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Barbara A Elliott

Publications and source records attributed to Barbara A Elliott.

11 recordsLinked to original sources
PubMed2006

Family decision-making for nursing home residents with dementia: rural-urban differences.

CONTEXT: Research has demonstrated substantial differences between end-of-life care in rural and urban settings. As the end of life approaches, rural elders are less likely to be hospitalized, to be placed in an intensive care unit, or to have a feeding tube, compared to their urban counterparts. These differences cannot be fully explained by rural-urban differences in access to medical services. PURPOSE: To describe and understand rural-urban differences in attitudes toward death and in end-of-life decision making. METHODS: Eight focus groups were convened in rural and urban Minnesota nursing homes. The 38 focus group participants were family members of nursing home residents with severe cognitive impairment. FINDINGS: Most rural focus group participants voiced unqualified acceptance of death and placed few conditions on death, beyond their hope that it would be quick and peaceful. Urban respondents presented a wider range of attitudes toward death, from unambiguous acceptance of immediate death to evident discomfort with welcoming death under any circumstances. These rural-urban differences had practical implications. Rural respondents were much less likely to endorse interventions that would impede death, compared to their urban counterparts. CONCLUSIONS: Rural respondents tended to express confidence in natural forces; death was seen as neutral or beneficent. Resistance to the approach of death was more characteristic of urban respondents, some of whom insisted upon aggressive medical care in advanced dementia.

Aged↗
PubMed2006

Foregone mental health care and self-reported access barriers among adolescents.

Adolescents forego mental health care in spite of self-perceived needs for services; this presents a significant public health problem. Using data from the 2001 Adolescent Health Care Access Survey of 16-year-olds in Saint Louis County, Minnesota, we assessed barriers to mental health care among the 878 respondents who reported ever needing psychological or emotional counseling. Demographic characteristics were compared among those who had always, had sometimes, or had never received needed mental health care. Overall, 57% of the youths reported foregoing mental health care at least once. Girls and adolescents living with both parents were significantly more likely to have foregone care. Youths identified two common barriers to accessing care: "Thought or hoped the problem would go away" (50%) and "Didn't want parents to know" (36%). School-based interventions should be sensitive to mental health needs, especially among girls and teens living in two-parent families.

Adolescent↗
PubMed2004

Adolescents in mid-sized and rural communities: foregone care, perceived barriers, and risk factors.

PURPOSE: To investigate the perceived health care needs, foregone care, barriers to care, and associated risk factors in a non-urban population of adolescents. METHODS: Tenth-grade students attending school and 15-17-year-old youth not attending school in a Midwestern county were surveyed or interviewed. Eighty-six percent provided usable data (n = 1948, 134 of whom were not in school). Nine focus groups (71 participants; 28 were not in school) were conducted in follow-up. Quantitative analysis included descriptive statistics, factor analysis, and logistic regression. Qualitative analysis of taped focus groups identified themes and interpreted findings. RESULTS: Although 91% had seen a physician in the past 2 years, 44% reported foregoing needed care in the last year. Barriers for specific health needs were: cost of care and lack of insurance coverage for injuries and illnesses; lack of knowledge, distrust, and stigma for depression; embarrassment and transportation for birth control and sexually transmitted infections (STIs); and not knowing where or how to access care for drug and alcohol use. Youth most likely to have foregone care included those involved with dangerous activities under peer pressure (1.8, CI: 1.44-2.13), sexual intercourse (1.4, CI: 1.25-1.67), marijuana use (1.4, CI: 1.17-1.67), anticipating parenthood before age 20 years (1.2, CI: 1.04-1.33), male gender (2.5, CI: 1.89-2.86) and perceiving good health (1.7, CI: 1.45-1.85). CONCLUSIONS: Nearly half of this non-urban population (both in and out of school) reported foregoing needed care in the last year. The barriers to care include lack of information, lack of access, poor insurance coverage, parenting issues, and concern about confidentiality.

Adolescent↗
PubMed2004

Tacrolimus effect on rosacea.

Twenty-four patients with erythrotelangiectatic or papulopustular rosacea were treated with 0.1% tacrolimus topical ointment in a 12-week open-label trial. Erythema was significantly improved in both rosacea subtypes (P<.05). There was no decrease in the number of papulopustular lesions. Side effects were consistent with those on the tacrolimus topical ointment labeling.

