PubMed Health⌕ Search

Biomedical subjects

E H Wagner

Publications and source records attributed to E H Wagner.

At least 19 recordsLinked to original sources
PubMed1992

Tubal sterilization and risk of subsequent hospital admission for menstrual disorders.

OBJECTIVE: Our objective was to investigate tubal sterilization and subsequent hospitalization for menstrual disorders. STUDY DESIGN: Automated discharge data were used in a population-based cohort study of 7253 women aged 20 to 49 years with tubal sterilization (1968 through 1983) at Group Health Cooperative of Puget Sound. Comparisons were with an age-matched cohort of 25,448 nonsterilized women and a nonmatched cohort of 5283 spouses of men with vasectomies. RESULTS: In the sterilization cohort, 282 had hospitalization for menstrual disorders (curettage, n = 191; hysterectomy, n = 66; nonsurgical, n = 25). Risk of hospitalization for menstrual disorders was 2.4 times greater after tubal sterilization (95% confidence interval 2.0 to 2.9). This risk was 6.1 times greater for sterilized women aged 20 to 24 years (95% confidence interval 0.72 to 3.2). Compared with the risk for nonsterilized women whose spouses had a vasectomy, the risk was 1.6 times greater (95% confidence interval 1.3 to 2.1). Hospitalization for menstrual disorders was not more common after unipolar sterilization than after other methods, as might have been expected if the menstrual disorder was related to impaired uteroovarian circulation. CONCLUSIONS: Tubal sterilization is associated with a greater risk of hospitalization for menstrual disorders. A biologic association is not supported by these results.

Cohort Studies↗
PubMed1992

Is magnitude of co-payment effect related to income? Using census data for health services research.

This study: (1) describes and evaluates a method for estimating household income using home addresses in conjunction with census data, and (2) uses this method in a study designed to determine if the introduction of copayments caused primary care office visit rates to decrease more for lower income enrollees than for higher income enrollees of a large health maintenance organization (HMO). Each step in the process of linking income estimates for small census units (block groups) to specific home addresses is described and the validity and precision of these estimates is assessed through comparisons of estimated income with self-reported income for residents of the Puget Sound area of Washington state. Although subject to considerable measurement error, this approach provided valid income estimates. This method was then used to estimate the incomes of over 20,000 households of HMO enrollees in a controlled study of the relationship between copayment effect on visit rates and enrollee income. Copayments were found to have a similar effect on higher and lower income enrollees.

Adult↗
PubMed1992

A chronic disease score from automated pharmacy data.

Using population-based automated pharmacy data, patterns of use of selected prescription medications during a 1 year time period identified by a consensus judgement process were used to construct a measure of chronic disease status (Chronic Disease Score). This score was evaluated in terms of its stability over time and its association with other health status measures. In a pilot test sample of high utilizers of ambulatory health care well known to their physicians (n = 219), Chronic Disease Score (CDS) was correlated with physician ratings of physical disease severity (r = 0.57). In a second random sample of patients (n = 722), its correlation with physician-rated disease severity was 0.46. In a total population analysis (n = 122,911), it was found to predict hospitalization and mortality in the following year after controlling for age, gender and health care visits. In a population sample (n = 790), CDS showed high year to year stability (r = 0.74). Based on health survey data, CDS showed a moderate association with self rated health status and self reported disability. Unlike self-rated health status and health care utilization, CDS was not associated with depression or anxiety. We conclude that scoring automated pharmacy data can provide a stable measure of chronic disease status that, after controlling for health care utilization, is associated with physician-rated disease severity, patient-rated health status, and predicts subsequent mortality and hospitalization rates. Specific methods of scoring automated pharmacy data to measure global chronic disease status may require adaptation to local prescribing practices. Scoring might be improved by empirical estimation of weighting factors to optimize prediction of mortality and other health status measures.

Adolescent↗
PubMed1992

Effects of physical activity on health status in older adults. II. Intervention studies.

This review has focused on a specific part of the relationship of exercise to health. The overall evidence supporting the health benefits of exercise is substantial and has been critically reviewed recently (18, 94). Thus, the United States Preventive Services Task Force recommends that all adults exercise regularly (94). The conclusions summarized below regarding older adults do not affect this basic recommendation. There is solid evidence that exercise can improve measures of fitness in older adults, particularly strength and aerobic capacity. These exercise effects occur in chronically ill adults, as well as in healthy adults. Because physical fitness is a determinant of functional status, it is logical to ask whether exercise can prevent or improve impairments in functional status in older adults. The evidence that exercise improves functional status is promising, but inconclusive. Problems with existing studies include a lack of randomized controlled trials, a lack of evidence that effects of exercise can be sustained over long periods of time, inadequate statistical power, and failure to target physically unfit individuals. Existing studies suggest that exercise may produce improvements in gait and balance. Arthritis patients may experience long-term functional status benefits from exercise, including improved mobility and decreased pain symptoms. Nonrandomized trials suggest exercise promotes bone mineral density and thereby decreases fracture risk. Recent studies have generally concluded that short-term exercise does not improve cognitive function. Yet the limited statistical power of these studies does not preclude what may be a modest, but functionally meaningful, effect of exercise on cognition. Future research, beyond correcting methodologic deficiencies in existing studies, should systematically study how functional status effects of exercise vary with the type, intensity, and duration of exercise. It should address issues in recruiting functionally impaired older adults into exercise studies, issues in promoting long-term adherence to exercise, and whether the currently low rate of exercise-related injuries in supervised classes can be sustained in more cost-effective interventions that require less supervision.

