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Biomedical subjects

David G Kleinbaum

Publications and source records attributed to David G Kleinbaum.

8 recordsLinked to original sources
PubMed2006

Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya district, Kenya.

Evaluation of a community health worker (CHW) programme in Siaya district, Kenya, showed CHWs commonly made errors in managing childhood illness. We assessed the effect of multiple interventions on CHW healthcare practices. A sample of 192 ill-child consultations performed by 114 CHWs in a hospital outpatient department between February and March 2001 were analysed. The mean percentage of assessment, classification and treatment procedures performed correctly for each child was 79.8% (range 13.3-100%). Of the 187 children who required at least one treatment or referral to a health facility, only 38.8% were prescribed all treatments (including referral) recommended by the guidelines. Multivariate analyses found no evidence that the intervention-related factors studied (refresher training, supervision, involvement of community women in the CHW selection process, adequacy of medicine supplies, and use of a guideline flipchart during consultations) were significantly associated with overall or treatment-specific guideline adherence. A multivariate linear regression analysis revealed that several non-intervention-related factors, such as patient characteristics, were significantly associated with overall guideline adherence. Given that our study was cross-sectional and our measurement of exposure to several interventions was based on CHW recall, the estimated effects of the interventions should be interpreted with caution. Despite these limitations, however, our results raise questions about the effectiveness, in the setting of Siaya district, of several interventions commonly used to improve the quality of care given by CHWs.

Child Health Services↗
PubMed2005

Asthma and panic in young adults: a 20-year prospective community study.

RATIONALE: Psychologic factors are increasingly recognized to influence the onset and course of asthma. Previous cross-sectional community-based studies have provided evidence for a relatively specific association between asthma and panic. OBJECTIVES: To examine concurrent and longitudinal associations between asthma and panic in young adults. MEASUREMENTS AND MAIN RESULTS: Prospective community-based cohort study of young adults (n = 591) followed between ages 19 and 40. Information was derived from six subsequent semistructured diagnostic interviews conducted by professionals. Cross-sectionally (over the whole study period), asthma was more strongly associated with panic disorder (odds ratio [OR] = 4.0; 95% confidence interval [CI], 1.7, 9.3) than with any panic, which included panic disorder and panic attacks (OR = 2.1; 95% CI, 1.1, 4.5). Longitudinally, after adjusting for potentially confounding variables, active asthma predicted subsequent panic disorder (OR = 4.5; 95% CI, 1.1, 20.1), and the presence of panic disorder predicted subsequent asthma activity (OR = 6.3; 95% CI, 2.8, 14.0). Asthma predicted any panic (OR = 2.7; 95% CI, 1.1, 7.1), whereas any panic did not predict subsequent asthma activity. Associations were stronger in smokers than in nonsmokers, and stronger in women than in men. Smoking, early-childhood anxiety, and a family history of allergy were important confounders of the asthma-panic association. CONCLUSIONS: This is the first long-term follow-up study on asthma and panic. It showed dose-response-type relationships between panic and asthma, and bidirectional longitudinal associations between the two conditions. It provided evidence for familial factors and smoking as possible shared etiologic explanations.

Adult↗
PubMed2005

Job strain and risk of musculoskeletal symptoms among a prospective cohort of occupational computer users.

OBJECTIVES: Most previous studies of the association between psychosocial stress and musculoskeletal illness among computer users have been cross-sectional and have yielded inconsistent results. The association between a measure of psychosocial stress, "job strain", and incident neck-shoulder and arm-hand musculoskeletal symptoms was investigated among recently hired computer users. METHODS: The participants worked for one of several large employers and were followed prospectively for 6 months. The "job demands" and "decision latitude" subscales of the Job Content Questionnaire were used to estimate the job-strain quadrants and a ratio measure of job strain which was subsequently categorized. Incident musculoskeletal symptoms were obtained with weekly diaries. Proportional hazards models were used to estimate associations between job strain and incident musculoskeletal symptoms. RESULTS: Those in the high-strain quadrant were at increased risk of neck-shoulder symptoms [hazard ratio (HR) 1.65, 95% confidence interval (95% CI) 0.91-2.99] when compared with those in the low-strain quadrant. Those in the highest strain-ratio category were also at increased risk of neck-shoulder symptoms when compared with those in the lowest strain-ratio category (HR 1.52, 95% CI 0.88-2.62). Modification by previous years of computer use was observed, with an elevated risk observed for those in the highest job-strain ratio category who also had low previous computer use (HR 3.16, 95% CI 1.25-8.00). There did not appear to be an association between either measure of job strain and incident arm-hand symptoms. CONCLUSIONS: In this cohort, workers who reported high job strain were more likely to develop neck-shoulder symptoms.

