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PubMed2004

Moderate physical activity and its relationship to select measures of a healthy diet.

CONTEXT: In rural communities, physical activity may influence and predict nutritional behaviors. PURPOSE: The purpose of this investigation was to determine if an individual's stage of participation in moderate physical activity was related to select measures of a healthy diet. METHODS: Data were collected using a mail-in survey from a random sample conducted in the rural/frontier communities of Idaho, Montana, and Wyoming. A total of 6 communities, 2 from each state, were surveyed with approximately 575 surveys sent to each community. The response rate was 51.5%. FINDINGS: Regression analysis revealed that there was a significant difference (P < 05) in select measures of a healthy diet between those in the maintenance stage of moderate levels of physical activity (physically active for 6 months or more) and those in precontemplation (not currently active and with no intention of starting), contemplation (not currently active but considering starting within the next 6 months), and preparation (not currently active but taking steps to become active within the next 30 days). Those in maintenance had a healthier diet. Additionally, women, older people, those with at least some college education, and those who were employed had healthier diets. CONCLUSIONS: These results lend preliminary support to the idea that moderate physical activity could act as a gateway behavior, a behavior that, if adopted, could lead to the adoption of other healthy behaviors. However, additional research is needed to confirm the nature, if any, of this relationship.

Adult↗
PubMed2000

Effect of adults' self-regulation of diabetes on quality-of-life outcomes.

OBJECTIVE: To examine the relationships among cognitive representations of diabetes, diabetes-specific health behaviors, and quality of life using Leventhal and Diefenbach's self-regulation model of illness (Leventhal H, Diefenbach M: The active side of illness cognition. In Mental Representation in Health and Illness. SkeltonJA, Croyle RT, Eds. New York, Springer-Verlag, 1991, p. 247-272). RESEARCH DESIGN AND METHODS: This research involved secondary analysis of a mailed survey completed by 296 adults (ages 20-90 years). Structural equation modeling was conducted to investigate relationships among cognitive representations, diabetes-specific health behaviors, and quality of life. Model differences by diabetes type were also investigated. RESULTS: Findings indicated that certain cognitive representation constructs were related to increased diabetes-specific health behaviors, decreased sense of burden, and positive quality-of-life outcomes. Individuals levels of understanding of diabetes and their perceptions of control over diabetes were the most significant predictors of outcomes. However, diabetes-specific health behaviors were related to an increased sense of burden that was negatively associated with quality of life. Multigroup analyses indicated that this self-regulatory model provided a good fit for individuals with type 1 diabetes, those with type 2 diabetes who take insulin, and those with type 2 diabetes who do not take insulin. CONCLUSIONS: These findings advance what is known about cognitive representations of illness and the self-regulation of diabetes as well as the relationships between cognitive representations of illness, quality of life, and behavioral factors. In particular, results from this study suggest the need for further study to address ways of reducing the burden of diabetes associated with health behaviors and decreased quality of life.

Adult↗
PubMed2002

High breast cancer incidence rates among California teachers: results from the California Teachers Study (United States).

OBJECTIVE: [corrected] To determine risk factor profiles and cancer incidence rates among participants in the California Teachers Study (CTS), a study designed to document high breast cancer incidence rates of California teachers and to investigate emergent hypotheses in the etiology of breast and other cancers. METHODS: The CTS is a prospective study of 133,479 California female teachers and administrators, established in 1995-1996 with members of the California State Teachers Retirement System completing a detailed mailed questionnaire regarding possible risk factors for breast and other cancers. Cancer outcomes were identified by linkage with the California Cancer Registry. RESULTS: CTS participants have a 51% higher age-standardized invasive breast cancer incidence rate and a 67% higher in-situ breast cancer incidence rate than would be expected based on race-specific statewide rates after three years of follow-up. CTS participants also have substantially elevated rates of endometrial cancer (rate ratio, RR = 1.72), ovarian cancer (RR = 1.28), melanoma (RR = 1.59), non-Hodgkin's lymphoma (RR= 1.53), and leukemia (RR = 1.28), but low rates of invasive cervix cancer (RR = 0.53) and lung cancer (RR = 0.66). CONCLUSIONS: CTS members have high rates of several major cancers, particularly breast cancer, and low rates of lung and cervix cancer. Although late age at first birth can explain a portion of the observed excess risk of breast cancer in this cohort, the unique risk factor profile of CTS members may account for much of their higher risk of breast and selected other cancers. The CTS offers a rich resource for future studies of cancer risk and of women's health, in general.

