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Biomedical subjects

P J Brantley

Publications and source records attributed to P J Brantley.

At least 19 recordsLinked to original sources
PubMed2001

Behavioral treatment of chronic psychogenic polydipsia with hyponatremia: a unique case of polydipsia in a primary care patient with intractable hiccups.

Psychogenic polydipsia is recognized as a dangerous and potentially life threatening disorder. Few studies have focused on the treatment of polydipsia presenting in the outpatient setting. A review of the behavioral treatment literature pertaining to psychogenic polydipsia is presented. This review is followed by a case illustration of an outpatient behavioral approach to the treatment of psychogenic polydipsia in a non-psychiatric, primary car, adult, male patient suffering from intractable hiccup. An ABA single-case design was used, with sodium concentration as the dependent variable. This behavioral method appears promising in settings where restriction of fluid intake is not practical.

Adult↗
PubMed2001

A prospective study of the impact of stress on quality of life: an investigation of low-income individuals with hypertension.

The role that major and minor life events play in the quality of life in low-income hypertensives was examined. Participants were randomly recruited from 2 primary care clinics at a public medical center. The study utilized a prospective design. Participants were determined to have hypertension and were being treated with antihypertensive medication prior to and throughout the duration of the study. Participants were administered the Life Experiences Survey and the Weekly Stress Inventory repeatedly during Year 1 to assess major and minor stress, respectively. Participants were repeatedly administered the RAND 36-Item Health Survey during Year 2 to assess quality of life. Usable data were obtained from 183 patients. Analyses revealed that major and minor stress were significant predictors of all measured domains of quality of life, even after age and number of chronic illnesses were statistically controlled. Minor stress contributed uniquely to the prediction of each dimension of quality of life even when age, number of chronic illnesses, and major life events were accounted for. Findings suggest that stress has a significant, persistent impact on the quality of life of low-income patients with established hypertension. These findings extend prior research that has examined the impact of medications on quality of life and suggest that stress needs to be accounted for as well.

Female↗
PubMed2001

The Attitudes Toward Women with HIV/AIDS Scale (ATWAS): development and validation.

Over the past 20 years, many scales have been created to measure general attitudes toward People with HIV/AIDS (PWA). A high correlation between negative attitudes toward PWA and rejecting attitudes toward homosexuality has been demonstrated in many studies, which may suggest that although the scales posit to examine "attitudes toward PWA," they may actually tap into attitudes toward homosexuals with HIV/AIDS. These scales may be inappropriate to use for examining attitudes toward other groups of people with HIV/AIDS (e.g., heterosexual women). The present researchers developed and validated the Attitudes Toward Women with HIV/AIDS Scale (ATWAS). Principal components analysis of the ATWAS yielded a four-factor structure accounting for 48.6% of the total variance of attitudes toward women with HIV/AIDS. The four factors were Child Care, Myths/Negative Stereotypes, Reproduction/Contraception issues, and Sympathy/Transmission Route. The ATWAS was found to have good internal consistency (r = .82) and construct validity.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Utilization of medical services and quality of life among low-income patients with generalized anxiety disorder attending primary care clinics.

OBJECTIVE: Anxiety disorders appear to influence morbidity and medical utilization. However, little is known about the relationship between Generalized Anxiety Disorder, quality of life, and medical utilization, especially among low-income patients. The goals of this investigation were to 1) determine if low-income patients with GAD utilize medical services more than patients with other Axis I diagnoses, or no psychopathology, and 2) compare the health-related quality of life of these three groups. METHOD: Participants were randomly recruited from public primary care clinics and administered intake assessments of demographics, stress, and health-related self-report questionnaires. At the end of the first year a structured psychiatric interview was administered (N = 431). Over the second year, patients (n = 360) were administered a health-related quality of life measure every three months for four assessments. Medical charts were abstracted to collect information about chronic illnesses and visits to outpatient clinics and the emergency department during the two years. RESULTS: Patients were predominantly middle-aged, low-income, uninsured African-American females. In this low-income sample, patients with GAD utilized the emergency department more and reported poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. CONCLUSION: Low-income patients with GAD utilize the emergency department more and report poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. Programs to identify and treat patients with GAD may yield improvements in quality of life, as well as reduce emergency department utilization.

Black or African American↗
PubMed2001

The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics. The Center for Epidemiologic Studies-Depression.

