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Biomedical subjects

Thomas M Vogt

Publications and source records attributed to Thomas M Vogt.

At least 19 recordsLinked to original sources
PubMed2007

Mechanisms by which childhood personality traits influence adult health status: educational attainment and healthy behaviors.

OBJECTIVE: The purpose of this study was to test a life span health behavior model in which educational attainment and health behaviors (eating habits, smoking, and physical activity) were hypothesized as mechanisms to account for relations between teacher ratings of childhood personality traits and self-reported health status at midlife. DESIGN: The model was tested on 1,054 members of the Hawaii Personality and Health cohort, which is a population-based cohort participating in a longitudinal study of personality and health spanning 40 years from childhood to midlife. OUTCOME: Childhood Agreeableness, Conscientiousness, and Intellect-Imagination influenced adult health status indirectly through educational attainment, healthy eating habits, and smoking. Several direct effects of childhood traits on health behaviors and health status were also observed. CONCLUSION: The model extends past associations found between personality traits and health behaviors or health status by identifying a life-course pathway based on the health behavior model through which early childhood traits influence adult health status. The additional direct effects of personality traits indicate that health behavior mechanisms may not provide a complete account of relations between personality and health.

Adolescent↗
PubMed2006

Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues.

Current public health and medical evidence rely heavily on efficacy information to make decisions regarding intervention impact. This evidence base could be enhanced by research studies that evaluate and report multiple indicators of internal and external validity such as Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) as well as their combined impact. However, indices that summarize the combined impact of, and complex interactions among, intervention outcome dimensions are not currently available. We propose and discuss a series of composite metrics that combine two or more RE-AIM dimensions, and can be used to estimate overall intervention impact. Although speculative and, at this point, there have been limited empirical data on these metrics, they extend current methods and are offered to yield more integrated composite outcomes relevant to public health. Such approaches offer potential to help identify interventions most likely to meaningfully impact population health.

Decision Making↗
PubMed2006

Mammography screening rates decline: a person-time approach to evaluation.

OBJECTIVES: Early detection through mammography can reduce breast cancer mortality. This cohort study evaluated trends in mammography screening, demonstrating a person-time approach. METHODS: Included were women HMO members aged 50-69 from 1999 to 2002 who had not had breast cancer, dysplasia, fibrocystic disease, or implant. The amount of person-time covered by mammography as a percent of the time eligible for mammography screening (the prevention index (PI)) was calculated using electronic data. The denominator was the time during which the guidelines recommended that each participant should have been covered by a mammogram (every 24 months), excluding times when breast mass, abnormal mammogram, galactorrhea, or other breast disorders were under evaluation. The numerator was the time during which she was covered by a mammogram. RESULTS: The number of women who contributed person-time increased from 43,283 to 49,512 and the number of screening mammograms declined from 23,586 to 22,719. The overall PI for screening mammography declined from 67.0 (67% of eligible person-time was appropriately covered by a mammogram) to 62.5, and the proportion of women with no coverage during a given year increased 16%. CONCLUSIONS: This study shows a declining pattern of mammography screening using a person-time approach, a decline greater than that shown by methods that include diagnostic mammograms. The study highlights opportunities for use of the PI and quality improvement initiatives to improve breast cancer outcomes.

Aged↗
PubMed2006

Ethnicity and nutrition of adolescent girls in Hawaii.