Adult↗
PubMed2006

Successful and unsuccessful outcomes with long-term opioid therapy: a survey of physicians' opinions.

BACKGROUND: The attitudes, beliefs, and experience of physicians will influence how they view the use of opioids for chronic nonterminal pain. OBJECTIVE: To survey pain specialists and primary care providers (PCPs) to obtain their opinion and attitude on aberrant drug-taking behaviors. DESIGN: We surveyed three physician groups, mailing 250 surveys followed by two followups. The survey consisted of (1) questions about beliefs in the effectiveness of long-term opioid therapy and successful and unsuccessful outcomes and (2) a ratings section for possible indicators of unsuccessful long-term opioid treatment. RESULTS: In total 147 questionnaires (82 PCPs, 65 pain specialists) were returned. Pain specialists reported a greater number of patients undergoing long-term opioid therapy compared to nonpain specialists. Opinion regarding the effectiveness of long-term opioid therapy among all physicians was mixed but there was no significant difference between pain specialists and PCPs. There was agreement among physicians with regard to highly aberrant behaviors being indicators of failed long-term opioid therapy. The ratings of the following indicators showed differences between each group: no improvement in pain control, not being able to return to work, and a deterioration in relationships with others. Physicians reported increases or decreases in function to be the most important successful or unsuccessful outcome, respectively. CONCLUSIONS: This preliminary survey showed consensus among physicians that highly aberrant behaviors indicate a failure of chronic opioid therapy. However, when considering less egregious behaviors, it would appear a physician's experience and the number of patients they had taking opioids influenced their opinion.

Analgesics, Opioid↗
PubMed1995

National survey of emergency medicine resident moonlighting. SAEM Inservice Examination Survey Task Force.

OBJECTIVES: To survey emergency medicine (EM) residents regarding moonlighting practices and perceptions for clarifying: 1) resident moonlighting remuneration; 2) any association of perceived educational debt with moonlighting income and hours; and 3) perceptions related to moonlighting (including motivations, impact on resident training, and potential medicolegal difficulties). METHODS: A confidential, voluntary survey was administered to all allopathic EM residents in the United States. This written survey was provided to residents at their in-service examinations. Completed forms were anonymously returned by residents or local administrative staff to a central site where all identifiers were removed prior to mailing en mass to the investigators. Comparisons between groups were made using chi-square tests and correlations were assessed using the Pearson correlation coefficient. RESULTS: Seventy-six percent (1,826/2,407) of the surveys were returned. There was a weak correlation (r = 0.11) between educational debt and moonlighting hours for residents in the second year and above, but no association of debt with moonlighting income. Most (88%) of the residents reported that their programs permitted moonlighting. Nearly half (49%) reported that they did moonlight in some way. Most (82%) thought moonlighting provided experience not available in the residency. Only 13 (2%) respondents stated they had been sued for malpractice while moonlighting. Most (66%) moonlighting respondents stated that they moonlighted for financial reasons, with educational debt the primary motivating factor. Of the moonlighting residents, 28% were unsure of their type of malpractice insurance coverage, and 9% had no coverage at all. CONCLUSIONS: Education about EM practice matters including the risks of moonlighting should begin early in residency, because moonlighting is widespread. Residents are vulnerable to medicolegal action while moonlighting and have insufficient knowledge of their malpractice insurance coverage. Although educational debt is perceived as a strong motivating factor for moonlighting, there is only a weak relationship between educational debt and moonlighting hours.

Analysis of Variance↗
PubMed2003

Personality as assessed by egogram is a possible independent predictive variable for post-discharge smoking abstinence in male cancer patients.

