Biomedical subjects

C R Pope

Publications and source records attributed to C R Pope.

At least 19 recordsLinked to original sources

PubMed2001

Effects of hearing impairment on use of health services among the elderly.

OBJECTIVES: To assess the effects of hearing impairment on health-service use in an elderly population, controlling for factors associated with hearing difficulties known to affect utilization. METHODS: Diagnoses of hearing impairment, depression, and chronic illnesses were used in hierarchical regression procedures to predict the volume and probability of any service use among 1,436 randomly selected 65-year-old health maintenance organization members. RESULTS: Hearing impairment substantially increased the likelihood of making at least one visit to a health care provider (OR = 3.31, 95%; CI = 1.55-7.06). Among those who made such visits, however, hearing impairment did not lead to use of additional services despite expectations to the contrary. DISCUSSION: Further research should explore whether underutilization of services exists, and, if so, whether it stems from clinician or patient attitudes about the seriousness of hearing impairment, from a paucity of available treatment strategies, or from some combination of these and other factors.

Aged↗

PubMed1999

Gender, psychosocial factors and the use of medical services: a longitudinal analysis.

Many researchers have reported gender differences in levels of reported symptoms, morbidity, mortality and medical care utilization, but the debate continues about the underlying causes of these differences. Some have argued that women use more medical services because they are more sensitive to symptoms and interested in health, while others believe that women's greater service utilization arises from the fact that women experience more morbidities than do men. To date, these questions have not been studied prospectively. Using data from a household interview survey carried out in 1970-1971 and linked to 22 years of health services utilization records, we explored the effects of gender, self-reported health status, mental and physical symptom levels, health knowledge, illness behaviors and health concerns and interest on the long-term use of health services. After controlling for the aforementioned factors, female gender remained an independent predictor of higher utilization over the 22-year period studied, and psychosocial and health factors measured at the initial interview predicted service use even 19-22 years later. Controlling for factors identified as likely causes of gender-related differences in healthcare utilization, gender remains an important predictor of medical care use before and after removing sex-specific utilization. In addition, the consistent predictive ability of attitudinal and behavioral factors, combined with the finding that health knowledge did not predict utilization, indicates that efforts to help patients assess their service needs should target the attitudinal and behavioral factors that vary with gender, rather than health-related knowledge alone.

Adolescent↗

PubMed1997

Measuring patient satisfaction: a post-visit survey vs a general membership survey.

OBJECTIVE: To explore the implications of alternative survey approaches for measuring patient satisfaction among members of an HMO. DESIGN: Comparisons of findings on patient satisfaction from two different mail surveys conducted in 1994 of HMO members: a post-visit survey and a general membership survey. SETTING: Kaiser Permanente, Northwest Region (KPNW). PARTICIPANTS: Two random samples of KPNW members: 7680 members surveyed shortly after an HMO office visit; 2142 members from the general KPNW membership roster. MAIN OUTCOME MEASURES: Patient or member ratings of satisfaction with various aspects of services received from physicians, other clinicians, and non-clinician staff, as well as the overall level of satisfaction with the care and service provided by KPNW. RESULTS: Satisfaction is greater for all aspects of care when patients are reporting on specific visits than when members are generalizing about the care they receive from KPNW. But the pattern of satisfaction is highly consistent across the two surveys. Among the sociodemographic characteristics of patients and members, age is the best predictor of satisfaction. CONCLUSIONS: Both surveys have value for managing, monitoring, and evaluating HMOs. The member survey probably reflects something of the reputation of the HMO while the patient survey mirrors more its current functional status. The member survey is probably more useful for managing and monitoring the health care system (which in turn will create its future reputation), but the visit survey provides valuable information for those purchasers and individuals making choices among contemporary health care options.

Demography↗

PubMed1995

Gender differences in the relationship between social network support and mortality: a longitudinal study of an elderly cohort.

