Biomedical subjects

J Earp

Publications and source records attributed to J Earp.

7 recordsLinked to original sources

PubMed1992

Parents' behavior and attitudes toward screening children for high serum cholesterol levels.

The American Academy of Pediatrics, concerned that pediatric cholesterol screening may lead to mislabeling and overly restrictive diets, stresses laboratory confirmation and nutritional follow-up for children with elevated cholesterol levels. Parents' behavior and attitudes toward screening children for high cholesterol were studied. During an 8-week period in summer of 1989 all children 2 through 15 years of age seen for well-child examinations at a community pediatric group practice were offered cholesterol screening by finger-stick method. Most parents were well-educated and white. Of 439 children screened, 134 (31%) had cholesterol levels above the recommended cutoff point of 175 mg/dL (75th percentile). Only 63 children returned for confirmatory lipid panels; parents of children who did not return were interviewed. Reasons for noncompliance included "not sure test machine was accurate" (67%); "child too traumatized by finger stick" (47%); and "will try low-cholesterol diet before recheck" (40%). A third of these parents believed that confirmation of an elevated cholesterol level "would make the child worry too much." Only 29% of these parents talked with a dietician. In this middle-class, well-educated population, a large proportion of children had elevated screening cholesterol values, but few complied with American Academy of Pediatrics guidelines. As a result, many children may be mislabeled as hypercholesterolemic and may not benefit from screening.

Adolescent↗

PubMed1990

Written case simulations: do they predict physicians' behavior?

Written case simulations are often used to investigate physicians' decision making and clinical competence. Their use rests on the assumption that physicians' responses to written simulations closely agree with their responses to actual clinical encounters, yet this assumption of criterion validity has received little attention. To determine the ability of written case simulations to predict actual clinical behavior, we applied methodologic criteria to published articles that used written simulations. Only 11 (15%) of 74 articles included an assessment of the criterion validity of their written case simulations. Only 2 of those 11 studies were designed and executed in such a way that criterion validity could be fully interpreted. No clear consensus emerged from an examination on the 11 studies on how well responses to written case simulations perform as proxy measures of actual behavior. More work is needed before assuming that written case simulations measure actual behavior.

Clinical Competence↗

PubMed1988

Attributing responsibility in cases of father-daughter sexual abuse.

This study examined the effects of social workers' attributions of responsibility on their strategies in cases of father-daughter sexual abuse. Social workers read three vignettes illustrating such abuse. Following each vignette, they rated the degree of responsibility they attributed to the father, mother, and daughter described in each vignette, and the likelihood that they would recommend the incarceration of the father or the placement of the daughter into foster care. The more responsibility workers attributed to the father and daughter and the less they attributed to the mother, the more likely they were to recommend the father's incarceration. The more responsibility they attributed to the father, the more likely they were to recommend that the daughter be placed into foster care.

Attitude of Health Personnel↗

PubMed1987

Social Security disability determinations. Knowledge and attitudes of consultative physicians.

Social Security spends $135 million yearly, contracting with physicians to provide consultative examinations for disability applicants. However, little is known about who these physicians are or how they view the determination of impairment. We surveyed a random sample of 153 physicians from North Carolina who performed consultative examinations for the North Carolina Disability Determinations Agency in 1983 (the consultative group), and a randomly selected group of 165 physicians of similar medical specialties (the comparison group). Response rates were 75% for the consultative group and 66% for the comparison group. Most consultative physicians (63%) performed fewer than 6 examinations per month. Characteristics of the consultative physicians were similar to the comparison group. Both groups were skeptical of the claims of disability applicants; 48% of the consultative and 55% of the comparison group thought that a majority of applicants could be employed. Of the consultative physicians, 53% indicated that they had learned little about disability programs from any source. Most consultative physicians (58%) judged it "almost impossible" to determine impairment on the basis of a single office examination. However, consultative physicians were less likely than the comparison group to view Social Security as difficult to work with (25% vs. 54%; P less than 0.01). Agencies that determine disability ask physicians to perform a task for which they feel ill prepared and have little special knowledge.

Attitude of Health Personnel↗

PubMed1986

Mitral valve prolapse. Disease or illness?

Mitral valve prolapse (MVP) is a common condition that is believed to be responsible for numerous symptoms and potentially serious complications. To determine whether symptoms and functional impairment are related to MVP itself, we studied 274 outpatients referred to an echocardiography laboratory for suspicion of MVP. The age, sex, and symptoms at the time of echocardiography were similar among patients with and without evidence of MVP. After 14 to 36 months, 158 patients were interviewed. There was a high rate of dysfunction, but echocardiographic evidence of MVP was not associated with disability, health care utilization, or reported symptoms. The results of this study suggest that symptoms and dysfunction are not related to the presence of MVP by echocardiography. The functional impairment that is seen in patients suspected of MVP may be caused by other factors.

Adult↗

PubMedDate not supplied

Pap tests of rural black women.

Cervical cancer is an important cause of cancer mortality in black women. Pap tests may prevent such deaths, but poor, rural black women are relatively less likely than others to be screened. In order to understand why that is so, the authors surveyed 149 women in three rural North Carolina counties. Thirty-three percent of the women interviewed had not had a Pap test in the preceding three years. Variables independently associated with not having a recent Pap test included: having no identifiable source of medical care; having more than one source of gynecologic care; having an internist provide gynecologic care; and perceiving psychological barriers to Pap tests and pelvic examinations. Income, educational level, and health insurance status were not associated with having a recent Pap test. Although access to care remains a problem for some, better use should be made of the medical care encounters available.

Adolescent↗

PubMedDate not supplied

Perceived vulnerability to serious heart disease and persistent pain in patients with minimal or no coronary disease.

A hypochondriacal personality has been shown to be a major determinant of continued pain in patients with chest pain, both in the presence and absence of significant (less than 75%) coronary stenosis. We investigated preoccupation with cardiac illness among 106 patients (63 women, 43 men) within a few days after coronary angiography, carried out for evaluation of chest pain, showed no significant stenosis. Thirteen questions were used in a structured interview to assess patients' beliefs, behaviors, and expectations pertaining to their cardiac health. Information about persistence of pain was obtained 1 year later by telephone interview. A composite variable, called Self-Label of Coronary Vulnerability, was determined by factor analysis; it accounted for 65% of the variance in the responses. In a multivariable regression analysis, a high score on Self-Label showed the strongest association (p less than 0.005) with continued, unimproved chest pain 1 year later even after adjusting for other variables. As a result, perhaps of a self-labeling process a set of beliefs about vulnerability to serious heart disease helps explain persistence of pain, despite the absence of significant coronary disease.

Coronary Disease↗