Biomedical subjects

Laura Trupin

Publications and source records attributed to Laura Trupin.

14 recordsLinked to original sources

PubMed2006

Work life of persons with asthma, rhinitis, and COPD: a study using a national, population-based sample.

OBJECTIVE: To estimate the duration of work life among persons reporting a physician's diagnosis of COPD, asthma, or rhinitis compared to those with select non-respiratory conditions or none and to delineate the factors associated with continuance of employment. METHODS: Persons ages 55 to 75 reporting a physician's diagnosis of COPD, asthma, or rhinitis as well as those without any of these conditions were identified by random-digit dialing (RDD) in the continental U.S and administered a structured survey. We used Kaplan-Meier life table analysis to estimate the duration of work life among persons with and without the three conditions and Cox proportional hazard regression to examine the role of demographic and work characteristics in the proportion leaving employment in each time interval. RESULTS: Persons with COPD, asthma, and rhinitis were no less likely than the remainder of the population to have ever worked, but those with COPD were less likely to be working when interviewed or as of age 65, whichever came first. As of age 55, only 62 percent of persons with COPD continued to work versus 72 and 78 percent of persons with asthma and rhinitis, respectively. Persons with COPD, asthma, and rhinitis all had an elevated risk of leaving work prior to age 65 relative to those without chronic conditions, with and without adjustment for demographic and work characteristics. CONCLUSION: COPD and to a lesser extent asthma and rhinitis were associated with a substantially shortened work life, an effect not due to demographic and work characteristics.

Journal Article↗

PubMed2005

Measuring the physical demands of work in hospital settings: design and implementation of an ergonomics assessment.

BACKGROUND: Assessing the physical demands of the heterogeneous jobs in hospitals requires appropriate and validated assessment methodologies. METHODS: As part of an integrated assessment, we adapted Rapid Entire Body Assessment (REBA), using it in a work sampling mode facilitated by a hand-held personal digital assistant, expanding it with selected items from the UC Computer Use Checklist, and developed a scoring algorithm for ergonomics risk factors for the upper (UB) and lower body (LB). RESULTS: The inter-rater reliability kappa was 0.54 for UB and 0.66 for LB. The scoring algorithm demonstrated significant variation (ANOVA p<0.05) by occupation in anticipated directions (administrators ranked lowest; support staff ranked highest on both scores). A supplemental self-assessment measure of spinal loading correlated with high strain LB scores (r=0.30; p<0.001). CONCLUSION: We developed and validated a scoring algorithm incorporating a revised REBA schema adding computer use items, appropriate for ergonomics assessment across a range of hospital jobs.

Algorithms↗

PubMed2005

Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease.

BACKGROUND: Exposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies. METHODS: Using data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD. Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD. RESULTS: Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure. CONCLUSION: ETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure.

Aged↗

PubMed2005

Exposure to vapors, gas, dust, or fumes: assessment by a single survey item compared to a detailed exposure battery and a job exposure matrix.

BACKGROUND: Occupational exposure assessment often relies upon subject report. We examined the characteristics of self-reported exposure in respondents' longest held job to vapors, gas, dust, or fumes (VGDF) compared to other measures of exposure risk. METHODS: We analyzed data from 1,876 respondents from a national US population-based telephone survey designed to estimate the association between occupational factors and chronic disease of the airways. We tested a single VGDF item against responses to a 16-item battery assessing specific inhalation exposures and against a job exposure matrix (JEM). We analyzed all of these measures for their association with adult-onset asthma after excluding subjects with COPD or asthma with onset before age 18. RESULTS: VDGF (single item) was reported by 744 (40%) subjects; any of the 16 exposures by 899 (48%); and an intermediate or high exposure likelihood job by JEM was assigned to 682 (36%). The sensitivity of the VGDF item measured against the 16-item battery was 69%; the specificity was 88%; (classification agreement kappa=0.58); against the JEM classification the sensitivity was 64% and specificity 74% (kappa=0.37). The relative odds (OR) for adult-onset asthma associated with various measures of exposure were: VGDF, 1.7 (95% Confidence Interval [CI] 1.0-2.8; P=0.04); any of the 16 exposures, 1.6 (95% CI 1.0-2.7; P=0.06), and intermediate or high by JEM, 1.2 (0.7-2.1; P>0.50). CONCLUSIONS: A single VGDF survey item appears to delineate exposure risk at least as well as a multiple-item battery assessing such exposures; it has modest agreement with a JEM-based exposure categorization.

