, with more information obtained for people who graduated from the program. The residents with planned discharge showed excellent outcomes in terms of living situation, working situation, healthcare utilization, and low severity of current symptoms. High compliance with medication spoke to the program's philosophy of including the residents in the decision-making process. The dual challenges of heterogeneity of outcomes and difficulty in follow-up that limit efforts to document the value of psychiatric rehabilitation are discussed.

Adult↗
PubMed2006

The role of attitudes in understanding disparities in adult influenza vaccination.

BACKGROUND: Racial/ethnic disparities in influenza vaccine coverage of adults aged 65 years and older persist even after controlling for access, healthcare utilization, and socioeconomic status. Differences in attitudes toward vaccination may help explain these disparities. The purpose of this study was to describe patient characteristics and attitudes toward influenza vaccination among whites and African Americans aged 65 years and older, and to examine their effect on racial disparities in vaccination coverage. METHODS: A cross-sectional telephone survey of Medicare beneficiaries in five U.S. sites, sampled on race/ethnicity and ZIP code. Multivariate analysis controlling for demographics, healthcare utilization, and attitudes toward influenza vaccination was conducted in 2005 to assess racial disparities in vaccine coverage during the 2003-2004 season. RESULTS: The analysis included 1859 white and 1685 African-American respondents; 79% of whites versus 50% of African Americans reported influenza vaccination in the past year (p < 0.00001). Both vaccinated and unvaccinated African Americans were significantly less likely than whites to report positive attitudes toward influenza vaccination. Even among respondents with provider recommendations, respondents with positive attitudes were more likely to be vaccinated than those with negative attitudes. After multivariate adjustment, African Americans had significantly lower odds of influenza vaccination than whites (odds ratio = 0.55, 95% confidence interval = 0.42-0.72). CONCLUSIONS: A significant gap in vaccination coverage between African Americans and whites persisted even after controlling for specific respondent attitudes. Future research should focus on other factors such as vaccine-seeking behavior.

Aged↗
PubMed2006

Mental health service utilization by Ethiopian immigrants and refugees in Toronto.

The purpose of this study was to examine the mental health service utilization patterns of Ethiopians in Toronto. A cross-sectional epidemiological survey of 342 randomly selected adults was conducted, based on a conceptual model of healthcare utilization suggested by Anderson and Newman. The results suggested that 5% of the respondents sought mental health services from healthcare professionals and 8% consulted nonhealthcare professionals. Although Ethiopians' utilization rate of mental health services did not greatly differ from the rates of the general population of Ontario (6%), only a small proportion (12.5%) of Ethiopians with mental disorders used services from healthcare professionals, mostly family physicians. The data also suggested that Ethiopians were more likely to consult traditional healers than healthcare professionals for mental health problems (18.8% vs. 12.5%). In multivariate logistic regression analyses, while the number of somatic symptoms experienced was positively associated with increased mental healthcare utilization (OR = 1.515, p < 0.05), having a mental disorder was associated with decreased mental healthcare utilization (OR = 0.784, p < 0.01). Our findings have important implications for mental health services. On the one hand, the findings suggest that somatic symptoms could lead to increased use of mental health services, particularly family physicians' services. On the other hand, the data suggested that although the mental healthcare needs of Ethiopians are high, they use fewer mental health services from healthcare professionals. It would seem that family physicians could play important role in identifying and treating Ethiopian clients with somatic symptoms, as these symptoms may reflect mental disorder.

Adolescent↗
PubMed2007

Cumulative cost pattern comparison of prostate cancer treatments.

