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Biomedical subjects

Patrick J O'Connor

Publications and source records attributed to Patrick J O'Connor.

At least 19 recordsLinked to original sources
PubMed2006

Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise.

UNLABELLED: This double-blind, placebo-controlled, repeated-measures experiment examined the effects of a 5 mg . kg(-1) body weight dose of caffeine on delayed-onset muscle pain intensity and force loss in response to 64 eccentric actions of the dominant quadriceps induced by electrical stimulation. Low caffeine-consuming college-aged females (n = 9) ingested caffeine or placebo 24 and 48 hours following electrically stimulated eccentric exercise of the quadriceps. One hour after ingestion, maximal voluntary isometric contractions (MVIC) and submaximal voluntary eccentric actions were used to determine force loss during activation of damaged quadriceps and whether caffeine attenuates muscle pain intensity. Pain intensity was measured using a 0 to 100 visual analog scale. Caffeine produced a large (12.7 raw visual analog scale [VAS] units; -48%; Cohen's d effect size = -0.88), statistically significant hypoalgesia during the MVIC (t = -2.52; df = 8; P = .036). The reduction in pain scores during submaximal voluntary eccentric movements was smaller (7.8 raw VAS units; -26%, d = -0.34), as was the increase in MVIC force (4.4%; d = 0.13). PERSPECTIVE: Eccentric exercise occurs when skeletal muscles produce force while being lengthened. For example, the biceps brachii muscles act eccentrically when a cup of coffee is lowered from the mouth to a tabletop. This experiment found that caffeine (equal to approximately 2 cups of brewed coffee) could produce a large reduction in pain resulting from eccentric exercise-induced, delayed-onset muscle injury. This finding may improve the quality of life of individuals who experience skeletal muscle pain after engaging in unaccustomed, eccentrically biased exercise.

Adolescent↗
PubMed2006

Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis.

The authors investigated the effect of chronic exercise on feelings of energy and fatigue using meta-analytic techniques. Chronic exercise increased feelings of energy and lessened feelings of fatigue compared with control conditions by a mean effect delta of 0.37. The effect varied according to the presence or absence of a placebo control or whether chronic exercise was completed alone or in combination with an additional therapy. Investigations that used a placebo control and examined chronic exercise alone found no effect of chronic exercise on feelings of energy and fatigue. Certain placebo controls may increase feelings of energy and lessen feelings of fatigue when used with older adults or people with psychological distress. The results highlight the need for research identifying the most useful control conditions for accurately interpreting mental health outcome data obtained in chronic exercise investigations.

Adaptation, Psychological↗
PubMed2006

The effect of cardiac rehabilitation exercise programs on feelings of energy and fatigue: a meta-analysis of research from 1945 to 2005.

BACKGROUND: Physical activity is a healthful behavior that has promise for combating feelings of low energy and fatigue. Despite evidence suggesting that fatigue is a prodromal symptom of major cardiac events, improvements in feelings of energy and fatigue have largely been ignored by reviewers of cardiac rehabilitation literature who have focused on anxiety, depression and general measures of quality of life. DESIGN: A meta-analytical review. METHODS AND RESULTS: Computer databases were searched from January 1945 to May 2005 to identify relevant literature. A total of 36 studies consisting of 4765 subjects were included. Cardiac rehabilitation exercise programs were consistently associated with increases in energy and decreases in fatigue. The magnitude of the effect was moderately large (mean delta 0.51; 95% confidence interval 0.42-0.61) but was heterogeneous and modified by features of the research design. Comparison of effect sizes in cardiac rehabilitation studies concurrently measuring energy/fatigue, anxiety and depression suggest that exercise-based cardiac rehabilitation programs have larger effects on feelings of energy and fatigue compared with anxiety and depression. CONCLUSION: This review quantifies the potential benefit of cardiac rehabilitation exercise programs on feelings of energy and fatigue, and suggests that cardiac rehabilitation researchers and practitioners may benefit from examining, and perhaps even focusing on, feelings of energy and fatigue as an important outcome variable. A greater understanding of the effect of cardiac rehabilitation exercise programs on feelings of energy and fatigue will be reached when more true experiments are conducted thereby avoiding the primary limitation of the literature reviewed; that is, the frequent use of non-experimental research designs.

