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Results for “Self-selection”

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PubMed1989

Energy intake and dietary macronutrient content in women with anorexia nervosa and volunteers.

This study was designed to compare the dietary intakes of patients with anorexia nervosa and normal controls. Twenty-four patients hospitalized for treatment of anorexia nervosa were compared with 10 normal controls. Patients ate a self-selected diet and maintained their admission weight to within 1.0 kg during this period (19 +/- 3 days). Food chosen by each subject was weighed before and after meals, and intake was determined to be the difference. Intakes of food energy, protein, fat, and carbohydrate were calculated. Patients were closely monitored to ensure that no disposal of food occurred. Patients with anorexia nervosa had a mean daily energy intake of 1,017 +/- 54 kcal (mean +/- SEM), significantly lower than the mean energy intake for controls (1,651 +/- 108 kcal). Similarly, mean intakes of macronutrients (41 +/- 4 gm protein, 34 +/- 2 gm fat, and 136 +/- 9 gm carbohydrate) were significantly lower for patients than for controls (68.5 +/- gm protein, 65 +/- 6 gm fat, and 204 +/- 13 gm carbohydrate). However, when protein, fat, and carbohydrate were assessed as a percent of total calories, there were no significant differences between patients and controls. There were also no significant differences in calories consumed per kilogram body weight. Underweight patients with anorexia nervosa who maintain their weight on an unrestricted hospital diet have energy intake per kilogram body weight and dietary macronutrient content indistinguishable from those of normal women.

Adult↗

PubMed1989

Relation of family physician or specialist care to obstetric interventions and outcomes in patients at low risk: a western Canadian cohort study.

To determine the relation of family physician or specialist care to intrapartum interventions and outcomes, we carried out a historical cohort study of 1456 obstetric patients at low risk admitted between Nov. 15, 1984, and Mar. 15, 1986, to a western Canadian teaching hospital. The patients were classified as being at low risk on admission by means of chart review. Family physicians and specialists were found to have similar rates for most of the interventions measured, although the interventions for which significantly different rates were found suggest a less interventionist style of intrapartum care by family physicians. There were no significant differences in maternal or neonatal outcomes except for a higher proportion of infants weighing less than 2500 g among primigravid women cared for by family physicians compared with those under the care of specialists. Self-selection of physician specialty by patients resulted in differences in the demographic characteristics of the two patient populations. The findings support the continued involvement of family physicians in the provision of obstetric care.

Adolescent↗

PubMedDate not supplied

The life space drawing as a measure of social relationships.

The life space drawing was prospectively assessed as a predictor of 12-month morbidity in 27 white female participants of a clinical trial. Women who subsequently experienced a high rate of self-reported morbidity (greater than or equal to 3 restricted-activity days per month) had a higher proportion of interpersonal relationships characterized by poor communication than did women with less than or equal to 2 restricted activity days per month. The quality of the relationship with a spouse/significant other appeared to be a particularly strong predictor of morbidity in this small self-selected group of women.

Adult↗

PubMed1986

Cocaine treatment outcome: cocaine use following inpatient, outpatient, and no treatment.

Based upon a sample of 83 cocaine users self-selected into one of 3 programs, several conclusions seem possible. There seems to be little difference in Ss populations who choose hospital, outpatient or self-help/no treatment. Current hospital aftercare programs may not be appropriately oriented for cocaine users. It appears the hospital program in this study retained fewer than 30% of the Ss in aftercare. Outpatient treatment for cocaine dependency is a viable form of treatment which Ss will participate in for up to 6 months on a fee for service basis. Only about 20% of the Ss who were referred to self-help groups attended more than one meeting. Preliminary outcome data suggest that outpatient treatment may result in a lower relapse rate to cocaine than hospital or no treatment. However, this conclusion is extremely guarded due to a large number of methodological issues and the short follow-up period. Relapse to cocaine use is higher among Ss who returned to alcohol or marijuana.

Cannabis↗

PubMedDate not supplied

Monitoring the levels and trends of HIV infection: the Public Health Service's HIV surveillance program.