BACKGROUND: Little is known about the relationship between a patient's personality and smoking behavior. METHODS: We assessed the smoking status of 262 male smokers who had been diagnosed with cancer and admitted to a teaching hospital, using a self-administered questionnaire that was mailed to the patients 6 months after discharge. The personality of the patients was assessed with the Kyushu University Egogram at admission, and the patients were categorized into five groups according to the ego state with the highest value among the five ego states, namely "Critical Parent" dominant, "Nurturing Parent" dominant, "Adult" dominant, "Free Child" dominant and "Adapted Child" dominant. Multivariate logistic regression analyses were used to assess the influence of the type of personality on smoking behavior after hospital discharge with adjustment for considerable predictive variables. RESULTS: The smoking cessation rate at 6 months after hospital discharge was 63% (164/262). Multivariate analyses revealed that after adjustment for age, cancer site, length of hospital stay, time elapsed since last cigarette, self-confidence to quit smoking and strength of nicotine dependence, and being an Adult dominant personality were positively (p<0.01), and being a Free Child dominant personality was negatively (p<0.05) associated with post-discharge abstinence. These findings did not change when the non-responders (n=50) of the questionnaire were included in the analysis as post-discharge smokers. CONCLUSIONS: These findings indicate that a male cancer patient's personality as assessed by the egogram has predictive significance for whether the patient will have a smoking habit after discharge.

Aged↗
PubMed1999

Patient assessments of hospital maternity care: a useful tool for consumers?

OBJECTIVE: To examine three issues related to using patient assessments of care as a means to select hospitals and foster consumer choice-specifically, whether patient assessments (1) vary across hospitals, (2) are reproducible over time, and (3) are biased by case-mix differences. DATA SOURCES/STUDY SETTING: Surveys that were mailed to 27,674 randomly selected patients admitted to 18 hospitals in a large metropolitan region (Northeast Ohio) for labor and delivery in 1992-1994. We received completed surveys from 16,051 patients (58 percent response rate). STUDY DESIGN: Design was a repeated cross-sectional study. DATA COLLECTION: Surveys were mailed approximately 8 to 12 weeks after discharge. We used three previously validated scales evaluating patients' global assessments of care (three items)as well as assessments of physician (six items) and nursing (five items) care. Each scale had a possible range of 0 (poor care) to 100 (excellent care). PRINCIPAL FINDINGS: Patient assessments varied (p<.001) across hospitals for each scale. Mean hospital scores were higher or lower (p<.01) than the sample mean for seven or more hospitals during each year of data collection. However, within individual hospitals, mean scores were reproducible over the three years. In addition, relative hospital rankings were stable; Spearman correlation coefficients ranged from 0.85 to 0.96 when rankings during individual years were compared. Patient characteristics (age, race, education, insurance status, health status, type of delivery) explained only 2-3 percent of the variance in patient assessments, and adjusting scores for these factors had little effect on hospitals' scores. CONCLUSIONS: The findings indicate that patient assessments of care may be a sensitive measure for discriminating among hospitals. In addition, hospital scores are reproducible and not substantially affected by case-mix differences. If our findings regarding patient assessments are generalizable to other patient populations and delivery settings, these measures may be a useful tool for consumers in selecting hospitals or other healthcare providers.

Adult↗
PubMed2002

Secular trends in overweight and obesity among Finnish adolescents in 1977-1999.