BACKGROUND: Studies that compare prostate cancer treatment costs show wide variation. None compare all contemporary treatment costs, and most focus on initial treatment costs. The authors compared healthcare utilization and cost patterns of prostate cancer treatments over a span of 5.5 years in 4553 newly diagnosed patients stratified by age and risk group. METHODS: Contemporary treatment and evaluation patterns for prostate cancer were identified by using CaPSURE, a national disease registry of men with prostate cancer that included ongoing clinical data collection from 31 academic and community urology practices and biennial patient-reported outcome questionnaires that included demography, medical condition, comorbidity, risk measures, and healthcare utilization. Costs of outpatient visits, medications, and hospitalizations were applied from various national sources. Recurrent events analysis (MCF) accounted for left and right censorship. A mixed effects regression model with bootstrapping for skewed cost data quantified the relation between MCF cost, age, and risk. RESULTS: Prostate-related costs in the first 6 months after treatment were 11,495 dollars, (from 2586 dollars for watchful waiting (WW) to 24,204 dollars for external beam radiation. After 6 months, average cost was only 3044 dollars. Annual cost is 7740 dollars, highest for androgen deprivation therapy (12,590 dollars) and lowest for watch waiting (5843 dollars). Risk and age were significantly related to initial treatment choice. Cumulative cost (42,570 dollars) allowed a better estimate of treatment pattern costs. CONCLUSIONS: The cost burden of prostate cancer is high, but it varies by treatment type even when controlling for disease, age, and stage. Cumulative cost analysis allowed inclusion of adverse events and disease recurrence costs, making new cost comparisons evident among treatments.

Aged↗
PubMed2006

The clinical history and costs associated with delayed diagnosis of bipolar disorder.

The purpose of this reported study was to determine healthcare utilization and costs associated with delayed diagnosis of bipolar disorder. With use of automated data from a large integrated health system in the Midwest, all patients with newly diagnosed bipolar disorder recorded in any inpatient or outpatient encounter from January 1, 2000 to August 31, 2002 were identified. The date of initial diagnosis was the index date. For each patient in the bipolar cohort, 5 comparison patients were randomly selected from the general population of health system members and matched with the bipolar patients by sex, race, and age (-/+ 5 years). Data on healthcare utilization (inpatient, outpatient, emergency department, pharmacy) were collected with a focus on mental health, from January 1, 1990, through 1 year after the index date. The cohort is 62% female and 64% White. Median time between initial mental health diagnosis and bipolar diagnosis was 21 months, with 33% of subjects receiving a bipolar diagnosis within 6 months of their initial mental health diagnosis; however, for 31% of the remaining bipolar subjects, the time of their initial mental health presentation to bipolar diagnosis was 4 years or more. The number and duration of treatment with antidepressants increased as time to bipolar diagnosis increased. Patients with bipolar disorder had at least twice the number of interactions with the healthcare system before the index date than the non-bipolar comparison group. Mean monthly costs before and after bipolar diagnosis were not strikingly different for patients with bipolar disorder, but costs after bipolar diagnosis increased with increasing time to bipolar diagnosis. Bipolar disorder is a costly illness for which the impact on the healthcare system may vary depending on how quickly it is diagnosed. Delays in diagnosis appear related to additional costs after diagnosis.

Adolescent↗
PubMed2006

Gender differences across race/ethnicity in use of health care among Medicare-aged Americans.

BACKGROUND: Despite Medicare, medical services are not equally used by elderly women and men in the United States. Our purpose is to examine gender differences in healthcare utilization among older Americans, the persistence of gender differences across race/ethnicity, and the roles of sociodemographic, health, and economic factors to explain differences. METHODS: Data from the 1998-2000 Health and Retirement Study are used to investigate gender differences in use of hospital, outpatient surgery, home health, and physician services. Analyses are controlled for sociodemographic, health (medical conditions, functional health), and economic (income, wealth, education, health insurance) factors. RESULTS: Women are significantly less likely to use hospital service (odds ratio [OR]=0.83) and outpatient surgery (OR=0.85) but are more likely to use home health care (OR=1.27) and physician services (OR=1.45), controlling for sociodemographics. Differences in health needs and economic resources partially mediate the gender differences in physician and home healthcare utilization but do not explain the gender differences in hospital service and outpatient surgery. Notably, African American, Hispanic, and white women compared with men show significantly less use of hospital services. CONCLUSIONS: Gender differences in medical use vary according to the type of services used and are largely consistent across racial/ethnic groups. As the size of the Medicare population increases, promoting equitable use of healthcare resources by both women and men is an important issue in developing healthcare policy and designing public health strategies.

