Biomedical subjects

Frederic C Blow

Publications and source records attributed to Frederic C Blow.

53 records · Page 3Linked to original sources

PubMed2003

Rates and correlates of alcohol use among pregnant women in obstetrics clinics.

BACKGROUND: The purpose of this study was to demonstrate feasibility of screening and to identify rates and correlates of alcohol use in a large, demographically representative sample of pregnant women across a number of obstetrics clinics, extending previous studies of single or high-risk settings. Identification of harmful alcohol use during pregnancy and of associated factors is critical for the design and implementation of secondary prevention strategies. METHODS: A total of 1131 pregnant women age 18 and older were screened in the waiting areas of eight obstetrics clinics in Southeastern Michigan using a brief (10 min) screening questionnaire. This survey consisted of direct and indirect (TWEAK) measures of alcohol use, as well items assessing demographic characteristics, use of tobacco, and whether participants' physicians discussed alcohol use behavior with them. Women ranged in age from 18 to 46, with a mean age of 28.7 (SD = 5.3). The racial/ethnic distribution of our sample suitably reflects the various racial segments of the Michigan population. RESULTS: We found that 15.1% of the total sample (n = 169) reported any alcohol use during pregnancy, with the majority of those women reporting relatively low levels of alcohol use. One hundred and forty-seven women (13%) scored above the cutoff on the TWEAK (i.e., above a score of 2). Based on multivariate analyses, higher risk alcohol use (defined as binge drinking or greater than one standard drink per week) during pregnancy was predicted by smoking and earlier stage of pregnancy. Caucasian race, smoking, psychological distress, and greater number of drinks during pregnancy predicted scores above a cutoff of 2 on the TWEAK. CONCLUSION: This study demonstrated that screening in busy obstetrics clinics is feasible and acceptable to women and that it may be optimal to use both indirect and direct measures of alcohol use. In addition, brief assessments should be conducted throughout pregnancy and may be targeted or intensified for smokers and for women earlier in their pregnancy.

Adolescent↗

PubMed2003

Alcohol effects on motor vehicle crash injury.

CONTEXT: Although alcohol is frequently present in injured patients, whether it exacerbates injury and whether tolerance to alcohol changes such a relationship is less clear. Most clinical studies do not consider other important predictors of injury, making interpretation of their findings problematic. OBJECTIVE: To examine alcohol's role in injuries, taking into account other important factors, and to examine the effect of tolerance, if any. DESIGN: Prospective cohort study. SETTING: University hospital and community hospital emergency departments and morgue. PATIENTS: 1362 Motor Vehicle Crash patients age >/=18, treated and released, admitted, and deceased. MAIN OUTCOME MEASURES: Excess injury measured by Injury Severity Scale (ISS) 90, Weighted Revised Trauma Score (WRTS), and G-Score. RESULTS: Using regression analysis, the best predictors of injury severity were vehicle crush (TAD), safety belt use, and their interaction, and age. Alcohol use further predicted injury. Using the final regression model, the effect of alcohol was to increase ISS90, on average, by about 30% (from a predicted ISS90 of 5.1 to 6.8, all else being equal). The adjusted odds ratio for serious injury (ISS90>15), was 1.59 for a patient with a positive blood alcohol concentration (alc+) compared to a alc- patient. This potentiating effect is seen even for patients with low levels of alcohol (<22 mmol/liter; <0.100 BAC) but is not linear with increasing alcohol level. Tolerance to alcohol did not affect the potentiation of injury by alcohol. CONCLUSION: When other relevant variables are considered, alcohol increases injury, but the effects of alcohol level and alcohol tolerance are less clear. These findings have important implications for injury prevention, treatment, and research.

Accidents, Traffic↗

PubMed2003

Rates of at-risk drinking among patients presenting to the emergency department with occupational and nonoccupational injury.

OBJECTIVES: To compare the characteristics and rates of at-risk drinking among patients presenting to the emergency department (ED) with occupational and nonoccupational injury. METHODS: Cross-sectional survey of injured patients presenting to a university hospital ED. Injured patients were prospectively identified, and consenting patients completed a survey including questions regarding quantity/frequency of alcohol use, TWEAK, CAGE, and work-relatedness of injury. Major trauma and motor-vehicle collisions were excluded. Demographic and injury information was obtained from the medical record. Patients with a TWEAK score > or =3, CAGE score > or =2, or who exceeded NIAAA quantity/frequency guidelines were defined as at-risk drinkers. Analysis utilized the Student t-test for continuous variables, and frequency and chi-square analysis for categorical variables. RESULTS: Among 3,476 enrolled patients, 766 (22%) had work injuries and 2,710 (78%) had nonwork injuries. Patients with work injuries were as likely as patients with nonwork injuries to be at-risk drinkers; 35% of patients with an occupational injury and 36% of those with a nonoccupational injury were at-risk drinkers (odds ratio = 0.96). CONCLUSIONS: Patients presenting to the ED with an occupational injury have rates of at-risk drinking similar to other injury patients, and may be an important group in which to target brief alcohol interventions.