Activities of Daily Living↗
PubMed1992

Preventing frail health.

Frailty is a state of reduced physiologic reserve associated with increased susceptibility to disability. Reduced physiologic capacity in neurologic control, mechanical performance, and energy metabolism are the major components of frailty. Although disease is an important cause of frailty, there is sufficient epidemiologic and experimental evidence to conclude that frailty is also due to the additive effects of low-grade physiologic loss resulting from a sedentary lifestyle and more rapid loss due to acute insults (illness, injuries, major life events) that result in periods of limited activity and bedrest. The pathogenesis of frailty involves a complicated interaction of factors that block recovery from rapid physiologic loss. To some extent, frailty is preventable. Approaches to prevention include (1) the periodic monitoring of key physiologic indicators of frailty, (2) the prevention of physiologic loss and acute and subacute episodes of physiologic loss, (3) the prediction of episodes of physiologic loss and the reduction of frailty prior to the loss, and (4) the removal of obstacles to recovery once physiologic loss has occurred.

Aged↗
PubMed1991

Sampling elderly in the community: a comparison of commercial telemarketing lists and random digit dialing techniques for assessing health behaviors and health status.

A study of health behaviors in four communities in the western United States in 1988 provided the opportunity to compare two methods of sampling elderly respondents for a telephone interview. The Polk telemarketing lists were used to identify 1,407 respondents aged 65 years and older in four communities, where 253 respondents in the same age group were also identified by the method of random digit dialing. Individuals identified from the Polk lists received a letter prior to the initial telephone contact. The overall response rate was 49.3% for random digit dialing and 57.3% for the Polk lists. On the average, the identification of one elderly respondent using the Polk lists required about 20-25% as much interviewer time per subject identified as was required by the random digit dialing method. The elderly identified by the Polk lists were significantly older than those identified by random digit dialing, and the proportions of the Polk sample who were married, white, or had an income of greater than $10,000 were slightly higher than those of the random digit dialing sample. Among 40 variables measuring various health behaviors, indicators of health status, and participation in health-related programs and classes, only three differed significantly between the two samples. The authors conclude that sampling from commercial telemarketing lists was an efficient method of identifying elderly respondents and that in these four communities, the estimates of health behaviors and health status were comparable with those obtained by random digit dialing techniques.

Aged↗
PubMed1991

An approach to several problems in using large databases for population-based case-control studies of the therapeutic efficacy and safety of anti-hypertensive medicines.

In this paper we discuss approaches to two distinct problems in using large computerized databases to conduct population-based case-control studies. The first topic, concerning case ascertainment, is a methodologic problem, and the second, concerning confounding by indication, is an analytic problem. The first involves attempting to ascertain all incident cases of coronary disease among enrollees of Group Health Cooperative of Puget Sound (GHC), a large health-maintenance organization. Methodologic studies reported here have helped us improve the efficiency of using the large computerized databases for case ascertainment at GHC. The second problem involves the issue of confounding by drug indication. Drugs such as beta-blockers have multiple indications, including the treatment of both high blood pressure and angina. These two indications may make it difficult in an observational study to determine whether beta-blockers may prevent coronary disease in patients with high blood pressure. We discuss here our current thinking about the best analytic approach to this problem.

Adrenergic beta-Antagonists↗
PubMed1991

The evaluation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grant Program: design.

The Kaiser Family Foundation's Community Health Promotion Grant Program (CHPGP) provides funding and technical assistance in support of community-based efforts to prevent major health problems. The first phase of the program was implemented in 11 communities in the western United States. This paper describes the evaluation design of the CHPGP in the West, the methods of data collection, and the baseline comparability of intervention and control communities. Major features of the evaluation design include: (1) the randomization of qualified communities making application into funded and unfunded comparison groups; (2) a second set of matched control communities for some intervention sites; (3) data gathering through repeated surveys of community residents (probability samples of adults and adolescents) and institutions (health-related organizations and randomly sampled grocery stores and restaurants); and (4) the use of secondary data to monitor health events. Selected baseline data show that intervention and control communities differ in racial/ethnic composition, but relevant health behaviors and ratings of community activation for health promotion appear comparable.