OBJECTIVE: To study the trends in overweight and obesity among Finnish adolescents in 1977-1999. DESIGN: Mailed surveys every other year. SUBJECTS: Nationally representative samples of 12, 14, 16 and 18-y-olds (n = 64,147, response rate 78.9%). METHODS: Overweight and obesity were measured by body mass index (BMI) and relative weight (RW) based on self-reported height and weight. BMI > or = the 85th percentile cut-off point for BMI in each age- and sex-specific group in the entire data set was considered as overweight, and BMI > or = 95th percentile cut-off point as obesity. RW > or = 110% and > or = 120%, calculated as the individual's weight divided by the mean weight in each age- and sex-specific height percentile group in the entire data set, were considered as overweight and obesity, respectively. The trends in overweight and obesity are described by the change in the 85th and 95th percentile cut-off points of BMI over time. The prevalence of overweight and obesity is also reported using BMI reference values recommended for international comparisons. Because of the similarity of the BMI and the RW criteria in classifying adolescents as overweight and obese, only results based on BMI are presented. RESULTS: Overweight and obesity increased linearly in all sex and age groups from 1977 to 1999. Depending on the age group, the average increase in the 85th percentile cut-off point of the BMI per 10 y was 0.6-1.1 kg/m2 in boys and 0.3-0.7 kg/m2 in girls. The 95th percentile cut-off point of the BMI for boys and girls increased by 1.1-1.6 kg/m2 and by 0.6-1.0 kg/m2 per 10 y, respectively. In boys, the increase in overweight and obesity was largest in the two youngest age groups. In girls, the increase in overweight was largest in the oldest age group, and that of obesity both in the 14 and 18-y-olds. Overweight and obesity increased more in boys than in girls in all age groups except in the 18-y-olds among whom the increase was similar in both sexes. Examination of the entire BMI distribution showed that there was little or no change over time at the lower (5th, 15th) and middle (50th) percentiles, but increasing differences at the upper end of the distribution, the increases in the 95th percentile being even more marked than those in the 85th percentile curves. According to international reference values, the age-standardized prevalence of overweight increased in boys from 7.2 to 16.7%, and in girls from 4.0 to 9.8%, between 1977 and 1999. The prevalence of obesity in boys was 1.1% in 1977 and 2.7% in 1999, and in girls 0.4 and 1.4%, respectively. CONCLUSION: Overweight and obesity increased remarkably among Finnish adolescents from 1977 to 1999. The changes concentrated at the upper end of the BMI distribution, suggesting that factors behind this development have influenced only a part of the adolescent population.

Adolescent↗
PubMed2000

Recent care of common mental disorders in the United States : prevalence and conformance with evidence-based recommendations.

OBJECTIVE: To relate the presence of recent mental disorders to use of mental health services. DESIGN: Cross-sectional survey. STUDY POPULATION: The study population was 3,032 respondents to the Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-and-mail survey conducted in 1996. Twelve-month diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition, of major depressive episode, panic disorder, generalized anxiety disorder, and serious mental illness were made using a structured assessment. Information was obtained on 12-month treatment for mental health problems in the general medical, mental health specialty, human services, and self-help sectors. Definitions of treatments consistent with evidence-based recommendations were developed using available practice guidelines. MEASUREMENTS AND MAIN RESULTS: Crude and adjusted likelihoods of receiving any mental health care and guideline-concordant care were measured. Although 53. 8% of respondents with at least one 12-month mental disorder received any mental health care in the previous year, only 14.3% received care that could be considered consistent with evidence-based treatment recommendations. Even among those with the most serious and impairing mental illness, only 25% received guideline-concordant treatment. Predictors of receiving guideline-concordant care included being white, female, severely ill, and having mental health insurance coverage. CONCLUSIONS: An epidemic of untreated and poorly treated mental disorders exists in the United States, especially among vulnerable groups such as African Americans and the underinsured. Cost-effective interventions are needed to improve both access to and quality of treatment.

Adult↗
PubMed1999

Comparison of self-reported diagnosis of connective tissue disease with medical records in female health professionals: the Women's Health Cohort Study.

To compare self-report of connective tissue disease (CTD) with medical records, subjects were selected from 395,543 female health professionals with and without breast implants who reported CTD on mailed questionnaires from 1992 to 1995. The authors identified 220 women with breast implants (exposed) who self-reported CTD and a random sample of 879 women without breast implants (unexposed) who also self-reported CTD, matched by age and date of diagnosis. Medical records were reviewed using classification criteria from the American College of Rheumatology or other published criteria. After up to three requests and a telephone call, 27.7% of the women provided consent for medical record review. Exposed women appeared somewhat more likely (33.2% vs. 26.3%, p = 0.04) to provide consent. Using medical record reviews for 90% of the women who provided consent, confirmation rates of definite CTD were similar among the exposed and unexposed (22.7% vs. 24.0%, p = 0.83). This study demonstrates the difficulty of obtaining consent for medical record review of CTD reported to have occurred years ago in women with and without breast implants. Confirmation rates were low but were similar in exposed and unexposed. Despite the fact that the study had low participation rates, the data suggest that relative risk estimates for any definite CTD among women with breast implants compared with women without breast implants would be similar in analyses of self-reported or medical record-confirmed cases.

Adult↗
PubMedDate not supplied

Five-year changes in North Carolina outpatient cardiac rehabilitation.

