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PubMed1992

Microprocesses in perception and personality.

This paper utilizes an ontogenetically validated personality test, the Meta-Contrast Technique (MCT). The instrument focuses on the microdevelopment of perception (percept genesis) reflecting the process of individual adaptation to and construction of reality. Empirical evidence for the adequacy of the MCT paradigm in neuropsychological personality research is presented. In all, 45 patients were tested; thirty-three patients with various forms of supratentorial brain tumors were examined and compared with a group of 12 cerebrovascular disease (CVD) patients. Without the examiner's knowledge of degree of tumor malignancy, the MCT results allowed differentiation among tumors of various histological types. Uninformed of the final diagnosis, patients with highly malignant gliomas showed panic-related anxiety and schizoid-like regressions, in contrast both to patients with low and nonmalignant brain tumors and to the group of CVD patients.

Adult↗
PubMed1994

Trends in hospital resource utilization by HIV-infected persons, January 1987-June 1990.

Trends in the utilization of various hospital resources by HIV-infected persons between January 1987 and June 1990 have been studied to support health care planning. Data on 126 asymptomatic and symptomatic HIV-infected persons have been recorded at a patient level and analyzed at half-yearly intervals. At a hospital level, increasing utilization trends were observed. At the patient level, a decreasing utilization intensity was measured for admissions, inpatient days, inpatient diagnostic examinations, and outpatient consultations. Increasing utilization intensity was measured for care during admissions. A constant utilization intensity was observed for outpatient diagnostic examinations and inpatient medication days. Use of interventions tended to increase at the end of the study period. Discriminating between trends in the utilization of different hospital resources can improve the management of hospital health care demands of HIV-infected people.

Adult↗
PubMed1997

A single measurement of biochemical markers of bone turnover has limited utility in the individual person.

Biochemical markers of bone turnover are used to estimate the rate of bone loss in the individual osteoporotic patient. During recent years it has become increasingly clear that the biological variability of biochemical bone markers has to be taken into consideration in the evaluation of their usefulness in the clinical setting. Eleven premenopausal, 8 perimenopausal and 11 postmenopausal healthy women were included. We assessed the analytical and the biological components of variation for a number of resorptive and formative bone markers: u-hydroxyproline, u-pyridinoline, and u-deoxypyridinoline together with u-calcium and u-creatinine, s-total alkaline phosphatases and s-osteocalcin. Blood and urine samples were collected five times with 7-day intervals. Urinary parameters were expressed as outputs and corrected for creatinine in fasting night urines and second void fasting morning urines. The absolute values differed with a tendency towards increasing values in the postmenopausal women, but the biological variations in relation to menopausal status were not different. The biological variability was much higher for the urinary resorptive markers than for the formative markers in the blood. The critical difference expressing the difference needed between two serial results from the same person to be significant at a 5% level was 15% for s-alkaline phosphatases, 18% for s-osteocalcin, and lowest in the second void fasting morning urines with values of 28% and 34% for u-pyridinoline/creatinine and u-deoxypyridinoline/creatinine, and 50% and 112% for u-hydroxyproline/creatinine and u-calcium/creatinine, respectively. The index of individuality, denoting the individual variation divided by the variation between subjects, was in the range from 0.19 for s-alkaline phosphatases to 1.23 for u-hydroxyproline/minute in second void fasting morning urine making the use of conventional reference intervals difficult. Low indices, however, indicate high test performance and offer the possibility of stratification of persons within a range. The number of samples required to determine the true individual mean value +/- 5% for the single person, ranged from 5 for s-total alkaline phosphatases, 6 for s-osteocalcin, 23 for u-deoxypyridinoline/creatinine in the fasting morning urine to over two hundred for u-calcium analytes. It is concluded that, due to high biological variation, a single measurement of biochemical markers of bone turnover is of limited utility in the individual person. We recommend that routine clinical use of biochemical markers should be restricted until further evidence justifies it.

Adult↗
PubMed1996

The validity of self-reported health-care utilization by AIDS patients.

