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Biomedical subjects

T E Kottke

Publications and source records attributed to T E Kottke.

At least 55 records · Page 3Linked to original sources
PubMed1996

A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community.

OBJECTIVE: To determine local screening rates for breast and cervical cancer screening among Cambodian women older than 50 years of age who had used the health-care system, to compare these rates with those for non-Cambodian women, to identify barriers to screening among Cambodians, and to implement community screening. MATERIAL AND METHODS: From review of medical records, cancer screening rates for 1 year among Cambodians (N = 57) were compared with rates for a matched non-Cambodian sample (N = 57). Southeast Asian focus groups identified barriers to screening as a basis for intervention. The intervention included community informational programs in the Cambodian language, group screening appointments, provision of transportation, use of female physicians and interpreters, and an informal clinic setting. Cancer screening rates were compared before and after the intervention. RESULTS: Initial screening rates for Cambodians were significantly lower than for the non-Cambodians. Expressed barriers included lack of knowledge about cancer, shyness at physical examination, lack of transportation, fear of a large, technical medical center, and individual appointments. After the intervention, community screening rates were almost 5 times higher than at baseline. CONCLUSION: The intervention was successful in overcoming organizational, economic, and cultural barriers to cancer screening among older Cambodian women in this setting.

Aged↗
PubMed1995

Cancer screening behaviors and attitudes of women in southeastern Minnesota.

OBJECTIVES: To determine the rates at which women received screening Papanicolaou tests, clinical breast examinations, and mammography and to determine the extent to which these women might be expected to respond to screening recommendations from their physicians. DESIGN: Random-digit-dial telephone interviews conducted in January 1993. SETTING: Fifteen counties in southeastern Minnesota. SUBJECTS: A sample of 1019 women who completed the telephone interview. MAIN OUTCOME MEASURES: Self-reported Papanicolaou test, clinical breast examination, and mammography screening rates, with verification from medical records for a randomly selected subsample of 200 respondents who reported having had a test within 1 year of the interview. RESULTS: For women aged 18 years and older, 60% (95% confidence interval, +/- 3.4%) reported having had a Papanicolaou test within the preceding year. For women 40 years of age and older, 57% (95% confidence interval, +/- 3.5%) reported having had a clinical breast examination in the past year, and 46% (95% confidence interval, +/- 3.6%) reported having had a screening mammogram within 1 year. The verified 1-year Papanicolaou test and mammogram rates were 35% and 33%, respectively. More than 90% of the respondents expressed a willingness to have these tests if their physicians were to advise them that the tests were indicated. However, 53% and 54% of the respondents, respectively, said that they either did not care or did not want their physicians to remind them when they were due for a Papanicolaou test or a mammogram. CONCLUSIONS: Although self-reported screening rates in this population meet Healthy People 2000 goals, verified rates were significantly below target levels. A substantial proportion of women in this population remain ambivalent about participating in cancer detection programs.

Adult↗
PubMed1995

Relation of saphenous vein graft obstruction to serum cholesterol levels.

OBJECTIVES: To determine the potential of lipid-lowering therapy to reduce saphenous vein graft obstruction, we retrospectively studied the association between graft obstruction and serum cholesterol levels. BACKGROUND: Atherosclerosis is the major cause of vein graft obstruction. Approximately 50% of grafts are occluded by 10 years after operation. It remains to be established whether lipid control affects long-term graft survival. METHODS: We carried out a retrospective review of all 284 patients who had undergone coronary artery bypass graft surgery at Juntendo University Hospital between 1976 and 1991 and met the following additional criteria: at least one saphenous vein graft, repeat coronary arteriography at some point after coronary artery bypass graft surgery and a serum cholesterol level > or = 200 mg/dl before operation. Saphenous vein graft obstruction rates were compared among three groups classified by serum cholesterol levels at follow-up arteriography: group I < 200 mg/dl; group II 200 to 239 mg/dl; group III > or = 240 mg/dl. A vein graft was considered obstructed if it was narrowed by > or = 70%. RESULTS: In group I, 88% of grafts were not obstructed 7 years after operation. The respective rates were 61% in group II and 57% in group III (p < 0.005). This relation was true for vein grafts to the left anterior descending and other coronary arteries. CONCLUSIONS: Lower serum cholesterol levels are associated with lower rates of vein graft obstruction for up to 7 years. This suggests that cholesterol-lowering therapy may improve long-term saphenous vein graft survival after coronary artery bypass surgery.

Aged↗
PubMed1995

Competing HMOs collaborate to improve preventive services.

