The Self-Administered Psoriasis Area and Severity Index provides an objective measure of psoriasis severity.
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Adult↗
Biomedical subjects
R T Anderson
Publications and source records attributed to R T Anderson.
Investigating correlates of health related quality of life in a low-income sample of patients with diabetes.
OBJECTIVE: We sought to describe and find correlates of health-related quality of life among under-served low-income patients in North Carolina with diabetes mellitus. METHODS: A telephone survey of 310 patients recording quality of life, patient satisfaction, self-reported health, and patient complaints was conducted as part of a diabetes care improvement project. Demographic and clinical records were available for 249 of these patients: 69% were female, 45% were minority, and 84% had type 2 diabetes. Ages ranged from 18 to 88 years with a mean of 56. Quality of life indices consisted of SF-36 physical functioning, mental health and diabetes-39 sub-scores. RESULTS: Comparison to SF-36 norms showed the sample had lower sub-scores than expected. The multivariate analysis suggested that being within an acceptable metabolic control predicted better quality of life physically, mentally, and sexually. Strong associations were detected between most sub-scores and complaints involving legs and feet, self-rated vision, and hassles in self-management. CONCLUSIONS: The consistent associations between the sub-scores and complaints, symptoms, and hassles underscore the strong relationship quality of life may share with the severity of diabetes complications as well as with psychosocial factors. Significantly lower quality of life in this sample highlights the need to improve the care of minority low-income diabetes patients.
Adolescent↗
Comment on "Abiotic controls on H2 production from basalt-water reactions and implications for aquifer biogeochemistry".
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Hydrogen↗
Effects of allergic dermatosis on health-related quality of life.
Allergic dermatosis is a class of immunologic skin diseases manifested as intense itching, which potentially leads to a cycle of skin pain, damage, and infection. Information collected from clinical samples on health-related quality of life shows that some individuals may suffer from poor-quality sleep, physical and emotional distress, and limitations in social functioning. Although many individual factors may moderate the impact of disease on quality of life, disease severity is consistently linked to amount of limitation. There are only sparse data from population surveys in which participants are not selected based on willingness to join a treatment trial for relief of symptoms. This article presents quality-of-life and disease burden data on 559 persons in a community survey who reported signs and symptoms consistent with allergic dermatosis. Quality of life was assessed using the Dermatology-specific Quality of Life (DSQL) questionnaire. Overall, greater disease severity was associated with higher DSQL scores. Noticeable deficits were reported among those who rated their disease as moderate or severe, especially in terms of physical discomfort, sleep disturbance, and negative self-perceptions and emotions. These complaints correlated significantly with out-of-pocket expenses for lotions and emollients to control skin disease. Despite these complaints, the median number of days from the last primary healthcare visit was 453 days, indicating that many dermatosis sufferers are not accessing expert medical care that could alleviate distress.
Adolescent↗
Quality of diabetes care among low-income patients in North Carolina.
BACKGROUND: Diabetes is a leading cause of death and disability, disproportionately affecting most ethnic minority groups, people of low socioeconomic status, the elderly, and people in rural areas. Despite the availability of evidence-based clinical recommendations, barriers exist in the delivery of appropriate diabetes care. The purpose of this study is to examine the level of diabetes care among low-income populations in North Carolina. METHODS: Baseline medical record abstractions were performed (N=429) on diabetic patients at 11 agencies serving low-income populations (community health centers, free clinics, primary care clinics, and public health clinics) across the state participating in a quality-of-diabetes-care initiative. Data were collected for four process (measurement of glycosylated hemoglobin and lipids, dilated eye examination, nephropathy assessment) and two outcome (glycemic and lipid control) measures based on the Diabetes Quality Improvement Project (DQIP) and the Health Plan Employer Data and Information Set (HEDIS), and three additional indicators (blood pressure measurement and control, and lower limb assessment). Compliance rates to individual measures were calculated overall and by demographic and health characteristics. RESULTS: Diabetes care compliance rates ranged from 77.9% for blood pressure testing to 3.3% for complete foot examinations. Differences in care were observed by age, insulin use, and prevalent disease. CONCLUSIONS: This study indicates low compliance with diabetes care guidelines in underserved North Carolinians, and inconsistency of care according to some demographic and health characteristics. These results stress the need for quality improvement initiatives that enhance the level of care received by patients with diabetes, particularly those most vulnerable to diabetes and its complications.
