PubMed Health⌕ Search

Biomedical subjects

A S Kapadia

Publications and source records attributed to A S Kapadia.

At least 19 recordsLinked to original sources
PubMed1997

Stress in Air Force aviators facing the combat environment.

BACKGROUND: This paper evaluates the effect of stress on four squadrons of United States Air Force aviators in tactical high performance aircraft deployed for combat operations compared with U.S. based aircrew using the Beck Depression Inventory (BDI) as the evaluating instrument. METHODS: This is a retrospective cross-sectional study consisting of 42 aviators in deployed squadrons stationed overseas and involved in a contingency mission, and 15 subjects stationed in the U.S. and not exposed to combat conditions. Each subject was administered the test instrument, which was completed in privacy and with complete anonymity. RESULTS: The hypotheses of interest were: a) the proportion of individuals in the population of fighter aircrew who would report excessive stress is 0; and b) no significant differences would exist in the proportion of individuals with excessive stress in the various squadrons. Using statistical methodology, these hypotheses were rejected. CONCLUSION: It is concluded that more studies in each given circumstance are necessary.

Adult↗
PubMed1996

Patient classification system: an optimization approach.

A patient classification system was developed integrating a patient acuity instrument with a computerized nursing distribution method based on an optimization algorithm. The objective was to minimize the total number of nursing personnel used by optimally assigning the nursing staff to meet the acuity needs of the various clinical units in the hospital. The validity of the model to assign staff was established by a 30-day comparison with the existing manual method of assignment.

Algorithms↗
PubMed1993

Screening for diabetic retinopathy. The wide-angle retinal camera.

OBJECTIVE: To define the test characteristics of four methods of screening for diabetic retinopathy. RESEARCH DESIGN AND METHODS: Four screening methods (an exam by an ophthalmologist through dilated pupils using direct and indirect ophthalmoscopy, an exam by a physician's assistant through dilated pupils using direct ophthalmoscopy, a single 45 degrees retinal photograph without pharmacological dilation, and a set of three dilated 45 degrees retinal photographs) were compared with a reference standard of stereoscopic 30 degrees retinal photographs of seven standard fields read by a central reading center. Sensitivity, specificity, and positive and negative likelihood ratios were calculated after dichotomizing the retinopathy levels into none and mild nonproliferative versus moderate to severe nonproliferative and proliferative. Two sites were used. All patients with diabetes in a VA hospital outpatient clinic between June 1988 and May 1989 were asked to participate. Patients with diabetes identified from a laboratory list of elevated serum glucose values were recruited from a DOD medical center. RESULTS: The subjects (352) had complete exams excluding the exam by the physician's assistant that was added later. The sensitivities, specificities, and positive and negative likelihood ratios are as follows: ophthalmologist 0.33, 0.99, 72, 0.67; photographs without pharmacological dilation 0.61, 0.85, 4.1, 0.46; dilated photographs 0.81, 0.97, 24, 0.19; and physician's assistant 0.14, 0.99, 12, 0.87. CONCLUSIONS: Fundus photographs taken by the 45 degrees camera through pharmacologically dilated pupils and read by trained readers perform as well as ophthalmologists for detecting diabetic retinopathy. Physician extenders can effectively perform the photography with minimal training but would require more training to perform adequate eye exams. In this older population, many patients did not obtain adequate nonpharmacological dilation for use of the 45 degrees camera.

Diabetic Retinopathy↗
PubMed1992

Cost-effectiveness of alternative methods for diabetic retinopathy screening.