PURPOSE: The purpose of this study was to describe cardiac rehabilitation programming, barriers to participation, and reasons for dropout in North Carolina from a program director's perspective and to compare those results with those of a similar statewide survey conducted 5 years earlier. METHODS: In 1999 and 2004, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72) in 1999 and 79% (61/77) in 2004. RESULTS: More than 85% of North Carolinians older than 40 years lived within a 15-mile buffer of an outpatient cardiac rehabilitation program in 2004. Most programs were staffed with personnel trained in nursing, exercise physiology, and nutrition in 1999 and 2004. Women and African Americans remained disproportionately underrepresented as participants in the program for both years. In 2004, approximately one third of cardiac rehabilitation programs reported having a referral to rehabilitation on the hospital discharge plan for myocardial infarction and coronary artery bypass surgery. In 1999 and 2004, the most frequently reported barrier to participation remained financial, followed by lack of interest or motivation and workplace conflicts. Work conflicts, lack of interest, and comorbidities were the most frequently reported reasons for dropping out from cardiac rehabilitation programs in both 1999 and 2004. CONCLUSIONS: Increasing participation in cardiac rehabilitation programs by addressing barriers at multiple levels may facilitate greater patient participation. This statewide survey could be used in other states as a surveillance tool, to track changes in rehabilitation over time from a program director's perspective.

Ambulatory Care Facilities↗
PubMed1999

Edentulism among Finnish adults of working age, 1978-1997.

OBJECTIVES: The dental health of Finnish children and young adults has improved considerably during the last 25 years. At the same time, there are still middle-aged or elderly individuals who have lost some or all of their teeth, since extractions were commonly used as a treatment for dental infections during earlier decades. The aim of the present study was to analyze changes of the prevalence of and risk indicators for edentulism among Finnish adults of working age (15-64 years) from 1978 to 1997. METHODS: The National Public Health Institute has, since 1978, conducted annual surveys concerning health behavior among the Finnish adult population. The data were collected through a mailed questionnaire including questions on the number of missing teeth. Sample sizes varied from 5000 to 6000 and the response rates from 70% to 85%. RESULTS: The dental status profile of the Finnish adult population has changed considerably since 1978. The prevalence of edentulism decreased from 14% to 6% during the study years. At the same time, the number of persons with complete dentition increased from 60% to 80%. The decrease in edentulism was obvious in both sexes, but the change was more remarkable among women. In 1997, the difference between the sexes had almost disappeared. The differences between regional and educational groups were still marked in 1997. Belonging to a certain birth cohort appeared to be the major factor affecting the percentage of edentulous subjects. In 1978 risk indicators of total tooth loss included age, gender, length of education, geographical area, urbanization, marital status, and medication for headache. In 1997 risk indicators included age, length of education, geographical area, history of smoking, and perceived status of health. CONCLUSIONS: The number of totally edentulous working-age persons is rapidly decreasing in Finland. Edentulism was strongly associated with birth cohorts and is apparently accumulating in a diminishing group of people. Relevant factors that were strongly associated with edentulousness did not vary considerably between the study years.

Adolescent↗
PubMed2003

[Knowledge on screening and diagnosis of breast cancer among gynecologists in Goiãs State (Brazil)].

OBJECTIVES: To evaluate the knowledge level on the screening and diagnosis of breast cancer among the gynecologists of the State of Goiãs, Brazil. METHODS: Questionnaires containing professional information and questions on breast cancer screening were posted for all the 427 gynecologists associated to the Goiãs Society of Gynecology and Obstetrics, between May and July of 1999. RESULTS: Of the 427 questionnaires, 26 (6%) were returned because incorrect mailing address. Of the 401 doctors who received the questionnaire, 85 (21%) answered and returned them back. Of these, 28% were female; the average of the profession time was of 17 years. The medical residence was the highest title level for 70%. The average age of the doctors was 44 years. The rates of correct answers were: 94% for the knowledge of the most frequent sign of breast cancer, 75% for the best method for screening, 88% for the period of when the mammography begins, 93% for the periodicity of the mammography after the 50 years and 83% about the indication of the complementary ultrasound. The doctors who have studied in a program of medical residence was the only factor that influenced the rate of correct answers, if compared to those that did not cursed it. The professional's gender, the Title in Gynecology and Obstetrics Specialty (TEGO) holders and the city of work did not influence the rates of correct answers. CONCLUSION: The gynecologists of the State of Goiãs who answered the questionnaire have a good knowledge on the screening and diagnosis of breast cancer. Medical residence was the single factor that influenced the rate of correct answers.