Accidents, Occupational↗

PubMed2003

Racial disparity in the use of atypical antipsychotic medications among veterans.

OBJECTIVE: This study assessed the current state of antipsychotic prescription practices regarding race among veterans receiving care through the Department of Veterans Affairs. METHOD: The authors examined pharmacy records over a 12-month period for all veterans with schizophrenia and antipsychotic prescriptions in fiscal year 1999. They used logistic regression analysis to assess the effect of race on the use of various atypical antipsychotic agents. Analytic models controlled for age, sex, comorbid substance use, bipolar disorder, and other psychosis. RESULTS: The sample of 69,787 veterans with schizophrenia was 61.3% white, 30.1% African American, and 8.5% Hispanic. Among them, 39% had prescriptions for conventional antipsychotics, 37% for atypical antipsychotics, and 23% for both atypical and conventional antipsychotics. Use of any atypical agent during the year was less likely for Hispanic veterans (55%) than for two other groups (both 61%). When examining specific medications in a multivariate model, the authors found that African American and Hispanic veterans were much less likely to receive clozapine than were white veterans. CONCLUSIONS: Overall use of atypical antipsychotics was slightly less common for African American and Hispanic veterans with schizophrenia than for white patients. However, use of clozapine, the first choice for refractory illness and possibly uniquely effective for patients with comorbid substance abuse, did vary greatly by race. This may reflect concern over serious side effects, such as loss of white blood cells and fluctuations of serum glucose levels, or patient preference.

Black or African American↗

PubMed2003

Recorded delirium in a national sample of elderly inpatients: potential implications for recognition.

This retrospective study examined delirium and related confusional diagnoses recorded in patients older than age 60 discharged from Veterans Affairs (VA) acute inpatient units nationally in 1996 (n = 267,947). Only 4% of patients had delirium or related confusional diagnoses recorded. Patients with recorded delirium had significantly higher mortality than did those without recorded delirium or those with other confusional diagnoses ("organic psychoses"); the most common delirium types were dementia with delirium and alcohol intoxication/withdrawal delirium. Organic psychoses patients had the longest lengths of stay and significantly more admissions to nonmedical/surgical units and discharges to nursing homes; almost 20% were African American. The recorded rate of delirium in the VA health system likely underestimates true prevalence and possibly reflects nonrecognition of delirium in many older veterans. Certain motoric and etiologic types of delirium may be more commonly diagnosed and recorded. Future research should prospectively examine recognition of motoric and etiologic delirium subtypes and racial differences in delirium diagnoses.

Aged↗

PubMed2003

Effect of strengths model versus assertive community treatment model on participant outcomes and utilization: two-year follow-up.

Community-based treatments for persons with serious mental illnesses have consistently proven to be effective. While most studies evaluate assertive community treatment (ACT) programs collectively, distinct models offer different approaches to improving participant outcomes. This study specifically examined the Strengths model versus more traditional ACT programs. Multivariate analyses tested changes in utilization, symptomatology, and clinical outcomes. Both ACT and Strengths reduced inpatient days while increasing outpatient care. Though all patients improved clinically, Strengths demonstrated a significantly greater advantage with symptomatology reduced by half. Findings support both treatment models, but additional clinical gains may be obtained from the Strengths approach.

Community Health Centers↗

PubMed2002

Correlates of received and expressed violence persistence following substance abuse treatment.

This study examined different types of violence (i.e. 'expressed' towards others and 'received' from others) across different relationship types (i.e. 'partners' and 'non-partners') among men and women in substance abuse treatment, and during a 2-year follow-up period. For received violence, participants were divided into three groups: no-violence before or after treatment, violence before treatment only, and violence both before and after treatment. Similarly, participants also were divided into three groups based on expressed violence: no-violence before or after treatment, violence before treatment only, and violence both before and after treatment. Both expressed and received violence (either before or after treatment) was associated with younger age. Unique demographic markers of received violence included being female, reporting less income and greater unemployment. For both received and expressed violence, several problem severity indicators (e.g. drug consequences, psychological distress) and psychosocial relapse risk indicators (e.g. resource needs, substance-using leisure activities) differentiated those who reported violence (either before or after treatment) and those who did not report violence. In addition, received violence was related to greater exposure to substances whereas expressed violence was related to greater cocaine use and craving. Continued received and expressed violence post-treatment was related to substance use during the follow-up, recruitment from inpatient treatment, and baseline psychological distress (expressed violence only). The results are consistent with contemporary models of violence specifying the impact of substance use, social/contextual and individual difference factors, and highlight risk factors that could be targeted during treatment to potentially reduce post-treatment substance use and violence.

