111 results on '"PERZYNSKI, ADAM T."'
Search Results
2. Self-reported determinants of COVID-19 vaccine acceptance among persons with and without autoimmune disease
- Author
-
Gong, Jenny D., Barnboym, Emma, O'Mara, Megan, Gurevich, Natalie, Mattar, Maya, Anthony, Donald D., Perzynski, Adam T., and Singer, Nora G.
- Published
- 2024
- Full Text
- View/download PDF
3. Clinical and sociodemographic characteristics as predictors for quality of life in transmasculine and transfeminine individuals receiving gender-affirming hormone therapy
- Author
-
Lad, Saloni U., Sinopoli, Jacob, Khong, Brian, Conroy, Britt, Perzynski, Adam T., and del Rincon, Juan P.
- Published
- 2024
- Full Text
- View/download PDF
4. Community Members as Reviewers of Medical Journal Manuscripts: a Randomized Controlled Trial
- Author
-
Huml, Anne M., Albert, Jeffrey M., Beltran, Joshua M., Berg, Kristen A., Collins, Cyleste C., Hood, Erika N., Nelson, Lisa C., Perzynski, Adam T., Stange, Kurt C., and Sehgal, Ashwini R.
- Published
- 2023
- Full Text
- View/download PDF
5. Neighborhood and racial influences on triple negative breast cancer: evidence from Northeast Ohio
- Author
-
Eom, Kirsten Y., Berg, Kristen A., Joseph, Natalie E., Runner, Kristen, Tarabichi, Yasir, Khiyami, Amer, Perzynski, Adam T., and Sossey-Alaoui, Khalid
- Published
- 2023
- Full Text
- View/download PDF
6. Alzheimer`s disease mortality in the United States: Cross-sectional analysis of county-level socio-environmental factors
- Author
-
Salerno, Pedro RVO, Dong, Weichuan, Motairek, Issam, Makhlouf, Mohamed HE, Saifudeen, Mehlam, Moorthy, Skanda, Dalton, Jarrod E, Perzynski, Adam T., Rajagopalan, Sanjay, and Al-Kindi, Sadeer
- Published
- 2023
- Full Text
- View/download PDF
7. The ADI-3: a revised neighborhood risk index of the social determinants of health over time and place
- Author
-
Berg, Kristen A., Dalton, Jarrod E., Gunzler, Douglas D., Coulton, Claudia J., Freedman, Darcy A., Krieger, Nikolas I., Dawson, Neal V., and Perzynski, Adam T.
- Published
- 2021
- Full Text
- View/download PDF
8. A Medicaid-Funded Statewide Diabetes Quality Improvement Collaborative: Ohio 2020‒2022.
- Author
-
Bolen, Shari D., Joseph, Joshua J., Dungan, Kathleen M., Beverly, Elizabeth A., Perzynski, Adam T., Einstadter, Douglas, Fiegl, Jordan, Love, Thomas E., Spence, Douglas, Jenkins, Katherine, Lorenz, Allison, Uddin, Shah Jalal, Adams, Kelly McCutcheon, Konstan, Michael W., and Applegate, Mary S.
- Subjects
DIABETES prevention ,GLYCOSYLATED hemoglobin ,INSTITUTIONAL cooperation ,HEALTH services accessibility ,MANAGED care programs ,EVALUATION of human services programs ,GLYCEMIC control ,DIABETES ,COST control ,PUBLIC health ,PRIMARY health care ,HUMAN services programs ,QUALITY assurance ,INTERPROFESSIONAL relations ,MEDICAL schools ,MEDICAID ,ENDOWMENTS ,HEALTH impact assessment ,ADVERSE health care events - Abstract
We used a collective impact model to form a statewide diabetes quality improvement collaborative to improve diabetes outcomes and advance diabetes health equity. Between 2020 and 2022, in collaboration with the Ohio Department of Medicaid, Medicaid Managed Care Plans, and Ohio's seven medical schools, we recruited 20 primary care practices across the state. The percentage of patients with hemoglobin A1c greater than 9% improved from 25% to 20% over two years. Applying our model more broadly could accelerate improvement in diabetes outcomes. (Am J Public Health. 2023;113(12):1254–1257. https://doi.org/10.2105/AJPH.2023.307410) [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
9. What Works in a Nurse Led Self-Management Program for Patients with Serious Mental Illness (SMI) and Diabetes (DM)
- Author
-
Blixen, Carol, Kanuch, Stephanie W., Perzynski, Adam T., Thomas, Charles, Dawson, Neal V., and Sajatovic, Martha
- Published
- 2018
- Full Text
- View/download PDF
10. Promoting the development of resilient academic functioning in maltreated children
- Author
-
Holmes, Megan R., Yoon, Susan, Berg, Kristen A., Cage, Jamie L., and Perzynski, Adam T.
- Published
- 2018
- Full Text
- View/download PDF
11. Optimal Omeprazole Dosing and Symptom Control: A Randomized Controlled Trial (OSCAR Trial)
- Author
-
Waghray, Abhijeet, Waghray, Nisheet, Perzynski, Adam T., Votruba, Mark, and Wolfe, M. Michael
- Published
- 2019
- Full Text
- View/download PDF
12. Physical abuse after child protective services investigation and adolescent substance use
- Author
-
Kobulsky, Julia M., Holmes, Megan R., Yoon, Susan, and Perzynski, Adam T.
