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Biomedical subjects

S J Zyzanski

Publications and source records attributed to S J Zyzanski.

At least 19 recordsLinked to original sources
PubMed1992

The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged men.

This study prospectively evaluated psychosocial as well as biologic, behavioral, and demographic factors in the development of duodenal ulcer. Baseline data were collected in 1963 on 8,458 Israeli men over age 40 years who had no history of duodenal ulcer. The subjects were followed for 5 years, and 254 reported the development of radiographically proven duodenal ulcer. The average annual incidence was six per 1,000 subjects. Multivariable logistic regression analysis confirmed several previously reported risk factors: smoking (odds ratio (OR) = 1.64, 95% confidence interval (Cl) 1.25-2.16), greater age (60 years and over) (OR = 1.85, 95% Cl 1.25-2.74), lower salary (OR = 1.50, 95% Cl 1.14-1.96), and lower systolic blood pressure (less than 140 mmHg) (OR = 1.58, 95% Cl 1.16-2.15). In addition, logistic regression analysis revealed a significant association of duodenal ulcer incidence with preceding measures of family stress, emotional support, and coping style. These were: increased family problems (OR = 1.60, 95% Cl 1.19-2.16), low level of perceived love and support from subject's wife (OR = 2.06, 95% Cl 1.05-4.05), and restraining retaliation when hurt by coworkers (OR = 1.89, 95% Cl 1.19-3.00). This study confirms several previously reported risk factors and underlines the importance of stress, lack of social support, and coping style in the development of duodenal ulcer.

Adaptation, Psychological↗
PubMed1992

Use of the Family CAGE in screening for alcohol problems in primary care.

OBJECTIVE: To establish the reliability and validity of the Family CAGE (an acronym indicating Cut down on drinking; Annoyed by complaints about drinking; Guilty about drinking; had an Eye-opener first thing in the morning), a four-item instrument intended to assess family alcohol-related problems. DESIGN: Two distinct cross-sectional studies using a survey, and in one study, retrospective chart review. PARTICIPANTS: A random sample of 172 adult patients presenting for nonurgent care to a network of family practice settings and a convenience sample of 107 patients who smoked presenting to a university family practice residency training setting. MAIN OUTCOME MEASURES: The Family CAGE was compared with alcohol-related variables and scales measuring psychosocial constructs. In the first study, these scales included the Family Stress and Coping Scale; Profile of Mood States; the Family Problems Checklist; and the Duke/University of North Carolina Mini-Health Profile. Chart review included medical utilization rates and prescription of medications. In the second study, a revised version of the Family CAGE was compared with other scales such as the standard CAGE questionnaire; an "Anomy" Scale; the Catchment Epidemiologic Study-Depression Scale; a global self-assessment of alcohol-related problems; and a self-report of lifetime history of major depression and recent self-limited depression. RESULTS: The Family CAGE showed strong internal consistency reliability, with Cronbach's alpha coefficients of .84 in the first study and .89 in the second. Construct validity was supported by Family CAGE correlations with family stress, family problems, depression, anxiety, individual stress, and marital dissatisfaction. The Family CAGE was strongly correlated with global assessment of family alcohol-related problems, and was superior to this variable in predicting help-seeking behavior. The Family CAGE was also significantly correlated with a higher sick visit rate and more medications prescribed (despite no difference in functional health status). The standard CAGE was correlated with a recent history of self-limited depression, while the Family CAGE was correlated with a lifetime history of major depression. Sensitivity and specificity rates vary depending on the criterion addressed, but a cutoff score of 2 or more appears to offer the best clinical information. CONCLUSION: The Family CAGE appears to be a reliable, valid, utilitarian measure of family alcohol problems. It offers more information than either a single-item global assessment regarding family alcohol-related problems or the standard CAGE questionnaire. The Family CAGE is strongly correlated with other important psychosocial problems, prescription of psychotropic medications, and health-care utilization. It is brief, understandable, and equally effective in interview and self-administered formats.

