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Research Highlights
Investigators from Group Health Center for Health Studies continue to publish findings in epidemiology, health services, behavioral health, and clinical research, addressing a wide and evolving range of clinical and public health issues. Abstracts of several recent studies are excerpted below. Effectiveness of telephone support in increasing physical activity levels in primary care patients. Physician counseling of patients to increase physical activity has had limited success in changing behavior. Providing organizational support to primary care providers and their patients may increase effectiveness. The objective of this study was to evaluate the effectiveness of a telephone-based intervention to increase physical activity among patients who exercised less than 15 minutes daily and wanted to increase their physical activity over a six-month period. In this randomized controlled trial, conducted from 1997 to 1998, 316 patients aged 18 to 65 were recruited from a mailed health risk assessment. Baseline and six-month post-intervention telephone assessments were conducted by telephone. The intervention included three sessions of telephone-delivered motivational counseling…After adjusting for baseline exercise, there was a significantly higher level of self-reported exercise among individuals randomized to the intervention at the six-month follow-up. Conclusions: Patients can be recruited using a health-screening questionnaire to receive a telephone-delivered behavioral intervention to successfully increase their physical activity levels. Green BB, McAfee T, Hindmarsh M, Madsen L, Caplow M, Buist D. American Journal of Preventive Medicine 2002;3:177–83. Psychotropic medication use in a population of children who have attention-deficit/hyperactivity disorder. Recent reports suggest a trend of increasing prevalence of psychotropic drug prescriptions among children with attention-deficit/hyperactivity disorder (ADHD); however, reasons for the increased use of such medications is unclear. The objectives of this population-based retrospective matched cohort study were to examine differences in nonstimulant psychotropic medication fills between children with and without identified ADHD and to assess associations with non-ADHD neurobehavioral disorders. Conclusions: Children who were identified as having ADHD were more likely to have a diagnosis of other neurobehavioral disorders and to receive nonstimulant psychotropic medications than were children without ADHD. Because many of these drugs have little or no empirical basis in the treatment of ADHD, the rationale for their use is less clear. Future research to examine the use, effectiveness, and safety of these medications alone and in combination in children with ADHD is urgently needed. Guevara J, Lozano P, Wickizer T, Mell L, Gephart H. Pediatrics 2002;109(5):733–9. Risk factors for hospitalized upper or lower gastrointestinal tract bleeding in treated hypertensives. This study examined the risk factors for hospitalized gastrointestinal bleeding among health maintenance organization (HMO) members with hypertension. Conclusions: This study confirmed several known risk factors for hospitalized gastrointestinal bleeding, including hepatic disease, renal dysfunction, and medication use, and also identified smoking and physical inactivity as independent risk factors. The magnitude of the relative risks associated with these behavioral factors suggests that lifestyle modification may substantially reduce the risk of gastrointestinal bleeding. Kaplan RC, Heckbert SR, Psaty BM. Preventive Medicine 2002;34:455–62. Racial/ethnic variation in asthma status and management practices among children in managed Medicaid. Racial/ethnic disparities in hospitalization rates among children with asthma have been documented but are not well-understood. Medicaid programs, which serve many minority children, have markedly increased their use of managed care in recent years. It is unknown whether racial/ethnic disparities in health care use or other processes of care exist in managed Medicaid populations. This study of Medicaid-insured children with asthma in five managed care organizations aimed to 1) compare parent-reported health status and asthma care processes among black, Latino, and white children and 2) test the hypothesis that racial/ethnic variations in processes of asthma care exist after adjusting for socioeconomic status and asthma status. Conclusions: Black and Latino children had worse asthma status and less use of preventive asthma medications than white children within the same managed Medicaid populations. Most other processes of asthma care seemed to be equal or better for minorities in the populations studied. Increasing the use of preventive medications is a natural focus for reducing racial disparities in asthma. Lieu TA, Lozano P, Finkelstein JA, Chi FW, Jensvold NG, Capra AM, Quesenberry CP, Selby JV, Farber HJ. Pediatrics 2002;109(5): 857–65. Depressive symptoms, stress, and weight concerns among African American and European American low-income female smokers. The relationships between perceived stress, depressive symptoms, concern about weight gain, and smoking dependence were examined among 83 European American and 175 African American female smokers bringing children to pediatric clinics serving a low-income population. Among African American women, but not European American women, greater stress and more depressive symptoms predicted greater smoking dependence, and less concern about weight gain predicted greater smoking dependence. Conclusion: The stronger relationships among stress, depressive symptoms, and smoking dependence among African American women may be indicative of smoking patterns more associated with affect regulation than are the smoking patterns of European American women. Ludman EJ, Curry SJ, Grothaus LC, Graham E, Stout J, Lozano P. Psychology of Addictive Behavior 2002;16 (1):68–71. Are biomarkers useful treatment aids for promoting health behavior