Adolescent↗
PubMed1991

Data analysis and sample size issues in evaluations of community-based health promotion and disease prevention programs: a mixed-model analysis of variance approach.

The growing interest in community-based approaches to health promotion and disease prevention (HP/DP) has been accompanied by a growing need to evaluate the effectiveness of such programs. Special issues that arise in these evaluation studies include (1) entire communities are assigned to intervention and control groups, (2) only a small number of communities can usually be studied, (3) the time course of changes in behavior and other outcomes is often of interest, and (4) surveys to measure such changes over time can be conducted with either repeated cross-sectional samples or with longitudinal samples. This paper shows how these issues can be addressed under a mixed-model analysis of variance approach. This approach serves to unify several ideas in the literature on evaluation of community studies, including use of time-series regression and the question of whether the individual or the community should be the unit of analysis. We also describe how the method can be used to estimate sample size requirements, statistical power, or minimum detectable program effect.

Analysis of Variance↗
PubMed1991

Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program.

Personalized feedback and a financial incentive, developed from an intrinsic/extrinsic motivation framework, were evaluated as adjuncts to self-help materials for smoking cessation. Ss (N = 1,217) were randomized to 4 treatment groups and were followed up at 3 and 12 months. Consistent with hypotheses derived from the motivation framework, the financial incentive increased the use of self-help materials, did not increase cessation rates among program users, and was associated with higher relapse rates among those who did manage to quit. The personalized feedback increased both smoking cessation and use of the materials 3 months after distribution of the materials. Continuous abstinence (abstinence at 3 and 12 months) in the group that received the personalized feedback alone was twice the rate of the other groups.

Adult↗
PubMed1991

Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling.

Smokers requesting self-help materials for smoking cessation (N = 2,021) were randomized to receive (a) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (b) the same self-quitting guide with a support guide for the quitter's family and friends, (c) self-quitting and support guides along with four brief counselor calls, or (d) a control guide providing motivational and quit tips and referral to locally available guides and programs. Subjects were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control subjects achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-month quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates.

Behavior Therapy↗
PubMed1991

Factors associated with participation in a senior health promotion program.

The health status and life-style characteristics of participants in a senior health promotion program were compared with those of nonparticipants from the same HMO enrollee population. Nonparticipation was associated with lower income, less education, and lower involvement in community organizations. Although nonparticipants smoked more and evaluated their health less favorably than did participants, other risky behaviors and health status indicators differed little between the groups.

Aged↗
PubMed1991

Correlates of postural hypotension in a community sample of elderly blacks and whites.

Postural hypotension is thought to be prevalent among the elderly, but few community-based studies of this condition have been conducted. In addition, little is known about postural hypotension in blacks despite well documented racial differences in hypertension and stroke. Data on 659 elderly (greater than or equal to 60 years of age) participants in a survey of two rural, biracial townships were analyzed to describe the frequency and correlates of postural hypotension. Twelve percent of the 659 adults experienced a drop of 10 mmHg or greater in systolic blood pressure on going from sitting to standing (supine measures were not available). This degree of postural hypotension was twice as common for whites as for blacks (14.5% vs 7.5%, P = 0.01). Postural hypotension was associated with elevated sitting blood pressure and showed positive but statistically non-significant relationships with anti-hypertensive medications and leanness. The association between race and postural hypotension persisted after adjusting for these and other risk factors (OR = 2.2, 95% CI:1.2,4.0).

Aged↗
PubMed1991

Tracking progress toward national health objectives in the elderly: what do restricted activity days signify?

Restricted activity days is the measure by which the 1990 health objectives for prevention of functional disability in older adults will be evaluated. Yet its significance in older populations is poorly understood. We evaluated its use as an outcome measure for a randomized trial designed to impact upon physical function in elderly HMO enrollees. As predicted, restricted activity days was more correlated with physical disability measures than with other health status measures. Distributional properties and rates of missing data were shortcomings.

Activities of Daily Living↗
PubMed1990

Tubal sterilization and the long-term risk of hysterectomy.

To assess the effect of tubal sterilization on the risk of hysterectomy, we studied 7414 women aged 20 to 49 years who had had a tubal sterilization at a health maintenance organization between January 1, 1968, and December 31, 1983. Compared with a population-based cohort of nonsterilized women, women sterilized while 20 to 29 years old were 3.4 times more likely to have had a subsequent hysterectomy (95% confidence interval, 2.4 to 4.7). Adjustment for the effects of potential confounders with a subset of 276 women did not appreciably alter this association. For multivariate comparisons with 5323 wives of vasectomized men, there was no significant elevation in the risk of hysterectomy following sterilization among women sterilized while 20 to 29 years old. Tubal sterilization was not associated with hysterectomy for married women who underwent tubal sterilization at age 30 or older. These results do not support a biological basis for the relationship between tubal sterilization and hysterectomy.

Adult↗