Coronary Disease↗
PubMed2006

Mental energy: Assessing the mood dimension.

Conceptualizing mental energy as a mood is impor tant, because these feelings are important to people and can influence behavior in the real world. If a person feels a lack of energy, for example, he or she is more likely to avoid physical or mental work if it is possible to do so. Alternatively, this person may seek to improve feelings of energy by eating, drinking, taking dietary supplements or drugs, sleeping, or engaging in other behaviors. Thus, the measurement of the mood of energy has importance in numerous ways, including public health, work productivity, and ultimately economic growth and productivity. Mood data have limitations, for example, self aware ness and literacy are necessary and faking is possible. The problem of faking is most salient in situations in which there is a strong motivation to fake, such as when psychological testing is used as part of an employment application. Despite these limitations, overwhelming evidence supports the validity for certain measures of the mood of energy such as the POMS vigor scale. This is not to say that mood measures are error free in all situations. Despite some error, however, validity evidence for mood measures is published in the scientific literature weekly. Future research aimed at determining the biological bases for the mood of energy, and its relationships to overlapping phenomena such as cognitive fatigue, should yield results that ultimately help us to understand how to optimize our feelings of energy.

Affect↗
PubMed2006

A review of physical activity patterns in pregnant women and their relationship to psychological health.

Regular physical activity contributes positively to physical and psychological health. Adverse consequences of inactivity may be an especially important problem among pregnant women. Up to 60% are inactive during pregnancy. This review found consistent evidence that physical activity is reduced during pregnancy; however, few investigators have sought to quantify physical activity patterns among pregnant women using well validated measures. Some of the barriers to physical activity during pregnancy, such as depression, anxiety and fatigue, have been shown to be attenuated by regular exercise performed by non-pregnant samples. There is a need to better understand the relationships between these factors and physical activity during pregnancy. Available retrospective and prospective results suggest that both leisure time and work-related physical activities are decreased across pregnancy. Intensity and duration decrease both during pregnancy compared with pre-pregnancy and in the third trimester compared with the first. There is a need for well designed longitudinal investigations that document pregnancy-related changes in physical activity at frequent intervals during pregnancy using validated and more precise measures of physical activity. Reductions in physical activity and a worsening mood are common during pregnancy. If the relationship between physical inactivity and mood disturbances is indeed observed and maintained during pregnancy, then decreases in physical activity in the third trimester would be expected to result in a worsening mood. In recent years, increased attention has been paid to antenatal mood disturbances, and this research has yielded a host of important findings. Prior correlational and experimental research with non-pregnant samples has demonstrated a consistent relationship between physical inactivity and mood disturbances. Whether this relationship occurs among pregnant women and/or is maintained as women progress during pregnancy is uncertain. Prior investigations have revealed that there is higher rate of mood disturbance during pregnancy than following pregnancy but little is known about the mechanisms that cause these mood disturbances. It is important to better understand changes in mood with pregnancy because mood disturbances can have major negative consequences for a pregnant woman. The major adverse consequences of depression among pregnant women are largely the same as those of non-pregnant individuals. Only six investigations have quantified the relationship between changes in physical activity and changes in mood during pregnancy. The available evidence suggests that inactivity is associated with worse mood. Additional research into this topic is warranted due to the limited number of published papers and the design and methodology limitations of these investigations.

Affect↗
PubMed2006

Impact of office systems and improvement strategies on costs of care for adults with diabetes.