OBJECTIVES: To examine the validity of self-reported health-care utilization among persons with AIDS. DESIGN: A comparison of survey data with information collected from medical and financial records. METHODS: Personal interviews provided information on utilization within a 4-month period for inpatient admissions (n = 296), ambulatory visits (n = 284), and hours of homecare (n = 106). Risk group, socioeconomic characteristics, disease stage, functional status, memory, and respondent's recall ability were also measured. Reporting error was defined as the difference between self reports and medical/financial records. Variations among subgroups of patients were examined using t tests and multiple regression. To determine whether reporting errors affected analysis of utilization data, we compared coefficients from parallel utilization models using each data source to predict use/non-use and total utilization. RESULTS: Mean overall reporting errors were small and not significantly different from zero. Reporting errors were lowest for hospital admissions and highest for homecare. High utilizers underreported all types of services. The interviewer evaluation of recall was an independent and significant predictor of reporting errors for admissions and ambulatory visits. Reporting errors varied by selected subgroup characteristics, but the direction and significance of the error depended on the type of utilization measured. In the parallel utilization models, few differences appeared between models using self-reports and medical/financial records to identify correlates of use/non-use, but some differences between the models of total utilization were apparent. CONCLUSIONS: Self-reports of utilization by AIDS patients with a recall period of 4 months or less provide, on average, valid data for analytic purposes. However, caution should be applied to reports by high or low users or by respondents judged by interviewers to have major recall problems.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Symptom utilization in strategic therapy.

Five techniques of symptom utilization have been presented in an interactional strategic approach. They are: utilization of peers, utilization of the desire to grow up, utilization of personal ambition and future expectations, utilization of an antagonistic relationship, and utilization of sibling rivalry. Emphasis is placed on helping the therapist develop a way of thinking to approach difficult problems.

Adolescent↗
PubMed2002

Fatigue severity, attributions, medical utilization, and symptoms in persons with chronic fatigue.

This study examined the roles of ethnicity, gender, and socioeconomic status (SES) in predicting fatigue severity, symptoms, medical utilization, and attributions among a sample of individuals with chronic fatigue. Using path analysis, a model was tested and revised. In the new model, gender predicted fatigue, ethnicity predicted attributions, fatigue predicted medical utilization and attributions, and attributions predicted medical utilization. Women reported more fatigue and were more likely to feel that stress and depression were causing their fatigue. Higher-SES participants were more likely to cite stress and overwork as causing their fatigue. Latinos reported more physical symptoms than African Americans and Whites. The implications of these results are discussed.

Chronic Disease↗
PubMed1998

[Home care service utilization by severely mentally and physically handicapped persons].

PURPOSE: To investigate the utilization of in-home services by severely mentally and physically handicapped persons at home in order to clarify the vital factors associated with the services. METHODS: Questionnaires were delivered to 174 severely mentally and physically handicapped persons who were registered with 8 institutions in Tokyo and Kanagawa prefecture through each institution. One hundred and thirteen respondents among them were the subjects of this study. As a conceptual model Andersen's model was adopted. RESULTS: (1) The age of subjects varied from 2 to 50. There were no subjects between the age of 7 to 17. The mean functional handicap severity score (SCORE) was 5.8 +/- 8.4 standard deviation. Ninety seven percent of main caregivers were mothers, even among the aged. (2) Over 1/2 of the subjects reported having utilized institutional services. On the other hand the percentage for visiting nurse service (VNS) and home help services were 28.3% and 7.7% respectively. (3) Subject who used V.N.S. had significantly higher SCORES and higher luck of health of caregivers. Caregivers utilized V.N.S. as a substitute to reduce their burden in activities care at home. On the other hand, users of institutional services showed high scores in difficulties with daily help and perceived difficulties with medical treatments: it showed that they sought institutional care to reduce there careburden. (4) Total number of used by each client for in-home service was explained only by both difficulties of daily help and SCORE from multiple regression analysis. CONCLUSION: Users of visiting nursing service expect highquality care based on current medical knowledge and also with the aim of caregiver's health. With the increasing age of caregivers it appears to be important to enhance visiting nurse services, reduce the caregiver burden, and provide active support of home care for the handicapped.

