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Biomedical subjects

Justin Nash

Publications and source records attributed to Justin Nash.

8 recordsLinked to original sources
PubMed2006

Transitions of care and changes in distressing pain.

This study employed a 22-state mortality follow-back survey to examine bereaved family members' perception of the level and pattern of distressing pain in decedents with cancer at the last two sites of care. Of the 1,578 individuals interviewed, 423 of their family members had cancer listed as the leading cause of death on the decedent's death certificate. Decedents were treated at home, hospitals, hospices, or nursing homes, with more than half of the respondents (n = 216) reporting that the decedent was at more than one site of care in the last month. Forty-two percent of decedents had distressing pain (defined as "quite a bit" or "very much") at their second to last place of care, with 40% having distressing pain at the last place. There was some variation in the degree of change depending on the transition between the second to last and last places of care. For many individuals, however, the transition to another place of care did not result in an improvement in the level of distressing pain. No significant differences were found in the change in distressing pain by transition of care. Increased attention is needed not only on how to adequately manage pain and pain-related distress but also on how to improve pain reduction measures in transitions between health care settings at the end of life.

Aged↗
PubMed2005

Cancer screening practices among cancer survivors.

BACKGROUND: Cancer survivors are more vulnerable to future cancers than individuals without cancer. As such, it is important to understand whether survivors are engaging in cancer screenings. METHODS: The screening practices reported in response to the 2000 Health Interview Survey of 2151 individuals with cancer were examined and compared to those of 30,195 individuals without cancer. RESULTS: The proportion of cancer survivors obtaining screenings ranged from 21% to 77%. Compared to individuals without cancer, women with cancer were more likely to have had a mammogram (odds ratio [OR]=1.8, 95% CI=1.5-2.1), a clinical breast exam (OR=2.2, 95% CI=1.9-2.5), and/or a Papanicolaou test (OR=1.3, 95% CI=1.1-1.5) in the recommended timeframe. Similarly, men with cancer were more likely than men without cancer to have had a prostate-specific antigen test performed (OR=2.5, 95% CI=2.0-3.0). All cancer survivors were more likely than individuals without a cancer diagnosis to have had a total body skin exam (OR=4.0, 95% CI=3.5-4.6), a fecal occult blood test (OR=1.4, 95% CI=1.2-1.6), and/or a colorectal exam (OR=2.2, 95% CI=1.9-2.5). Similar results were obtained when individuals diagnosed with the cancer for which the screen was designed to detect were excluded. CONCLUSIONS: The results demonstrate that cancer survivors have higher screening rates than individuals without a cancer diagnosis. Despite this, the proportion of survivors obtaining screenings varies considerably by the type of screen. An understanding of the impact of cancer screening in cancer survivors, as well as the reasons for and against obtaining cancer screenings, is necessary.

Adult↗
PubMed2005

A self-administered behavioral intervention using tailored messages for migraine.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of a Self-Administered Behavioral Intervention using Tailored messages (SEABIT) for migraine. The primary measures were headache days, headache-related disability, behavioral/emotional factors, and headache-related beliefs. BACKGROUND: Behavioral and cognitive-behavioral interventions for migraine treatment are well established and possess "Grade-A" evidence based on the U.S. Headache Consortium evidence-based guidelines. To increase the accessibility of behavioral interventions in primary and other settings, treatment can be delivered in self-administered formats. Incorporating tailored health communication strategies (via tailored messages) into a self-administered format can help maintain a level of personalization without requiring regular visits to a behavioral specialist. Tailored messages are created using individual-level assessment data to educate and motivate the patient to develop behavioral skills and strategies for migraine prevention and management. METHODS: Twenty-five individuals (95% female, 90% Caucasian, mean headache years = 21.0) began and 84% (21/25) completed all phases of the 8-week SEABIT developed for migraine prevention (preceded by a 1-month baseline phase and followed by a 1-month postintervention phase). RESULTS: Overall, 62% (13/21) reported at least a 50% reduction in headache frequency, and mean headache frequency for the group was also significantly reduced from baseline to postintervention (16.9 vs. 10.7, P < .001; eta2= .61). Headache-related disability, behavioral/emotional factors, and headache-management self-efficacy also showed significant improvement. CONCLUSION: The findings suggest that the SEABIT for migraine prevention is an effective behavioral intervention that potentially could be accessed and distributed in a variety of settings including primary care.

Adult↗
PubMed2003

The impact of apathy and depression on quality of life in patients infected with HIV.

Apathy refers to decreased self-initiation and goal-directed behavior. Apathy is a relatively common neuropsychiatric symptom associated with HIV, yet the impact of apathy on health-related quality of life (QOL) has not been investigated. We examined the relationship between apathy, depression, and QOL among individuals infected with HIV. Apathy was quantified using the Marin Apathy scale and QOL was measured with the Medical Outcomes Study Short-Form 36 (SF-36). Results of the study revealed that both apathy and depression were more common among patients with HIV than healthy control subjects. Twenty-six percent of the patients with HIV reported clinically significant apathy while 80% of the patients reported clinically significant depression. Apathy did not relate to ratings of overall QOL, but it was modestly associated with ratings of mental health and role disruption secondary to mental health. By contrast, ratings of depression were strongly related to overall QOL and most indices of SF-36. Regression equations revealed that depression and apathy independently contributed to mental health and role disruption secondary to mental health. Importantly, ratings of depression accounted for the majority of variance for ratings of QOL. The findings indicate that while apathy is more common among individuals with HIV compared to healthy control subjects, the impact of apathy on QOL is less significant than depression. Clinicians should continue to focus on depression as an important neuropsychiatric symptom associated with HIV.

Adult↗
PubMedDate not supplied

Predictive genetics in primary care: expectations for the motivational impact of genetic testing affects the importance family physicians place on screening for familial cancer risk.

PURPOSE: To investigate whether the importance family physicians place on familial cancer-risk screening is influenced by expectations for the motivational impact of a high-risk genetic test result. METHODS: Mailed survey of the Massachusetts Academy of Family Physicians. RESULTS: Respondents expected patients would increase pursuit of screening for cancer (99.6%) and other diseases (89.9%), quit smoking (93.6%), and improve diet/exercise (92.5%). The degree of motivational effect was significantly related to the importance they place on screening. CONCLUSIONS: Family physicians believe that a high-risk cancer genetic-test result would motivate their patients to pursue risk-reduction behavior, and this belief is related to the importance they place on screening their patients for an inherited risk of cancer.

Attitude of Health Personnel↗
PubMedDate not supplied

Family physician self-efficacy with screening for inherited cancer risk.

BACKGROUND: Recent evidence has shown low and inconsistent rates of family history screening among generalist physicians. Little has been done to investigate the physician factors likely to mediate this behavior. We investigated family physicians' beliefs about screening their patients for inherited cancer risk, measuring their perceptions of self-efficacy and the importance of screening. METHODS: We mailed a cross-sectional, 1-page questionnaire to all active members (691) of the Massachusetts Academy of Family Physicians, measuring their attitudes about predictive genetic cancer screening. RESULTS: We received responses from 300 of the 691 members (43%). Although 87% believed screening to be important, less than two thirds believed they were effective in screening. CONCLUSIONS: Many family physicians lack confidence in their ability to screen patients for a family history of cancer despite recognizing its importance to their practice.

Adult↗