OBJECTIVE: Depressive disorders are among the most common medical disorders seen in primary care practice. The Center for Epidemiologic Studies-Depression (CES-D) scale is one of the measures commonly suggested for detecting depression in these clinics. However, to our knowledge, there have been no previous studies examining the validity of the CES-D among low-income women attending primary care clinics. METHOD: Low-income women attending public primary care clinics (n = 179, ages 20-77) completed the CES-D and the Diagnostic Interview Schedule for the DSM-IV (DIS-IV). RESULTS: The results supported the validity of the CES-D. The standard cut-score of 16 and above yielded a sensitivity of .95 and specificity of .70 in predicting Major Depressive Disorder (MDD). However, over two-thirds of those who screened positive did not meet criteria for MDD (positive predictive value = .28). The standard cut-score appears valid, but inefficient for depression screening in this population. An elevated cut-score of 34 yielded a higher specificity (.95) and over 50 percent of the patients who screened positive had a MDD (positive predictive value = .53), but at great cost to sensitivity (.45). CONCLUSION: Results indicated that the CES-D appears to be as valid for low-income, minority women as for any other demographic group examined in the literature. Despite similar validity, the CES-D appears to be inadequate for routine screening in this population. The positive predictive value remains very low no matter which cut-scores are used. The costs of the false positive rates could be prohibitive, especially in similar public primary care settings.

Adult↗
PubMed2001

Knowledge and attitudes of family physicians about clinical practice guidelines and the care of patients with type 2 diabetes mellitus.

This study examined the attitudes of Louisiana family physicians toward clinical practice guidelines in general and specifically how attitudes and familiarity with the American Diabetes Association Clinical Recommendations (ADACR) correlated with knowledge and evidence-based "best practice" in the care of type 2 diabetes. Surveys were mailed to a random sample of 278 eligible physicians from which a 32% response rate was obtained (n = 90). Family physicians' general attitudes towards guidelines were neutral. Attitude correlated significantly with knowledge of the ADACR (P = .03) but not with "best practice". Despite low scores for knowledge, all but one of the ADACR were adhered to by more than 85% of respondents. Physician attitudes do not appear to be barriers to guideline implementation. Results may be used to focus studies of processes and outcomes in guideline implementation.

Adult↗
PubMed2000

Maximizing medication adherence in low-income hypertensives: a pilot study.

A pilot study was conducted to examine the association between free medication and comprehensive care on blood pressure control for 60 adults with uncontrolled essential hypertension (mean blood pressure = 157/96 mm Hg) referred from a variety of primary care clinics at a public teaching hospital. Subjects received comprehensive care, free antihypertensive medication dispensed in the clinic, and patient education regarding hypertension and medication compliance. Matched-pair t-tests revealed average drops in blood pressure of 22 mm Hg systolic and 13 mm Hg diastolic for the entire sample from baseline to 6 months post-enrollment (both P's < .001). The comprehensive hypertension management program with education and free medication was significantly related to reduced blood pressure across the 6 months of the study period.

Adult↗
PubMed1999

Aerobic fitness and leisure physical activity as moderators of the stress-illness relation.

Exercise as a moderator of the stress-illness relation was examined by exploring leisure physical activity and aerobic fitness as potential "buffers" of the association between minor stress on physical and psychological symptoms in a sample of 135 college students. The goal was to gather information regarding the mechanisms by which exercise exhibits its buffering effects. Researchers have examined both physical activity and physical fitness in an attempt to demonstrate this effect; however, whether both of these components are necessary to achieve the protective effects against stress is unknown. This study examined engaging in leisure physical activity and having high aerobic fitness to determine if both were necessary for the stress-buffering effects or if one factor was more important than the other. Findings suggested a buffering effect for leisure physical activity against physical symptoms and anxiety associated with minor stress. This effect was not found with depression. Additionally, there was no moderating effect for aerobic fitness on physical or psychological symptoms. Collectively, the data suggested that participation in leisure physical activity as opposed to level of aerobic fitness is important to the stress-buffering effect of exercise. Implications for exercise prescription are discussed.

Exercise↗
PubMed1999

Attentional reactions to an MI: the impact of mood state, worry, and coping style.

This study investigated the possible development of an attentional bias to cardiac-related words in subjects who recently experienced a myocardial infarction (MI). It was hypothesized that cardiac-related stimuli would have attention-capturing characteristics for post-MI subjects, and this bias would be moderated by level of anxiety, degree of cardiac-related worry, and the subject's coping style. Post-MI subjects (n = 33) and matched controls (n = 31) participated in an attentional search task. The post-MI subjects failed to show the predicted group increases in attention allocated to cardiac stimuli, but a difference between groups still occurred as the control group exhibited directed inattention to cardiac stimuli. Subsequent analysis indicated those post-MI subjects who did evince an attentional bias toward cardiac stimuli had higher monitoring scores on a self-report measure of coping style. Level of emotional distress and cardiac-related worry failed to predict attentional bias for the post-MI subjects.