Adult↗
PubMed1992

Life events and daily hassles and uplifts as predictors of hospitalization and outpatient visitation.

Increased occurrence of major life events and daily "hassles" and "uplifts" have been shown to be associated with several measures of health status and health care utilization. In order to test for such an association with hospital admission, a prospective study was designed. Navajo Indians presenting for either inpatient or outpatient health care at a U.S. Indian Health Service facility were questioned regarding the occurrence of major life events in the preceding six months and of hassles and uplifts in the preceding week. Two years later the subsequent numbers of outpatient visits and of hospital admissions were determined for each subject. An increased number of either major life events (relative risk 1.66) or daily hassles and uplifts (relative risk 1.87) was found to be associated with an increased risk of hospital admission. The effects of major and daily life events were additive on the risk of admission. In addition, hassles were predictive of subsequent outpatient utilization. While further demonstrating the influence of major and daily life occurrences on health care utilization, this study also shows their importance in an additional cultural setting.

Adult↗
PubMed1992

Problems and issues in family medicine psychosocial research.

The authors believe that, despite their complexity, psychosocial factors should be included with biological variables in family medicine research. To aid this process, this article reviews some problems and issues in selected areas of psychosocial research relevant to family medicine. Basic background material, dimensions, models, intra-individual, intra-familial physiological mechanisms of transmission, and factors related to stress, support and coping, are discussed. This is followed by methodological issues that include research design, psychometric properties of measures, data collection, quantitative and qualitative methods, family assessment problems and techniques, and analytic procedures. The latter includes scoring problems, global versus specific questions, and statistical analyses issues. Finally, a discussion of biological relationships and potential biological markers for psychosocial processes or variables concludes this review.

Data Collection↗
PubMed1992

A clinical trial to reduce the rate of low birth weight in an inner-city black population.

BACKGROUND: The goal of our study was to measure the effectiveness of a home-based intervention for prevention of low birth weight with 154 high-risk, low-income black women attending a prenatal clinic in Cleveland. METHODS: Based on previous research, risk was defined by clinic registration between the 17th and 28th weeks of gestation, low family functioning score, and experience of at least one stressful life event prior to registration. Optional factors included being a smoker, a low maternal weight-height ratio, being age 27 or older, and a previous premature birth. A 21-item family function screen previously validated in a similar population was the primary determinant of psychosocial risk. Low birth weight was defined as weight less than 2,500 g regardless of gestational age. RESULTS: There was no decrease in the rate of low birth weight for women who received four home visits focusing on smoking, drug and nutrition education, support, and links with community services, compared to women who received no visits. The number of prenatal visits was significantly higher in the intervention group, but an increased number of prenatal visits did not correlate with a reduced rate of low birth weight. Despite previous research, the family function screen was not an effective predictor of low birth weight in our study. A revised equation involving a history of previous premature birth, smoking, and a low maternal weight-height ratio did predict low birth weight. CONCLUSIONS: These findings question the utility of short-term psychosocial interventions for influencing low birth-weight rates in low-income black clinic populations. The family function screen was not cross validated. Integration of any psychosocial intervention with the routine prenatal care occurring in the obstetrical clinic is suggested for future research.

Adolescent↗
PubMed1992

Physician agreement with US Preventive Services Task Force recommendations.

BACKGROUND: No large-scale work has yet assessed the reactions of physicians to the report of the US Preventive Services Task Force (USPSTF), despite its potential for fostering a consensus among practitioners. This study undertook a survey of family physicians to assess their agreement with the recommendations of the Task Force. METHODS: A survey containing the verbatim summary recommendations of the USPSTF was mailed to all 1784 active members of the Ohio Academy of Family Physicians. RESULTS: No evidence of selection bias was found among the 898 responding physicians. The average physician agreed with 88% of the recommendations. For a number of recommendations, however, particularly those in which the Task Force differed with the American Cancer Society, there was a high level of disagreement. Physician disagreement with the recommendations was associated with older age, not having completed a residency, male sex, less prior exposure to the USPSTF guidelines, and greater perception of the impracticality of applying them. CONCLUSIONS: The high level of agreement with most USPSTF recommendations implies that they represent an emerging consensus about which preventive services should be delivered. Attempts at USPSTF guideline dissemination should focus on recommendations with high agreement. Additional research is needed to assess the reasons for disagreement.