OBJECTIVE: To describe the ethnicity and nutrition of adolescent girls in Hawaii. DESIGN: This was a cross-sectional survey. SUBJECTS: Girls, aged 9 to 14 years, were identified from the membership files of Kaiser Permanente Hawaii, a large Hawaii health maintenance organization. MAIN OUTCOME MEASURES: Nutrient and food group intakes were compared against recommended intakes, physical activity levels, and anthropometric measurements of height, weight, body mass index (BMI), and subscapular and iliac skinfold thicknesses. STATISTICAL ANALYSIS PERFORMED: Asian girls, girls of mixed ethnicity, and white girls were compared using analysis of variance. RESULTS: Although Asian girls weighed the least and were the most sedentary, white girls had the lowest BMIs. Mixed ethnicity girls had the highest weights, BMIs, and subscapular and iliac skinfold thicknesses. No significant differences were found in major macronutrient intake. However, mixed ethnicity and Asian girls had lower fiber, iron, folate, and calcium intake than white girls. All groups met recommendations for iron intake, whereas none met fiber and calcium recommendations. All girls met folate recommendations. No differences were found in intakes for tofu, soy, grains, vegetables, or fruit and nuts food groups. Mixed ethnicity girls had the highest sweetened carbonated beverage intake although overall sugar intake was highest in white girls. Asian and mixed ethnicity girls' meat intakes were higher than white girls'. Intakes of mixed ethnicity girls more closely resembled those of Asians, although they exhibited the highest BMIs. CONCLUSIONS: These data suggest grain, vegetable, fruit, and dairy intake should be encouraged as part of a balanced diet for adolescent girls in Hawaii.

Adolescent↗
PubMed2006

Forty years on: teachers' assessments of children's personality traits predict self-reported health behaviors and outcomes at midlife.

A life span health-behavior model was investigated in this longitudinal study of personality influences on health. Teachers assessed 963 elementary schoolchildren on traits that formed scales assessing the dimensions of the five-factor (Big Five) model of personality. Smoking, alcohol use, body mass index (BMI), and self-rated health were assessed 40 years later in midlife. Childhood personality traits were significantly associated with all 4 outcomes, and the effects were consistently larger for women than men. For men and women, childhood Conscientiousness was associated with less adult smoking and better adult self-rated health and, for women only, with lower adult BMI. Mediation analyses suggested that the effects of Conscientiousness on self-rated health were partially mediated by smoking and BMI. These findings add to the growing evidence that childhood personality traits predict adult health outcomes and are discussed in terms of future testing of the life span health-behavior model.

Child↗
PubMed2006

Relationships of serum ferritin, transferrin saturation, and HFE mutations and self-reported diabetes in the Hemochromatosis and Iron Overload Screening (HEIRS) study.

OBJECTIVE: We evaluated the associations of self-reported diabetes with serum ferritin concentration, transferrin saturation (TfSat), and HFE C282Y and H63D mutations in six racial/ethnic groups recruited at five field centers in the Hemochromatosis and Iron Overload Screening (HEIRS) study. RESEARCH DESIGN AND METHODS: Analyses were conducted on 97,470 participants. Participants who reported a previous diagnosis of diabetes and/or hemochromatosis or iron overload were compared with participants who did not report a previous diagnosis. RESULTS: The overall prevalence of diabetes was 13.8%; the highest prevalence was in Pacific Islanders (20.1%). Of all participants with diabetes, 2.0% reported that they also had hemochromatosis or iron overload. The mean serum ferritin concentration was significantly greater in women with diabetes in all racial/ethnic groups and in Native-American men with diabetes than in those without diabetes. The mean serum ferritin concentration was significantly lower in Asian men with diabetes than in those without diabetes. Mean TfSat was lower in participants with diabetes from all racial/ethnic groups except Native-American women than in those without diabetes. There was no significant association of diabetes with HFE genotype. The mean serum ferritin concentration was greater (P < 0.0001) in women with diabetes than in those without diabetes for HFE genotypes except C282Y/C282Y and C282Y/H63D. Log serum ferritin concentration was significantly associated with diabetes in a logistic regression analysis after adjusting for age, sex, racial/ethnic group, HFE genotype, and field center. CONCLUSIONS: Serum ferritin concentration is associated with diabetes, even at levels below those typically associated with hemochromatosis or iron overload.

Adult↗
PubMed2005

Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study.