Aged↗

PubMed2005

Functioning and psychological status among individuals with COPD.

BACKGROUND: We examined the link between functioning and psychological status among persons with chronic obstructive pulmonary disease (COPD), using measures of both general functional status and performance of life activities. METHODS: 334 persons with COPD were interviewed by telephone. Functioning was assessed with two measures of difficulty with specific types of activities (self-care, recreational activities/hobbies) and a general measure of functional status (SF-12 Physical Component Score (PCS)). RESULTS: About 16.2% of the sample had SF-12 Mental Component Score (MCS) scores indicative of psychological distress (MCS < 35). In separate regression models, difficulty with self-care and recreational activities was associated with an increased likelihood of distress (self-care: OR=2.9, 95%CI 1.3, 6.6; recreation: OR=7.5 [2.4, 23.7]), while PCS scores were not. In a model including all three predictors, difficulty with recreation was strongly associated with distress (OR=7.7 [2.1, 29.2]), difficulty with self-care was less strongly associated with distress (OR=2.1 [0.8, 5.5]), and PCS did not contribute significantly to the predictive ability of the model. However, low functioning as measured by the PCS was a significant risk factor for difficulty performing activities. CONCLUSIONS: Measures of activity difficulty were independent predictors of psychological distress, while general physical function was not. Poor general physical function was a risk factor for activity difficulties, suggesting an indirect relationship between low PCS and psychological distress, with activity difficulties as the intermediate variable.

Activities of Daily Living↗

PubMed2005

Impact of the home indoor environment on adult asthma and rhinitis.

OBJECTIVE: We sought to study the combined effects of multiple home indoor environmental exposures in adult asthma and rhinitis. METHODS: We studied 226 adults with asthma and rhinitis by structured interviews and home assessments. Environmental factors included dust allergen, endotoxin and glucan concentrations, and indoor air quality (IAQ) variables. Outcomes included forced expiratory volume in 1 second (FEV1) percent predicted, Severity of Asthma Score (SAS), Short-Form (SF)-12 Physical Component Scale (PCS), and asthma Quality of Life (QOL) score. RESULTS: House dust-associated exposures together with limited IAQ variables were related to FEV1 % predicted (R = 0.24; P = 0.0001) and SAS (R = 0.18; P = 0.007). IAQ and limited dust variables were associated with SF-12 PCS (R = 0.15; P = 0.02), but not QOL (R = 0.13; P = 0.16). CONCLUSIONS: The home environment is strongly linked to lung function, health status, and disease severity in adult asthma and rhinitis.

Air Pollution, Indoor↗

PubMed2005

Development and validation of a survey-based COPD severity score.

