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Biomedical subjects

M B Dignan

Publications and source records attributed to M B Dignan.

At least 19 recordsLinked to original sources
PubMed1992

Racial differences in lipid and lipoprotein levels in diabetes.

Racial differences in plasma lipid and lipoprotein levels were investigated in 145 patients with non-insulin-dependent diabetes mellitus (NIDDM). Black men had higher high-density lipoprotein (HDL) cholesterol levels, lower triglyceride levels, and an improved atherogenic index compared with white men. Premenopausal black women were also found to have higher HDL cholesterol levels, lower triglyceride levels, and a lower atherogenic index than their white counterparts. Adjustment for age, waist to hip ratio (WHR), hemoglobin A1c (HbA1c), and physical activity did not eliminate the significant differences found. There were no racial differences found regarding total and low-density lipoprotein (LDL) cholesterol. Metabolic control as measured by HbA1c was significantly correlated with the triglyceride level in black women. These data confirm that racial differences exist in plasma lipid levels among patients with NIDDM.

Adult↗
PubMed1992

Assessment of the patient-doctor interaction scale for measuring patient satisfaction.

This study assessed the validity, reliability and usability of the Patient-Doctor Interaction Scale (PDIS) in a university-based family practice center. Health maintenance visits and problem visits were included, and data were collected at the time of the visit and again 1 month later. Three different methods of administration (in-person, telephone, and mail) were used to assess usability. Of 91 patients approached, 1 refused to participate. A total of 64 (70%) patients completed the instrument adequately to permit analysis. PDIS scores correlated with overall assessment of patient satisfaction (P < 0.01), suggesting criterion-based validity. Internal consistency (reliability) of the PDIS was indicated by Cronbach's alpha which were consistently greater than 0.80. Scores and return rates varied by method of administration, with the telephone method performing best. The PDIS appears to fulfill the requirements for a valid, reliable and useful instrument to assess patient satisfaction in family practice settings.

Adult↗
PubMed1992

The use of illustrations and narrative text style to improve readability of a health education brochure.

Research suggests that much of the available health education literature requires a level of reading ability that makes it inaccessible to a large proportion of the population in greatest need of health information. The present study tested the value of illustrations and a narrative text style as means of improving the readability of a brochure designed to provide information on cervical cancer and condyloma. Two versions of the brochure were designed, one that had only text presented as simple sentences in bullet-type format (SMOG reading level score of 7.7), and a second version that had somewhat more difficult text formatted in a narrative style (SMOG grade level score of 8.4) together with drawings designed to complement the text. A randomized study design was used to test for comprehension, perceived ease of understanding, and overall rating of the two brochures. Women selected from one private and three public health primary-care clinics were randomly assigned to read one of the two brochures. The brochure with illustrations and narrative text was given a significantly higher overall rating than the one with bullet-type text and no illustrations, while no difference was found in perceived ease of reading. Among poor readers, comprehension was significantly greater for women who read the brochure with illustrations and narrative text, with no difference in comprehension of the two brochures for better readers. The results suggest that the use of aids such as illustrations and text style can make health education literature more accessible to high-risk populations, while remaining interesting enough to appeal to individuals at all levels of reading ability.

Adult↗
PubMed1992

Race-related differences in metabolic control among adults with diabetes.

The effect of race on differences in metabolic control was examined in patients with non-insulin-dependent (NIDDM) and insulin-dependent (IDDM) diabetes mellitus. Data were collected on HbA1c, age, duration of diabetes, age at onset, family function, stress, body mass index, waist/hip ratio, total cholesterol, insulin dose, diet, and physical activity. Among those with NIDDM, black patients had significantly higher HbA1c levels than their white counterparts. This difference persisted after adjustment for covariates. Among patients with IDDM, black subjects were found to have higher HbA1c levels, body mass index, and total cholesterol levels than their white counterparts. After correction for diabetes duration, relative insulin dose, physical activity, body mass index, and cholesterol, black women had significantly higher HbA1c levels than black men, white men, or white women. We conclude that race and sex differences do affect the metabolic control of patients with diabetes mellitus.

