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Biomedical subjects

E Berkanovic

Publications and source records attributed to E Berkanovic.

At least 19 recordsLinked to original sources
PubMed1996

The relationship between socioeconomic status and recently diagnosed rheumatoid arthritis.

OBJECTIVE: To examine the role of socioeconomic status (SES) in physical functioning, pain, and depressive symptoms among newly diagnosed rheumatoid arthritis (RA) patients with severe disease. METHODS: Data are from 118 non-Hispanic patients of European origin at baseline of a longitudinal study of early, severe RA. Outcome measures with the Health Assessment Questionnaire (HAQ) functional disability index, the HAQ visual analog pain scale, and the Center for Epidemiologic Studies Depression Scale. Hierarchical regression analyses were conducted using a health status block (disease activity and comorbidities), a non-SES related social structure block (age, sex and Lubben Social Network Scale), and indicators of SES (income and education). RESULTS: Non-SES related social structure and SES were important independent determinants of functional disability and depressive symptoms, but both they and the health status variables were unrelated to pain. Further, neither income nor education was related to disease activity or comorbidities. CONCLUSION: It cannot be argued from these data that poorer health status explains the link between SES and disability and depressive symptoms. Although, at baseline, the psychosocial effects of early RA are more severe for those with SES, the disease does not appear to be more severe. It may be that the biologic impact of status differentials will become clearer as the effects of treatment and the course of the disease unfold over time.

Activities of Daily Living↗
PubMed1995

Physician visits by rheumatoid arthritis patients: a prospective analysis.

OBJECTIVE: To examine prospectively, using the behavioral model of health service utilization, patient-initiated physician visits, physician-requested visits, and visits for disease flares by 270 patients with rheumatoid arthritis (RA). METHODS: Four waves of telephone interviews were conducted over 2 years. Hierarchical regression analyses were used to assess the relative contributions to variance explained by blocks of variables indicating need for care and predisposing and enabling factors. RESULTS: Predisposing and enabling factors accounted for 50-67% of the explained variance in the 3 types of visits, while need accounted only for 33-50%. CONCLUSIONS: Studies seeking to identify factors other than need for care that facilitate or inhibit physician visits among RA patients are essential to analyzing the costs of care.

Acute Disease↗
PubMed1995

Concordant and discrepant views of patients' physical functioning.

OBJECTIVE: Although considerable research has been done on patient-physician interaction, few studies have examined discrepancies between patients and physicians in their assessments of the patient's physical functioning. One recent study reports such discrepancies between rheumatologists and 41% of their rheumatoid arthritis patients. This article reports data replicating that study and examining the relationships between such discrepancies and a number of other variables. METHODS: This is a longitudinal study of 158 patients with rheumatoid arthritis who were interviewed 4 times over a 2-year period and who reported their levels of physical functioning on the Arthritis Impact Measurement Scales. At the time of the fourth interview, the rheumatologists rated each patient's physical functioning on the revised criteria published by the American College of Rheumatology. RESULTS: Rheumatologists' assessments of their patients' physical functioning were discrepant with the patient's assessment for 35% of these patients. Twenty-seven patients were rated as worse than they rated themselves and 28 were rated as better. There were no differences between the concordant and the two discrepant groups in demographic or health status characteristics.

Activities of Daily Living↗
PubMed1993

The stress process in rheumatoid arthritis.

OBJECTIVE: To evaluate the Stress Process Model proposed by Pearlin and colleagues by examining the role of personal and social resources in mediating the relationship between the rheumatoid arthritis (RA) related stressors of functional disability, pain, and flares, and the outcome of depressive symptoms. METHODS: Data are from 285 patients who participated in a study of the natural history of RA, comorbidity and depression. Measures include the Center for Epidemiologic Studies-Depression (CES-D) scale, the Arthritis Impact Measurement Scale Functioning and Pain scales, the Lubben Social Network scale, and items indicating sociodemographic status, health status and personal resources. A series of hierarchical regression analyses with multiplicative interaction terms were conducted. RESULTS: Substantial consistency between the Stress Process Model and relationships observed in the data was demonstrated. CONCLUSION: Although no claim is made to having demonstrated that the observed relationships are causal, the fact that the data are consistent with the model invites a prospective analysis in which the ordering of the variables over time can be established unambiguously. Because of the implications of the Stress Process Model for the design of psychosocial interventions, such a test is especially important.

Adult↗
PubMed1991

Care seeking for musculoskeletal and respiratory episodes in a Medicare population.

Responses to episodes of musculoskeletal illness, musculoskeletal injury, and respiratory illness are examined separately. Data are from a 1-year longitudinal study of the illness experiences of 885 Medicare recipients. Unlike studies examining aggregate use of medical services, this study examines both episodes for which medical care was sought and episodes for which no medical care was sought. Both factors associated with the decision to seek medical care for each type of episode and the illness response patterns associated with whether medical care is sought are analyzed. The three types of episode have different characteristics and profiles of illness response. Perceived seriousness and duration of the episode are the best predictors of physician visits for all episode types. However, the relative effect of predisposing and need variables on the decision to seek medical care is greatest for musculoskeletal illness episodes. These data also bear on the relationship between self-care, informal care, and the use of formal medical care. Use of nonprescription medications is shown to substitute for medical care in a significant number of illness episodes. Lay consultation and restricted activity are often linked with physician visits; however, they cannot be assumed to precede care seeking. The analytic strategy of examining responses to specific types of episodes suggests that both characteristics of the person and characteristics of the illness affect how people respond to illnesses and that the relative importance of each type of characteristic is specific to each illness type. Implications of these findings for health education are discussed.