Activities of Daily Living↗
PubMed2005

Assessment of anosognosia in persons with frontal lobe damage: clinical utility of the Mayo-Portland Adaptability Inventory (MPAI).

OBJECTIVES: To determine if the Mayo-Portland Adaptability Inventory (MPAI) demonstrates clinical utility in differentiating between persons with severe TBI and frontal lobe damage/anosognosia and persons with mild TBI and no frontal lobe damage. PARTICIPANTS: Forty-three persons with TBI and documented frontal lobe damage (mean age = 34; mean time since injury = 5.2 years) and 69 persons with mild TBI and no frontal lobe damage (mean age = 34.3; mean time since injury = 4.8 4.8 years). MEASURE: MPAI. RESULTS: Total inventory and select sub-category difference scores were significantly greater in the frontal lobe group than in the non-frontal lobe group. However, as expected, there was no significant difference between the two groups on the mobility sub-category difference scores. CONCLUSIONS: The MPAI appears to be potentially clinically useful in assessing for frontal lobe damage and associated anosognosia in patients with TBI.

Adult↗
PubMedDate not supplied

[Personal identity and multiple personality].

The present study analyses the internal organization of self concepts in a woman who meets the DSM III criteria of multiple personality disorder. The aim of this single case study, was to assess the personal identity of this patient, the degree of internal coherence and the hierarchical structure of the descriptions of self and others in the frame of cognitive theories of personality. After the clinical observation, the experimental procedure is presented. It consists in asking the patient to describe her different roles or alternated personalities (N = 12), as well as the target persons of her familial and social environment (N = 8) on the basis of a preestablished list of adjectives (extracted from the 16 P.F. Cattell sphere of personality). The factorial analysis of the contingency table: traits attributed x persons described shows a Guttman like hierarchical structure. Similarities and differences between the descriptions can be ordered on a unidimensional order, the multiple roles or personalities being no more complex nor simple than the target persons. The present results have been discussed in reference to cognitive theories of personality and their utility in studying personal identity and multiple personality.

Adult↗
PubMed2003

Predicting adolescents' global functioning from personality typologies.

This study examined the utility of three personality typologies in predicting global functioning in a non-clinic sample of adolescents. Participants were 140 students from middle class suburban public high schools (74 girls; mean age = 16.0 +/- 1.2; 70.7% Caucasian, 11.4% African American, 7.1% Asian, 7.1% Hispanic, and 3.6% other) who completed psychometrically sound standardized measures of personality. They were combined into three four quadrant personality typologies. Global Assessment of Functioning (GAF) ratings were based on clinical interviews utilizing DSM criteria and were obtained by raters blind to self-report results. All three systems overlapped modestly but significantly. Each model detected significant GAF differences among quadrants. There was no gender difference in representation among the quadrants of the three systems. Results suggest that compared with unitary dimensions of personality, typologies concurrently utilizing two dimensions of personality functioning better capture individual differences on a complex psychological construct such as global functioning. Further research is warranted to examine the utility of these typological systems in predicting global functioning across a variety of clinical and nonclinical adolescent populations, and to determine how other aspects of global functioning may influence or interact with personality typologies.

Adolescent↗
PubMed1999

Associations between health status and utilities implications for policy.

BACKGROUND: If shape of a person's utility function is associated with his health status, as is predicted by Prospect Theory, the use of utilities from the healthy could result in 'de facto' discrimination against the sick. OBJECTIVES: To determine if patients' utilities for hypothetical states and for their current health were associated with their health status. DESIGN: A cross-sectional study of the health and values of patients with depressive illnesses. SETTING: Patients from three large primary care practices with various medical illnesses complicated by symptoms of depression. MEASURES: Short-Form 12 health status measurements, standard gamble, and visual analog scale preference measurements for patients' current health and for three hypothetical states. RESULTS: One hundred and forty nine patients enrolled in the study and 139 patients completed the survey. Utilities for the best and worst states were similar across different levels of health status; however, standard gamble utilities for intermediate health states were higher for patients in poorer health than patients in better health (P = 0.019,) suggesting utility functions with radically different shapes. Utilities for patients' current health were also associated with their health status. Patients in poor health tended to overvalue their current health relative to the most similar hypothetical state; whereas, patients in good health tended undervalue their current health state (P = 0.036). CONCLUSIONS: In patients with depressive illnesses, there were significant interactions between health and values, that were consistent with the predictions of Prospect Theory, and that could result in systematic under valuation of the health effects of treatments that primarily benefit more severely patients ill.