OBJECTIVE: To develop a comprehensive disease-specific COPD severity instrument for survey-based epidemiologic research. STUDY DESIGN AND SETTING: Using a population-based sample of 383 US adults with self-reported physician-diagnosed COPD, we developed a disease-specific COPD severity instrument. The severity score was based on structured telephone interview responses and included five overall aspects of COPD severity: respiratory symptoms, systemic corticosteroid use, other COPD medication use, previous hospitalization or intubation, and home oxygen use. We evaluated concurrent validity by examining the association between the COPD severity score and three health status domains: pulmonary function, physical health-related quality of life (HRQL), and physical disability. Pulmonary function was available for a subgroup of the sample (FEV1, n = 49; peak expiratory flow rate [PEFR], n = 93). RESULTS: The COPD severity score had high internal consistency reliability (Cronbach alpha = 0.80). Among the 49 subjects with FEV1 data, higher COPD severity scores were associated with poorer percentage of predicted FEV1 (r = - 0.40, p = 0.005). In the 93 subjects with available PEFR measurements, greater COPD severity was also related to worse percentage of predicted PEFR (r = - 0.35, p < 0.001). Higher COPD severity scores were strongly associated with poorer physical HRQL (r = - 0.58, p < 0.0001) and greater restricted activity attributed to a respiratory condition (r = 0.59, p < 0.0001). Higher COPD severity scores were also associated with a greater risk of difficulty with activities of daily living (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.8 to 3.0) and inability to work (OR, 4.2; 95% CI, 3.0 to 5.8). CONCLUSION: The COPD severity score is a reliable and valid measure of disease severity, making it a useful research tool. The severity score, which does not require pulmonary function measurement, can be used as a study outcome or to adjust for disease severity.

Activities of Daily Living↗

PubMed2004

Medical care expenditures and earnings losses of persons with arthritis and other rheumatic conditions in the United States in 1997: total and incremental estimates.

OBJECTIVE: To provide estimates of the total medical care expenditures and earnings losses associated with arthritis and other rheumatic conditions (AORC), as well as the increment in such costs specifically attributable to these conditions, in the US in 1997. METHODS: The estimates were derived from the 1997 Medical Expenditures Panel Survey (MEPS), a national probability sample of 14,147 households including 34,551 persons, of whom 4,776 self-reported arthritis. After weighting, those who self-reported AORC represent 38.4 million persons. We tabulated all medical care expenditures of the adult MEPS respondents, stratified by arthritis and comorbidity status, and then used regression techniques to estimate the increment in health care expenditures attributable to AORC, after taking comorbidity, demographic characteristics, and insurance status into account. Using the same methods, we also estimated the magnitude of the earnings losses sustained by persons of working ages (18-64 years) who had AORC. RESULTS: Persons with AORC incurred mean total medical care expenditures of 4,865 dollars (total 186.9 billion dollars). The largest components of these expenditures were inpatient care (39%), ambulatory care (29%), and prescriptions (14%). The mean increment in medical care expenditures specifically attributable to AORC among those ages 18 years and older was 1,391 dollars(total approximately 51.1 billion dollars). Persons with AORC ages 18-64 years earned 3,812 dollars less on average than did other persons of these ages (total 82.4 billion dollars). Of this average, 1,579 dollars was attributable to the AORC (total 35.1 billion dollars). CONCLUSION: In 1997, persons with AORC incurred direct and indirect costs of 269.3 billion dollars, of which 86.2 billion dollars was attributable to these conditions.

Adult↗

PubMed2004

The impact of managed care on health care utilization among adults with asthma.

STUDY OBJECTIVES: To compare kinds and amounts of health care used by adults with asthma in managed care and fee-for-service settings. DESIGN: Cross-sectional structured telephone survey of Northern California adults with asthma from random samples of pulmonologists, allergist-immunologists, family practitioners, and from a random sample of the non-institutionalized population. MEASUREMENTS: Validated measures of kind of health insurance plans, kinds and amounts of services used for asthma and other reasons, demographic characteristics, severity of asthma, comorbidity, and overall health and functional status. RESULTS: Eighty one percent of the 416 adults with asthma studied were in some form of managed care (75% in HMOs and 6% in PPOs). Those in managed care (MC) and fee-for-service (FFS) did not differ substantively in the proportion with a regular source or principal provider of asthma care, with a peak flow meter or action plan, having received instructions in the use of an inhaler, reporting current use of inhaled beta-agonists, home nebulized beta-agonists, or inhaled steroids, or reporting ER visits or flu shots in the year prior to interview. Persons with asthma in MC reported significantly fewer total physician visits (after adjustment, 4.3 MC, 7.1 FFS, difference = 2.8, 95% CI -5.4, -0.1), principally because those in MC had many fewer visits to allergist-immunologists (after adjustment 4.9 MC, 21.4 FFS, difference = -16.5, 95% CI -27.8, -5.3). The two groups did not differ significantly in the proportion with asthma-related or nonasthma hospital admissions. CONCLUSIONS: Persons with asthma in fee-for-service settings reported a greater number of certain kinds of ambulatory visits, particularly visits to allergist-immunologists, for their asthma than those in managed care, but did not differ in the use of the hospital for their asthma and in nonasthma care.