OBJECTIVE: To examine users' attitudes to implementation of an electronic medical record system in Kaiser Permanente Hawaii. DESIGN: Qualitative study based on semistructured interviews. SETTING: Four primary healthcare teams in four clinics, and four specialty departments in one hospital, on Oahu, Hawaii. Shortly before the interviews, Kaiser Permanente stopped implementation of the initial system in favour of a competing one. PARTICIPANTS: Twenty six senior clinicians, managers, and project team members. RESULTS: Seven key findings emerged: users perceived the decision to adopt the electronic medical record system as flawed; software design problems increased resistance; the system reduced doctors' productivity, especially during initial implementation, which fuelled resistance; the system required clarification of clinical roles and responsibilities, which was traumatic for some individuals; a cooperative culture created trade-offs at varying points in the implementation; no single leadership style was optimal--a participatory, consensus-building style may lead to more effective adoption decisions, whereas decisive leadership could help resolve barriers and resistance during implementation; the process fostered a counter climate of conflict, which was resolved by withdrawal of the initial system. CONCLUSIONS: Implementation involved several critical components, including perceptions of the system selection, early testing, adaptation of the system to the larger organisation, and adaptation of the organisation to the new electronic environment. Throughout, organisational factors such as leadership, culture, and professional ideals played complex roles, each facilitating and hindering implementation at various points. A transient climate of conflict was associated with adoption of the system.

Attitude of Health Personnel↗
PubMed2005

Natural language processing in the electronic medical record: assessing clinician adherence to tobacco treatment guidelines.

BACKGROUND: Comprehensively assessing care quality with electronic medical records (EMRs) is not currently possible because much data reside in clinicians' free-text notes. METHODS: We evaluated the accuracy of MediClass, an automated, rule-based classifier of the EMR that incorporates natural language processing, in assessing whether clinicians: (1) asked if the patient smoked; (2) advised them to stop; (3) assessed their readiness to quit; (4) assisted them in quitting by providing information or medications; and (5) arranged for appropriate follow-up care (i.e., the 5A's of smoking-cessation care). DESIGN: We analyzed 125 medical records of known smokers at each of four HMOs in 2003 and 2004. One trained abstractor at each HMO manually coded all 500 records according to whether or not each of the 5A's of smoking cessation care was addressed during routine outpatient visits. MEASUREMENTS: For each patient's record, we compared the presence or absence of each of the 5A's as assessed by each human coder and by MediClass. We measured the chance-corrected agreement between the human raters and MediClass using the kappa statistic. RESULTS: For "ask" and "assist," agreement among human coders was indistinguishable from agreement between humans and MediClass (p>0.05). For "assess" and "advise," the human coders agreed more with each other than they did with MediClass (p<0.01); however, MediClass performance was sufficient to assess quality in these areas. The frequency of "arrange" was too low to be analyzed. CONCLUSIONS: MediClass performance appears adequate to replace human coders of the 5A's of smoking-cessation care, allowing for automated assessment of clinician adherence to one of the most important, evidence-based guidelines in preventive health care.

Counseling↗
PubMed2005

Introduction.

Explore the source record for details and available documents.

Biomedical Research↗
PubMed2005

Building a research consortium of large health systems: the Cancer Research Network.

Critical questions about cancer prevention, care, and outcomes increasingly require research involving large patient populations and their care delivery organizations. The Cancer Research Network (CRN) includes 11 integrated health systems funded by the National Cancer Institute (NCI) to conduct collaborative cancer research. This article describes the challenges of constructing a productive consortium of large health systems, and explores the CRN's responses. The CRN was initially funded through an NCI cooperative agreement in 1999 and has since received a second 4-year grant. Leadership and policy development are provided through a steering committee, subcommittees, and an external advisory committee. The CRN includes integral and affiliated research projects supported by a Scientific and Data Resources Core. Three characteristics of the CRN intensified the general challenges of consortium research: 1) its members are large health systems with legitimate concerns about confidentiality of data about enrollees, providers, and the organization; 2) CRN research projects often generate highly sensitive data about quality of care; and therefore 3) each participating organization wants a strong voice in CRN direction. CRN experience to date confirms that a consortium of health systems with internal research capacity can address a range of important cancer research questions that would be difficult to study in other venues. The advantages and challenges of consortium research are explored, with suggestions for the development, execution, and management of multisystem population laboratories.

