RESUMEN
OBJECTIVES: To compare the efficiency and cost of two distinct but complementary recruitment strategies for a clinical trial of physically frail, community-living persons, age 75 and older. DESIGN: In the first recruitment strategy, potential participants were identified and screened for physical frailty during office visits to their primary care physicians; in the second, potential participants were identified from the patient rosters of primary care physicians and were screened for physical frailty in their home. Physical frailty was defined on the basis of slow gait speed and inability to stand from a chair with one's arms folded. SETTING: General community in greater Bridgeport, Connecticut. PARTICIPANTS: Community-living persons, age 75 and older, who met criteria for physical frailty. MEASUREMENTS: Measures of efficiency included the number of persons screened for each participant randomized, the number of persons eligible for each participant randomized, and the refusal rate. Costs were calculated per randomized participant. RESULTS: One hundred eighty-eight participants, with a mean age of 83.2 years, were enrolled over 22 months. One hundred and one participants were enrolled via the office-based strategy; 87 were enrolled via the roster-based strategy. Participants in each group had considerable quadriceps weakness and performed poorly on objective measures of gait and upper- and lower-extremity function. For each participant randomized, the number of persons screened, number of persons eligible, and cost were 15.2, 1.2, and $868, respectively, for the office-based strategy and 11.6, 1.1, and $764, respectively, for the roster-based strategy. The corresponding refusal rates for the two strategies were 14.9% and 10.1%, respectively (P < .001). CONCLUSIONS: Although each recruitment strategy successfully identified older persons who were physically frail, the roster-based strategy was less expensive and performed modestly better on each measure of efficiency than the office-based strategy.
Asunto(s)
Ensayos Clínicos como Asunto , Anciano Frágil , Evaluación Geriátrica , Selección de Paciente , Anciano , Anciano de 80 o más Años , Ensayos Clínicos como Asunto/economía , Connecticut , Análisis Costo-Beneficio , Eficiencia Organizacional , Femenino , Humanos , MasculinoRESUMEN
CONTEXT: Ischemic heart disease is the leading cause of death in the United States. Recent studies report inconsistent findings on the changes in the incidence of hospitalizations for ischemic heart disease. These reports have relied primarily on hospital discharge data. Preliminary data suggest that a significant percentage of patients suffering acute myocardial infarction (MI) in rural communities are transferred to urban centers for care. Patients transferred to a second hospital may be counted twice for one episode of ischemic heart disease. OBJECTIVE: To describe the impact of double counting and transfer bias on the estimation of incidence rates and outcomes of ischemic heart disease, specifically acute MI, in the United States. DESIGN: Analysis of state hospital discharge data from Kansas, Colorado (State Inpatient Database [SID]), Nebraska, Arizona, New Jersey, Michigan, Pennsylvania, and Illinois (SID) for the years 1995 to 1997. A matching algorithm was developed for hospital discharges to determine patients counted twice for one episode of ischemic heart disease. Validation of our matching algorithm. PATIENTS: Patients reported to have suffered ischemic heart disease (ICD9 codes 410-414, 786.5). MAIN OUTCOME MEASURES: Number of patients counted twice for one episode of acute MI. RESULTS: It is estimated that double count rates range from 10% to 15% for all states and increased over the 3 years. Moderate sized rural counties had the highest estimated double count rates at 15% to 20% with a few counties having estimated double count rates a high as 35% to 50%. Older patients and females were less likely to be double counted (P <0.05). CONCLUSIONS: Double counting patients has resulted in a significant overestimation in the incidence rate for hospitalization for acute MI. Correction of this double counting reveals a significantly lower incidence rate and a higher in-hospital mortality rate for acute MI. Transferred patients differ significantly from nontransferred patients, introducing significant bias into MI outcome studies. Double counting and transfer bias should be considered when conducting and interpreting research on ischemic heart disease, particularly in rural regions.