Despite well-recognized gender differences in patterns of social network support, few studies have explored whether the pathways by which social support affects mortality risk differ for men and women. In a 15-year follow-up study of elderly HMO members, we found that network size affected men's mortality risk indirectly, through their health status, while no such indirect effect was found for women. The data also suggested that network size had a direct protective effect on mortality risk for both men and women, with men gaining protection at a lower level of network size than women. These findings confirm the need for a gender-specific approach to further research on this subject, and suggest the need to measure variables that capture the different meaning and value of social network participation for men and women.

Aged↗

PubMed1993

The quality of social roles as predictors of morbidity and mortality.

This study uses a longitudinal design to examine the health effects of the quality of social roles among a cohort of women and men. The specific roles of interest are the spouse role, the parent role, and the worker role. The cumulative and interactive effects of role characteristics and role satisfactions and stresses are also examined. The study population was randomly selected from among members of a large HMO and were part of a household interview conducted in 1970-71. Medical records for the 2 years prior to the interview and for 15 years after the interview for the cohort members are linked with the survey data. The findings show that for women, particular qualities of the marital and work roles are predictive of subsequent morbidity and mortality. For married women, equality in decision making and companionship in marriage are protective against death. None of the marriage characteristics are predictive of health outcomes among men. Work support is protective against death, malignancy, and stroke among employed women, and work stress increases the risk of ischemic heart disease among employed men. None of the parental role characteristics were significant predictors of health outcomes for men or women. No interactions were found.

Adolescent↗

PubMed1993

Health effects of discontinuities in female employment and marital status.

The discontinuities that characterize women's work histories are also a factor in women's marital histories. Family obligations and childbearing contribute to women's unique employment histories, which include intermittent labor force participation and mobility between employers. While research has increasingly focussed on the effect of labor force participation on women's health, little attention has been given to the effect of the consistency or the stability of labor force participation on health. The purpose of this paper is to examine 15 years of employment histories and marital status changes among a cohort of women and to determine the cumulative effect of these histories on subsequent morbidity and self-reported health. The cohort of 556 women examined in this study were interviewed as part of a household interview survey completed in 1970-71, and resurveyed via a mail-out questionnaire, in 1985-86. Medical record data for the full 15 years of the study have been linked with the survey data. The findings suggest that work discontinuities and marital status discontinuities are unrelated to morbidity during the study period. However, two or more changes in marital status are related to poor self-reported health at follow-up.

Adolescent↗

PubMed1992

Social networks as predictors of ischemic heart disease, cancer, stroke and hypertension: incidence, survival and mortality.

Three social network measures were obtained from a randomly sampled cohort of 2603 HMO members in 1970-71. Mortality and first incidence of ischemic heart disease, cancer, stroke, and hypertension were assessed over the next 15 years. Outcome data were adjusted for age, sex, smoking, SES, and baseline health status. Persons with histories of a given morbidity at or prior to baseline were excluded from the analyses of that morbidity. Social network measures, particularly network scope (a measure of the number of different domains in which a person has social contacts), were powerful predictors of 15-year mortality hazard, but weak predictors of incident disease. Only network scope predicted IHD incidence, and none of the other morbidities was predicted by the social network measures. However, social network measures were strong predictors of both cause-specific and all-cause mortality among persons who had incident cases of IHD, cancer, and stroke. These data suggest that social networks may be more effective in supporting recovery after illness has occurred than in preventing the incidence of new disease.

Adult↗

PubMed1992

Women's employment, social support, and mortality.

This study uses a longitudinal design to examine the extent to which social support at work is protective against death and the degree to which it explains mortality differences between employed women and those not in paid employment. Women's total role responsibilities and community involvement, as an alternative source of social support and social integration, are also considered in the analysis. The outcome examined is mortality risk over a 15 year period. The 1140 women included in this study were randomly selected from among members of a large HMO and were part of a household interview conducted in 1970-71. Medical and vital records for 15 years post interview period are linked with the survey data. The results of this analysis suggest that social support at work is protective against mortality among employed women and contributes to mortality risk differences between employed and nonemployed women. While the relative hazard of death for nonemployed women who have some community involvement is greater than for employed women, the difference is not statistically significant. Community involvement may provide an alternative, albeit weaker, avenue for gaining some of the same advantages available in paid employment. Future research directions are discussed.