Adult↗

PubMed2003

Association between etanercept use and employment outcomes among patients with rheumatoid arthritis.

OBJECTIVE: To assess the association between use of etanercept and employment outcomes among patients with rheumatoid arthritis (RA). METHODS: In 1999, 497 RA patients of working ages (18-64 years) reported their employment status in the year of diagnosis and as of the study year, in structured telephone interviews. Of these, 238 had been in clinical trials of etanercept and were currently taking that medication, while 259 were members of an observational study and were not taking etanercept. We used regression techniques to estimate whether employment outcomes in 1999 (employed versus not and, among the employed, hours of work per week, weeks of work per year, and hours of work per year) among the 379 of the 497 patients who were employed at the time of diagnosis were associated with etanercept use, with and without adjustment for demographic characteristics, RA status, overall health status, and the nature of the job held at the time of diagnosis. RESULTS: At the time of diagnosis, 75% of RA patients from the observational study who did not take etanercept and 77% of those who did take the medication were employed. By 1999, among those employed at diagnosis, 55% of the former group and 71% of the latter were employed (difference 16 percentage points). After adjustment for demographics, overall health status, duration of RA, RA status, and occupation and industry, the difference widened to 20 percentage points. Among all who were employed at the time of diagnosis, those from the etanercept clinical trials worked an average of 5.4 more hours per week in 1999; after adjustment, the etanercept group worked 7.4 more hours per week. CONCLUSION: Among all persons who were employed at the time of RA diagnosis, having been in the etanercept clinical trials was associated with higher employment rates in 1999 and a greater number of hours per week of work in that year, suggesting that a randomized trial to establish the relationship between treatment and employment outcomes is now warranted.

Adolescent↗

PubMed2003

Effects of physician-related factors on adult asthma care, health status, and quality of life.

PURPOSE: To study the association of physician characteristics, the characteristics of their practice settings, patient mix, and reported frequency of prescribing asthma medication with patients' health status and health-related quality of life in asthma. METHODS: We conducted a mail-back survey of physicians (n = 147) that included demographic characteristics, practice and training characteristics, and reported prescribing frequencies for common asthma treatments. We also conducted structured telephone interviews with 317 of their patients, assessing demographic characteristics, health status (as measured by the Short Form-12 [SF-12] physical component score), and asthma-specific quality of life (as measured by the Marks questionnaire). RESULTS: In adjusted analyses, pulmonary specialists were more likely to report using leukotriene modifiers (odds ratio [OR] = 4.7; 95% confidence interval [CI]: 1.2 to 18) and theophylline (OR = 3.0; 95% CI: 1.0 to 9.0) in adult patients with asthma. Working in a practice of >75% health maintenance organization (HMO)- or preferred provider organization (PPO)-insured patients was associated with a lower likelihood of prescribing leukotriene modifiers (OR = 0.1; 95% CI: 0.01 to 0.5). Adjusting for patient demographic characteristics and steroid dependence, physician prescribing tendencies were not associated with patients' perceived health status or quality of life. Although an HMO- or PPO-predominant practice was associated with better physical health status (mean difference in SF-12 physical component score, 3.1; 95% CI: 0.05 to 6.2; P = 0.05), there was no statistical association with quality of life. CONCLUSION: The characteristics of physicians, their practices, and the asthma medication prescribing strategies that they adopt are not strongly associated with patients' perceived outcomes.

Adult↗

PubMed2002

The prevalence and impact of managed care for persons with rheumatoid arthritis in 1994 and 1999.