Aged↗
Magnetic resonance imaging in ophthalmoplegic migraine of children.
PURPOSE: To present 2 children with ophthalmoplegic migraine and characteristic magnetic resonance imaging (MRI) findings post enhancement with gadopentetate dimeglumine diethylenetriamine pentaacetic acid (Gd-DTPA). METHODS: Two patients, ages 3 years and 7 years, underwent MRI during the acute phases of a recurring oculomotor palsy. MRI was repeated several weeks later as symptoms resolved. RESULTS: In both cases, enhancement and thickening of the cisternal segment of the oculomotor nerve were present at initial presentation. Ophthalmoplegia resolved spontaneously in 1 child and after steroid treatment in the other. Both postresolution MRIs demonstrated decrease in enhancement and thickening of the third nerve. CONCLUSIONS: The enhancing, thickened lesion identified on MRI in our patients may represent an inflammatory process similar to Tolosa-Hunt syndrome occurring in the interpeduncular segment of the oculomotor nerve. Patients with ophthalmoplegic migraine may, therefore, benefit from the use of steroids. MRI of the brain post enhancement is a useful adjunct in the diagnosis and treatment of ophthalmoplegic migraine and should be considered as part of a workup of ophthalmoplegic migraine in children.
Acute Disease↗
A qualitative analysis of women's satisfaction with primary care from a panel of focus groups in the National Centers of Excellence in Women's Health.
Health issues unique to women and differences in healthcare experiences have recently gained attention as health plans and systems seek to extend and improve health promotion and disease prevention in the population. Successful efforts focused on enhancing quality of care will require information from the patient's perspective on how to improve such services to best support women's attempts to lead healthy and productive lives. The National Centers of Excellence in Women's Health program (CoE), sponsored by the Office on Women's Health within the Department of Health and Human Services, is based on an integrated model uniting research, training, healthcare, and community education and outreach. To examine women's concept and definitions of healthcare quality, 18 focus groups comprising 137 women were conducted nationwide on experiences and attributes of healthcare that women value in primary care. Following the focus groups, a woman-focused healthcare satisfaction instrument was developed for the purpose of assessing and improving healthcare delivery. We describe the qualitative results of the focus group study.
Adolescent↗
Predictive power of a risk-assessment questionnaire across different disease states: results in an elderly managed care enrolled population.
OBJECTIVE: To examine the predictive power of self-reported assessment questionnaire data to explain changes in healthcare service utilization and expenditures of a population of Medicare health maintenance organization enrollees during a 2-year period. STUDY DESIGN: A prospective cohort study with a 2-year postenrollment follow-up period. Multiple robust regression analyses were conducted to examine associations among self-reported health status variables obtained from responses to the questionnaire. SAMPLE AND METHODS: Participants were administered a voluntary comprehensive questionnaire at enrollment that collected self-reported information on morbidity, health status, perceptions of health, and healthcare service utilization during the preenrollment year. Questionnaire responses were combined with actual 2-year postenrollment claims data. For the complete follow-up period, 4128 patients were available. RESULTS: Participants with such chronic conditions as depression and diabetes were likelier than the average enrollee to have higher healthcare service utilization. Self-reported health status predictors examined in this study explained a larger percentage of the variance (as much as 20%) in such chronic conditions as cancer and depression. Despite evidence of underreporting of preenrollment healthcare service utilization, these variables were highly predictive of actual postenrollment utilization patterns. CONCLUSIONS: Self-reported health status information collected at baseline is as predictive of postenrollment risk as are currently used traditional approaches that require archival healthcare service utilization data. In addition, this approach is sensitive to changes in healthcare service utilization across differing morbidity states in older adults.