OBJECTIVE: To assess from the perspectives of a government delivery system and patients, the cost-effectiveness of the 45-degrees retinal camera compared to the standard ophthalmologist's exam and an ophthalmic exam by a physician's assistant or nurse practitioner technician, for detecting nonproliferative and proliferative diabetic retinopathy. RESEARCH DESIGN AND METHODS: Comparison of 45-degrees fundus photographs with and without pharmacological pupil dilation taken by technicians and interpreted by experts, direct and indirect ophthalmoscopy by ophthalmologists, and direct ophthalmoscopy by technicians with seven-field stereoscopic fundus photography (reference standard). Costs were estimated from market prices and actual resource use. The study included 352 patients attending outpatient diabetes and general-medicine clinics at VA and DOD facilities. RESULTS: Medical system costs per true positive were: 45-degrees photos with dilation, $295; 45-degrees photos without dilation, $378; ophthalmologist, $390; and technician, $794. Patient costs per true positive were: 45-degrees photos with dilation, $139; 45-degrees photos without dilation, $171; ophthalmologist, $306; and technician, $1009. Cost-effectiveness is sensitive to program size due to high fixed cost of the camera methods but not to prevalence. Cost-effectiveness of the technician exam is strongly affected by its sensitivity. CONCLUSIONS: Primary-care screening with retinal photographs through pharmacologically dilated pupils for diabetic retinopathy is an appropriate and cost-effective alternative to screening by an ophthalmologist in this setting. Ophthalmologists are scarce, primary-care physicians are extremely busy, and large clinics allow fixed equipment costs to be spread across many patients.

Cost-Benefit Analysis↗
PubMed1989

Cardiovascular mortality trends in Harris County, Texas: 1980 to 1986.

Cardiovascular diseases are the leading causes of death in Texas and in the United States. This study determines the trend in mortality rates attributed to cardiovascular diseases in Harris County from 1980 to 1986. The region of the county that does not include the City of Houston was specifically studied. Mortality of cardiovascular diseases in these two areas follow patterns similar to that of the United States in the same time period. Both the entire county and Harris County excluding Houston show declines in cardiovascular mortality rates in the 7-year period. The populations were divided into four ethnic categories (white, black, Hispanic and "other"), and each ethnic group reported significant declines in overall cardiovascular mortality except in the "other" population, which showed an increase in the male group. Significant downward trends were noticed in the white and Hispanic population in the two major subcategories of cardiovascular diseases: diseases of the heart and cerebrovascular diseases. The black population in each geographic area studied was consistently higher in cardiovascular mortality than the other three ethnic groups observed (white, Hispanic and "other"). Knowledge of cardiovascular disease mortality rates by ethnicity, sex, and age as well as temporal changes in mortality rates within Harris County are important for health planners in continuing and implementing programs aimed at awareness, prevention, and treatment of cardiovascular diseases.

Cardiovascular Diseases↗
PubMed1989

An illness-death process with time-dependent covariates.

A general model for the illness-death stochastic process with covariates has been developed for the analysis of survival data. This model incorporates important baseline and time-dependent covariates in order to make an appropriate adjustment for the transition and survival probabilities. The follow-up period is subdivided into small intervals and a constant hazard is assumed for each interval. An approximation formula is derived to estimate the transition parameters when the exact transition time is unknown. The method developed is illustrated with data from a study on the prevention of the recurrence of a myocardial infarction and subsequent mortality, the Beta-Blocker Heart Attack Trial (BHAT). This method provides an analytical approach with which the effectiveness of the treatment can be compared between the placebo and propranolol treatment groups with respect to fatal and nonfatal events simultaneously.

Biometry↗
PubMed1989

Long-term follow-up of weight status of subjects in a behavioral weight control program.

Few studies have examined the long-term effectiveness of behavioral weight control programs. Interpretation of the results from these studies has been limited due to small sample size, use of only one sex, and the number of evaluation parameters. A 2-year follow-up study was designed to assess the effectiveness of a behavioral weight control program on 123 obese male and 386 obese female subjects. Body weights were measured by dietitians at baseline and after an 8-week treatment program. Two-year follow-up weights were self-reported from a mailed questionnaire. The subjects' mean weight at baseline was 185.6 +/- 43.4 lb (no. = 509). Their mean percent over ideal body weight at baseline was 29.7%. Following an 8-week treatment period, mean weight was 176.4 +/- 41.3 lb (no. = 509), yielding a mean weight loss of 9.2 +/- 6.4 lb. Weight change after the 8-week treatment period ranged from a loss of 37 lb to a gain of 5 lb. The 2-year follow-up study showed that mean weight of the 498 subjects was 179.8 +/- 42.9 lb, yielding a mean weight loss of 5.8 +/- 15.5 lb. Weight change ranged from a loss of 71 lb to a gain of 47 lb. After 2 years, 325 subjects (65.3%) were still below their baseline weights, 182 subjects (36.6% of the entire study group) had maintained or enhanced the weight loss achieved during treatment, and 80 subjects (16.1%) weighed at least 10% less than their baseline weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients.