Adult↗
PubMed1999

Physician utilization by Hispanic elderly persons: national perspective.

BACKGROUND: The number of elderly Hispanic Americans is projected to more than double by 2010 and account for 16% of all elders by 2050. The complex health needs and diversity of that growing population poses challenges for planning and delivery of health services. OBJECTIVES: The behavioral model of health services utilization was used to examine predisposing, enabling, and need factors associated with physician use by Hispanic elders and to assess whether Mexican American, Cuban American, and Puerto Rican elders differ in their likelihood of use. RESEARCH DESIGN: Data are from the 1988 National Survey of Hispanic Elderly People, which is a nationally representative sample of Hispanic elders living within telephone exchanges with at least 30% concentration of Hispanics. SUBJECTS: There were 2,299 completed interviews. Analyses are based on a subsample of 773 Mexican Americans, 714 Cuban Americans, and 368 Puerto Ricans. MEASURES: The dependent variable, physician utilization, was self-reported number of visits in the previous year. It was dichotomized because of skewness. Independent variables include predisposing, enabling, and need factors. RESULTS: Using hierarchical logistic regression, all three sets of factors contributed to the likelihood of a visit. Enabling factors, especially insurance coverage and adult children, had the greatest impact. Cuban Americans and Puerto Ricans were 2.3 and 2.6 times more likely, respectively, to have seen a physician than were Mexican Americans. CONCLUSIONS: In seeking to improve access and use of physician services, health care providers and policy makers should consider the role of social and economic factors and national origin group.

Adult↗
PubMed2000

Mothers' personality and its interaction with child temperament as predictors of parenting behavior.

In this longitudinal, multimethod investigation, the authors examined mothers' personality and its interaction with infants' negative emotionality as predictors of parenting behavior. When infants were 8-10 months old (N = 112), mothers completed personality self-reports, and the authors observed infants' negative emotionality in both standard procedures and naturalistic daily contexts. When infants were 13-15 months old (N = 108), the authors observed two aspects of parenting, power assertion and maternal responsiveness, in mother-child interactive contexts. Maternal personality alone and also in interaction with child emotionality predicted future parenting behaviors. The longitudinal links established between personality and parenting behaviors indicate the predictive utility of personality. Findings also highlight the bidirectionality of the early parent-child relationship.

Adult↗
PubMedDate not supplied

The heterogeneous pain personality: diverse coping styles among sufferers of chronic pain.

The utility of personality assessment in chronic pain populations can be greatly enhanced with the understanding of risk assessment and the heterogeneous nature of at-risk personality types. Simplistic, unidimensional notions of risk have not been useful in assessing psychosocial and functional impairment in those with chronic pain syndromes. Previous literature suggests that certain combinations of psychometric scales, as opposed to individual scales, may be more useful in predicting the multiplicity of factors associated with functional disability among chronic pain patients. A hierarchical cluster analysis was performed on the 8 coping scales of the Millon Behavioral Health Inventory. Analyses revealed 3 distinct groups. The first cluster, termed repressors, exhibited high introversive and cooperative scales, and low forceful scales. The second cluster, termed amplifiers, exhibited high inhibited and sensitive scales. The third cluster, termed social copers, exhibited high confident and social scales. Analyses of these 3 clusters with regard to measures of psychopathology (Minnesota Multiphasic Personality Inventory II), depression (Beck Depression Inventory), functional impairment (Chronic Illness Problem Inventory), and other measures (Multidimensional Pain Inventory) resulted in significantly different levels of psychosocial and functional impairment. These clusters identified those patients who are at risk for nondisclosure of psychosocial dysfunction, those who are most emotionally distressed, and those who are most likely to comply with treatment. Consequently, such classifications identify psychosocial variables that will dictate a differential treatment approach and thus have potentially important clinical applications.