Adolescent↗

PubMed1991

Pathology of lymphoid organs with emphasis on immunosuppression.

A review of the literature is presented to include recent diagnostic and research histopathology accessions from poultry produced on the Delmarva peninsula region of the U.S.A. Emphasis is placed on immunosuppression (IS) and pathology of primary lymphoid organs of the chicken. The evolutionary relationship of the avian and mammalian lymphoid systems is based on a common reptilian past with 160 million years of evolutionary dichotomy. Four methods used to assess IS anatomically include: (1) recognition of marked reduction of lymphocytes in both primary and secondary lymphoid organs; (2) recognition of diseases commonly associated with IS; (3) recognition of known immunosuppressive diseases; (4) germinal center enumeration. An experimental method of qualifying and quantifying IS related to single or multiple insults is explored through the use of germinal center enumeration. The effect of stress and inanition on avian lymphocytes must be considered in histological evaluations as chickens are a steroid sensitive species.

Animals↗

PubMed1991

Chicken anemia agent.

Chicken anemia agent (CAA) is a small, spherical, non-enveloped virus containing a circular single-stranded DNA genome. CAA remains unclassified and probably should be classified in a new virus family. The chicken is the only recognized natural host for CAA. CAA was initially isolated in Japan and the associated disease chicken infectious anemia described in 1979. The virus has a world-wide distribution and is common in intensive poultry raising areas. Chicken infectious anemia is not a new disease but a newly recognized disease. CAA is now thought to play a key role in several multiple etiology disease syndromes; hemorrhagic syndrome; aplastic anemia, gangrenous dermatitis, hemorrhagic anemia syndrome, hemorrhagic aplastic anemia syndrome, anemia dermatitis and blue wing disease. The pathogenesis of chicken infectious anemia is described. Vertical transmission appears to be more important than horizontal spread. A yellow fatty bone marrow is the most characteristic lesion and thymic atrophy is the most consistent finding in CAA infection. Thymic and bone marrow intranuclear inclusion bodies occur with infection but are of limited value diagnostically and are very transient and rarely seen. Five different disease-producing scenarios that lead to clinical CAA infection in young chickens are presented.

Anemia↗

PubMed1991

Effect of domestic and occupational roles on morbidity and mortality.

This study examines the effect of labor force participation, occupational status and domestic roles on morbidity and mortality among women and men over a 15-year period. The main research questions address the long-term effects of multiple roles. Does the combination of domestic and work roles result in adverse health effects, or provide some health advantage? The study population was randomly selected from among members of a large HMO and were part of a household interview conducted in 1970-71. Medical records for the two years prior to the interview and for 15 years after the interview for the cohort members are linked with the survey data. The findings show that for women there is some longevity advantage in paid employment. Overall, the combination of employment and domestic roles apparently poses no health threat to women, and may provide some advantage. Multiple roles are unrelated to mortality and morbidity outcomes among men.

Adult↗

PubMed1990

Consistently high users of medical care among the elderly.

This study identified consistently high and low users of medical care services in a group of older HMO members continuously enrolled for six years. Consistently high users made up 26% of the sample, but accounted for more than 50% of total outpatient contacts and hospital admissions. Average ambulatory care costs were more than four times greater for the high users compared with the low users. Consistently high users were older than consistently low users, but did not differ significantly in other sociodemographic characteristics. Compared with the low users, the high users reported more total medical conditions and were more likely to indicate they had arthritis, high blood pressure, heart conditions, and other chronic problems. They perceived themselves to be in poorer health and reported higher levels of psychologic distress. The low users tended to be less satisfied, but the two user groups were not significantly different regarding use of services outside the HMO.

Aged↗

PubMed1990

Smoking and consistently high use of medical care among older HMO members.

Smoking behavior of consistently high and low users of medical care services were compared in two groups of older health maintenance organization (HMO) members continuously enrolled for five years and a subgroup who were continuously enrolled for 10 years. Smokers and former smokers, combined, were more likely than never-smokers to be consistently high users of ambulatory services (52 percent vs 34 percent in the five-year group, and 45 percent vs 30 percent in the 10-year group).