BACKGROUND: In July 1993, an unusual collaboration developed between competing managed care plans and with competing primary care clinics as part of a federally funded research grant (IMPROVE from the Agency for Health Care Policy and Research). The goal of this collaboration is to scientifically test the ability of an health maintenance organization (HMO) to improve the delivery of eight adult preventive services by training and facilitating the use of continuous quality improvement and prevention systems by contracted private primary clinics. METHODOLOGY: In order to conduct this effectiveness study, it was necessary for two HMOs to come to a structural and functional understanding of how to operate jointly. Investigators recruited 44 private clinics for a randomized controlled trial in which 22 are being assisted in improving the process used to deliver these preventive services and 22 are being left alone as comparison clinics. The intervention is a train-the-trainer and consultation approach focused on clinics as collaborating customers. The comparison will be based on repeated surveys of patients and clinic personnel as well as chart audits to measure changes in systems and prevention rates. SUMMARY: Although this project was made possible by a number of unusual favorable factors, it can serve as a model for support of the clinician leadership that is essential to true health care delivery reform.

Adult↗
PubMed1995

Health plans helping smokers.

Tobacco use is the leading cause of preventable mortality in the United States. Therefore, health care organizations have an important role to play in the control of tobacco use both among their plan members and in the communities that they serve. To be effective, they need to adopt a policy that all tobacco users will be identified and provided with advice to quit smoking (or chewing) at each contact with a health care professional. This same policy ought to be adopted for parents of pediatric patients. The policy can be implemented by defining tobacco use as a "vital sign" and periodically assessing implementation rates with a chart review. Patients who express an interest in quitting should be supported through individual or group follow-up. To make clinical interventions more effective, to counteract tobacco promotion that is directed at youth, and to protect the health of non-smokers, HMOs will want to support local and regional tobacco control coalitions that are taking action against tobacco promotion and are promoting smoke-free public areas.

Advertising↗
PubMed1994

Evaluating the effectiveness of dyslipidemia control strategies.

While cost-effectiveness analyses of anti-hyperlipidemia programs featuring drug treatment suggest that the best use of public dollars is to delay treatment until an individual develops coronary heart disease, a comprehensive hyperlipidemia treatment policy must take a broader perspective. The high case-fatality rates of patients exhibiting first manifestations of coronary heart disease, the limited population impact of interventions aimed solely at high risk groups, the cost of testing to identify the high risk segment of the population, the social origins of the behavioral risk factors for coronary heart disease, and the perspective of the individual must also be considered. Available data suggest that the best public policy to control the burden of heart disease is one with two components: On the one hand, all individuals without clinically manifest heart disease would be encouraged to adopt healthy behaviors without an attempt to sort the population into 'high' and 'not high' risk groups. On the other hand, the risk factors of individuals who already have coronary heart disease would be treated aggressively with a case-management system of follow-up. The data that support this conclusion are presented in this paper.

Adult↗
PubMed1993

Effect of gender on long-term outcome of angina pectoris and myocardial infarction/sudden unexpected death.

OBJECTIVE: To determine the effects of female gender on long-term survival and subsequent coronary heart disease events in a population developing first clinical manifestations of coronary artery disease. DESIGN: Follow-up of all Rochester, Minn, residents first diagnosed with either angina pectoris or myocardial infarction/sudden unexpected death between January 1, 1960, and December 31, 1979. MAIN OUTCOME MEASURES: Patients with angina pectoris were followed up through 1982 for survival and time to initial myocardial infarction/cardiac death. Patients with myocardial infarction were followed up through 1982 for survival and time to recurrent myocardial infarction/cardiac death. RESULTS: Angina pectoris was the initial diagnosis for 529 women and 504 men. Myocardial infarction or sudden unexpected death was the initial diagnosis for 611 women and 997 men. The average age of patients diagnosed with angina pectoris was 67.0 years (SE, 0.5 years) for women and 60.0 years (SE, 0.5 years) for men. The average age of patients diagnosed with myocardial infarction/sudden unexpected death was 71.9 years (SE, 0.5 years) for women and 62.0 years (SE, 0.4 years) for men. Women presenting with angina pectoris survived significantly longer and had a lower incidence of subsequent myocardial infarction/cardiac death compared with men of similar age (P < .01). When rates of myocardial infarction and sudden unexpected death were combined to assess all cardiac endpoints with objective criteria ("hard" endpoints), women presenting with myocardial infarction/sudden unexpected death had survival rates and risk of subsequent myocardial infarction/coronary death that were similar to men of the same age. When survival following myocardial infarction was analyzed separately, survival also did not vary by gender. CONCLUSION: In this population, women with angina pectoris as an initial diagnosis, but not those with myocardial infarction or sudden unexpected death, have longer survival and lower risk of subsequent myocardial infarction/cardiac death than do men with the same presentation and of a similar age.

