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Biomedical subjects

K Rost

Publications and source records attributed to K Rost.

At least 19 recordsLinked to original sources
PubMed1992

Measuring the outcomes of care for mental health problems. The case of depressive disorders.

To conduct effectiveness research in mental health, many nontrivial problems need to be addressed. A multidisciplinary expert panel designed an outcomes module for major depression and dysthymia to measure disease-specific outcomes, treatments routinely provided, and patient characteristics that influence treatment or its outcomes. The outcomes module was pilot-tested to evaluate its ability to identify a diagnostically homogeneous group of patients, to establish its reliability and validity, and to assess the feasibility of administering the module in a mental health setting. In a cohort of 40 patients, the module identified all 31 patients who had a research diagnosis of major depression or dysthymia (100% sensitivity), and 2 of 9 patients who did not have this diagnosis (77.8% specificity). The outcomes module measured key constructs accurately enough to discriminate between groups of depressed patients expected to differ, indicating positive construct validity. High rates of instrument completion supported the feasibility of using the module in specialty settings. Extensive efforts locating patients for follow-up will be needed to draw valid conclusions about treatment effectiveness.

Adult↗
PubMed1992

Family psychiatric history of patients with somatization disorder.

We estimated the prevalence of psychiatric disability and disorders (depression, mania, schizophrenia, alcohol disorder, drug disorder, antisocial personality, and somatization) in the parents, siblings, and children of three groups of index cases: primary care patients with somatization disorder (n = 70), primary care patients who approached, but did not reach, DSM-III-R criteria for somatization disorder (n = 29), and randomly-selected community residents with no psychiatric disorder (n = 1633). Nearly all psychiatric disorders were more common in relatives of both patient samples than in relatives of community residents, and the patient samples rarely differed from each other. In the patient samples, the 22.9% rate of patients with multiple unexplained medical problems is substantially higher than previous investigations of somatization would predict. The most common disorders in patients' relatives were depression and alcohol disorder. There was little difference in the rates of depression in relatives of somatization patients who were or were not themselves depressed. A similar pattern occurred for alcohol disorder. There was a high risk for antisocial personality disorder in parents of patients meeting DSM-III-R criteria for somatization disorder, but this increase was not found for other relatives.

Adult↗
PubMed1992

An analysis of panel data. The impact of a psychiatric consultation letter on the expenditures and outcomes of care for patients with somatization disorder.

In this study, the cost and health outcomes of a psychiatric consultation letter to primary care physicians caring for a sample of patients diagnosed with somatization disorder, a psychiatric condition associated with multiple, unexplained medical complaints, was assessed. To accommodate the small sample size of 73 patients, outcome effects were calculated using panel analysis. Study patients were randomized to a consultation or noconsultation group, and were repeatedly assessed at equal time intervals. Data were analyzed using parsimonious regression models derived from economic theory. During the 1-year follow-up period, a psychiatric consultation letter was associated with a 12% reduction in health care costs ($455 per patient within first year), with no evidence of deterioration in physical, mental, or general health. Less powerful t-test comparisons between treated and control groups lead to different conclusions. Reasons for these differences are discussed.

Adult↗
PubMed1992

Return to work after an initial myocardial infarction and subsequent emotional distress.

We examined how return to work predicted subsequent change in emotional distress in 143 patients who had been employed at the time of initial myocardial infarction. Ninety patients (63%) returned to work by 4 months and remained employed at 12 months. There were no differences in mental health at baseline between those who returned to work and those who did not, but emotional distress decreased significantly between 4 and 12 months only in the group who returned to work. Emotional distress declined after resuming work even when employees returned to jobs with which they reported dissatisfaction at the time of the myocardial infarction. The relationship between return to work and decreasing emotional distress remained after controlling for initial physical and psychological adjustment as well as sociodemographic and social support characteristics. The improvements in mental health associated with return to work should reassure clinicians who emphasize the emotional as well as economic value of work after an initial myocardial infarction.

Employment↗
PubMed1991

Measuring physical activity with a single question.

Using 1,004 subjects enrolled in a worksite health promotion program, this report evaluated the validity of a single question about participation in regular exercise. Measured at baseline, this one question had a significant age-adjusted association with body mass index (p less than 0.0001 in women and p = 0.001 in men), HDL cholesterol (p less than 0.0001 in women), and oxygen capacity (p = 0.0007 in women and p = 0.002 in men). Thus, one self-reported question can provide useful information about who is and who is not participating in regular exercise. The potential validity of a single exercise question is particularly relevant in complex epidemiologic studies where lengthy questionnaires highlight the importance of brief instruments.

Adult↗
PubMed1990

Capacity to remember prescription drug changes: deficits associated with diabetes. Collaborative Study Group of the Task Force on the Medical Interview.

This study compared the capacity of 44 diabetes patients and 131 non-diabetic patients to remember prescription medication recommendations made during return visits to primary care clinics. Diabetes patients were 1.6-times less likely to remember all medication recommendations immediately after the visit than non-diabetic patients, a discrepancy which remained significant after controlling for sociodemographic, health status and treatment differences between the two groups. The results suggest that the cognitive deficits that diabetes patients demonstrate in laboratory testing may be severe enough to diminish their ability to learn treatment recommendations made in primary care settings. Further research is needed to determine whether recall is problematic for diabetes patients in general, or primarily for those in poor metabolic control. Clinicians who treat diabetes patients need to incorporate readily implemented strategies to promote patient recall for substantial numbers of diabetes patients to benefit from pharmacological treatment.

Aged↗
PubMed1990

Predictors of employee involvement in a worksite health promotion program.