Age Factors↗
PubMed1991

Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy.

Dimensions of health beliefs (perceived risk of behavior and benefit of behavior change), social support (family and others' support for change), and self-efficacy (magnitude and strength) were examined in 215 patients undergoing a prospective trial of health promotion in a primary care medical practice. Discriminant analyses were performed to evaluate how well these dimensions predicted motivation for change and lifestyle behavior change. These relationships were examined for six lifestyle areas: cigarette smoking, dealing with stress, amount and type of food eaten, use of seat belts, and exercise habits. The analyses demonstrated a statistically and clinically significant prediction of motivation by one or more health belief and self-efficacy dimensions for most lifestyle areas. The strongest single predictors were perceived benefits and self-efficacy strength, which were each significant predictors of motivation in four lifestyle areas (P less than 0.05). Support dimensions, as measured, were not shown to have predictive value in most areas. Behavior change was poorly predicted by beliefs, support, and self-efficacy for most lifestyle areas. However, adding motivation to the discriminant function equation resulted in significant predictions in all six lifestyle areas (P less than 0.05), with an average correct classification rate of 71%. This finding strongly suggests that motivation is a very important intervening variable when evaluating health promotion and resulting behavior change.

Adolescent↗
PubMed1991

Health and illness behavior of Type A persons.

The complex and controversial relationship of type A behavior to myocardial infarction and other illnesses may be mediated through health habits and illness behavior. We hypothesized that type A persons tend to reject the sick role, delay in seeking medical care, seek convenient medical care facilities, are impatient for recovery, return to work before they have fully recovered, and are less likely to engage in positive health habits. A cross-sectional survey was conducted at a large corporation in Cleveland, Ohio. A detailed questionnaire that examined health-promoting and illness behaviors was sent to 385 managers, 54% of whom responded. Models tested using path analysis supported the hypotheses that type A persons are more likely than are type B employees to reject the sick role, delay in seeking medical care, be impatient for recovery, and return to work before a full recovery. The study findings imply that type A employees may be less likely to miss work for minor illnesses, but they may be prone to adverse outcomes from illnesses that require early care or assumption of the sick role. The hypothesis that type A persons are less likely to engage in positive health-habits behavior was not supported.

Adult↗
PubMed1991

Effect of the white blood count on the clinical management of the febrile infant.

BACKGROUND: The white blood count is commonly used in the evaluation of the febrile infant without a focal source of infection. This study describes the physician's use of diagnostic tests in this clinical situation and also evaluates the effect of an elevated white blood count (WBC) on diagnostic test ordering and patient management. METHODS: A case scenario describing a febrile infant was mailed to all 294 pediatric, family, general, and emergency physician members of the Academy of Medicine of Cleveland. Questions about test ordering and case management were asked, both before and after the patient's WBC was known. Physicians were randomly assigned to receive a case scenario with either a normal or an elevated WBC. RESULTS: Of the 294 physicians contracted, 196 (67%) returned usable questionnaires. Physicians ordered an average of 1.4 tests in the initial management of the case, for an average cost of $82. Emergency physicians ordered more tests than other physicians (2.4 vs 1.2 tests, P = .001). Once the WBC was known, physicians in the high WBC group ordered more additional tests than the normal WBC group (0.89 vs 0.33 tests, P less than .001), and were more likely to change to a more aggressive therapeutic management strategy (P less than .001). CONCLUSIONS: The cost of physician-ordered laboratory testing is significant for the clinical scenario of a febrile infant without a localizing source. An elevated WBC affects physician management by causing more tests to be ordered and by influencing some physicians to choose more aggressive management strategies.