Adult↗
PubMed2001

Assessing psychological distress in patients with skin diseases: reliability, validity and factor structure of the GHQ-12.

OBJECTIVE: We studied reliability, validity and factor structure of the 12-item General Health Questionnaire (GHQ-12) in dermatological patients. METHOD: Subjects attending a dermatological outpatient clinic were administered the GHQ-12 and the Skindex-29. A random subsample was mailed another copy of the questionnaires to be completed within 1 week. RESULTS: A total of 2,579 subjects completed the GHQ-12. The internal consistency of the GHQ-12 was high (Cronbach's alpha = 0.88). Test-retest reliability on 137 subjects was also fairly satisfactory (intraclass correlation coefficient = 0.72), notwithstanding a re-test artefact probably related to reassurance from the physician. Evidence of construct validity was provided by the pattern of correlation between scores on the GHQ-12 and on the scales of Skindex-29, which were as hypothesized. Also, GHQ-12 scores of patients in different clinical groups varied as hypothesized, with patients affected by inflammatory skin diseases scoring significantly higher than patients with isolated skin lesions. We obtained both a two-factor and a three-factor solution: the latter seemed theoretically more appropriate, although the first may have practical advantages. A 'social dysfunction' factor emerged in both analyses, while the other items loaded on a 'general dysphoria' factor or on two separate factors interpreted as 'anxiety' and 'loss of self-esteem'. CONCLUSIONS: The GHQ-12 is a reliable and valid instrument with a factor structure that is quite stable across different samples as well as across diverse cultures. Its brevity and easiness of completion make it a useful tool to assess psychological distress in dermatological patients.

Adolescent↗
PubMed1996

Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection.

BACKGROUND: Chlamydia trachomatis is a frequent cause of pelvic inflammatory disease. However, there is little information from clinical studies about whether screening women for cervical chlamydial infection can reduce the incidence of this serious illness. METHODS: We conducted a randomized, controlled trial to determine whether selective testing for cervical chlamydial infection prevented pelvic inflammatory disease. Women who were at high risk for disease were identified by means of a questionnaire mailed to all women enrollees in a health maintenance organization who were 18 to 34 years of age. Eligible respondents were randomly assigned to undergo testing for C. trachomatis or to receive usual care; both groups were followed for one year. Possible cases of pelvic inflammatory disease were identified through a variety of data bases and were confirmed by review of the women's medical records. We used an intention-to-screen analysis to compare the incidence of pelvic inflammatory disease in the two groups of women. RESULTS: Of the 2607 eligible women, 1009 were randomly assigned to screening and 1598 to usual care. A total of 645 women in the screening group (64 percent) for chlamydia; 7 percent tested positive and were treated. At the end of the follow-up period, there had been 9 verified cases of pelvic inflammatory disease among the women in the screening group and 33 cases among the women receiving usual care (relative risk, 0.44; 95 percent confidence interval, 0.20 to 0.90). We found similar results when we used logistic-regression analysis to control for potentially confounding variables. CONCLUSIONS: A strategy of identifying, testing, and treating women at increased risk for cervical chlamydial infection was associated with a reduced incidence of pelvic inflammatory disease.

Adolescent↗
PubMed2006

Management of patients with cirrhosis in Southern California: results of a practitioner survey.

INTRODUCTION: Cirrhosis is an important medical and public health concern. A paucity of data exists on how patients with cirrhosis are managed. Our aims were to determine how cirrhosis is managed and whether current management practices follow established recommendations. METHODS: A questionnaire was mailed to Southern California Society of Gastroenterology members. Most had practiced for more than 15 years (67%) in a private practice setting (69%). Proportions of physicians who followed established guidelines versus those who had not were compared using chi test. RESULTS: Hepatitis A, hepatitis B, influenza, and pneumococcus vaccinations were recommended by most respondents. Ninety-one percent of respondents routinely screened patients for hepatocellular carcinoma. A significantly greater proportion of respondents screened for hepatocellular carcinoma using either alpha-fetoprotein or ultrasound every 6 months (P < 0.05). Seventy-six percent recommended antibiotic prophylaxis in patients with prior spontaneous bacterial peritonitis, whereas less than half recommended prophylaxis in patients with ascitic protein fluid <1 g/dL, current variceal bleed, and those on the liver transplant list. Sixty-seven percent of respondents performed screening esophagogastroduodenoscopy upon diagnosis of cirrhosis. Most respondents did not recommend repeating endoscopy in 1 to 2 years if a patient was found to have small varices (P < 0.05), and would repeat an endoscopy if large varices were found (P < 0.05). CONCLUSION: The management of patients with cirrhosis in the community varied and did not always conform to established guidelines. These results should be confirmed in a larger group of physicians, and the rationales for physicians accepting or rejecting established guidelines should be further assessed.