Biomedical Research↗
PubMed2004

Adolescent dairy consumption and physical activity associated with bone mass.

BACKGROUND: This study identifies key modifiable factors influencing Asian and White adolescent bone development. Cross-sectional analysis of baseline data of cohort. METHODS: Three hundred and twenty-three girls were examined from age-eligible girls at Kaiser Permanente Oahu in Hawaii. Girls' age, ethnicity, Tanner stage, 3-day diet record, level of physical activity, anthropometry, and calcaneal bone status were obtained by questionnaire and measurement, respectively. Lunar Achilles calcaneal was used to measure calcaneal bone mass. Multiple regression was used for analysis of factors influencing bone mass. RESULTS: The mean age of adolescents was 11.6 +/- 1.5 years. Girls were generally ethnically mixed; the mean Asian ethnic proportion was 48% while White ethnic proportion was 43% and other ethnic proportion was 10%. Multiple regression explained 40.8% and 25.6% of the variation in calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS), respectively, in a model where age, weight, biacromial breadth, Tanner pubic hair stage, Asian ethnicity, dairy intake, and physical activity positively influenced bone mass. CONCLUSIONS: Tanner pubic hair stage, ethnicity, and biacromial breadth had the greatest influence on SOS; while physical activity, body weight, and dairy product intake had the greatest influence on BUA.

Activities of Daily Living↗
PubMed2004

Dairy intake is associated with lower body fat and soda intake with greater weight in adolescent girls.

Body fat and weight of 9- to 14-y-old girls (n = 323) from Kaiser Permanente were studied in relation to age, ethnicity, and physical activity. Mean age, calcium intake, weight, and iliac skinfold thickness were 11.5 +/- 1.4 y, 736.5 +/- 370.7 mg/d, 44.6 +/- 13.0 kg, and 12.4 +/- 6.1 mm, respectively. Multiple regression with age, ethnicity, height, Tanner breast stage, physical activity, energy, soda, and calcium intake explained 17% of the variation in iliac skinfold thickness. Calcium intake, age, and physical activity were significantly negatively associated with iliac skinfold thickness whereas height, Tanner breast stage, and Pacific Islander ethnicity were significantly positively associated (P < 0.0001, R(2) = 0.165). Substituting total calcium with dairy and nondairy calcium in separate models accounted for 16 and 15% of the variance, respectively (P < 0.0001, both models); 1 mg of total and dairy calcium was significantly associated with 0.0025 mm (P = 0.01) and 0.0026 mm (P = 0.02) lower iliac skinfold thickness. Thus, 1 milk serving was associated with 0.78 mm iliac skinfold thickness. The interaction of Asian ethnicity and dairy intake was significant (P = 0.027). Nondairy calcium was not associated with weight or iliac skinfold thickness. Soda intake was significantly positively associated with weight in both models (P = 0.01, both models). Decreasing soda and increasing dairy consumption among Asians may help maintain body fat and weight during adolescence.

Adipose Tissue↗
PubMed2004

The Prevention Index: using technology to improve quality assessment.

OBJECTIVE: To improve quality of care assessment for preventive medical services and reduce assessment costs through development of a comprehensive prevention quality assessment methodology based on electronic medical records (EMRs). DATA SOURCES: Random sample of 775 adult and 201 child members of a large nonprofit managed care system. STUDY DESIGN: Problems with current, labor-intensive quality measures were identified and remedied using EMR capabilities. The Prevention Index (PI) was modeled by assessing five-year patterns of delivery of 24 prevention services to adult and child health maintenance organization (HMO) members and comparing those services to consensus recommendations and to selected Health Plan Employer Data and Information Set (HEDIS) scores for the HMO. DATA COLLECTION: Comprehensive chart reviews of 976 randomly selected members of a large managed care system were used to model the Prevention Index. PRINCIPAL FINDINGS: Current approaches to prevention quality assessment have serious limitations. The PI eliminates these limitations and can summarize care in a single comprehensive index that can be readily updated. The PI prioritizes services based on benefit, using a person-time approach, and separates preventive from diagnostic and therapeutic services. CONCLUSIONS: Current methods for assessing quality are expensive, cannot be applied at all system levels, and have several methodological limitations. The PI, derived from EMRs, allows comprehensive assessment of prevention quality at every level of the system and at lower cost. Standardization of quality assessment capacities of EMRs will permit accurate cross-institutional comparisons.