A comprehensive, multifaceted approach to HIV surveillance is needed to provide the information necessary for public health management and policy. Because HIV infection is not readily or uniformly ascertained, survey methods and sentinel surveillance approaches must be used. At least some of the surveys must be blinded, that is, anonymous and unlinked to identifiable persons, to avoid the uninterpretable impact of self-selection bias that could lead to both significant underestimates and occasional overestimates of HIV prevalence. Other surveys must be nonblinded, with careful interviews of volunteer participants to evaluate risk factors for HIV infection. These various surveys must continue over time to evaluate trends in infection. A comprehensive family of complementary HIV surveys and studies and a national household-based HIV seroprevalence survey have been undertaken by the Public Health Service in collaboration with other Federal agencies, State and local health departments, blood collection agencies, and medical research institutions. These projects focus on accessible segments of the general population, childbearing women, persons at high risk for HIV, and persons in special settings such as prisons and colleges. This comprehensive surveillance approach will help monitor the levels and trends of HIV infection in the United States and help prioritize, target, and evaluate HIV prevention activities.

Acquired Immunodeficiency Syndrome↗

PubMed1988

An evaluation of sampling methods within communities and the validity of parasitological examination techniques in the field.

In order to enable the assessment of schistosomiasis control, it has to be monitored. The methods and techniques employed for monitoring have to be validated in turn. In the Malian National Schistosomiasis Control Programme, only samples of the village population are examined. For practical and economic reasons, the sampling procedure is not free of bias from self-selection. When rates of samples are compared with results of examining the whole population no significant difference between the rates was found. Infection rates were precise to about +/- 5%. The sensitivity and specificity of laboratory technicians put to the task of identifying and counting the eggs of Schistosoma haematobium or S. mansoni in urine or stool samples differed considerably. The lowest scores were obtained by a laboratory technician from a district health centre who accompanied the central control team for a month. The predictive values of samples read positive dropped significantly below a general prevalence of 20%. The technician from the district centre would read samples falsely positive in more than 70%. However, the same person would read only 10% of slides falsely negative, once prevalence has dropped below the threshold of 20%, when maintenance depends on the performance of basic health services. The amount of stool used for a Kato-Katz preparation is only a 25th of one gram. The distinction between light and intensive infections with S. mansoni is therefore based on counting 1 to 3 or 4 or more eggs in a preparation. In a poisson distribution with mean 1, the difference between 1 and 4 is not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1988

Profiling of wife assaulters: preliminary evidence for a trimodal analysis.

A review of the experimental literature on wife assault causation indicates that differing "profiles" of wife assaulters have been developed by different research strategies. Profiles based on interviews with victims suggest a tyrannical, personality-disordered type of wife assaulter. Clinical assessments reveal several profiles, only one of which is consistent with this view. Other types of wife assaulters are dependent and unassertive. By comparing the emerging data on wife assaulters with the initial clinical descriptions, an assessment is made of the contribution of empirical studies to date. While the potential for a major contribution to our understanding of wife assaulters exists through use of systematic empirical methods, it is concluded that this potential has not yet been fulfilled. Some suggestions are made for future research strategies to improve empirical capabilities in furthering this understanding, including a more thorough assessment of early trauma as a major causative factor affecting a large subcategory of wife assaulters and greater attention to the self-selection of wife assault samples.

Aggression↗

PubMed1988

[Problems in using survival data of cancer patients as a method of gauging the effectiveness of cancer control efforts].

Survival rates of cancer patients have been widely used as a method of gauging the effectiveness of cancer control efforts. Sometimes, however, they cannot be considered reliable indicators due to many biases, such as a lead time bias, a length bias, a self-selection bias and an overdiagnosis bias. Instead, cancer mortality rates should be used for evaluating screening programs and for assessing the recent progress against cancer, although some problems are encountered in the accuracy of death certificates.

Humans↗

PubMed1988

The association of health with stressful life changes, social supports, and coping.

Cross-sectional associations of social stressors, social supports, and coping strategies with health status were explored in a self-selected sample of 157 white adults. Using a mailed questionnaire, stressful life changes were assessed by a 40-item version of the Social Readjustment Rating Scale, social supports were measured by a 13-item index, and health status was assessed by the 63-item Duke-UNC Health Profile (DUHP). Responses to a recent stressful event were categorized by method of coping and by focus of coping. In a multivariate analysis controlling for the effects of age, gender, and education level, higher 12 month life change score was related to lower composite DUHP score. The use of active-cognitive coping was directly associated and the use of avoidance-coping was inversely associated with health status. When interaction terms were included in the multivariate analysis, avoidance-coping potentiated the adverse health effect of stressors and weak social supports potentiated the harmful effect of avoidance-coping on health. The findings suggest that the propensity to engage in avoidant behavior in response to a stressful experience is associated with health impairment, particularly when social supports are weak.