The risk of nosocomial pneumonia and atelectasis is high among critically ill immobilized patients. We hypothesized that continuous turning on the kinetic treatment table would reduce their incidence. Sixty-five critically ill patients, immobilized because of head injury or traction, were prospectively randomized for treatment in a conventional bed (n = 38) or the kinetic treatment table (n = 27). Patients were well matched for baseline demographic and pulmonary risk factors. Patients in the conventional bed group had a higher incidence of cigarette smoking. The combined incidence of significant atelectasis or pneumonia was higher (66%) in the conventional vs. kinetic treatment table (33%) groups (p less than .01). Atelectasis, pneumonia, adult respiratory distress syndrome, requirements for ventilator treatment, for PEEP, and for an FIO2 greater than 0.50 were not significantly different, but tended to be higher in the control group. Survival and the incidence of decubitus ulcers were similar.

Adult↗
PubMed1985

A computer program for an illness-death process with time-dependent covariates.

This paper presents a computer program for estimating transition probabilities between states in a stochastic model for an illness-death process which incorporates time-dependent covariates. Parameters are estimated by the method of maximum likelihood using the Newton-Raphson iterative procedure. The program provides the standard normal deviate statistics as well as the value of the maximum of the likelihood function which can be used on repeated applications to test hypotheses concerning coefficients associated with covariates. Although this program is demonstrated by using a model with two 'illness' states and two 'death' states, it is also suitable for analyzing data with models involving fewer states, such as the analysis of survival time with covariates assuming a proportional hazard model.

Computers↗
PubMed1985

Prevalence of bone demineralization in the United States.

A study of the distribution and prevalence of bone demineralization in the US population is reported. Based on the HANES I Survey data that incorporated bone density examination of V-2 by the Goldsmith and Vose techniques in a national sample of 6030 adults, it was observed that (1) age-adjusted bone density differences between sexes were consistently found when controlling for race (the prevalence of low bone density was greater among females than males) and (2) whites of both sexes had higher prevalence of low density than blacks in most age-sex categories.

Adult↗
PubMed1985

Patient characteristics and the demand for care in two freestanding emergency centers.

Because freestanding emergency centers (FECs) represent a new approach to the delivery of health care services, little is known about them and their patient populations. This article reports on a study of 551 systematically sampled users of two commonly owned FECs. It describes the patient population and develops an economic demand model to compare the patients' use of the FECs with their use of other sources of ambulatory care. The typical FEC patient is a 27-year-old white male with at least a high school education. Age, education, and affiliation with a regular source of care most influenced FEC use, whereas health status and affiliation with a regular source best predicted the use of other sources of ambulatory care.

Adult↗
PubMed1982

Effects of cost-sharing on users of a state's health service program.

This study analyzed some of the effects of the introduction of cost-sharing on users of the state's health service program. The study population had previously received services at no charge and consisted of people with provider-determined medical need, and included, but was not limited to people in financial need. The study sample was selected from 3 years of program service records (1977-1980). Sampling was random and stratified by key variables. Time-series analysis as well as pre/post-policy comparisons were employed. Analysis of changes in the distributions of service user characteristics and in services provided indicated that use of services was not affected adversely and that lower-income, medically needy people were not deterred from using services following the introduction of cost-sharing. Limitations to the study are reviewed, and implications of using cost-sharing in programs such as Medicaid are considered.

Adolescent↗