Adult↗
PubMed2004

Tobacco control efforts in managed care: what do the doctors think?

OBJECTIVES: To use physician reports to evaluate their awareness of health plan tobacco control guidelines and cessation support coverage and to validate the extent to which health plan cessation support material had been disseminated and implemented in clinical settings. STUDY DESIGN: Comparison of survey responses of physicians with tobacco control activities reported by key informants in the health plans with which those physicians were associated. METHODS: A total of 100 primary care physicians in the care delivery organizations associated with 9 nonprofit health plans were randomly selected to receive a survey asking about their health plan's tobacco cessation guidelines, coverage, and support for clinician action. Their responses were compared to data reported by the plan with which they were associated. RESULTS: Responses were obtained from 91%. Although 88% were aware of their health plan's tobacco cessation guidelines, considerably fewer were correctly aware of whether the health plan covered medications and cessation classes or counseling. Physician reports of cessation supports during care bore little relationship to health plan reports of those supports. CONCLUSIONS: Physician reports may be a useful way to verify health plan dissemination and implementation of tobacco control activities. Even these relatively high-performing plans have ample room for further improvement.

Attitude of Health Personnel↗
PubMed2004

The role of research in integrated healthcare systems: the HMO Research Network.

Science is the basis of medicine. Good science leads to better decisions and more effective systems to support those decisions. Most individuals associate science primarily with academic institutions. However, top-quality research relevant to managing the health of populations and the care of specific clinical conditions is increasingly being carried out by investigators working in integrated healthcare systems. This introduction outlines the activities of the HMO Research Network, whose researchers have made and continue to make important contributions to the field of health research. Its objective is to inform readers of the activities and value of systems-based health research. We describe the importance and extent of the research conducted by HMO Research Network members, as well as the advantages of conducting research in such settings.

Delivery of Health Care, Integrated↗
PubMed2003

The safety net: a cost-effective approach to improving breast and cervical cancer screening.

PURPOSE: The purposes of the study were (1). to assess the cost-effectiveness of three interventions to deliver breast and cervical cancer screening to women unscreened for >or=3 years and (2). to determine the relation of an invasive cervical cancer diagnosis to the interval since the last true screening test. METHODS: In a randomized trial, women were randomly assigned to (1). usual care, (2). letter plus follow-up letter, (3). letter plus follow-up phone call, (4). phone call plus follow-up phone call. Screening within 12 weeks was the outcome. A 5-year retrospective review of cervical cancer cases and screening histories was done. RESULTS: The 8% of women not screened for >or=5 years had 62% of the invasive cervical cancer cases. Mammography outreach led to screening in 10%, 24%, 51%, and 50% of controls, letter/letter, letter/phone, and phone/phone interventions groups, respectively. Cervical cancer screening outreach led to screening in 17%, 22%, 54%, and 50% of the respective groups. Letter reminders alone produced fewer tests at substantially higher costs than did personalized telephone notification. CONCLUSIONS: For cervical cancer, only 1 person in 12 was not screened in the preceding 5 years, but these accounted for nearly two thirds of invasive cancers. Aggressive outreach to the rarely screened is an important part of screening programs. Letter reminder, followed by a telephone appointment call, was the most cost-effective approach to screening rarely screened women. Lack of accurate information on prior hysterectomy adds substantial unnecessary costs to a screening reminder program.

Adult↗