OBJECTIVE: To assess the impact of organizational features and improvement strategies of primary care clinics on health care costs of adults with diabetes. RESEARCH DESIGN AND METHODS: This study included a prospective cohort study of 1,628 adults with diabetes in a large, health care organization receiving care in 84 clinics within 18 medical groups. Data from surveys of patients, clinic medical directors and managers, and medical record reviews were merged with 3 years of medical claims. Costs were estimated using health plan data on resource use and common Medicare payment methodologies. Generalized linear regression models were used to analyze costs related to clinic characteristics, adjusting for individual patient comorbidity, demographic, and socioeconomic factors. RESULTS: Clinics with regular clinician meetings to discuss patient care problems and clinics that used diabetes registries to prioritize patients based on cardiovascular risk were associated with lower 3-year costs: -$3,962 (P = 0.002) and -$2,916 (P = 0.019), respectively. The use of databases to monitor lab results was associated with higher costs ($2,439, P = 0.038). Quality improvement strategies focused on resource use related to diabetes care (-$2,883, P = 0.017) or heart disease care (-$3,228, P = 0.014) were associated with lowered costs, whereas quality improvement strategies that emphasized pharmacy use for patients with heart disease ($3,059, P = 0.029) or depression ($2,962, P = 0.038) were associated with increased costs. CONCLUSIONS: Several organizational features of primary care offices were significant predictors of future health care costs for adults with diabetes. The mechanism by which such factors affect costs of care and the relationship of costs to clinical outcomes merits further evaluation.

Aged↗
PubMed2006

Increasing primary care physician productivity: A case study.

OBJECTIVE: To ascertain the impact of advanced access and productivity-based pay on physician productivity and compensation, patient satisfaction, and medical group cost of delivering care. STUDY DESIGN: Longitudinal case study. METHODS: Study subjects were 105 primary care physicians (PCPs) continuously employed at a Minnesota medical group that implemented major changes in access to primary care appointments and to PCP compensation arrangements in 2000. We tracked physician productivity, physician compensation, patient satisfaction, and cost to the medical group per relative value unit (RVU) of patient care from 1998 through 2002. RESULTS: In 1998, 105 PCPs (99.6 full-time equivalents [FTEs]) generated 275,000 work RVUs (WRVUs), and PCP pay averaged 123,500 dollars per FTE. In 2002, the same 105 PCPs (now 98.1 FTEs) generated 374,000 WRVUs and 148,000 dollars pay per FTE. From 1998 through 2002, WRVUs per FTE rose 38%, PCP compensation increased 20%, cost of PCP compensation per WRVU produced fell by 13%, overall direct cost of running the clinics per total RVU fell by 20%, and patient satisfaction remained constant. Improvement in operating costs was due to increased physician productivity, lower physician compensation per RVU, and a decline in support staff per 10,000 RVUs from 6.80 to 4.50. CONCLUSIONS: It is possible to substantially and simultaneously improve costs of care, physician compensation, and patient access without harming patient satisfaction. Advanced access and productivity-based pay may be effective ways to address the challenges of timeliness, efficiency, and patient centeredness identified by the Institute of Medicine.

Efficiency↗
PubMed2005

Cholesterol levels and statin use in patients with coronary heart disease treated in primary care settings.