Aged↗
PubMed1990

Rheumatoid arthritis and comorbidity.

Data collected from 288 patients with rheumatoid arthritis (RA) indicated that 54% of respondents also reported other chronic conditions, and that 20% rated at least one of these other conditions as severe. Both the frequency and severity of these comorbidities affected scores on measures of depressive symptoms, social connectedness and on the Arthritis Impact Measurement Scales. These findings suggest that the absence of controls for comorbidity may bias measures of functional status among patients with RA.

Adult↗
PubMed1989

Psychological distress and the decision to seek medical care among a Medicare population.

Although there have been a number of studies linking psychological distress to the demand for medical care, few studies have examined this relationship among the aged. The issue is important, however, partly because it has been suggested that distress might cause some individuals to seek unneeded medical care. The financial impact of the aged seeking unneeded care on Medicare is, thus, a matter of public concern. This study presents results from a prospective investigation of the impact of psychological distress on the seeking of medical care among a sample of 1,009 Medicare recipients. Following a baseline interview that assessed, among other things, psychological distress, the respondents were reinterviewed six times over the course of one year. Respondents reporting episodes of illness at each interview were asked a series of questions regarding how they responded to the episode. The present analysis examines the impact of a series of variables, including psychological distress, on the decision to seek care for each of the episodes about which the respondent was queried. It also examines the impact of psychological distress on the total number of physician visits requested by the respondent over the study year. Finally, since a panel of 22 geriatricians rated whether or not the episodes reported by the respondents should have resulted in a physician visit, the impact of psychological distress on the medical necessity of the visits made by these respondents is analyzed. The analyses found no relationship between psychological distress and any of these outcomes. Thus, it does not appear that, among these respondents, psychological distress has any impact either on the frequency of physician visits or the medical necessity of visits made for episodes of illness.

Aged↗
PubMed1988

Psychological distress and the decision to seek medical care.

There have been a number of studies linking psychological distress with the demand for medical care. The importance of these studies lies in the finding that the distressed use of services more frequently than the non-distressed. To the extent that many of the visits of the distressed are for medically trivial reasons, which is the most frequent interpretation of this finding, there may be an argument in favor of cost containment strategies aimed at diverting the distressed away from seeking 'unneeded' medical attention. There are, however, a number of difficulties both with most of the studies that have been done to date and with how the finding of more frequent visits among the distressed is interpreted. The present study examines the reporting of illnesses, disability per illness reported, patient initiated physician visits per illness reported and physicians' judgement regarding the medical necessity of the visits reported for a representative sample of the Los Angeles metropolitan area. The 950 respondents in this analysis were divided into groups by three levels of psychological distress. Illnesses reported both prospectively and retrospectively to the measurement of psychological distress are analyzed. The data indicate that, although the distressed report more illnesses, they are no more likely either to report disability per illness or to initiate medical care per illness. Further, the distressed are no more likely either to initiate unnecessary physician visits or to avoid initiating necessary visits. The implications of these findings for the impact of cost containment strategies on equity in the delivery of medical services are discussed.

Adult↗
PubMed1985

Mexican-American, black-American and white-American differences in reporting illnesses, disability and physician visits for illnesses.

This paper presents data on the reporting of illnesses, disability due to illnesses and the decision to seek medical attention for illnesses among a representative sample of Mexican-Americans, Black-Americans and White-Americans in Los Angeles. Few differences were observed among these groups with respect to the reporting of illnesses, disability due to illnesses or in the frequency with which illnesses were brought to medical attention. Hierarchical stepwise multiple regressions were run for each of these variables within each of these subgroups. Some differences were found among these groups in the variables that predicted illness reporting, disability and the use of physician services for illnesses. These differences indicate that ethnicity affects health behavior through its interaction with other variables. Speculations are offered regarding the meaning and historical sources of the differences observed.

Black or African American↗
PubMed1984

Mass media based health behavior change: televised smoking cessation program.

This report describes the 1-year follow-up assessment of a television-based smoking cessation program shown as a part of local news in the Los Angeles area. The post-broadcast experiences of two distinct samples was considered: individuals who wrote in for additional materials (Registrants) and a cross section sample (CS) contacted by a random survey method. Results showed significant between-group differences in demographic characteristics and smoking behavior outcomes. Compared to the CS sample, registrants displayed more quitting attempts during the 1-year follow-up period (70.7% and 49.8%) and more abstinence (6.2% and 2.4%, respectively). When compared to results from a comparison survey, both registrant and CS subjects made significantly more quitting attempts in the three week period following broadcast. In terms of abstinence, only registrant results significantly differed from the comparison survey (6.2% vs. 2.9%). Few correlates of outcome were identified. Overall, analyses suggest that the televised quit smoking program encouraged viewers to initiate more numerous attempts to quit smoking than otherwise would have been expected. In terms of maintaining nonsmoking over time, however, only registrants experienced significantly greater success than might have been observed in the general population. Implications for research and policy recommendations of televised health promotion programs are proposed.