OBJECTIVES: To estimate the proportion of persons with rheumatoid arthritis (RA) in managed care and fee-for-service settings in 1994 and 1999, to ascertain whether there are differences in utilization between persons in the 2 systems of care in the 2 years, and to determine whether 1994 managed care status or change between 1994 and 1999 in managed care status affects outcomes. METHODS: The present study uses data from the University of California, San Francisco RA Panel Study, in which 310 patients with RA from a random sample of Northern California rheumatologists were interviewed annually between 1994 and 1999 using a structured survey instrument. We use linear and logistic regression to compare the health care utilization and outcomes of persons in managed care and fee-for-service after adjusting for differences in demographic and health characteristics. RESULTS: The proportion of respondents in managed care increased from 60% to 79% between 1994 and 1999, including an increase from 37% to 68% among persons eligible for Medicare and an increase from 74% to 92% among persons ineligible for Medicare. With the exception of physical therapy visits in 1999, patients with RA in managed care did not report significantly different utilization of any service for RA than those in fee-for-service in either 1994 and 1999, including hospital admissions and joint replacement surgery. Managed care status in 1994, and change in managed care status between 1994 and 1999, were not associated with significantly different outcomes in 1999. CONCLUSION: Despite the growth in the proportion of patients with RA in managed care, those in managed care did not differ from those in fee-for-service settings in utilization or outcomes.

Arthritis, Rheumatoid↗

PubMed2002

The influence of chronic respiratory conditions on health status and work disability.

OBJECTIVES: This study examined the impact of asthma and chronic obstructive pulmonary disease (COPD) on health status and work disability. METHODS: We used data from a population-based sample of 3805 California adults. RESULTS: Compared with adults with no chronic health conditions, adults with COPD or asthma had a greater risk of self-reported diminished general health (odds ratio [OR] = 10.95; 95% confidence interval [CI] = 6.31, 19.0 and OR = 3.92; 95% CI = 2.31, 6.65, respectively). Respondents with COPD or asthma also had worse mental health status, as indicated by a greater risk of depressive symptoms (OR = 10.05; 95% CI = 5.29, 19.08 and OR = 2.59; 95% CI = 1.33, 5.04). COPD was associated with reduced current employment (OR = 0.41; 95% CI = 0.24, 0.71). CONCLUSIONS: Asthma and COPD are associated with poor health status and greater work disability.

Adolescent↗

PubMed2002

The impact of functional status and change in functional status on mortality over 18 years among persons with rheumatoid arthritis.

OBJECTIVE: To calculate mortality rate associated with rheumatoid arthritis (RA), to estimate the effect of initial functional status and of change in functional status on mortality among persons with RA, and to compare the mortality experience of such persons to that of the US population. METHODS: The study used a prospective panel of 1269 persons followed for a mean of 8.4 years (median 7 yrs, interquartile range 3-12, maximum 18). Mortality status was ascertained from contacts with next of kin, study physicians, and search of the National Death Index. The Kaplan-Meier method was used to calculate the proportion dying in each time interval, with and without stratification for initial functional status [Health Assessment Questionnaire (HAQ) score] or average change in functional status. Cox proportional hazards regression was used to establish the effect of functional status, demographic characteristics, and health status on mortality risk. RESULTS: There were 270 deaths among the 1269 persons with RA. After 18 years of followup the overall death rate was 39%. The death rates in the best through worst initial quartiles of HAQ score were 29, 33, 44, and 54%. The death rate was 51% among persons with declining HAQ score versus 31 and 32% among those with no change or improvement in this measure, respectively. Demographic and health status did not reduce the effect of HAQ or average change in HAQ on mortality risk. Compared to the US population, the persons with RA had a standardized mortality rate of 1.32. CONCLUSION: The persons with RA in this study had elevated mortality rates. Poor initial functional status and declining functional status significantly increased mortality risk among these persons with RA.

Activities of Daily Living↗