Adult↗
PubMed1993

A population-based estimate of candidacy rates for the implantable cardioverter-defibrillator.

The implantable cardioverter-defibrillator (ICD) increases survival of patients who receive the device. However, candidacy rates have not been calculated for a defined population, and the potential effect of the device on the survival of all patients with heart disease has not been estimated. To make these calculations, medical records were reviewed for 1976 to 1988 in a population demographically similar to the white population of the United States. Definite and possible candidates were identified on the basis of American Heart Association/American College of Cardiology guidelines. Candidacy rates ranged from 3.3/100,000 (counting only definite candidates for the entire period) to 8.7/100,000 (counting definite and possible candidates after 1980). Extrapolated to the 1990 U.S. population, estimates ranged from 8,207 to 21,637 new candidates each year. During an average follow-up of 5 years, half of all deaths among candidates had the potential to be delayed by an ICD. In a similar population that has a death rate from heart disease of approximately 280/100,000, 0.6 to 1.6% of subjects have the potential to have their deaths delayed to some extent by an ICD.

Actuarial Analysis↗
PubMed1993

The incidence and prevalence of congestive heart failure in Rochester, Minnesota.

Although congestive heart failure is a fairly common clinical syndrome and the societal costs associated with its care are high, relatively little is known about the incidence or prevalence of the condition in the community. Using the resources of the Rochester Epidemiology Project, we identified all 46 persons 0 through 74 years of age who had a new diagnosis of congestive heart failure during 1981 and all 113 persons with a prevalent diagnosis on Jan. 1, 1982, in the city of Rochester, Minnesota. After confirming the diagnosis in the medical record by using criteria similar to those in the Framingham study, we found the annual incidence of congestive heart failure to be 110 per 100,000 after adjusting for age. Incidence rates were higher among male than among female study subjects (157 versus 71 per 100,000). In both male and female subjects, the incidence generally increased with advancing age, reaching 1,618 per 100,000 and 981 per 100,000, respectively. Prevalence rates on Jan. 1, 1982, demonstrated similar patterns. Overall, the prevalence of congestive heart failure was higher among male than among female subjects (327 versus 214 per 100,000) and increased exponentially with advancing age, reaching almost 3% in both sexes. Survival after a diagnosis of congestive heart failure was extremely poor, with only 80% alive at 3 months and 66% at 1 year. These data underscore the effect of congestive heart failure in the community and provide estimates of the number of persons who might benefit from early intervention.

Adolescent↗
PubMed1993

Making "time" for preventive services.

Although the implementation of clinical preventive services is a high priority on the national agenda and physicians acknowledge the importance of these services, implementation rates remain far below the target years after the recommendations have been released. Physicians repeatedly report that the reason for not providing preventive services is that they do not have "time." In this article, we identify attributes of the health-services system that create this phenomenon. We present evidence that formal delivery systems for preventive services must be developed if the "time" problem is to be solved, and we review why preventive-services systems need to be integrated into the current health-services system. Finally, we list the attributes that we believe a preventive-services system must have if it is to be successful. The success of clinical trials of such systems indicates that our goals of preventive services can be achieved if all persons who have an investment in clinical preventive services commit themselves to developing and supporting these systems.

Health Policy↗
PubMed1993

Managing tobacco dependence in chemical dependency treatment facilities: a survey of current attitudes and policies.

This paper presents survey results of Minnesota licensed chemical dependency treatment facility directors. The baseline survey was conducted by telephone in May and June of 1988; and the self-administered follow-up survey was conducted in February and March of 1990, subsequent to a statewide tobacco dependence educational campaign which targeted Minnesota's chemical dependency professionals. Both the baseline (n = 227) and the follow-up (n = 257) surveys contained items concerning the directors' beliefs about the health effects of tobacco use, their attitudes regarding tobacco use in chemical dependency treatment, current tobacco policy in the facility, and barriers to banning tobacco use in the facility. The study used a matched-pair analysis (n = 104) of the survey data to assess changes in attitudes and practices during the two years of the study. The majority (71%) of chemical dependency directors at follow-up agree that tobacco dependence should be treated like other drug dependencies. The percentage of matched facilities that treat tobacco dependence increased from 10% at baseline to 18% at follow-up. The percentage of facilities that prohibit smoking increased from 11% at baseline to 27% at follow-up. Implications of the findings and areas for further research are discussed.

Behavior, Addictive↗