Aged↗

PubMed1989

Marital interaction and the health and well-being of spouses.

This study examines the extent to which the various dimensions of marital interaction are associated with differences in health status of spouses measured by the use of medical services and self-reported health and well-being. Dimensions of marital interaction and health and well-being measures with most covariation are identified and the relative effect of the quality of marital interaction on the health and well-being of husbands and wives are assessed. The study population includes 1004 married couples. Medical record and survey data for each respondent are linked for the analysis. The findings do support the hypothesis that the quality of marital interaction is related to the health of marital partners.

Adult↗

PubMed1987

Women's roles, interest in health and health behavior.

The purpose of this study is to assess the extent to which women's roles are associated with health interest and health concerns. In addition, the degree to which interest and concern with health are related to health behaviors is examined. The study population includes 1155 women between the ages of 18 and 64 from a random sample of members of a large health maintenance organization. The subjects were part of a large household interview survey. Medical record data covering seven years of outpatient services are linked with the survey data. The findings indicate that those roles which typically include responsibilities for caring for and protecting the health of family members are associated with a greater interest in health. For example, women who have the responsibility for younger and more dependent children have a greater interest in health than those women with older or no children in the household. Both health interest and health concerns are weakly related in the expected direction to both self-defined and medically-defined health behaviors.

Adolescent↗

PubMed1987

Employment characteristics and health status among men and women.

This study examines the characteristics of jobs held by women as compared to men during the 1970s and assesses associations between job characteristics and family status with health status by sex. Sex differences in perceptions about the meaning of work, commitment to the work role, and stresses and rewards are considered. Survey data on 1490 employed men and women, ages 18-64, drawn from a random sample of enrollees of a large health maintenance organization in 1970-71 are linked with medical record data covering seven years of outpatient and inpatient services. The findings suggest important differences in the characteristics of jobs held by men and women and in the relative importance of these job characteristics in relation to health. Men held jobs with higher quality intrinsic work characteristics and perceived their jobs to be less stressful and less physically and mentally tiring than did women. Social support and integration through work and occupational status were significantly related to health status for both sexes, however, family responsibilities interact with job characteristics to affect health status for women. Single motherhood, in combination with low social support and integration through work, was related to poor health among women.

Adolescent↗

PubMed1986

Age differences in the use of medical care in an HMO. An application of the behavioral model.

The goal of this study was to determine the factors that are related to utilization rates among older compared with younger enrollees in a health maintenance organization (HMO). Andersen's behavioral model was used as the conceptual framework for examining utilization rates. The approach was to determine the relative importance of predisposing, enabling, and medical need factors in explaining utilization rates among younger and older enrollees of an HMO. The study population included 2,603 adults enrolled in a large HMO. Three years of medical record data were linked with survey data for the analysis. The findings suggest that while the model as a whole explains about the same amount of variation in total doctor office visits for both age groups, the actual predictor variables are not the same. Predisposing factors are more important in explaining variation in utilization among the younger than the older enrollees. Enabling factors are more important in explaining variation in utilization among the older than the younger enrollees. Medical need factors explain about the same amount of variation in total doctor office visits for both age groups. Theoretic and practical implications are discussed.

Adult↗

PubMed1986

Utilization patterns and mortality of HMO enrollees.

Data from a 6-year follow-up period were used to analyze the mortality of adults who had been continuously enrolled in a prepaid group practice health maintenance organization (HMO) for the previous 7 years. Thirteen percent of the HMO members were classified as consistently high users of outpatient care. Even after adjustment for age, sex, and cigarette smoking, this high user group's mortality rates during the follow-up period were significantly greater than those of the other HMO enrollees. The HMO members as a whole had mortality rates marginally lower than the mortality of the general Oregon population. It can be concluded that HMO enrollees who consistently use high quantities of health care resources generally have significant medical problems in addition to psychosocial difficulties. Assuming that mortality reflects health, long-term HMO members as a group are not much healthier than ordinary Oregonians.

Adult↗