Black or African American↗
PubMed2001

Impact of a school-based intervention on access to healthcare for underserved youth.

PURPOSE: To determine whether a multidimensional school-based intervention, which included physical and mental health services, increased adolescents' use of needed medical care and preventive care and decreased emergency room use. METHODS: A total of 2832 seventh- through twelfth-grade students in six public urban intervention schools and 2036 students in six demographically matched comparison schools completed a previously validated survey regarding health status and healthcare utilization in spring 1998 and 1999. Bivariate analyses examined the association between intervention status and Year 1/Year 2 outcomes. The multifaceted intervention included programs such as anger management groups, substance abuse prevention, tutoring, home visits, and enhanced school health services. Stepwise multivariate logistic models tested differences between the intervention and comparison groups across years, controlling for potential confounding variables [gender, age, race/ethnicity, maternal education, grade in school, school district (city or county), health status, and chronic health problems]. The interaction term for Group x Year was used to test the effect of the intervention. Multivariable modeling was also used to determine student factors independently associated with healthcare utilization. RESULTS: Respondents had a median age of 15 years, 56% were female, 51% were white, 42% were black, and 34% reported chronic health problems. In both years, over 45% of students in both groups reported not seeking medical care they believed they needed. The proportion with missed care in the intervention schools did not change, whereas the proportion with missed care in the comparison schools increased. Emergency room use decreased slightly in the intervention schools and increased slightly in the comparison schools between Year 1 and Year 2. There were no major changes in healthcare delivery in this area during the year, demonstrating the volatility of adolescents' perceived access to care. Among the student factors, health status, having a chronic condition, and being in a higher grade were independently associated with students' report of not seeking care they believed they needed. CONCLUSION: These results confirm that many adolescents have unmet healthcare needs. Those with poor health status are most likely to report underutilization and unmet needs. These findings underscore the need for comparison groups when evaluating interventions and suggest the need for better understanding of community level changes in perceived healthcare access and use.

Adolescent↗
PubMed1998

The impact of influenza and influenza-like illness on productivity and healthcare resource utilization in a working population.

Four hundred and eleven subjects who either reported to Occupational Health at onset of influenza or influenza-like illness (I/ILI) symptoms or on return to work completed questionnaires on entry to the study and after 28 days. On average they were incapacitated or confined to bed for 2.4 days, missing 2.8 days from work per episode of illness. On return to work, they reported reduced effectiveness and inability to resume normal activity until a mean 3.5 days after the onset of symptoms. Each participant reported a mean of 6.5 I/ILI symptoms. There was a positive correlation between the number of symptoms and bed days (r = 0.24) and missed work days (r = 0.18). There was a positive correlation between the number of healthcare contact and the number of reported symptoms (r = 0.23). A relatively high level of contact with general practitioners and pharmacists was observed and there was substantial use of both prescription and over-the-counter medication. In conclusion, the impact of I/ILI on productivity in a working population and the resultant cost to employers and employees may be considerable.

Adult↗
PubMed2001

Medicaid's beta 2-agonist recipients and their treatment by national standards.