Asunto(s)
Interpretación Estadística de Datos , Investigación sobre Servicios de Salud/normas , Infarto del Miocardio/epidemiología , Evaluación de Resultado en la Atención de Salud/normas , Alta del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Arizona/epidemiología , Sesgo , Colorado/epidemiología , Episodio de Atención , Femenino , Mortalidad Hospitalaria , Humanos , Illinois/epidemiología , Incidencia , Kansas/epidemiología , Masculino , Michigan/epidemiología , Persona de Mediana Edad , Infarto del Miocardio/terapia , Nebraska/epidemiología , New Jersey/epidemiología , Pennsylvania/epidemiología , Vigilancia de la Población , Sensibilidad y EspecificidadRESUMEN
Although an extensive literature has accumulated documenting the maladaptive outcomes associated with childhood victimization, a limited body of knowledge addresses resilience. This paper sought to operationalize the construct of resilience across a number of domains of functioning and time periods and to determine the extent to which abused and neglected children grown up demonstrate resilience. Substantiated cases of child abuse and neglect from 1967 to 1971 were matched on gender, age, race, and approximate family social class with nonabused and nonneglected children and followed prospectively into young adulthood. Between 1989 and 1995. 1,196 participants (676 abused and neglected and 520 controls) were administered a 2-hr in-person interview, including a psychiatric assessment. Resilience requires meeting the criteria for success across six of eight domains of functioning: employment, homelessness, education, social activity, psychiatric disorder, substance abuse, and two domains assessing criminal behavior (official arrest and self-reports of violence). Results indicate that 22% of abused and neglected individuals meet the criteria for resilience. More females met the criteria for resilience and females were successful across a greater number of domains than males. We speculate on the meaning of these findings and discuss implications for the child maltreatment field. Limitations of the study are also acknowledged.
Asunto(s)
Adaptación Psicológica , Maltrato a los Niños/psicología , Desarrollo de la Personalidad , Ajuste Social , Adolescente , Adulto , Niño , Maltrato a los Niños/diagnóstico , Preescolar , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Delincuencia Juvenil/psicología , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , New Jersey , Estudios Prospectivos , Factores de Riesgo , Abandono Escolar/psicología , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
OBJECTIVE: To study the effect of specimen preparation and observer variation on the accuracy of interpretation of PAPNET images. STUDY DESIGN: The PAPNET scanner makes use of conventional Papanicolaou-stained smears and presents the cytologist with pictures of selected "abnormal" cells. This minitrial was designed to investigate the human variability in different grades of personnel and to consider any problems caused by the use of conventional smears. RESULTS: The personnel involved consisted of a consultant cytopathologist, a senior chief medical laboratory scientific officer and two senior cytotechnologists, one from another laboratory. Experience with the system ranged from six months to a few years. The best interobserver agreement was found between the senior chief and the senior technologist, who worked in the same laboratory. Majority agreement with the "gold standard" (at least three out of four) was highest for the extremes of "negative" and "high grade" smears. Three high grade smears were "missed" due to the quality of the smears and scantiness of "abnormal" cells. CONCLUSION: Although fatigue in screening is reduced by the interactive mode, it does not overcome the subjectivity of human examination both in review of the dat tape and in microscopic examination of selected cells on the slides. Experience with the method is important, and different background experiences will have an effect. The technical quality of the smear is important since the automated scanner cannot be expected to select abnormal cells if they are absent or obscured for any reason. A monolayer may be the solution, although at greater cost.
Asunto(s)
Diagnóstico por Computador/instrumentación , Prueba de Papanicolaou , Neoplasias del Cuello Uterino/prevención & control , Frotis Vaginal/instrumentación , Frotis Vaginal/métodos , Diagnóstico por Computador/métodos , Femenino , Humanos , Tamizaje Masivo , Variaciones Dependientes del Observador , Manejo de Especímenes/métodosRESUMEN
Sensitive research issues call for anonymous questionnaires. This makes accurately matching pretests with posttests difficult or impossible. Various subject-generated coding schemes have been developed, but their accuracy has been unknown. This anonymous study, with 745 students, used subject-generated coding to match pretests with posttests. The matching was verified for accuracy with the use of a collateral, anonymous, sticker identification system. The coding system was able to accurately match 75.2% of all the pretest-posttest pairs. An additional 22.1% of the pairs were left unmatched and only 2.7% were matched incorrectly. Subject-generated coding systems can be very effective where confidentiality is important to protect.
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Confidencialidad , Encuestas y Cuestionarios , Adolescente , Niño , Curriculum , Evaluación Educacional , Femenino , Educación en Salud , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Proyectos de InvestigaciónRESUMEN
In a survey of 2,548 adolescents, 11.5 percent reported ever having had the human immunodeficiency virus (HIV) antibody test. Those who had been tested were significantly more likely to be male, black, and to reside in metropolitan areas than those who had not been tested. Tested adolescents were more than three times as likely to report having injected drugs and were more than twice as likely to have had sexual intercourse, had sexual intercourse at earlier ages, and with multiple partners. More than half of adolescents who had been HIV-tested had no reported risks for HIV infection. More than one-quarter of adolescents not tested reported at least one HIV risk factor. These data suggest the importance of discussing the HIV testing and counseling process within any HIV education program directed to adolescents.