Adolescent↗
PubMed2004

Condom effectiveness for reducing transmission of gonorrhea and chlamydia: the importance of assessing partner infection status.

This analysis examined the importance of differential exposure to infected partners in epidemiologic studies of latex condom effectiveness for prevention of sexually transmitted infections. Cross-sectional, enrollment visit data were analyzed from Project RESPECT, a trial of counseling interventions conducted at five publicly funded US sexually transmitted disease clinics between 1993 and 1997. The association between consistent condom use in the previous 3 months and prevalent gonorrhea and chlamydia (Gc/Ct) was compared between participants known to have infected partners and participants whose partner infection status was unknown. Among 429 participants with known Gc/Ct exposure, consistent condom use was associated with a significant reduction in prevalent gonorrhea and chlamydia (30% vs. 43%; adjusted prevalence odds ratio = 0.42, 95% confidence interval: 0.18, 0.99). Among 4,314 participants with unknown Gc/Ct exposure, consistent condom use was associated with a lower reduction in prevalent gonorrhea and chlamydia (24% vs. 25%; adjusted prevalence odds ratio = 0.82, 95% confidence interval: 0.66, 1.01). The number of unprotected sex acts was significantly associated with infection when exposure was known (p for trend < 0.01) but not when exposure was unknown (p for trend = 0.73). Restricting analyses to participants with known exposure to infected partners provides a feasible and efficient mechanism for reducing confounding from differential exposure to infected partners in condom effectiveness studies.

Adult↗
PubMed2003

Readmissions and the quality of care in patients hospitalized with heart failure.

OBJECTIVES: Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD. METHODS AND RESULTS: Data were abstracted from the medical records of 2943 randomly selected patients hospitalized for heart failure in 50 hospitals. The outcome of interest was the number of readmissions occurring up to 21 months after discharge. Six-hundred and eleven patients were eligible for analysis. Compared with patients discharged at a recommended ACEI dose, patients not prescribed an ACEI at discharge had an adjusted rate ratio of readmission (RR) of 1.74 [95% confidence interval (CI) 1.22-2.48], while patients prescribed an ACEI at less than a recommended dose had an RR of 1.24 (95% CI 0.91-1.69) (P = 0.005 for the trend). CONCLUSION: Our results show that ACEI use at discharge in patients with LVSD is associated with decreased rate of readmission. These findings suggest that compliance with the ACEI prescribing recommendations listed in clinical practice guidelines for patients with heart failure due to LVSD confers benefit.

Aged↗
PubMed2002

Epidemiologic methods: the "art" in the state of the art.

When performing empirical research in public health and medicine, the investigator is typically faced with a variety of methodologic issues to resolve at the design and analysis stages of the research. The investigator must specify the research question, conceptualize and operationalize the variables to be measured, consider several research designs to choose from, determine appropriate measures of disease frequency and effect, address potential biases, devise the analytic strategies to follow, choose the appropriate software procedures or packages to use, carry out the analysis, and interpret the results. Most of these issues concern principles and methods of epidemiology and biostatistics, which, taken together, embody the methodologic "science" that underlies such research. Nevertheless, in bringing all these issues together to achieve a coherent and valid research conclusion, there is an "art" that is required that goes beyond the quantitative mechanics involved in carrying out the research. The art part is not easily quantifiable and typically is more skillfully performed as one becomes a more experienced investigator. Nevertheless, such methodologic art can be addressed methodologically through guidelines that identify the options or strategies available and suggest how appropriate choices can be made from such options or strategies. Selection bias and mathematical modeling are especially addressed.

Epidemiologic Studies↗