OBJECTIVE: To determine whether Connecticut's Medicaid high-dose beta 2-agonists (HDB) users (> 1 canister/mo) are receiving medications according to National Institutes of Health (NIH) asthma guidelines, and to compare healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month. METHODS: All Connecticut Medicaid pharmacy claims from April to December 1998 were examined. Subjects were included if they had an asthma diagnosis and were excluded if they had chronic obstructive pulmonary disease. The percentage of HDB users not receiving long-term-control medication; receiving low doses of a long-term-control medication; and receiving oral, nebulized, or long-acting beta 2-agonists was determined. Healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month was also compared. RESULTS: Of 1599 profiles included, 14% (n = 223) were HDB users. Twenty-five percent of these patients did not receive a long-term-control medication, and 35% received low doses of a long-term-control medication. Claims for oral, nebulized, and long-acting beta 2-agonists were submitted for 4%, 29%, and 22% of HDB users, respectively. More claims for short courses of oral corticosteroids were submitted for HDB users than for patients receiving no more than one canister of a short-acting beta 2-agonist per month (n = 1376) (1.99 +/- 3.60 vs. 0.39 +/- 1.07 mean +/- SD; p < 0.001). HDB users visited their physicians' offices an average of 4.72 +/- 24.08 times per month compared with an average of 2.40 +/- 14.4 office visits per month for patients receiving no more than one canister of a short-acting beta 2-agonist (p = 0.04). CONCLUSIONS: A high proportion of Connecticut's Medicaid HDB users are not receiving medications according to NIH guidelines. HDB users were significantly more likely to receive short courses of oral corticosteroids and required significantly more office visits than patients receiving no more than one canister of a short-acting beta 2-agonist per month. Intervention programs designed to improve adherence to the guidelines will be developed.

Adolescent↗
PubMed2002

Safety of the trivalent, cold-adapted influenza vaccine (CAIV-T) in children.

The trivalent, cold-adapted influenza vaccine (CAIV-T, FluMist, Aviron, Mountain View, CA) is a live attenuated influenza virus vaccine that is administered by nasal spray. CAIV-T is efficacious in preventing influenza virus infection. The vaccine was submitted to the Food and Drug Administration for licensure in healthy children and adults. Universal immunization is being considered in children, and an effective vaccine with minimal adverse reactions is thus required. The published studies on the safety of CAIV-T in children reviewed in this article were clinical trials sponsored by the National Institutes of Health (NIH) conducted in children from 1975 to 1991, clinical trials from 1991 to 1993 sponsored by a cooperative agreement between NIH and Wyeth-Ayerst Research, and clinical trials from 1995 to the present sponsored by a cooperative agreement between NIH and Aviron. Safety assessments included the occurrence of: 1) specific influenza-like symptoms, unexpected symptoms, and use of medications within the first 10 days after vaccination; 2) acute illness and use of medication within 11 to 42 days postvaccination; 3) serious adverse events and rare events within 42 days after vaccination; 4) healthcare utilization within 14 days after vaccination; and 5) acute respiratory symptoms with annual sequential vaccine doses. CAIV-T was safe and well-tolerated. Transient, mild respiratory symptoms were observed in a minority (10%-15%) of children and primarily with the first CAIV-T dose. Vomiting and abdominal pain occurred in fewer than 2 percent of CAIV-T recipients. The gastrointestinal symptoms were mild and of short duration. An excess of illness or use of medication was not observed after the 10th day of vaccination. Sequential annual doses of CAIV-T were well-tolerated and not associated with increased reactogenicity. CAIV-T did not cause an increase in healthcare utilization. Thus CAIV-T is safe in healthy children and should complement the use of inactivated influenza vaccine, trivalent (IIV-T) in children with underlying chronic conditions.

Abdominal Pain↗
PubMed2006

Use and impact of an automated telephone outreach system for asthma in a managed care setting.