Adaptation, Psychological↗
PubMed1999

Chronic minor stressors and major life events experienced by low-income patients attending primary care clinics: a longitudinal examination.

Chronic minor stressors and major life events were assessed from 129 randomly selected low-income patients attending primary care medical clinics. Participants reported experiencing an average of 15 chronic minor stressors in a 12-month period. The most common chronic minor stressors were reported in the areas of finances and domestic activities. Participants also reported these stressors as the most intense. The t tests revealed that female participants reported significantly (p = .05) more chronic events than males. The most common major life events were reported in the areas of vegetative symptoms (i.e., major change in sleeping and eating habits), financial status, illness, and interpersonal relationships. The most stressful life events were changes in vegetative symptoms, family illness, and interpersonal relationships. The t tests revealed that employed participants reported significantly (p < .05) more positive life events than did unemployed participants. Implications of the findings are discussed.

Adolescent↗
PubMed1999

Predictors of outpatient medical appointment attendance among persons with HIV.

Non-adherence to medical regimens is a critical threat to the health of HIV-infected individuals. Patients who do not adhere to routine medical care cannot fully benefit from the increasingly efficacious treatments available to them. Consistent attendance at medical appointments plays a central role in both prolonging life and enhancing quality of life for persons living with HIV/AIDS. By identifying why many patients do not reliably attend medical services, interventions can be undertaken to improve appointment-keeping. The primary purpose of the present study was to identify factors predictive of HIV-related medical appointment attendance. One-hundred-and-forty-four outpatients in a public hospital ambulatory care HIV clinic were followed for seven months. Demographic, medical care and psychosocial factors were measured in order to prospectively predict the percentage of missed clinic appointments by persons with HIV disease. Greater outpatient appointment non-attendance was associated with younger age, minority status, less severe illness and lower perceived social support. Treatment duration, provider consistency, hopelessness and religious coping did not emerge as significant predictors of outpatient appointment-keeping in this sample. Practical and theoretical implications of these findings are discussed in light of recent medical advances in HIV/AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Minor stressors and generalized anxiety disorder among low-income patients attending primary care clinics.

The total number of minor life events and subjective ratings of distress associated with these events were assessed for individuals with generalized anxiety disorder (GAD) and for nonanxious controls. Participants consisted of 256 randomly selected, low-income patients from primary care medical clinics. Diagnoses were obtained using the Diagnostic Interview Schedule for the DSM-IV (DIS-IV). An analysis of variance revealed that GAD individuals reported significantly more minor life events than did nonanxious controls (F = 50.97, p < .001). An analysis of covariance indicated that persons with GAD perceived their minor stressors as significantly more stressful than did nonanxious controls, even after the total number of events was controlled (F = 42.07, p < .001). These findings are consistent with cognitive theories of GAD and current revisions to the definition of the disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Implications for theory and research on GAD are discussed.

Adolescent↗
PubMed1999

Prevalence of high-risk behaviors and obesity among low-income patients attending primary care clinics in Louisiana.

This study examined the prevalence of the most prominent high-risk behaviors that contribute to mortality in the United States (i.e., sedentary lifestyle, cigarette smoking, and high dietary fat intake) and obesity among low-income patients attending primary care clinics in Louisiana. The sample consisted of 1,132 patients attending primary care clinics that were randomly selected and administered a demographic questionnaire, the 1994 Behavioral Risk Factor Surveillance System, and the Eating Patterns Questionnaire. Participants consisted predominantly of African-American (67.7%), uninsured (73.3%), low-income, middle-aged females. Prevalence of high-risk behaviors included sedentary lifestyle (47.1%), cigarette smoking (26.2%), and high dietary fat intake (61.3%). Prevalence of obesity was 63.5%. In conclusion, low-income patients attending primary care clinics in Louisiana display a high frequency of important high-risk behaviors that contribute to mortality in this country. Obesity is also extremely prevalent in this population. Clinical implications and directions for future studies are discussed.

Adult↗
PubMed1998

Alcoholism among indigent inpatients: identification and intervention by internal medicine residents.