Adolescent↗
PubMed1991

Errors in reporting cervical screening among public health clinic patients.

This study examines women's knowledge of whether or not they had a cervical smear as part of their examination in a public health clinic for sexually transmitted diseases. Usable interviews were completed with a cluster sample of 318 women. Approximately 56% of the women were not able to correctly report if they had a cervical smear; and 90% of the erroneous responses consisted of reporting a cervical smear when none actually was done. Young women and single women were more likely to report incorrectly. Overall, the results suggest considerable error in overreporting cervical screening in this population.

Adult↗
PubMed1991

Computerized literature searching in a teaching family practice center.

Computerized literature searching was introduced into a family practice residency office site after a series of training sessions. BRS Colleague was the searching program used. Over 15 months, 147 searches were conducted, primarily by faculty. Because residents used the system infrequently, they preferred to find a faculty member to help with the search rather than complete the search by themselves. The mean number of searches per faculty user was 6.4 and the median number of documents found per search was 15. The users were moderately satisfied with the search process (2.4 on a scale of 1 as excellent to 5 as unusable). Search strategies tended to be unsophisticated, often using only one of several possible related search terms. Most searches took a limited amount of time (5 to 20 minutes). The program was sufficiently successful to warrant continuation. Computerized literature searching offers a method to meet the physicians' needs for ready access to information on patient-related questions.

Follow-Up Studies↗
PubMed1990

Development of a direct education workshop for cervical cancer prevention in high risk women: the Forsyth County project.

With funding from the National Cancer Institute, a public health education program was developed with the primary objective of increasing the proportion of black women in Forsyth County, North Carolina, who receive Pap smears on a regular basis. This paper reports on the development and implementation of the direct education component of the program. The content of the workshop was based on community analysis of current knowledge, attitudes, and behaviors in the target population, and a review of relevant literature on cervical cancer and the Pap smear. Methods for presentation of the content were refined through three pilot tests. Audiovisual materials were also developed to illustrate key points. The direct education component of the program was designed to function as a short workshop and includes an overview of healthy lifestyles, coverage of the importance of early detection of cancer, a description and discussion of the pelvic exam and the Pap smear, and a discussion of common barriers to obtaining Pap smears on a regular basis. Evaluation of the workshop emphasizes process measures, including a questionnaire to collect demographic information and impressions of the presentation. Interim results of the evaluation are discussed.

Adolescent↗
PubMed1990

Knowledge and attitudes about cervical cancer and the Pap smear among 10th-grade girls.

Data from questionnaires completed by 419 10th-grade girls were analyzed as part of a school health education program. The questionnaire was designed to collect knowledge of, attitudes toward, and experiences with cancer and cancer prevention. Data were collected from randomly selected health classes preceding a presentation on breast and cervical cancer prevention. Results showed that the girls were pessimistic about chances of surviving cancer and did not differentiate survival by type or site of the cancer. Although there was considerable confusion about its purpose, 27.6% reported having had a Papanicolaou smear within the past year and 79.2% correctly identified the Pap smear as a test for cancer.

Adolescent↗
PubMed1990

Screening diabetic patients for microalbuminuria.

Abnormal rates of urinary albumin excretion have been shown to predict the development of nephropathy and may signal atherosclerotic disease in diabetic patients. This study demonstrated the feasibility of measuring microalbuminuria in diabetic patients from a large family practice population. Although only one half of the 473 diabetic patients offered free screening took advantage of the testing, those participating did not differ in terms of sex, race, type of diabetes, mean age, systolic blood pressure, and fasting blood glucose levels from those not electing to participate. Over 40% of those screened had abnormally elevated albumin excretion rates as defined as greater than 0.02 g of albumin per gram of creatinine. Those participating in the screening perceived the process as useful and were able to comply with directions for overnight urine collection. Results show that screening for microalbuminuria in diabetic patients cared for by family physicians is feasible, simple, and inexpensive. Interventions to slow or reverse the progression of abnormal microalbuminuria and future risk for nephropathy in those with diabetes are underway.

Adult↗
PubMed1986

Is hysterectomy a risk factor for vaginal cancer?