OBJECTIVE: To test the ability of an automated telephone outreach intervention to reduce acute healthcare utilization and improve quality of life among adult asthma patients in a large managed care organization. STUDY DESIGN: Randomized clinical trial. METHODS: Patients with persistent asthma were randomly assigned to telephone outreach (automated = 3389, live caller = 192) or usual care (n = 3367). Intervention participants received 3 outreach calls over a 10-month period. The intervention provided brief, supportive information and flagged individuals with poor asthma control for follow-up by a provider. A survey was mailed to 792 intervention participants and 236 providers after the intervention. Additional feedback was obtained as part of the final intervention contact. RESULTS: The intent-to-treat analysis found no significant differences between the intervention and usual-care groups for medication use, healthcare utilization, asthma control, or quality of life. Post hoc analyses found that, compared with the control group, individuals who actually participated in the intervention were significantly more likely to use inhaled steroids and to have had a routine medical visit for asthma during the follow-up period and less likely to use short-acting beta-agonists. They also reported higher satisfaction with their asthma care and better asthma-specific quality of life. Of surveyed providers, 59% stated the program helped them to clinically manage their asthma patients and 70% thought the program should be continued. CONCLUSIONS: This study did not find improved health outcomes in the primary analyses. The intervention was well accepted by providers, however, and the individuals who participated in the calls appeared to have benefited from them. These findings suggest that further studies of automated telephone outreach interventions seem warranted.

Adult↗
PubMed2006

Gender differences in IgE-mediated allergic asthma in the epidemiology and natural history of asthma: Outcomes and Treatment Regimens (TENOR) study.

BACKGROUND: The TENOR study consists of a large cohort of subjects with severe or difficult-to-treat asthma. The objective of this analysis was to evaluate demographic and clinical characteristics of subjects 12 years of age or older with immunoglobulin E (IgE)-mediated allergic asthma (skin test positive with an IgE level = 30 to =700 IU/mL), and specifically, to assess gender differences in this cohort. METHODS: A total of 4,756 subjects were enrolled by 283 US study sites between January and October 2001. Of those subjects 12 years or older at baseline with an IgE measure and who were skin tested (n = 2,843), 1,783 (63%) were skin test positive and had an IgE level between = 30 to = 700 IU/mL. RESULTS: Compared to males, females reported significantly greater healthcare utilization (steroid bursts in previous 3 months: 50% vs 42%, p < 0.001; unscheduled office visits in previous 3 months: 50% vs 36%, p < 0.0001; missed 1+ days of work/school in previous 2 weeks: 14% vs 10%, p < 0.01). Females also reported significantly more asthma control problems and lower asthma-related quality of life (4.6 +/- 1.3 vs 5.2 +/- 1.2; p < 0.0001); the difference was clinically meaningful. Asthma triggers and allergic comorbidities, such as allergic rhinitis and atopic dermatitis, were more common in female subjects. Despite their overall worse health outcomes, female subjects demonstrated better lung function, had similar treatment patterns, and showed no differences in physician-assessed asthma severity when compared with males. CONCLUSIONS: The reasons for these gender differences in subjects with IgE-mediated allergic asthma are complex, but results from this analysis suggest that detailed evaluations of asthma patients, including symptom-related questions and asthma-related healthcare utilization, are needed to accurately assess asthma severity and control.

Adolescent↗
PubMedDate not supplied

The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms.

OBJECTIVE: Somatization is prevalent in primary care and is associated with substantial functional impairment and healthcare utilization. However, instruments for identifying and monitoring somatic symptoms are few in number and not widely used. Therefore, we examined the validity of a brief measure of the severity of somatic symptoms. METHODS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-15 comprises 15 somatic symptoms from the PHQ, each symptom scored from 0 ("not bothered at all") to 2 ("bothered a lot"). The PHQ-15 was administered to 6000 patients in eight general internal medicine and family practice clinics and seven obstetrics-gynecology clinics. Outcomes included functional status as assessed by the 20-item Short-Form General Health Survey (SF-20), self-reported sick days and clinic visits, and symptom-related difficulty. RESULTS: As PHQ-15 somatic symptom severity increased, there was a substantial stepwise decrement in functional status on all six SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. PHQ-15 scores of 5, 10, 15, represented cutoff points for low, medium, and high somatic symptom severity, respectively. Somatic and depressive symptom severity had differential effects on outcomes. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSIONS: The PHQ-15 is a brief, self-administered questionnaire that may be useful in screening for somatization and in monitoring somatic symptom severity in clinical practice and research.

Adult↗