California↗
PubMed2006

Assessment of health-related quality of life in arthritis: conceptualization and development of five item banks using item response theory.

BACKGROUND: Modern psychometric methods based on item response theory (IRT) can be used to develop adaptive measures of health-related quality of life (HRQL). Adaptive assessment requires an item bank for each domain of HRQL. The purpose of this study was to develop item banks for five domains of HRQL relevant to arthritis. METHODS: About 1,400 items were drawn from published questionnaires or developed from focus groups and individual interviews and classified into 19 domains of HRQL. We selected the following 5 domains relevant to arthritis and related conditions: Daily Activities, Walking, Handling Objects, Pain or Discomfort, and Feelings. Based on conceptual criteria and pilot testing, 219 items were selected for further testing. A questionnaire was mailed to patients from two hospital-based clinics and a stratified random community sample. Dimensionality of the domains was assessed through factor analysis. Items were analyzed with the Generalized Partial Credit Model as implemented in Parscale. We used graphical methods and a chi-square test to assess item fit. Differential item functioning was investigated using logistic regression. RESULTS: Data were obtained from 888 individuals with arthritis. The five domains were sufficiently unidimensional for an IRT-based analysis. Thirty-one items were deleted due to lack of fit or differential item functioning. Daily Activities had the narrowest range for the item location parameter (-2.24 to 0.55) and Handling Objects had the widest range (-1.70 to 2.27). The mean (median) slope parameter for the items ranged from 1.15 (1.07) in Feelings to 1.73 (1.75) in Walking. The final item banks are comprised of 31-45 items each. CONCLUSION: We have developed IRT-based item banks to measure HRQL in 5 domains relevant to arthritis. The items in the final item banks provide adequate psychometric information for a wide range of functional levels in each domain.

Activities of Daily Living↗
PubMed2004

Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study.

OBJECTIVE: To determine whether undiagnosed celiac disease is associated with irritable bowel syndrome (IBS) or dyspepsia in the community. SUBJECTS AND METHODS: A self-report bowel disease questionnaire was mailed to a random sample of Olmsted County, Minnesota, residents aged 20 to 50 years. All respondents who reported symptoms of dyspepsia or IBS (cases) and all respondents without notable gastrointestinal symptoms (controls) were invited to participate (260 eligible subjects; 150 [58%] were studied). Each respondent was examined by a physician, and the medical records of each were reviewed (3 subjects did not meet the criteria for dyspepsia or IBS at the time of the physician interview). Serum was obtained to measure antiendomysial antibodies and tissue transglutaminase (TTg) IgA antibodies using validated assays. RESULTS: A total of 34 subjects had dyspepsia (20 had ulcerlike dyspepsia), 50 had IBS (19 had diarrhea-predominant IBS), and 15 met criteria for both dyspepsia and IBS; 78 were asymptomatic healthy controls. The overall prevalence of positive TTg serology was 4% (95% confidence interval [CI], 1.5%-8.5%). The number of subjects who were seropositive for TTg was 2 of 34 (5.9%) with dyspepsia (95% CI, 0.7%-19.7%), 2 of 50 (4.0%) with IBS (95% CI, 0.5%-13.7%), and 2 of 78 (2.6%) of asymptomatic controls (95% CI, 03%-9.0%) (P = .64 IBS vs controls; P = .58 dyspepsia vs controls). No subjects had positive antiendomysial antibodies. CONCLUSION: In this community, celiac disease did not explain the presence of either IBS or dyspepsia.

Adult↗