Several recent case series have called attention to a possible association between previous hysterectomy and the subsequent development of vaginal cancer. To study this relationship, we compared 49 patients with vaginal cancer with 49 controls matched for age, race, and prior cervical dysplasia or neoplasia. Patients and controls were alike in terms of exposure to estrogens. Twenty-four patients (49%) had had prior hysterectomies, of which 13 (27%) were for benign disease. Similarly, 24 controls had a history of a hysterectomy. The matched-pairs odds ratio relating prior hysterectomy to vaginal cancer was 1.00 based on these data, with a 95% confidence interval of 0.47 to 2.12. In the subsample of women without a history of cervical disease, a similar odds ratio appeared. Although the study sample size did not permit exclusion of a twofold increase in risk, the statistical power to detect an actual odds ratio of 2.5 is 76%. At this level of statistical power, our data suggest that hysterectomy has a low probability of being a risk factor for vaginal cancer when age and cervical disease are controlled for. In the absence of such a relationship, screening for vaginal cancer does not appear to be necessary for women who have had a hysterectomy for benign disease.

Adult↗
PubMed1986

Prevalence of health-risk behavior among seventh grade students in North Carolina.

Data from 386 seventh grade students, 48% male and 65% white, were collected at two sites in North Carolina. The purpose of the study was to estimate the prevalence of alcohol and drug use among adolescents as part of a continuing study of preventive health behaviors. The data were collected anonymously from self-completed questionnaires and were analyzed by race and sex to determine knowledge of and attitudes toward alcohol and smoking, self-concept, and locus of control. Black boys had the highest prevalence of alcohol (16%) and tobacco (20%) use and at the same time had the lowest amount of knowledge about the dangers of the substances. White boys, while knowing more about the potential dangers, reported similar patterns of use. In general, girls used much less alcohol and tobacco and had higher levels of knowledge and more prudent attitudes. Boys, particularly blacks, were found to be at greater risk than girls of developing patterns of behavior that are associated with abuse of alcohol and heavy smoking. The findings suggest that health education to inform adolescents of the dangers of alcohol and smoking needs to be specific to cultural and sex groups.

Adolescent↗
PubMed1985

Evaluation of the North Carolina Risk Reduction Program for smoking and alcohol.

Seventh grade students in two school systems in rural North Carolina were subjects for a program designed to reduce health risks associated with use/abuse of tobacco and alcohol. One school system was located in the central area of the state, and the other in the western mountains. Both groups were assessed before and after introduction of novel teaching programs dealing with alcohol and tobacco. Knowledge about smoking and alcohol increased in both sites (p less than .05). Attitudes toward alcohol did not change. Attitudes toward smoking eroded in both sites, with attitudes at one site showing a severe erosion (p less than .05). Smoking education in these communities may have conflicted strongly with ambient attitudes toward smoking, eliciting a "boomerang" effect.

Adolescent↗
PubMedDate not supplied

Evaluation of the North Carolina Stroke Care Program.

A study of 774 patients in eastern North Carolina was undertaken to determine the effects of a coordinated program of care and follow-up on recovery from stroke. The program was designed to coordinate and improve in-hospital stroke care and rehabilitation, to provide for education and training of the family for post-hospital care, and to coordinate and facilitate continued access to services after discharge. As measured by the Barthel Index at discharge, three, six and 12 months, the impact of the program was found to be minimal. Patients' scores throughout follow-up were influenced by age, whether the stroke event was new or recurrent, and the state of consciousness at admission. Follow-up Barthel scores were also related to scores obtained at discharge.

Activities of Daily Living↗
PubMedDate not supplied

Risk factors for extracranial carotid artery atherosclerosis.