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Anticuerpos Anti-VIH/sangre , Infecciones por VIH/diagnóstico , VIH-1/inmunología , Asunción de Riesgos , Conducta Sexual , Adolescente , Distribución de Chi-Cuadrado , Colorado/epidemiología , Demografía , Femenino , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Masculino , Factores de Riesgo , Conducta Sexual/estadística & datos numéricosRESUMEN
BACKGROUND: This article reports the results of the impact of a school-based HIV prevention intervention on students' knowledge, attitudes, and behavior related to HIV infection. METHODS: Seventeen schools within six Colorado school districts were assigned to either intervention or comparison conditions. Students in 10 schools received a 15-session, skills-based HIV prevention curriculum implemented by trained teachers. A total of 2,844 students completed at least one survey during the study period; surveys were matched using demographic questions, yielding a cohort of 979 students who had baseline and 6-month follow-up data. RESULTS: Intervention students exhibited greater knowledge about HIV and greater intent to engage in safer sexual practices than the comparison students. Among sexually active students at the 6-month follow-up, intervention students reported fewer sexual partners within the past 2 months, greater frequency of using condoms, and greater intentions to engage in sex less frequently and to use a condom when having sex. Intervention students were also more likely to believe that teens their age who engage in HIV risk behaviors are vulnerable to infection. The intervention neither delayed the onset nor decreased the frequency of sexual intercourse and the frequency of alcohol and other drug use before sex by the 6-month follow-up assessment. CONCLUSIONS: The results suggest that skills-based risk reduction programs can have an effect on student behavior. Among sexually active students, evidence suggests that school-based interventions can reduce behavior associated with risk of HIV infection.
Asunto(s)
Infecciones por VIH/prevención & control , Educación en Salud/métodos , Conducta Sexual , Adolescente , Conducta del Adolescente , Colorado , Curriculum , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Masculino , Evaluación de Programas y Proyectos de Salud , Análisis de Regresión , Encuestas y CuestionariosRESUMEN
The health risks, health perceptions, and health claim costs of health hazard appraisal (HHA) responders and nonresponders were compared in a sample of employees of the Adolph Coors brewery. HHA responders had lower levels of risks than nonresponders. Responders also rated themselves in better health than nonresponders. Despite the health advantage, HHA responders were more likely to file health claims in 1989 than nonresponders and also had significantly greater claims costs. Comparing the top 10% most expensive employees in each group, however, nonresponders had greater claims costs than responders. Distribution patterns also differed based on perceived health status. HHA responders who perceived themselves in poor/fair health status tended to cost less than nonresponders of similar health. Responders perceiving themselves in good/excellent health status cost more than nonresponders. The findings support the "worried well" syndrome in healthy HHA responders.
Asunto(s)
Planes de Asistencia Médica para Empleados/economía , Promoción de la Salud/economía , Indicadores de Salud , Servicios de Salud del Trabajador/economía , Adulto , Colorado , Costos de Salud para el Patrón , Femenino , Conductas Relacionadas con la Salud , Humanos , Industrias , Masculino , Persona de Mediana EdadRESUMEN
LIFECHECK, a voluntary, in-plant cardiovascular risk identification and modification program, was developed to complement Coors Wellness Center-based programs. LIFECHECK was offered to the 1,320 employees located at the Coors Engineering Center and Can Manufacturing Complex at the Coors Brewing Company. The initial 30-minute screening included height, weight, blood pressure, cholesterol, smoking history, weekly Kcal expenditure, self-rating of health, and health effects of stress. Participants concluded the screening session with a wellness counselor who reviewed results and referred them to the appropriate intervention activities. The eight-week intervention was provided at the worksite and was available to all shifts. The intervention included an activity competition and activity classes; nutrition, hypertension, smoking, and lipid classes; a smoke-out day; one-on-one counseling; exercise equipment at four worksites; posters; traymats; table tents; and electronic messages. A total of 692 employees, 52% of those eligible, participated in the initial screening. Of these, 91% had one or more risk factors, and 33% had three to five cardiovascular disease risk factors. A total of 499 employees, 72% of those eligible, completed the follow-up screening. Thirty-two percent of the employees who participated in LIFECHECK had not used the Wellness Center in the eight years it had been open. There were significant changes in employees who completed the eight-week program for systolic blood pressure, total cholesterol, weight, physical activity, and risk of ischemic heart disease within eight years as measured by the Framingham score (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Promoción de la Salud/métodos , Salud Laboral , Adulto , Terapia Conductista , Enfermedades Cardiovasculares/economía , Demografía , Femenino , Estudios de Seguimiento , Conductas Relacionadas con la Salud , Costos de la Atención en Salud , Promoción de la Salud/economía , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Factores de RiesgoRESUMEN
Beginning in 1982, the 3-year incidence of nursing home admission was determined for community-dwelling residents aged 65 and over in East Boston, Massachusetts (4%); New Haven, Connecticut (9%); and Iowa and Washington Counties, Iowa (12%). A common methodology was used to collect baseline risk factor and follow-up data on nursing home admissions among persons in each community as part of the National Institute on Aging's Established Populations for Epidemiologic Studies of the Elderly. A multivariate logistic regression model of baseline risk factors that included the participant's age, race, sex, history of prior admission, ADL limitations, cognitive function, living arrangements, and level of income predicted 80% of the users in each community.