Clinical Laboratory Techniques↗
PubMed1991

Characteristics of inner-city women giving birth with little or no prenatal care: a case-control study.

Lack of prenatal care has been identified as an important risk factor for poor perinatal outcomes. A case-control study was conducted to identify risk factors for inadequate prenatal care. Records of women giving birth at an inner-city hospital who had fewer than three prenatal visits (cases) were compared with those of women giving birth at the same hospital who had more adequate prenatal care (controls). The final sample contained 120 women in each group. Women in the case group were more likely to be multiparous, to be less educated, and to have no telephone in the home. Tobacco and drug abuse were recorded significantly more often among these women. There was no difference in racial distribution between the case and control groups. Infants of women with minimal or no prenatal care had a lower mean birthweight and a higher frequency of prematurity. In logistic regression analysis, higher parity, age less than 30 years, single status, smoking, drug abuse, and residence in one of two statistical planning areas in the city were independently associated with increased odds of not receiving prenatal care. To be effective, prenatal outreach programs for inner-city women must be based on knowledge of the characteristics and needs of this population.

Adult↗
PubMed1990

Prevalence of lifestyle risk factors in a family practice.

The prevalence of eight adverse lifestyle risk factors which are linked to increased morbidity and mortality was determined. Smoking, excess alcohol use, obesity, lack of exercise, lack of seatbelt use, use of hazardous transportation vehicles, and inadequate rest were studied. A random sample of 147 patients from a private family practice were selected in a cross-sectional survey. Data were collected by mailed questionnaire. The most prevalent adverse habits were lack of seatbelt use (71%) and sedentary lifestyle (44%). Patients with multiple adverse health habits had poorer self-reported physical as well as emotional well-being. Using a factor analysis of the correlations among eight habits, no significant clustering of habits emerged as indicators of high risk. Thus, no abbreviated list of adverse lifestyle risk factors for clinical use was found that could replace a complete review of risk factors.

Adult↗
PubMed1990

Patient selection and outcomes for out-of-hospital births in one family practice.

This paper reports a study of the pregnancies followed to delivery in one family medicine group practice that offered a choice of childbirth settings. Those choosing out-of-hospital birth (OHB) were a self-selected group of highly motivated couples interested in natural childbirth or desiring to minimize the cost of pregnancy care. Of 790 singleton pregnancies followed to term, 71 (9.0%) planned home births, 510 (64.6%) planned clinic births, and 209 (26.5%) planned hospital births. Of those planning clinic or home birth, 73% gave birth outside the hospital as planned (44 at home and 379 in the clinic), 81 (14%) changed plans prenatally and gave birth in a local hospital, 46 (8%) were transferred to the local hospital intrapartum, and 29 (5%) were referred to tertiary care. Primiparas who initially chose OHB were more likely than multiparas to give birth in a hospital (46% vs 16%). Controlling retrospectively for obstetric risk and parity, there were few differences in outcome between local hospital and out-of-hospital births. The observed rates of serious complications for OHB were low, but overall, 27% of those initially considered candidates for birth outside the hospital required a change to a higher level of care. For primiparas initially planning clinic or home birth, discriminant analysis revealed five variables that together might have improved the prediction of the eventual decision for hospital delivery in 46%. Clinical pelvimetry was the most powerful variable, in keeping with the finding that most intrapartum transfers were for arrests of labor. The results also suggest that financial factors and other features of the physician-patient relationship influenced clinical decision making.

Adult↗
PubMed1988

The frequency of sexual problems among family practice patients.

Two hundred-twelve patients attending a family practice center participated in a questionnaire study of their sexual identity and function. Using conservative definitions of problems, 75% were identified as having at least one specific sexual problem area. Most of these problems were functional in nature and involved desire, arousal, or orgasm. While the frequency of sexual problems was high in both sexes among all age groups, identity problems were primarily seen among the young, and desire problems among older adults. The prevalence rate of reporting sexual problems did not differ significantly by sex. However, females reported more specific sexual problems than males. Only 26% of the subjects summarized their overall sexual lives as problematic and the vast majority of patients thought their family physicians were able to help with such problems. This study reaffirms the high prevalence of sexual disorders in the population. Given adequate training, family physicians may be the ideal providers of assistance for these problems.