change? An empirical review. Some researchers have suggested that using biomarkers to educate individuals about their health status and disease risk may be an effective strategy to promote behavior change. …This article reviews the research literature to determine the effectiveness of using biomarker feedback to motivate and enable health behavior change….The results of this work were mixed, but suggest that biological information conveying harm exposure, disease risk, or impaired physical functioning may increase motivation to change. Subsequent behavior change is also affected by the availability and intensity of concomitant treatment. Conclusions: Preliminary findings suggest that combining biomarkers with appropriate behavioral treatment may enhance health behavior change, but more research in this area is warranted. McClure JB. American Journal of Preventive Medicine 2002;22(3):200–7. Body mass index and the risk of recurrent coronary events following acute myocardial infarction. Although excess adiposity appears to increase the risk of coronary heart disease in the general population, its importance in patients with established coronary disease is less defined. The study evaluated a population-based inception cohort of survivors to hospital discharge following first acute myocardial infarction (AMI) to assess the association between body mass index (BMI) and the risk of recurrent coronary events and to explore the mechanisms for this relationship. Conclusions: Excess adiposity as measured by BMI was associated with an increased risk of recurrent coronary events following AMI, particularly among those who were obese. Rea TD, Heckbert SR, Kaplan RC, Psaty BM, Smith NL, Lemaitre RN, Lin D. American Journal of Cardiology 2001;88(5):467–72. Formal education and back pain: A review. Sixty-four articles published between 1966 and 2000 that documented the association of formal education with back pain were reviewed. Overall, the current available evidence points indirectly to a stronger association of low education with longer duration and/or higher recurrence of back pain than to an association with onset. Conclusion: Scientific evidence supports the hypothesis that less well educated people are more likely to be affected by disabling back pain. Further study of this association may help advance our understanding of back pain as well as understanding of the relation between socioeconomic status and disease as a general phenomenon. Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. Journal of Epidemiology and Community Health 2001;55(7):455–68. Diuretic therapy, the alpha-adducin gene variant, and the risk of myocardial infarction or stroke in persons with treated hypertension. A genetic variant in alpha-adducin has been associated with renal sodium re-absorption and salt-sensitive hypertension. Whether this genetic variant modifies the effect of diuretic therapy on the incidence of myocardial infarction (MI) and stroke is unknown. The objective of this study was to estimate the interaction between alpha-adducin and diuretic therapy on the risk of MI or stroke. Conclusions: In carriers of the adducin variant, diuretic therapy was associated with a lower risk of combined MI or stroke than other antihypertensive therapies. If these findings are confirmed in other studies, this large subgroup of the hypertensive population may be especially likely to benefit from low-dose diuretic therapy. Psaty BM, Smith NL, Heckbert SR, Vos HL, Lemaitre RN, Reiner AP, Siscovick DS, Bis J, Lumley T, Longstreth WT Jr, Rosendaal FR. Journal of the American Medical Association 2002;287(13): 1680–9. Screening mammography: clinical image quality and the risk of interval breast cancer. The objective of this study was to evaluate the association between clinical image quality and breast cancer occurrence within 24 months of a negative mammogram. Conclusion: Invasive breast cancer detection by mammography may be improved through attention to correct positioning. Taplin SH, Rutter CM, Finder C, Mandelson MT, Houn F, White E. American Journal of Roentgenology 2002;178(4):797–803. Self-management aspects of the Improving Chronic Illness Care Breakthrough Series: Implementation with diabetes and heart failure teams. Self-management is an essential but frequently neglected component of chronic illness management that is challenging to implement. Available effectiveness data regarding self-management interventions tend to be from stand-alone programs rather than from efforts to integrate self-management into routine medical care. This article describes efforts to integrate self-management support into broader health care systems change to improve the quality of patient care in the Chronic Illness Care Breakthrough Series. We describe the general approach to system change (the Chronic Care Model) and the more specific self-management training model used. The process used in training organizations in self-management is discussed, and data are presented on teams from 21 health care systems participating in a 13-month-long Breakthrough Series to address diabetes and heart failure care. Conclusion: Available system-level data suggest that teams from a variety of health care organizations made improvements in support provided for self-management. Improvements were found for both diabetes and heart failure teams, suggesting that this improvement process may be broadly applicable. Glasgow RE, Funnell, MM, Bonomi, AE, Davis C, Beckham V, Wagner, EH. Annals of Behavioral Medicine 2002;24 (2):80–7. Results from the Working Well Trial. The current study examined the relation between drinking and smoking abstinence in a community-based sample from the Working Well Trial (WWT). Conclusions: The results suggest (a) a dose-response relation between baseline drinking and duration of smoking abstinence, and (b) that heavier drinkers are less likely to quit smoking over a four-year period. McClure JB, Wetter DW, deMoor C, Cinciripini PM, Gritz ER. Addictive Behaviors 2002;27(3):367–79. |
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