Adult↗
PubMed1983

Smoking and television: review of extant literature.

Smoking cessation programming is appearing with increasing frequency over the medium of television. This report reviews those television quit smoking programs that have been described in the literature. Programming features (e.g., program timing, content, utilization, and cost-effectiveness) are examined in addition to the assessment of the impact on viewers' smoking behavior. Overall, published reports have described a host of intriguing ways the TV medium can be used to encourage widespread smoking cessation. To date, however, there has been relatively less innovation and thoroughness in terms of assessing program impact. Implications are discussed for the burgeoning realm of health promotion programming via the electronic media.

Australia↗
PubMed1982

Seeking care for cancer relevant symptoms.

Although it has been estimated that a fourth of the individuals who die of cancer each year might have survived if their cancer had been detected earlier, little is known about the characteristics of individuals who seek care for cancer relevant symptoms. This study reports data from a 1 yr panel study of 1210 individuals in metropolitan Los Angeles who were asked to report any symptoms they had experienced during each six week interval between interviews. These symptoms were classified according to the National Ambulatory Symptom Classification and then rated for their cancer relevance by three university-based oncologists working independently. There were 35 symptoms rated as cancer relevant. Inter-rated reliability was 0.73. Analysis is directed towards the distribution of these symptoms in the population, the distribution of physician visits for these symptoms and the structural and social psychological factors that predict the decision to seek medical care for these symptoms. The implications of the results for health education are twofold. First, because these symptoms occur homogeneously across subgroups, education programs targeted to specific subpopulations are likely to be inefficient. Second, even if successful education campaigns could be undertaken, it is unlikely that all physicians would agree that all of the increased demand for services would be appropriate.

Cross-Sectional Studies↗
PubMed1982

Social networks, beliefs, and the decision to seek medical care: an analysis of congruent and incongruent patterns.

This article focuses on the impact of congruent and incongruent patterns of symptom specific beliefs and social network advice on the decision to seek medical care for symptoms. Data from 769 individuals who reported symptoms in the Los Angeles Health Survey are used to examine this issue. Further, the role of more general health orientations and social network influences in the decision to seek care is examined under these congruent and incongruent conditions. It is concluded that the more general factors, which have little effect on the aggregate, may play a role in decision making when beliefs and advice are incongruent. Further, it is concluded that reports of beliefs and advice about specific symptoms that have been given after the decision has been made to seek care may be valid and not the result of retrospective reconstruction.

Attitude to Health↗
PubMed1981

Structural and social psychological factors in the decision to seek medical care for symptoms.

Panel data are presented from the Los Angeles Health Survey, in which 1 year of symptom experience is analyzed. Of the 1,210 individuals originally in the panel, 769 reported at least one symptom in reinterviews conducted every 6 weeks during the study year. The dependent variable in the analysis is whether or not the individual decided to seek medical attention for his symptoms. Hierarchical multiple regression was used to organize the independent variables into five groups: 1) need; 2) social structure; 3) organization of care; 4) general social network patterns and health orientations; and 5) social network influences and personal beliefs specific to the symptoms. Of the 57 per cent of the variance explained by the entire set of independent variables, need factors accounted for 12 per cent and network influences and personal beliefs specific to the symptom accounted for 42 per cent. In spite of the amount of variance explained in this analysis, the allocation of the explained variance among the predictor variables raises some disturbing questions regarding our ability to understand the decision to use health services.

California↗
PubMed1980

The effect of inadequate language translation on Hispanics' responses to health surveys.

Data bearing on the effect of language of the interview on Hispanics' responses to a health survey in which no back-translation was undertaken reveal both lower reliabilities and lower bivariate correlations among Hispanics interviewed in Spanish than among Hispanics interviewed in English. An independent back-translation aimed at creating an English version of the questionnaire that was linguistically equivalent to the Spanish version indicated several instances in which the Spanish version was unidiomatic. Differences between the Spanish and English version in the idiomatic quality of the interview items, while not affecting meaning, appear to have affected the seriousness with which the interview situation was perceived. These perceptions, in turn, appear to have led to the response discrepancies observed.

Attitude to Health↗
PubMed1979

Awareness, opinion and behavioral intention of urban women regarding mammography.

A representative sample of women living in metropolitan Los Angeles were asked what they heard and what they believed about mammography and whether they would obtain a mammogram if their doctor advised it. Forty percent of these women said they had not heard of mammography even after the procedure was described. Few of those who had heard of mammography had negative feelings about it. Further, 93 percent of the overall sample said they would obtain a mammogram if their physician recommended it.

Attitude to Health↗