Adult↗

PubMed2002

Violence among individuals in substance abuse treatment: the role of alcohol and cocaine consumption.

This study examined factors associated with expressed violence in the 90 days prior to substance abuse (SA) treatment among 125 men and 125 women recently enrolled in treatment. Approximately 85% of the sample reported a significant conflict situation, and over 32% reported an incident of physical violence. Both general alcohol and cocaine use patterns (on days not involving significant interpersonal conflict), as well as alcohol and cocaine use on the day of the violent incident, were associated with violence severity. Regression analyses revealed that race, education, age, and both general drinking and cocaine use patterns were associated with violence severity for the most severe violent incident reported. Similarly, regression analyses focusing on alcohol and cocaine use on the day of the most severe incident revealed that higher drinking levels, younger age, minority status, and the interaction of alcohol and cocaine use were associated with violence severity. The results provide important information regarding factors associated with expression of violence among men and women in SA treatment, and have implications regarding the assessment of violence risk factors. Further, the findings suggest that screening and intervention approaches for violence-related problems should be routine in SA treatment, and appear to be especially indicated for patients reporting alcohol consumption, and co-occurring alcohol and cocaine consumption.

Adolescent↗

PubMed2002

The mental health care context and patient characteristics: implications for provider job satisfaction.

This research examines job satisfaction among 282 staff providing mental health care to 574 patients with serious mental illness. The mental health staff worked in 18 Department of Veterans Affairs inpatient and outpatient mental health care units at 12 Veterans Affairs Medical Centers located across the contiguous 48 states. The purpose was to identify (1) aspects of the health care context that were associated with provider job satisfaction and (2) administrative and organizational procedures/interventions that might sustain or improve provider job satisfaction. The association of provider job satisfaction with patients' functional status and symptom severity was tested in multilevel statistical models that accounted for provider and unit characteristics. Provider job satisfaction was found to be greater on smaller units and units with higher patient functioning and lower illness severity. Implications of these results are discussed.

Activities of Daily Living↗

PubMed2002

Health care costs of seriously mentally ill patients enrolled in enhanced treatment.

Patients with psychosis (N = 866) were recruited into enhanced or standard Veterans Administration (VA) treatment. Enhanced programs, previously shown to be more effective, were less costly than VA standard care. Adjusted costs fell from $32,000-$55,000 (for the 1st year) to $20,000-$36,000 (for the 4th year). Costs were associated positively with schizophrenia, living in the Northeast region of the United States, and poorer baseline functioning.

Adult↗

PubMed2002

Prevalence of domestic violence and associated factors among women on a trauma service.

BACKGROUND: Despite the increasing recognition of the problem of domestic violence (DV), it has not been studied in surgical populations. METHODS: Eligible patients underwent screening for a recent history of DV and alcohol abuse (AA). Other demographic, health, and injury-related data were also collected. RESULTS: Of 127 subjects entered into the study, 18% screened positive for DV and 21% screened positive for AA. Of those screening positive for DV, 65% screened positive for AA compared with 12% of those screening negative for DV (p < 0.001.) Screening for DV was recommended by a vast majority of subjects, with only 6% of subjects responding that it was not appropriate. CONCLUSION: Both DV and AA have a high prevalence among female trauma patients admitted to trauma centers. Nearly all subjects recommended screening for DV. Screening for DV should be incorporated into the routine care of female trauma patients.

Adult↗

PubMed2002

Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission.

BACKGROUND: Health care organizations may be able to use pharmacy data to identify patients with schizophrenia and poor antipsychotic adherence. OBJECTIVE: To determine whether a pharmacy-based measure of outpatient adherence, the medication possession ratio (MPR), is associated with adverse outcomes among patients with schizophrenia, as evidenced by increased psychiatric admission. RESEARCH DESIGN: Cohort study linking pharmacy and utilization data for veterans with schizophrenia. MPRs were calculated by dividing the number of days' supply of antipsychotic medication the veteran had received by the number of days' supply they needed to receive to take their antipsychotic continuously. Using multivariate regression, the relationship between MPRs and psychiatric admission was examined. SUBJECTS: Sixty-seven thousand seventy-nine veterans who received a diagnosis of schizophrenia and had outpatient antipsychotic medication fills between October 1, 1998 and September 30, 1999. RESULTS: Patients with MPRs close to 1.0 had the lowest rates of admission. As patients secured progressively smaller proportions of required antipsychotic medication (and had smaller MPRs), rates of admission climbed. Among patients on one antipsychotic (n = 49,003), patients with poor adherence (MPRs < 0.8) were 2.4 times as likely to be admitted as patients with good adherence (MPRs from 0.8-1.1). 23% of poorly adherent patients but only 10% of adherent patients were admitted. Once admitted, poorly adherent patients had more hospital days. Patients who received excess medication also had higher admission rates. CONCLUSIONS: Many health care systems may be able to use pharmacy data to identify poorly adherent patients with schizophrenia. These patients are at-risk for admission and may benefit from intervention.