Female↗
PubMed2004

Health-related quality of life (HRQoL) in patients with cancer and other concurrent illnesses.

This study analyzed the impact of eight common chronic medical conditions on cancer patients' health-related quality of life (HRQoL) as measured by the functional living index-cancer (FLIC). The FLIC was administered to a population of 405 people in 14 communities in the North Central US within 4-8 weeks of diagnosis with breast or colorectal cancer. At that time, patients also self-reported any other health conditions for which they had been receiving medical treatment. The impact of the selected chronic conditions on the FLIC scores was analyzed using Student's t-tests and linear multiple regression. In the bivariate analysis, patients with heart/circulation problems had lower FLIC total scores (p < 0.05), physical well-being subscale scores (p < 0.05), and nausea subscale scores (p < 0.01). Patients with diabetes had lower nausea subscale scores (p < 0.05). The social well-being subscale score was higher with the report of arthritis/joint problems (p = 0.001). In multivariate analysis adjusted for age, arthritis/joint problems were predictive of the social well-being (p < 0.01) and hardship due to cancer (p < 0.05) subscale scores; heart/circulation problems (p < 0.001) and diabetes were predictive of the nausea subscale scores. ECOG performance status was significant predictor for the FLIC total and all of the subscale scores. HRQoL as measured with the FLIC scores in patients with cancer is impacted by the presence of other concurrent health conditions; this finding has implications for HRQoL theory and application.

Aged↗
PubMed2004

Improving rural cancer patients' outcomes: a group-randomized trial.

CONTEXT: Significant barriers exist in the delivery of state-of-the-art cancer care to rural populations. Rural providers' knowledge and practices, their rural health care delivery systems, and linkages to cancer specialists are not optimal; therefore, rural cancer patient outcomes are less than achievable. PURPOSE: To test the effects of a strategy targeting rural providers and their practice environment on patient travel for care, satisfaction, economic barriers, and health-related quality of life. METHODS: A group-randomized trial was conducted with 18 rural communities in the north-central United States. Twelve of these communities were included and defined as the unit of analysis for the patient outcomes portion of the study. The intervention targeted rural providers and their practice environment. The subjects were patients with breast, colorectal, lung, and prostate cancers from the rural communities. The main outcomes were patients' travel to obtain health care, satisfaction with care, perceptions of economic barriers to care, and health-related quality of life. In total, 881 patients were included. RESULTS: Group randomization was balanced. Travel for health care was significantly reduced in the community group exposed to the intervention during months 13 to 24 following cancer diagnosis. The mean miles traveled per patient were 1,326 (SE = 306) for the experimental group and 2,186 (SE = 347) for the control group (P = 0.03). No significant differences in satisfaction with care, economic barriers to care, or health-related quality of life were found. CONCLUSIONS: The intervention significantly reduced cancer patient travel for health care, which suggests that access to care improved in the experimental group. The results of this study do not allow conclusion that there was no effect on other patient outcomes. The results supported the study's conceptual framework and many of its hypotheses.

Aged↗
PubMed2004

Rural-urban differences in cancer care: results from the Lake Superior Rural Cancer Care Project.

Past studies have shown significant differences between rural and urban cancer patients in many measures of cancer care. There is little recent information about this disparity, which generally has shown disadvantages in rural populations. This study reports the rural and urban differences in cancer care using data from the Lake Superior Rural Cancer Care Project. The study used a prospective, population-based design that included all incident cases of breast, colorectal, lung, and prostate cancers diagnosed in northeastern Minnesota, northwestern Wisconsin, and the western portion of Michigan's Upper Peninsula from 1992 to 1997. The outcome measures were 9 endpoints that represented state-of-the-art cancer care during the study. Rural cancer patients as compared with their urban counterparts were disadvantaged in proportion staged, stage at diagnosis, initial management procedures, post-treatment surveillance testing, and participation in cancer clinical trials. These findings are similar to previously published studies. Further research is needed to determine more clearly the barriers in rural cancer care and to find more effective strategies.

Adult↗
PubMed2003

Risk factors associated with camp accidents.

