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Biomedical subjects

Caroline Carney Doebbeling

Publications and source records attributed to Caroline Carney Doebbeling.

6 recordsLinked to original sources
PubMed2006

Borderline personality disorder and traits in veterans: psychiatric comorbidity, healthcare utilization, and quality of life along a continuum of severity.

OBJECTIVE: To examine the presence of borderline personality disorder (BPD) traits in Gulf War veterans, and to assess psychiatric comorbidity, health status, healthcare utilization, and quality of life (QOL) along a continuum of BPD trait severity. METHOD: BPD and traits were evaluated using the Schedule for Non-Adaptive and Adaptive Personality in 576 veterans who were either deployed to the Persian Gulf (1990-1991) or were on active duty though not deployed to the Gulf. Demographic and military characteristics, personal and family history, psychiatric comorbidity, and QOL were also assessed. RESULTS: One or more BPD traits were present in 247 subjects (43%), and BPD (>5 traits) was identified in 15 subjects (3%). The number of traits was significantly associated with age and level of education. Lifetime psychiatric comorbidity was significantly associated with the number of BPD traits present, and level of functioning, health status, healthcare utilization, social functioning, self-injurious tendencies, and military/behavioral problems. CONCLUSION: BPD and traits identified in Gulf War veterans were associated with significant psychiatric morbidity, poorer QOL, and increased utilization of healthcare resources. Early recognition and treatment of veterans with BPD symptoms may be warranted to minimize the burden on the healthcare system.

Adult↗
PubMed2006

The Indiana Chronic Disease Management Program.

The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation.

Chronic Disease↗
PubMed2006

Nonadherence to depression treatment guidelines among veterans with diabetes mellitus.

OBJECTIVE: To assess the adequacy of antidepressant dosage and duration among veterans with and without diabetes mellitus (DM), as well as provider-level and patient-level predictors of depression care quality, based on Veterans Health Administration (VHA) evidence-based clinical practice guidelines. STUDY DESIGN: Retrospective (1997-2005) cohort study of administrative, clinical, and pharmacy data from a midwestern VHA facility. METHODS: The sample included 2332 subjects (773 with DM) who had a new episode of depression, received antidepressant therapy, and had neither schizophrenia nor bipolar disorder. Antidepressant dosage and duration were evaluated in the acute and continuation phases. Dosage was adequate if the treatment dosage met the minimum therapeutic dosage specified in VHA guidelines. Treatment duration was adequate if the medication possession ratio was at least 80%. Multivariate logistic regression analysis was used to calculate odds ratios (ORs), adjusted for demographic, clinical, and healthcare utilization characteristics. RESULTS: Most subjects received an adequate dosage during the acute (88%) and continuation (58%) phases. Subjects with DM were 1.51-fold more likely to receive adequate dosage during the acute phase but were similarly likely (OR, 1.15) to receive adequate dosage during the continuation phase. Few subjects (<10%) received adequate treatment duration. Diabetes mellitus was not associated with less adequate duration during the acute phase (OR, 1.14). Few factors were identified as significant predictors of both antidepressant dosage and duration. CONCLUSIONS: Diabetes mellitus did not adversely affect depression care quality. Adequate antidepressant dosages were prescribed, but treatment duration fell short of guideline recommendations. Strategies to more effectively manage depression treatment are needed.

Adult↗
PubMedDate not supplied

Specific phobia of illness in the community.

This study evaluated the prevalence, risk factors and morbidity associated with specific phobia of illness. Subjects were from a random, community telephone survey of 500 persons age 40 to 65 who lived in Johnson County, Iowa, USA. Forty-three subjects reported that illness fears substantially bothered them personally or affected their medical care, work, or social life. Twenty-one of these subjects could be contacted and agreed to a semistructured interview designed to diagnose specific phobia of illness and screen for other common psychiatric disorders. Based on the interview, 10 subjects met the criteria for specific phobia of illness, 10 for major depressive disorder, 5 for obsessive-compulsive disorder, 5 for generalized anxiety disorder, 4 for hypochondriasis, 4 for panic disorder and 4 for specific phobia other than illness. Assuming subjects not interviewed were similar to subjects who were, the community prevalence of specific phobia of illness is 4.0%. Among the 10 subjects with specific phobia of illness, 7 had prior negative experiences with illness and 8 had comorbid Axis I disorders. The phobia interfered with medical care as well as social functioning for many subjects. These results suggest a prevalence rate and risk factors that will be useful for additional studies of illness phobia.

Adult↗
PubMedDate not supplied

Posttraumatic stress disorder and self-reported physical health status among U.S. Military personnel serving during the Gulf War period: a population-based study.

The objective of this study was to investigate the relation between posttraumatic stress disorder (PTSD) and perceived physical health. Participants included 3,682 Gulf War veterans and control subjects of the same era who completed a telephone survey about their health status. PTSD was assessed using the PTSD Checklist-Military Version. Veterans screening positive for PTSD reported significantly more physical health symptoms and medical conditions than did veterans without PTSD. They were also more likely to rate their health status as fair or poor and to report lower levels of health-related quality of life. The results of this study are consistent with studies of other combat veterans and provide further support for an association between PTSD and adverse physical health outcomes. Stressful or traumatic life events, such as those encountered during a rapid military deployment and conflict, are associated with a variety of adverse health effects. These health effects may manifest themselves in both psychological and physical outcomes. Health care providers must be attentive to recognize and evaluate both of these dimensions.

Adult↗