Adaptation, Psychological↗

PubMed1988

Referrals and notifications by British optometrists.

1031 British optometrists completed a questionnaire to give information on their rates of referral and notification to the medical profession. Data were collected in relation to the conditions concerned, the age and sex of the patient, and the spectacle correction. Major causes of referral were cataract, glaucoma, fundus changes, headaches/migraine/eye pain and lowered visual acuity; 6.5% of all patients seen were referred to their general medical practitioner notified, and of this group it was estimated that 25-30% could have managed with reading glasses which comprised spherical lenses of equal power. If such glasses could be self-selected, without reference to a medical practitioner or optometrist, a significant number of people would not benefit from the health screening aspects of the eye examination.

Adolescent↗

PubMed1988

South African health care and the proprietary medicine industry.

A large-scale national sample survey was conducted to assess the health and sickness profiles of the population by conventional demographic parameters. The objective was to ascertain how people treated particular ailments and in particular how and when they used proprietary medicines and other self-medication alternatives rather than a professional medical practitioner. The attitudes to self-medication by the respondents were largely positive. Self-selected treatments were perceived to be successful. A panel of physicians was asked to comment on the medical suitability of the ailments chosen for self-treatment and of the medicines selected. People were deemed generally to administer self-medication responsibly and sensibly and in the case of more serious ailments did, correctly, consult professionals.

Adolescent↗

PubMed1988

Effects of gastric bubble implant on weight change with and without compliance with a behavior modification program.

The purpose of this prospective study was to evaluate the effect of compliance versus noncompliance with a behavior modification program (BMP) for 35 patients who underwent implantation of 51 Garren-Edwards gastric bubbles (GEGB). Criteria for morbid obesity was met by every patient. Two patient groups were formed by self-selection. Compliant patients (group I) attended 75% or more of the BMP. Group II consisted of noncompliant patients, and was divided further into partially complaint and totally noncompliant. A significant difference was found in both loss of weight and loss of body mass index (BMI) between the complaint and noncompliant groups, with no significant difference in weight loss between the partially and totally noncompliant groups. Patients' compliant or noncompliant behavior had a significant effect on changes in weight (p = 0.007) and body mass index (p = 0.005). Sixteen patients had two consecutive bubble implants. The rate of compliance was significantly higher during the first implant program, with a significantly greater loss in both weight and BMI for compliant patients. Follow-up data for 28 of 35 patients revealed a continued, albeit small, average weight decrease. In summary, weight loss does not result from the gastric bubble alone. Our study demonstrates that the key factor is compliance with a behavior modification program.

Adolescent↗

PubMed1987

Correlates of adolescent parenting.

A self-selected sample of 177 teenage parents participated in a study of the correlates of teenage parenting. An ecological model of the predictors of parenting behavior was used to define factors which potentially influence teenage parents' parenting skills as measured by the Home Observation for Measurement of the Environment (HOME). The factors tested include level of punitiveness toward child rearing, knowledge of developmental milestones, level of depression, perceived social support, parental age, and parental race. The results of a stepwise hierarchical regression analysis found that parental race, punitive attitudes toward child rearing, and parental age were statistically significant predictors of total HOME scores. The older, white adolescent mother with less punitive attitudes toward child rearing and child discipline scored the highest on parenting skills. The relevance of these findings to program planners and service providers involved in teenage parent support and education programs is discussed.

Adolescent↗

PubMedDate not supplied

Reported frequency of dairy farm-associated health hazards, Otsego County, New York, 1982-1983.

We surveyed a self-selected sample of dairy farm owners/residents to determine the feasibility of establishing a surveillance system that would identify health risks common to this type of farming activity. Data obtained included demographic characteristics of the farm families, number of milk cows, prevalence of selected respiratory diseases, and farm-related injuries among farm owners. Despite a low overall response rate (45 percent), farm owners/residents reported a higher prevalence of respiratory conditions than that of the United States as a whole. Male farm owners were less likely to smoke than U.S. white males as a whole. The number of farm owners reporting farm-related injuries during a one-year period (9 percent) was similar to previous reports.

Animals↗

PubMed1987

Results of a second-opinion program for coronary artery bypass graft surgery.