We related risk factors, cardiovascular symptoms, and coronary status to the extent of extracranial carotid atherosclerosis as measured by B-mode ultrasonography in 376 volunteers hospitalized for elective coronary angiography. In a first analysis, we correlated risk factors and cardiovascular symptoms with carotid atherosclerosis. Univariate analysis showed that relations between many continuous risk factors and carotid atherosclerosis were graded and consistent for men and women. Multivariate analysis identified 6 significant variables (age, hypertension, pack-years smoked, and inversely, plasma concentrations of high density lipoprotein cholesterol and uric acid, and Framingham Type A score) that together accounted for 35% of the variability in extent of carotid atherosclerosis. In a second multivariate analysis, addition of coronary status (presence or absence of coronary stenosis as evaluated by coronary angiography) to the roster of candidate independent variables produced a new equation that accounted for an additional 5% of the variability in carotid atherosclerosis extent. Although much of the variability in extent of carotid atherosclerosis remains unexplained, these data define an association between coronary and carotid atherosclerosis that depends partly on shared exposure of both arteries to the same risk factors. They are also consistent with the concept that as yet undiscovered risk factors and/or genetic (e.g., arterial wall) factors common to both arterial beds also contribute to the relation between coronary and carotid atherosclerosis in human beings.

Age Factors↗
PubMedDate not supplied

Use of process evaluation to guide health education in Forsyth County's project to prevent cervical cancer.

The Forsyth County, NC, Cervical Cancer Prevention Project is a 5-year public health education program designed to increase the proportion of black women in the county who are appropriately screened for cervical cancer. In this paper, the authors report on process evaluation--the procedures used to monitor the intervention and to insure that the target population was reached with a high quality, community-based health education program. A system that encompasses documentation of program activities, interviews with women in waiting rooms of primary care providers, semiannual interviews with a panel of approximately 100 women from the target population, and telephone followup with participants in direct education workshops was designed and implemented. Through October 1990, more than 2,100 interviews had been conducted. Data from these activities have facilitated continued development and refinement of educational materials, provided guidance for developing new strategies for reaching the target population, and provided continuous feedback to program managers to allow monitoring the impact of all program activities.

Black or African American↗
PubMedDate not supplied

Association between exercise and other preventive health behaviors among diabetics.

Two hundred and seventy patients were studied to investigate the cross sectional association between exercise and other preventive health behaviors in a diabetic population. Patients included both insulin and noninsulin dependent diabetics and were recruited from the Family Practice and Pediatrics Clinics at Bowman Gray School of Medicine. During screening, patients underwent a physical examination as well as completing a survey to assess exercise and health behavior habits. Three exercise groups were compared: (a) patients who expended more than 600 kilocalories per week during exercise, (b) patients who expended 600 kilocalories or less, and (c) patients who did not exercise. The mean body weights of both exercise groups were found to be less than the nonexercise group, and the heavy exercise group also had a lower mean body mass index. Heavy exercisers reported greater caloric intakes than both moderate and nonexercisers. There were no differences found concerning the composition of their diets among groups. The heavy exercise group reported wearing their seatbelts a greater percentage of the time and visited the dentist more often compared with the sedentary group. There were no significant differences found among exercise groups concerning blood sugar monitoring, alcohol consumption, smoking, or in obtaining periodic health examinations. It was concluded that exercise was associated with several, but not a majority, of other healthful behaviors in a population of diabetics.

Blood Glucose↗
PubMedDate not supplied

Methods for determining patient improvement following visits to family physicians.

Two instruments were used to assess patient improvement following visits to providers in a university based family practice center--the Modified Williamson Functional Assessment (MWFA) and the Mini-Duke-UNC Health Profile (Mini-DUHP). Of the 90 patients over the age of 18 seen for problem or health maintenance visits who were included in the study, 64 adequately completed the instruments at the time of the visit and one month later. Functional assessments by in-person, mail, and telephone methods of administration were similar. Patients' MWFA scores did not significantly improve by the time of the one-month follow-up. Mini-DUHP subscales for symptom and physical function also did not significantly improve. Mini-DUHP emotional, social, and composite scores indicated a decrease in function following the visits, particularly visits for health maintenance. MWFA and Mini-DUHP scores correlated only modestly, with the highest correlation occurring between Mini-DUHP Physical Score and the MWFA (0.414 or 0.509, P less than .001). Additional study is needed to identify or develop an instrument that can adequately assess broad changes in functioning for multiple diagnoses following specific physician interventions, and the reason for the decline in emotional and social function following visits needs further elucidation and evaluation.

Adolescent↗