BACKGROUND: This study examined alcoholism identification and interventions by internal medicine residents, determined the prevalence of alcoholism among indigent inpatients, and examined some variables related to alcoholism in this population. METHODS: The alcohol abuse and dependence section of the Diagnostic Interview Schedule was administered to 197 inpatients, and chart audits were done. RESULTS: The obtained prevalence of alcoholism was 17%. Residents identified current alcohol abuse among 71% of current alcoholics, 17% of past alcoholics, and 3% of nonalcoholics. Sixty-two percent of alcoholics identified by the residents did not receive advice or referral, 13% received advice, 17% were referred to Alcoholics Anonymous, and 8% were referred to an inpatient facility. CONCLUSIONS: Our results suggest that although residents' identification of alcoholism is satisfactory, it is necessary to improve their rates of intervention. The profile of the alcoholic inpatients in this study includes demographics, presence of chronic illnesses, and utilization of medical services as compared with nonalcoholics.

Adult↗
PubMed1998

Emergency medical technician schedule modification: impact and implications during short- and long-term follow-up.

OBJECTIVE: To determine whether modifying work schedules from 24- to 12-hour shifts results in favorable improvements across a range of psychological and social variables among emergency medical technicians (EMTs). METHOD: Sequential (before and after) surveys were completed voluntarily by EMTs at 1 month prior to, 2 months after, and 1 year after a workshift modification (change from 24- to 12-hour shifts). The surveys assessed job satisfaction, occupational burnout, and attitudes toward work schedules. The questionnaires were completed at emergency medical service stations. RESULTS: Of 70 EMTs in the system, 51 (73%) completed the first 2 stages of this study; 35 (50%) completed all 3 stages. Paired-sample t-tests revealed significant differences between baseline and 2-month posttest scores on the following variables: the Maslach Burnout Inventory: Emotional Exhaustion Scale (less perceived exhaustion at 2 months); the Schedule Attitudes Survey: General Affect (perceived more positive view toward schedule at 2 months); Social/Family Impact (perceived less disruption of social/family life at 2 months); and Composite (less overall disruption in quality of life at 2 months). Statistically significant differences between baseline and 1-year posttest scores were found on the following: Schedule Attitudes Survey: General Affect (more positive view toward schedule at 1 year); Social/Family Impact (less disruption in social/family life at 1 year); and Composite (less overall disruption in quality of life at 1 year). CONCLUSION: Modifying EMTs' work schedules from 24- to 12-hour shifts was associated with improvements in EMTs' general attitudes toward their schedules, less disruption of social and family life, and decreased levels of emotional exhaustion at 2 months after the change. While the improvements in EMTs' attitudes toward their schedules persisted at the 1-year follow-up, the measure of emotional exhaustion returned to baseline.

Adult↗
PubMed1998

Predicting smoking stage of change among a sample of low socioeconomic status, primary care outpatients: replication and extension using decisional balance and self-efficacy theories.

An expanding body of research using the transtheoretical model with both self-change and treatment programs suggests that differences in readiness for smoking cessation are important predictors of successful abstinence. Understanding the cognitive processes underlying these differences may hold tremendous potential for improving the efficacy and efficiency of intervention strategies. Decisional balance theory and self-efficacy theory have been used to help explore how and why people move through the stages of change, but they have been validated almost exclusively with middle-class, educated White samples This study sought to investigate whether these theories relate in each other in the same manner among low socioeconomic status (SES) primary care outpatients. Results indicated that variables from decisional balance theory (pros, cons) and self-efficacy theory successfully differentiated stage membership and yielded results consistent with the extant literature. Self-efficacy demonstrated the most powerful association with stage membership, whereas pros, cons, and temptations exhibited varying degrees of association. Clinical implications and special considerations when conducting research and implementing interventions with low-SES smokers are discussed.

Journal Article↗
PubMed1996

Factors associated with depression in a heterogeneous HIV-infected sample.

The present study examined factors contributing to depressive symptomatology in a low SES, heterogeneous HIV seropositive sample. The sample was comprised of 120 HIV-infected patients who completed psychosocial measures upon their initial visit to an outpatient HIV clinic. Length of time since HIV seropositive notification and HIV-related symptomatology were also assessed. Social support, major life stress, and HIV-related symptomatology were significantly associated with depression. Perceived availability of social support accounted for the greatest variance in depression scores. Length of time since seropositive notification was not significantly associated with depression. These findings extend previous research with middle-class, homosexual, white males to the rapidly growing minority, heterosexual, and low SES populations and point to the need for the inclusion of social support interventions in the provision of services of these individuals.

Adult↗