Activities of Daily Living↗
Effect of prescription benefit changes on medical care utilization in a Medicare HMO population.
OBJECTIVE: To examine the impact of 2 cost-containment efforts in prescription benefits in successive years that included changes in copayment and coverage levels, expanded generic coverage, and brand name prescription drug limit-of-coverage in a Medicare health maintenance organization (HMO). The benefit changes included moving to a drug benefit with increased total coverage and higher copayments in the first year (1998) and to one with brand name limit-of-coverage and unlimited generic availability in the second year (1999). STUDY DESIGN: A repeated-measures analytical design with enrollee follow-up before and after introduction of the 2 policies. PATIENTS AND METHODS: A cohort of 2411 older adults continuously enrolled in a Medicare HMO since 1998 was followed up for 1 year pre-post for healthcare service utilization and costs; 259 patients enrolled since 1997 were available to test the effects of the first policy change. RESULTS: Bivariate and multivariate analyses found a significant decrease of 27% in prescription costs, a 4% decrease in physician visits, and a 6% decrease in total costs associated with the change in prescription benefit in the second year (1999). The policy change in the first year (1998) resulted in a 29% increase in prescription costs and 38% increased total costs for the HMO. CONCLUSIONS: Introduction of a prescription benefit that included substantial brand name limit-of-coverage and generic drug coverage expansion was associated with significantly reduced prescription costs. In addition, this change did not seem to increase nonprescription-related healthcare service use in the population.
Aged↗
Hexadecane decay by methanogenesis.
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Alkanes↗
Emerging techniques for anaerobic bioremediation of contaminated environments.
Over the past decade, it has been recognized that the diversity of anaerobic microbial metabolism is far greater than was previously assumed, and that many contaminants previously considered to be recalcitrant under anoxic conditions can in fact be biotransformed in the absence of molecular oxygen. Here, we summarize recent advances in the understanding of novel forms of anaerobic microbial metabolism and their potential application to bioremediative technologies.
Anaerobiosis↗
Issues of aging and adherence to health interventions.
This review article describes several processes and considerations that are important to adherence in aging research and potential strategies that could be used to facilitate adherence among older adults. In many large aging trials participants are purposefully selected to reduce the risk of suboptimal adherence and retention. This selection often involves screening out those with barriers such as transportation needs, sensory deficits, functional dependence, major diseases limiting life expectancy, or apparent psychological distress. However, trends toward extending interventions to the general population of older adults require specific knowledge about the circumstances and processes that support adherence among older adults or the conditions that make them vulnerable to adherence problems. Addressing the diversity of needs, expectations, and capabilities of older adults that promote adherence is a key consideration in aging research. Control Clin Trials 2000;21:171S-183S
Aged↗
Race, socioeconomic status, and cause-specific mortality.
PURPOSE: Life expectancy for black Americans is five to eight years less than for Whites. The socioeconomic status (SES) of Blacks is also less than for Whites, and SES is associated with early mortality. This paper estimates the proportion of the racial difference in mortality attributable to SES by specific causes of death. METHODS: Data on 453,384 individuals in the National Longitudinal Mortality Study were used to estimate the hazard ratio associated with black race, with and without adjustment for income and education (measures of SES), in 38 strata defined by cause of death and age. RESULTS: For women, SES accounted for much (37-67%) of the black excess mortality for accidents, ischemic heart disease (ages 35-54), diabetes, and homicide; but not for hypertension, infections, and stomach cancers (11-17%). For men, SES accounted for much of the excess risk (30-55%) for accidents, lung cancer, stomach cancer, stroke, and homicide; but not for prostate cancer, pulmonary diseases, hypertension, and cardiomyopathy (0-17%). CONCLUSIONS: These results confirm those specific causes of death likely to underlie the overall excess mortality of Blacks, and identify those causes where SES may play a large role.