Second opinions for surgical procedures are now being sought by patients or are required by insurance carriers. We examined outcomes among 88 patients (76 men; average age, 59 years) referred for a second opinion as to the need for coronary artery bypass graft surgery. All patients had undergone coronary arteriography, which disclosed in 63 (72%) multivessel coronary artery disease, while in the remaining 25 patients single-vessel disease involved the left anterior descending coronary artery. Continuation of medical therapy was recommended for 74 (84%) of the 88 patients. Sixty of these 74 patients chose this option and continued to receive medical therapy without any fatalities during a follow-up period of 27.8 months. The remaining 14 patients elected to cross over to surgical therapy at an average of 11.3 months from the second opinion. We conclude that second opinions for selected, motivated patients slated for coronary artery bypass graft operation afford a significant and safe option. Moreover, a majority of patients will adhere to a second opinion recommending medical therapy, thus reducing the need for surgical intervention by as much as 50%. Since the study was based on a small sample size of self-selected patients, these data require caution in extrapolating to the general population with coronary artery disease.

Adult↗

PubMed1979

Potential effect of demographic and other variables in studies comparing morbidity of breast-fed and bottle-fed infants.

Comparing the morbidity of breast-fed and bottle-fed infants is confounded by inherent differences in breast-feeding and bottle-feeding mothers and their infants. Self-selection introduces complex variables encompassing much more than milk source used for infant feeding. Reasons for selecting breast or bottle feeding relate to demographic, socioeconomic, educational, ethnic, cultural, and psychological factors, as well as maternal and infant physical and emotional health. Many of the differences in the maternal populations may affect infant care practices, access to medical care, and infant health status. Studies published to date have not quantified these confounding effects and other potential biases in comparing morbidity to breast- and bottle-fed infants and the relationship between milk source and incidence of infantile disease remains in question. There is need for more cautious use of the available data and investigators must seek ways to design future studies to take into account the differences between breast-feeding and bottle-feeding mothers that affect both reported and actual infant morbidity.

Bottle Feeding↗

PubMedDate not supplied

[Treatment of the sick elderly in households accommodating several generations].

Multigenerational households with widowed persons aged 70 and more have been studied in order to determine the relationship between the following two groups of variables: (a) variables in the aged person describing the existence and degree of an organic mental impairment due to a dementive process and of other signs of physical illnesses. (b) variables in her daughter or daughter in law consisting of selfratings of psychosomatic complaints and of attitude-scales. Results were as follows: (a) If there were indications of personality changes due to an organic brain syndrom the relatives had a lower degree of life-satisfaction and more frequently suffered from psychosomatic symptoms and interpersonal stress than those, whose old relatives showed an unaltered personality. (b) A great number of comparisons failed to show any statistical differences. Especially severe physical illness, organic brain syndrome and the need for physical care were not related to life satisfaction, psychosomatic complaints, stress due to emotional involvement and the attitude towards home-care. Our attempt to explain the missing correlations led to the following factors: the small size of the sample, self-selection of the sample and possibly inappropriate operationalisation and measurement of variables. In respect to these results the ongoing study will be modified in some details: There will be a qualitative analysis of transcribed semi-structured interviews. The proportion of families with severely demented relatives will be increased. In an additional step we shall examine families, who have decided to transfer their old member into an institution.

Aged↗

PubMed1978

The effect of energy and nitrogen intake upon urea production in children with uremia and undernutrition.

Children with severe uremia who had anorexia were observed in a clinical study center where dietary energy and nitrogen intake could be compared with urea nitrogen production (UNPr). The children received a supplement of dextrose and amino acids at night, ate a self-selected diet and were encouraged to use carbohydrate supplements. Energy intake varied from 22 to 110 kcal/kg/day and nitrogen intake from 105 to 323 mg/kg/day. UNPr was reciprocally related to energy intake. Nitrogen intake minus UNPr, an index of nitrogen balance, was positively related to energy intake. UNPr was not related to nitrogen intake. Nitrogen intake (NI) and NI-UNPr were correlated and the slope of the regression was 1.15. We inferred from the data that low energy intakes (less than 60 kcal/kg/day) were associated with catabolic losses of body protein. Intakes above that level were associated with a low and stable rate of UNPr. The level of energy and nitrogen intake within the range observed limited the rate of nitrogen retention. Once maintenance requirements for energy and nitrogen were satisfied, the efficiency with which nitrogen was used for net protein synthesis was very high.

Adolescent↗