Adaptation, Psychological↗
PubMedDate not supplied

Psychiatric service utilization and cost for persons with schizophrenia in a Medicaid managed care program.

A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs.

Adult↗
PubMedDate not supplied

Selected personality and demographic variables: academic success in radiography programs.

This study was designed to investigate the feasibility of utilizing selected personality inventories and demographic variables as predictors of academic success in radiography programs. The findings of the investigation indicate that the personality and demographic variables are not related to student performance in academic courses, but that the personality variables have potential for utilization as predictors of clinical performance.

Achievement↗
PubMed2000

Outcome and utilization differences for older persons with stroke in HMO and fee-for-service systems.

OBJECTIVES: To compare treatment and outcomes for older persons with stroke in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) systems. DESIGN: Inception cohort stratified by payer and followed for 1 year. SETTING: Six HMOs and five FFS systems with large Medicare populations in the West, Midwest, and Eastern United States. PARTICIPANTS: A total of 429 randomly selected stroke patients receiving rehabilitation in nursing homes or rehabilitation hospitals (RHs) from June 1993 to June 1995. MEASUREMENTS: Improvement in activities of daily living (ADLs) during rehabilitation, and ADL recovery, community residence, and utilization until 12 months after stroke. Outcomes were adjusted for premorbid function, marital status, comorbid illness, posthospital function, cognition, psychological problems, and stroke deficits. RESULTS: At baseline, HMO patients were more likely to be married, and less likely to be blind or have psychiatric diagnoses. HMO patients had shorter hospitalizations (P < .001), were less likely to be admitted to RHs (13% vs 85%, P < .001), and received fewer therapy and physician specialist visits (P < .001) but more home health visits (P < .001). During rehabilitation, FFS patients made greater improvement in ADLs (difference, 0.73 ADLs; 95% CI, .37-1.09). At 1 year, there was no difference in ADL recovery (difference, -0.24 ADL; 95% CI, -0.64-0.16), but FFS patients were more likely to reside in the community (adjusted OR, 1.8; 95% CI, 1.1-3.1), and HMO patients were more likely to reside in nursing homes (adjusted OR, 2.4; 95% CI, 1.1-5.5). CONCLUSION: Study findings suggest that short-term functional outcomes and eventual community residence rates are poorer for Medicare HMO patients with stroke than for stroke patients receiving FFS care, consistent with the lower intensity of rehabilitation (in nursing homes vs RHs) and less specialty physician care.

Aged↗
PubMed2002

Identifying the needs of elderly, hearing-impaired persons: the importance and utility of hearing aid attributes.

Older patients represent the majority of hearing-aid users. The needs of elderly, hearing-impaired subjects are not entirely identified. The present study aims to determine the importance of fundamental hearing-aid attributes and to elicit the utility of associated hypothetical hearing aids for older patients. This was achieved using a questionnaire-based conjoint analysis--a decompositional approach to preference measurement offering a realistic study design. A random sample of 200 experienced hearing-aid users participated in the study. Though three out of the six examined attributes revealed age-related dependencies, the only significant effect was found for the attribute "handling", which was considerably more important for older than younger hearing-aid users. A trend of decreasing importance of speech intelligibility in noise and increasing significance of speech in quiet was observed for subjects older than 70 years. In general, the utility of various hypothetical hearing aids was similar for older and younger subjects. Apart from the attribute "handling", older and younger subjects have comparable needs regarding hearing-aid features. On the basis of the examined attributes, there is no requirement for hearing aids designed specifically for elderly hearing-aid users, provided that ergonomic features are considered and the benefits of modern technology are made fully available for older patients.

Age Factors↗