INTRODUCTION: Therapy with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, has proven to be effective in the treatment of lipid disorders. However, statin therapy continues to be underused, even though statins are a relatively safe and well-tolerated class of agents. In this study, we assessed trends in lipid control in patients with heart disease who receive most of their health care in primary care clinics. The objective was to determine whether systems of care implemented within a large medical group are associated with improved treatment and control of dyslipidemia in a high-risk group of coronary heart disease patients. METHODS: All adults with heart disease in a Minnesota medical group (N = 2947) were identified using diagnosis and procedure codes related to coronary heart disease (sensitivity = 0.85; positive predictive value = 0.89) in 1996. Study subjects were observed from 1995 to 1998. Subjects had a baseline and follow-up test for low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Changes between baseline and follow-up measurements and trends in the use of statins and other lipid-active agents among the study subjects were analyzed. RESULTS: Among 1388 subjects with two or more eligible lipid measurements, mean low-density lipoprotein cholesterol improved from 137.6 mg/dL to 111.0 mg/dL (P < .001), and mean high-density lipoprotein cholesterol improved from 42.3 mg/dL to 46.3 mg/dL (P < .001). The percentage of patients with low-density lipoprotein cholesterol < or = 100 mg/dL rose from 12.5% to 39.8% (P < .001), and the percentage with high-density lipoprotein cholesterol > or = 40 mg/dL rose from 52.5% to 67.6% (P < .001). In multivariate models, statin use was identified as the main factor that contributed to the improvement in low-density lipoprotein cholesterol (P < .001). Men had greater decreases in low-density lipoprotein cholesterol than women after adjusting for other variables (P < .001). Statin use rose from 24.3% at baseline to 69.6% at follow-up. The statin discontinuation rate was 8.3% for baseline statin users and 12.2% for subjects who used statins at any time during the study period. CONCLUSION: Investment in better heart disease care for patients in primary care clinics led to major improvement in lipid control over 30 months, primarily due to increased statin use. Improvements in low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were sufficient to substantially reduce risk of subsequent major cardiovascular events.

Aged↗
PubMed2005

Making improvements in the management of patients with type 2 diabetes: a possible role for the control of variation in glycated hemoglobin.

Glucose level varies over time due to a number of complex physiologic processes. Evidence suggests variation in glucose level contributes to risk of complications. The timescale associated with variation in glucose level is on the order of seconds to minutes, yet diabetes complications stem from years of cumulative effects. This difference between timescale suggests a slower timescale may better represent the influential component of variation. We hypothesize variation in glycated hemoglobin captures the component of variation associated with future complications. Moreover, we hypothesize that patient-management strategies influence variation in glycated hemoglobin level. From a systems control perspective, increasing variation may well reflect a policy of closed loop feedback control where changes in patient glycated hemoglobin are addressed after the fact. Such a strategy attends to problems as they arise. In contrast, decreasing variation may result from a clinical strategy that is anticipatory and proactive. A physician using a proactive strategy will base current moves on anticipation of future states, controlling variation in patient outcomes such as glycated hemoglobin. We motivate our discussion using observational data from a large multispecialty medical group in Minnesota: we characterize the within-patient trend and variation of glycated hemoglobin in adults with type 2 diabetes, describe patterns of variation, and identify factors associated with variation. Our hypotheses imply: (1) patterns of variation in glycated hemoglobin reflect physician treatment strategy; (2) variation provides an independent contribution to risk of diabetes complications; (3) the development of treatment strategies that control variation may be a beneficial goal in the management of type 2 diabetes.

Adult↗
PubMed2005

The QUEST for quality: what are medical groups doing about it?

BACKGROUND: It is important to know whether medical groups have quality improvement (QI) priorities, approaches, activities, and congruence that will allow them to achieve major improvements in quality of care. METHODS: Simultaneous surveys were sent to medical and administrative leaders of 18 medical groups, 84 of their constituent clinics, and their primary care physicians providing the majority of the primary care in the Minneapolis/St. Paul metropolitan area. RESULTS: Of the 18 medical groups, 17 have an overall physician leader for QI and 11 have the same at each of their constituent clinics. Nearly 100% of clinic leaders report their group leaders see QI as important and expect clinics to improve care, while 69%-84% of their physicians report the clinic leaders are committed to QI for diabetes and heart disease. Diabetes and coronary heart disease are the priorities for improvement by 14 and 12 medical groups respectively. Only seven groups report adequate QI resources and only three report that incentives are aligned with quality. Intermediate groups generally appear to be just as active and supportive of QI as large ones. DISCUSSION: These medical groups and their constituent clinics and physicians appear ready to work on the issues raised by the Institute of Medicine (IOM). However, they believe that limited resources and financial incentives that are not aligned with quality constrain their ability to help America cross the quality chasm.