Adolescent↗
PubMed1988

Stress in the clinical setting: the Brief Encounter Psychosocial Instrument.

Integration of knowledge regarding the relationship between stress and illness into clinical practice has been slowed by a lack of clarity in the definition of stress and the difficulties involved in rapid assessment of stress in a busy office setting. The stimulus, response, and interactional models of stress are discussed, and the development of a new stress measure, the Brief Encounter Psychosocial Instrument (BEPSI), is detailed. The reliability of this six-item instrument is demonstrated (Cronbach's alpha .80). Validity is measured through correlation with a variety of instruments measuring stress, including depression (r = .52, P less than .001), anxiety (r = .61, P less than .001), life change (r = .56, P less than .001), bodily expression of stress (r = .56, P less than .001), and a total stress score (r = .67, P less than .001). The BEPSI also demonstrated appropriate negative correlations with family cohesion (r = .29, P = less than .01) and support (r = .31, P = less than .01). When the single open-ended item is strongly positive, 77 percent of patients also score high on the BEPSI. A negative response to the same question corresponds to a low BEPSI value 52 percent of the time. Suggestions are made regarding clinical and research applications.

Adolescent↗
PubMed1987

Predicting low birthweight and complicated labor in urban black women: a biopsychosocial perspective.

This study explored demographic, biomedical and psychosocial factors as predictors of two adverse pregnancy outcomes: intrapartum complications and low birthweight, in 140 urban black pregnant women. The intrapartum complication rate was 18%. A four factor equation (low family functioning, advanced maternal age, working during pregnancy, and short stature) predicted intrapartum complications (80% sensitivity, 67% specificity and 35% positive predictive value). The low birthweight rate was 14%. Four factors (low family functioning, stressful events, Quetelet's Index, and cigarette smoking) predicted low birthweight (65% sensitivity, 84% specificity and 42% positive predictive value). Family functioning, alone, predicted low birthweight with 65% sensitivity, 64% specificity and 31% positive predictive value. Family functioning, was the only predictor for both outcomes. Family functioning and other psychosocial risk factors may potentially improve identification of high risk pregnant urban black women.

Adolescent↗
PubMed1987

Patient satisfaction with the clinical encounter: social psychological determinants.

Patient-practitioner transactions in the ambulatory setting have become an increasingly important focus for research in recent years. In particular, there is growing interest in providing empirical support for our anecdotal, 'common-sense' notions that clinical encounter experiences are a major determinant of outcomes such as the patient's satisfaction with the encounter. The present study was designed to look at this issue and addressed the following two research questions: Is there a relationship between fulfillment of patient requests for services and patient satisfaction with the clinical encounter? and What degree of satisfaction is explained by the qualities of the encounter as compared to the characteristics of the patient, physician, and system of health care? Four newly-developed instruments were administered to a convenience sample of 144 adult patients and their physicians prior to and following actual visits to a University Family Practice Center. Meeting patients' requests increased their satisfaction with the encounter. At least 19% of the variance in patient satisfaction could be attributed to request fulfillment. The implications of these findings for future research into the doctor-patient relationship are discussed.

Adult↗
PubMed1987

Grief in widowhood and divorce.

This article describes the development of scales to assess grief and anger in widowhood and divorce. Widows have significantly higher grief scores than do divorcees, but the two groups do not differ in the degree of anger they report. Grief and anger scores are higher for widows and divorcees with social and psychological vulnerabilities and demographic characteristics that have been hypothesized as making them at greater risk for difficulties in adjustment. The data are from age, race, and census tract of residence-matched samples of widows and divorcees interviewed approximately 3 months after the death of or filing for divorce from their spouses.

Adolescent↗