Adolescent↗
Caregivers' unmet needs for support in caring for functionally impaired elderly persons: a community sample.
Few estimates have been made of the extent to which the needs of caregivers are met. In addition to the inadequate capacity of services, many caregivers lack adequate financial resources, social resources, or other means to access them. Caregivers who provide services to minority or poor elderly may be particularly needy since their care receivers tend to be less healthy and are less likely to use institutional facilities. To address this issue, the authors studied a community sample of 124 caregivers who identified correlates of their perceived unmet caregiver needs and their use of supportive services available for their caregiving. Results indicated that 51.8 percent of women and 67.4 percent of men reported needs for one or more community services that were not met. It was concluded that caregivers who are poor or who required financial assistance are at the highest risk for needing assistance while providing caregiving services. Community services may more effectively target potential needs of caregivers through routine screenings.
Activities of Daily Living↗
The relation of residential segregation to all-cause mortality: a study in black and white.
OBJECTIVES: This study investigated the influence of an aggregate measure of the social environment on racial differences in all-cause mortality. METHODS: Data from the National Longitudinal Mortality Study were analyzed. RESULTS: After adjustment for family income, age-adjusted mortality risk increased with increasing minority residential segregation among Blacks aged 25 to 44 years and non-Blacks aged 45 to 64 years. In most age/race/gender groups, the highest and lowest mortality risks occurred in the highest and lowest categories of residential segregation, respectively. CONCLUSIONS: These results suggest that minority residential segregation may influence mortality risk and underscore the traditional emphasis on the social underpinnings of disease and death.
Adult↗
Self-reported health status predictors of healthcare services utilization and charges in elderly asthmatic patients.
This study examined the associations between self-reported health status predictors and healthcare service utilization in a cohort of elderly asthmatic patients. The results of the study showed a strong association among self-reported prior healthcare utilization, comorbidities, patient's perception of health status, and self-reported quality of life with healthcare service utilization and charges. A large amount of variance in healthcare service utilization and charges in this population was explained by these factors. Patient's self-reported health status could be important in earlier detection of high-risk older adults with asthma, and targeting them for disease management interventions.
Activities of Daily Living↗
Functional status, assistance, and the risk of a community-based move.
This study examined the effects of declining functional status and the availability of assistance on community-based residential mobility. Wolinsky and colleagues (1993), using data from the 1984, 1986, and 1988 waves of the Longitudinal Study on Aging, reported other transitions that result from increased health demand, namely those of nursing home placement and death. Using their functional health scales and recently available statistical techniques, we performed a two-stage analysis within a health behavior conceptual framework. We conclude that older adults who report several cognitive limitations in the absence of assistance in the home are more likely to make residential changes. Additionally, we determined that the independent effects of cognitive and lower body deterioration trigger, in this case, community-based moves even when adjusting for the effect of baseline levels of functional health and other factors in the model. Our analysis extends the earlier findings of Wolinsky and colleagues to encompass residential change as an ecological outcome of health decline in old age.
Activities of Daily Living↗
Using a hand-held computer to collect data in an orthopedic outpatient clinic: a randomized trial of two survey methods.
OBJECTIVES: In a randomized study, the authors examine how data can be collected at the point of care. Specifically, examining to what extent handheld computer data collection systems introduce bias or increase respondent difficulty. METHODS: Volunteers were randomized to 1 of 2 survey methods: the hand-held computer or a paper and pencil form of similar content. Differences between group scale scores were compared using the Wilcoxon (rank sum) test. RESULTS: The hand-held computer system produced comparable scores to paper and pencil surveys. However, there was evidence of lower internal consistency reliability with the handheld computer. CONCLUSIONS: This study demonstrated the comparability of the hand-held computer methodology to the paper and pencil methodology in obtaining survey information in an ambulatory clinic. The hand-held computer method of survey data collection offers an alternative to paper methods when point-of-care administration is acceptable. Preliminary evidence shows that this method produces comparable results to paper forms.
Adolescent↗