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Hogares para Ancianos/estadística & datos numéricos , Institucionalización/estadística & datos numéricos , Probabilidad , Anciano , Boston , Connecticut , Femenino , Humanos , Entrevistas como Asunto , Iowa , Modelos Logísticos , Masculino , Análisis Multivariante , Análisis de Regresión , Factores de Riesgo , Factores SocioeconómicosRESUMEN
The interviews of abusive caretakers originally carried out by Kadushin and Martin (1981) were coded and subjected to statistical analyses to determine what aspects of the caretakers' situation and of their interaction with the abused child had contributed to their belief that their treatment of the youngster was justified or not. A multiple regression analysis employing scores on the various indices obtained from the sample of 73 interviews indicated that the abusers tended to believe their behavior was justified if they thought the child had been defiant and they themselves had been under considerable environmental stress. On the other hand, they generally regarded their action as less justified if they had lost their temper and had been experiencing emotional distress. The latter finding suggests, in accord with Berkowitz's analysis of emotional aggression, that some instances of child battering were impulsive reactions to a provocative event. Although major emphasis is given to the meaning of these findings for the theoretical analysis of aggression, implications for protective service practice are also indicated.
Asunto(s)
Maltrato a los Niños/psicología , Relaciones Padres-Hijo , Racionalización , Adulto , Ansiedad/psicología , Niño , Trastornos de la Conducta Infantil/psicología , Depresión/psicología , Femenino , Humanos , Masculino , Desarrollo de la Personalidad , Factores de Riesgo , Estrés Psicológico/complicacionesAsunto(s)
Clorobencenos/metabolismo , Fungicidas Industriales/metabolismo , Nitrilos/metabolismo , Administración Oral , Animales , Radioisótopos de Carbono , Clorobencenos/administración & dosificación , Fungicidas Industriales/administración & dosificación , Masculino , Nitrilos/administración & dosificación , Ratas , Absorción Cutánea , Equivalencia Terapéutica , Factores de Tiempo , Tráquea/metabolismoRESUMEN
Reduction in cerebral blood flow (CBF) following global ischemia has been implicated as a pathogenetic mechanism in progressive brain damage seen after restoration of effective cardiac action and cerebral perfusion pressure. There are serious limitations to many of the techniques for measuring regional cerebral blood flow, particularly during low flow states. In 15 dogs anesthetized with thiopental, 12 minutes of total cerebral ischemia (TCI) was produced using a double balloon occlusion technique. Total and regional cerebral blood flows were sequentially measured before and after balloon release by left ventricular injection of 15 mu microspheres labelled with 5 different radionuclides. Total CBF was reduced 53 +/- 5% (mean +/- SEM) from pre-ischemic values between 1 and 3 hours after "resuscitation" despite normal perfusion pressure and arterial blood gases. CBF remained slightly reduced (24 +/- 7%) at 6 hours post-ischemia. Thirty minutes after balloon release, grey matter flow was reduced 38 +/- 8% from control values while adjacent white matter flow was increased 21 +/- 10%. However, by 1 hour after ischemia, grey and white matter flows were both reduced (60 +/- 3%, 41 +/- 5% respectively). Similar differences in brain stem and cerebellar flow were also observed. The majority (71-86%) of the reduction in total CBF seen at one hour post-TCI is due to increased cerebrovascular resistance, with 14-29% of the decrease related to arteriovenous shunting.