Disease Management↗
PubMed2005

Chronic physical activity and feelings of energy and fatigue.

This brief review summarizes key epidemiological and experimental evidence concerning relationships between chronic physical activity and feelings of energy (vigor, vitality) and fatigue. The epidemiological studies show a positive association between the amount of typical weekly physical activity reported and the frequency with which people report feeling energetic. The randomized controlled experiments show that 10-20 wk of exercise training is associated with an increase in the frequency and intensity of feelings of energy among fatigued people with medical conditions. The results of longitudinal studies with non-fatigued, healthy adults are mixed. Overtraining by athletes is associated with increased intensity of feelings of fatigue. Additional well-controlled investigations into relationships between physical activity and feelings of energy and fatigue, especially among sedentary and fatigued individuals, are warranted given the available evidence and the importance of these moods to health, work productivity, and quality of life.

Emotions↗
PubMed2005

Physical activity and mood during pregnancy.

PURPOSE: To compare three physical activity (PA) measures in pregnant women and examine mood correlates of physical activity changes during pregnancy. METHODS: A sample of 12 pregnant women (PW) was recruited during their first trimester and 12 nonpregnant women (NPW) (baseline age = 30.7 +/- 4.4 yr) were matched to the PW (29.8 +/- 4.2 yr). Once monthly, for seven consecutive months, total weekly energy expenditure (TWEE) was assessed using a physical activity diary (PAD) and a recall interview (PAR). Accelerometers were worn for 3 d each month. Mood was also assessed. A two-factor mixed-model ANOVA was used to analyze the data (2 groups [PW vs NPW] x 7 times across pregnancy). RESULTS: Mean PAR TWEE and daily mean MTI counts were positively and moderately correlated with mean PAD TWEE (PW: r = 0.40 and NPW: r = 0.50, P < 0.001). The MTI counts decreased significantly in PW by 23% from gestational weeks 12 to 36 compared with a 5% decrease in NPW. Fatigue and vigor scores improved from gestational weeks 12 to 16 and worsened from weeks 32 to 36 in PW. Changes in PA were not correlated to changes in mood in either group. CONCLUSIONS: The results provide some evidence for the validity of the 7-d PAR and accelerometer as measures of physical activity in pregnancy. Healthy women who maintain an above average level of physical activity during the second and third trimesters can enjoy mood stability.

Affect↗
PubMed2005

Predictors of health care costs in adults with diabetes.

OBJECTIVE: The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes. RESEARCH DESIGN AND METHODS: A prospective analysis was performed of data from a patient survey and medical record review merged with 3 years of medical claims. Costs were estimated using detailed data on resource use and Medicare payment methodologies. Generalized linear models were used to analyze costs related to clinical predictors after adjusting for demographic and socioeconomic factors. RESULTS: In multivariate analysis of 1,694 adults with diabetes, 3-year costs in those with coronary heart disease (CHD) and hypertension were over 300% of those with diabetes only (46,879 dollars vs. 14,233 dollars; P < 0.05). Depression was associated with a 50% increase in costs (31,967 dollars vs. 21,609 dollars; P < 0.05). Relative to those with a baseline A1c of 6%, those with an A1c of 10% had 3-year costs that were 11% higher (26,408 dollars vs. 23,873 dollars; P < 0.05). Higher A1c predicted higher costs only for those with baseline A1c >7.5% (P = 0.015). CONCLUSIONS: In adults with diabetes, CHD, hypertension, and depression spectrum disorders more strongly predicted future costs than the A1c level. Concurrent with aggressive efforts to control glucose, greater efforts to prevent or control CHD, hypertension, and depression are necessary to control health care costs in adults with diabetes.

Coronary Disease↗