Adult↗

PubMed2002

Aging and schizophrenia: current health services research and recommendations.

Little is known about the functioning and health care use of older patients with schizophrenia. Understanding the use patterns of older patients with schizophrenia, a rapidly growing population, will inform health care planners and policy makers who make decisions about resource allocation and program development. The results are presented from a large-scale study to examine the relationship between age and the use of health services and level of functioning in patients with schizophrenia. Older adults with schizophrenia experienced fewer psychiatric hospitalizations but, once hospitalized, had longer inpatient stays. In contrast, older patients had fewer outpatient psychiatric visits and more medical outpatient visits and medical hospitalizations than younger individuals. The relatively lower use of outpatient psychiatric care by older patients with schizophrenia suggests that there may be barriers to accessing these services. When older patients are hospitalized for psychiatric reasons, their stays are longer. The implications of these findings are discussed.

Adolescent↗

PubMed2002

Use and misuse of alcohol among older women.

Older women may be especially at risk for alcohol problems because they are more likely than men to outlive their spouses and face other losses that may lead to loneliness and depression. Physiologically, women are also at greater risk for alcohol-related health problems as they age. Because of these risks, alcohol use recommendations for older women generally are lower than those set for both older men and younger women. Screening and brief intervention may be especially useful in minimizing alcohol problems in older women. Although brief intervention research with this population is limited, the findings are promising.

Aged↗

PubMedDate not supplied

Rates of maternal depression in pediatric emergency department and relationship to child service utilization.

This cross-sectional study aimed to (a) identify rates and correlates of untreated elevated depression in mothers of young children in a pediatric emergency department (ED) setting and (b) examine the association of depression and other key variables to child healthcare use. Mothers (n=176) bringing their child (<age 7) to the pediatric ED completed a screening survey assessing depression, demographic information, and select child healthcare information. Up to 31% of mothers screened evidenced elevated depression, and most were not being treated (78%). Elevated depression was related to both missed pediatric outpatient visits and greater use of pediatric ED services. Thus, the pediatric ED setting may provide the opportunity to identify mothers whose depressive symptoms have been obstacles to seeking routine primary care for their children. Detection of maternal depression in pediatric settings using a screening tool accompanied by appropriate follow through may be a reasonable strategy to improve health outcomes for both the mother and her child.

Adult↗

PubMedDate not supplied

Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices.

OBJECTIVE: The purpose of this study was to provide information on rates of depression treatment among pregnant women at risk for depression and among those with clinician-diagnosed current major depressive disorder (MDD) and to examine predictors of depression treatment. METHOD: Women seeking prenatal care completed a screening survey (including the Center for Epidemiological Studies-Depression Scale) in several hospital-based obstetrics clinics. Women identified as high risk for depression completed diagnostic interviews (n=276) during pregnancy, consisting of the Structured Clinical Interview for DSM-IV, measures of depression symptom severity (Beck Depression Inventory-II), health functioning (SF-36) and current and past psychiatric treatment. RESULTS: Among women with a current MDD diagnosis, most of whom were experiencing a recurrence, 33% were currently receiving any depression treatment. The presence of current MDD was not found to be related to use of treatment. Prior history of MDD, history of psychiatric treatment and depression severity were significant predictors of depression treatment during pregnancy. CONCLUSIONS: Most women with current MDD were found to be either untreated or suboptimally treated, and prenatal MDD was not predictive of treatment. These findings point to the need for effective detection, targeted follow-up assessment and treatment linkage interventions to be studied in medical settings that encounter perinatal women.

Adult↗

PubMedDate not supplied

Alcohol and/or other drug use among adult non-occupant motor vehicle crash victims.

AIMS: To identify the frequency of current or lifetime history of alcohol and/or other drug (AOD) use among the full range (admitted and discharged) of injured bicyclists and pedestrians involved in motor vehicle crashes. METHODS: In a prospective study of non-occupant motor vehicle crash (NOMVC) victims >or=18 years over a 29-month period, blood was obtained for alcohol and drug testing. Current alcohol abuse/alcohol dependence (AA/AD) or drug abuse/drug dependence (DA/DD) was based on the Diagnostic Interview Survey. RESULTS: In all, there were 108 NOMVC victims. Eleven per cent were alcohol (+), 7% drug (+), and 3% both. Sixteen per cent were AA/AD (+), 2.7% DA/DD (+), and 1.4% both. CONCLUSIONS: A substantial portion of patients with NOMVC injuries tested AOD (+) and had a current or lifetime substance abuse (AA/AD; DA/DD) diagnosis.

Accidents, Traffic↗