OBJECTIVE: Project goals included creating a database for medical incidents at a Minnesota canoe and backpacking camp and identifying those most at risk within this population using one summer's experience. METHODS: YMCA Camp Widjiwagan employed a total of 123 staff and served 725 campers in summer 2000. This resulted in 9418 camper trail days (CTD), 2497 staff trail days (STD), and 20150 participant days (PD), the evaluation units for this study. Data were collected using routine documentation: treatment logs (TL) for any event that required care, and incident reports (IR) for more serious injuries and near misses. Information was entered into an Access database and analyzed using descriptive statistics and analysis of variance. RESULTS: Canoe and backpack trips were compared using staff and camper days (CD). There were 582 TL and 59 IR, including 12 cases that resulted in evacuation to medical care (1/1000 PD). Canoe groups were no more at risk than backpack groups (P = .607), and campers reported more incidents than staff regardless of sex or location of injury (0.4/1000 CD compared with 0.1/1000 CD; P < .001). The camper groups most at risk were those beginning a series of advanced canoe trips (10 IR/1000 CTD; P < .001) and those on the longest, most advanced backpack trips (9 IR/1000 CTD; P < .001). CONCLUSION: Careful tracking of health incidents and near misses over time can reveal which campers and camper groups are at greatest risk for injuries and illnesses occurring during participation.

Accidents↗
PubMed2002

Dying of old age: an examination of death certificates of Minnesota centenarians.

OBJECTIVES: To compare how causes of death are recorded on the death certificates of centenarians with those who die in their 70s, 80s, and 90s. We also examined direct and indirect acknowledgment of age as a cause of death. DESIGN: Retrospective review of death certificates. SETTING: State of Minnesota. PARTICIPANTS: The death certificates of 26,415 individuals aged 70 and over who died in Minnesota in 1998 were examined for underlying causes of death. Of these, 449 were for individuals who were aged 100 and older at the time of their death. MEASUREMENTS: Causes of death. RESULTS: Diabetes mellitus, chronic obstructive pulmonary disease, cirrhosis, myocardial infarction, and most cancers decreased in frequency as reported causes of death with advancing age. Conversely, congestive heart failure, atherosclerosis, and neurological/mental and poorly defined conditions increased in frequency with age. CONCLUSIONS: Centenarians appear to "outlive" the risks for many of the conditions that are common causes of death for those who die in their 70s, 80s, and 90s, such as cancer and myocardial infarction. Conditions associated with aging, such as congestive heart failure and degenerative neurological conditions become more prominent as reported causes of death in the oldest individuals. The guidelines for the completion of death certificates should be modified to facilitate direct acknowledgment of age-related frailty as a contributing cause of death.

Aged↗
PubMedDate not supplied

Lake Superior Rural Cancer Care Project, Part III: provider practice.

PURPOSE: Effective methods that encourage rural primary-care physicians to adopt state-of-the-art cancer-management practices are needed. The purpose of this study was to evaluate educational and systems strategies to improve rural primary-care physicians' cancer practice behaviors. DESCRIPTION OF STUDY: The Lake Superior Rural Cancer Care Project was a group-randomized, controlled trial conducted with 18 rural communities in the North Central United States over 4 years. Although the unit of analysis was the community, the subjects were 104 primary-care physicians and 2089 rural patients with cancer. The intervention was educational and comprised systems strategies that targeted rural primary-care physicians and their healthcare delivery systems. The outcome measures reported here were physician practice behaviors regarding cancer diagnosis, staging, treatment, clinical trial participation, and post-treatment surveillance. RESULTS: The intervention significantly improved 5 of the 37 cancer practice end points. The overall result of the study did not support the majority of the study hypotheses. Because 16 practice end points were found to be at acceptable performance levels, the possibility of a measurable intervention effect was limited. CLINICAL IMPLICATIONS: Earlier, the authors reported the results of the intervention on providers' cancer management knowledge, which showed significant improvement. The present study findings demonstrated that improving provider knowledge does not necessarily improve practice performance. Changing practice behaviors requires much more effort. Furthermore, interventions found to be effective in other diseases, types of providers, or settings may not work on rural providers for cancer management.

Aged↗