Although worksite health promotion programs have proliferated, little is known about the population they reach. This study of employees of a large utility company compared whether the same characteristics which predict recruitment also predict extended participation. The study also prospectively assessed how risk factors are related to employees' on-going extended participation. The findings demonstrate that sociodemographic predictors of recruitment are almost mirror images of the predictors of extended participation. Over time employees who are at higher risk for cardiovascular disease participated in on-going sessions less frequently. Data suggest that referral to targeted sessions does not result in higher rates of attendance by employees with a particular risk factor, although there is no evidence of selective avoidance. Organizational influences on participation evident from the beginning are sustained through four sessions. Programs targeting higher risk employees nested within worksite-wide programs may be useful to increase the extended participation of individuals at elevated risk for heart disease.

Adult↗
PubMed1989

Introduction of information during the initial medical visit: consequences for patient follow-through with physician recommendations for medication.

While negotiation of treatment decisions in the medical visit has long been recognized as an important interviewing skill, limited work has been done to investigate how doctors and patients negotiate what information is relevant in understanding the patient's problem. In this research we tested how the introduction of information reflecting both the patient's and physician's perspective is related to the patient's adherence to physician recommendations for medication. Introduction of information was defined as bi-directional if patients independently offered information or behavior as frequently as they provided the information or exhibited behavior that physicians requested. Thirty random samples of audiotaped dialogue were used to construct estimates of introduction of information during the history, examination, and consultation phases of initial ambulatory care visits of 45 older male patients. The data demonstrate that bi-directional introduction of information during the examination segment explains more than half of the variance in patient adherence to physician recommendations for new medication. These findings support the idea that physician willingness to allow patients to contribute input may contribute to the partnership's arrival at treatment decisions that have meaning for both.

Adult↗
PubMed1986

Smoking cessation: a practical guide for the physician.

Physicians play critical roles in efforts to encourage nonsmoking, both in their individual interventions with smokers and in their contributions to broader political, educational, and public health efforts to encourage nonsmoking. These broader efforts, much aided by the authority and concern of individual physicians and organized medicine will continue, also, to provide a supportive background for individual clinical efforts. Together, the broad based and the clinical activity potentiate each other in decreasing the prevalence of smoking. The difficulties individuals experience in quitting smoking are best understood when placed within the context of the billion dollar marketing of an addictive product; the reality that quitting smoking occurs gradually over time, many smokers attempting to quit several times before succeeding; and the influence of physicians' continuing clinical and community activity in maintaining a culture actively cognizant of the risks of smoking. Through brief clinical counseling as outlined in this article, physicians can help almost all of their smoking patients move toward becoming a nonsmoker by trying to quit or, at least, giving greater thought to doing so. Additionally, the physician can help patients eager to quit by referral to well developed programs and materials such as have been described. In all, then, numerous effective resources are available for the clinician who wishes to deal responsibly with the most important preventable cause of morbidity and mortality in the approximately 30 per cent of patients who smoke.

Counseling↗
PubMed1984

Factors associated with the use of child restraint devices.

A thorough behavioral diagnosis of why parents do and do not use car safety seats is important for designing an effective, comprehensive approach to the significant public health problem of childhood motor vehicle occupant deaths and injuries. With a clear understanding of the demographic, knowledge, attitudinal and social support factors related to car seat use, it will be possible to develop or refine program methods and persuasive communication strategies which will have the greatest potential for effectiveness. Project KISS (Kids in Safety Seats) of the Maryland Department of Health and Mental Hygiene surveyed parents of young children in Maryland to identify factors which differentiate child restraint device users from nonusers. A statewide telephone survey was conducted using random digit dialing, a method of computerized sampling for telephone interviewing. The survey instrument incorporated demographic variables and used Fishbein and Ajzen's model of behavioral intention to develop an attitude scale and identify social referents important to parental safety seat use. Of the factors associated with reported use of car seats, the attitudinal variables were extremely significant. Using these variables as well as spouse approval, socio-demographic characteristics, and other preventive health behaviors of parents, resulted in the correct classification of 75.5% of cases and 26.7% of the variance in reported car seat use. Practitioners can use this analysis to design and target effective educational efforts to those individuals who are least likely to use car seats properly and consistently.

Adult↗
PubMedDate not supplied

The teacher simulation exercise: changes in physician teaching emphasis and strategy. The SGIM Task Force on the Medical Interview.

OBJECTIVES: The objective of the study was to determine the effect of a faculty development course in teaching medical interviewing on participants' ability to provide effective feedback to interviewers. DESIGN: The study used a non-concurrent control group design which randomized subjects into two groups before the intervention. The two groups completed different pre-tests; each group then completed the other group's pre-test as its post-test. The post-course scores of one group were compared with the pre-course scores of the other group to establish differences. SETTING: The research was conducted at the 1985 faculty development course sponsored by the SGIM Task Force on the Medical Interview. PARTICIPANTS: 49 of 52 teachers of medical interviewing attending the course completed the study. INTERVENTION: The week-long intervention consisted of a variety of educational activities which assisted the participants in defining and actively pursuing their learning objectives in interviewing, teaching, and self-awareness. MEASUREMENTS AND MAIN RESULTS: In their assessment of two videotaped segments of initial medical visits, participants were more likely after the course to comment on the interviewer's lack of attention to patient affect (69.0% versus 27.2%, p = 0.005 in one segment) and somewhat more likely to identify teaching strategies that actively involved the interviewer (47.2% vs. 35.0%, p = 0.09 in one segment). Both shifts were congruent with assessments made by course faculty. CONCLUSIONS: Faculty development can influence teachers to recognize the need to provide feedback on skills that expert teachers would emphasize. The non-concurrent control group design provides an innovative approach to common constraints in evaluating faculty development courses.

Curriculum↗