- Published
- 2016
- Full Text
- View/download PDF
13. Ecologic Momentary Assessment: Perspectives on Applications and Opportunities in Research and Practice Regarding Nutrition Behaviors
- Author
-
Hand, Rosa K. and Perzynski, Adam T.
- Published
- 2016
- Full Text
- View/download PDF
14. A Preliminary Analysis of Individuals With Serious Mental Illness and Comorbid Diabetes
- Author
-
Sajatovic, Martha, Gunzler, Douglas, Einstadter, Douglas, Thomas, Charles, McCormick, Richard, Perzynski, Adam T., Kanuch, Stephanie, Cassidy, Kristin A., and Blixen, Carol
- Published
- 2016
- Full Text
- View/download PDF
15. Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study.
- Author
-
Becerril, Alissa, Pfoh, Elizabeth R., Hashmi, Ardeshir Z., Mourany, Lyla, Gunzler, Douglas D., Berg, Kristen A., Krieger, Nikolas I., Krishnan, Kamini, Moore, Scott Emory, Kahana, Eva, Dawson, Neal V., Luezas Shamakian, Lorella, Campbell, James W., Perzynski, Adam T., and Dalton, Jarrod E.
- Subjects
DEMENTIA risk factors ,CONFIDENCE intervals ,RACE ,RETROSPECTIVE studies ,SOCIOECONOMIC factors ,RISK assessment ,DEMENTIA ,DESCRIPTIVE statistics ,FACTOR analysis ,RESEARCH funding ,SPATIAL behavior ,NEIGHBORHOOD characteristics ,LONGITUDINAL method - Abstract
Background: Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. Methods: In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR‐documented dementia diagnosis or dementia‐related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing‐risk regression analysis, with non‐dementia‐related death as the competing risk. Fine‐Gray sub‐distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. Results: Increasing neighborhood disadvantage was associated with increased risk of EHR‐documented dementia diagnosis or dementia‐related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69–1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. Conclusion: Neighborhood disadvantage is related to the risk of EHR‐documented dementia diagnosis or dementia‐related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
16. Go‐along interview assessment of community health priorities for neighborhood renewal.
- Author
-
Berg, Kristen A., DeRenzo, Maria, Carpiano, Richard M., Lowenstein, Irwin, and Perzynski, Adam T.
- Subjects
NEIGHBORHOODS ,COMMUNITY development ,SOCIAL belonging ,COMMUNITIES ,PUBLIC health - Abstract
Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go‐along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra‐ and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self‐worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well‐being by being valid and meaningful to the community of focus. Highlights: Health system investments in social determinants are often untethered from neighborhood preferences.Go‐along interviews efficiently ascertain community priorities for neighborhood transformation.Neighborhood residents articulate social connectedness as a key meaning of health.Participants described neighborhood emplacement of self‐worth from internalizing outsiders' views.Community development interventions should include resident voices in planning and evaluation. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
17. A randomized prospective pilot trial of Web‐delivered epilepsy stigma reduction communications in young adults
- Author
-
Sajatovic, Martha, Herrmann, Lynn K., Van Doren, Jamie R., Tatsuoka, Curtis, Welter, Elisabeth, Perzynski, Adam T., Bukach, Ashley, Needham, Kelley, Liu, Hongyan, and Berg, Anne T.
- Published
- 2017
- Full Text
- View/download PDF
18. Experiences with Continuous Positive Airway Pressure Among African American Patients and their Bed Partners.
- Author
-
Berg, Kristen A., Marbury, Marquisha, Whaley, Morgan A., Perzynski, Adam T., Patel, Sanjay R., and Thornton, J. Daryl
- Subjects
CONTINUOUS positive airway pressure ,AFRICAN Americans ,DROWSINESS ,SLEEP apnea syndromes ,VIDEOCONFERENCING ,URBAN health ,THEMATIC analysis - Abstract
Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking. To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play. We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis. 15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP. African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
19. Food Insecurity Trajectories in the US During the First Year of the COVID-19 Pandemic.
- Author
-
Kim-Mozeleski, Jin E., Moore, Stephanie N. Pike, Trapl, Erika S., Perzynski, Adam T., Tsoh, Janice Y., and Gunzler, Douglas D.
- Published
- 2023
- Full Text
- View/download PDF
20. How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?
- Author
-
Perzynski, Adam T. and Stange, Kurt C.
- Subjects
- *
SCHIZOPHRENIA treatment , *PERSONALITY , *WELL-being , *CONTINUING education units , *MEDICAL screening , *DRUGS , *MEDICAL ethics , *SOCIAL status , *HOMELESSNESS , *PATIENT compliance , *PATIENT care , *DIGNITY , *NEEDS assessment , *SOCIAL services - Abstract
Patients experiencing homelessness and mental illness face conditions and circumstances that deserve focused ethical and clinical attention. The first commentary on the case applies insights from qualitative research about social determinants of health to these patients' care and dignity. The second commentary describes 3 kinds of power wielded by physicians--charismatic, social, and Aesculapian--each of which is considered in terms of whether and to what extent physicians' power should be owned, aimed, or shared. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
21. Attitudinal Tolerance of Deviance in At-Risk Early Adolescents.
- Author
-
Kim, June-Yung, Minnes, Sonia, Ridenour, Ty A., Perzynski, Adam T., Min, Meeyoung O., and Singer, Lynn T.
- Subjects
PRENATAL drug exposure ,TOLERATION ,TEENAGERS ,AT-risk behavior ,TEENAGE girls ,SEXUAL intercourse ,PRENATAL exposure - Abstract
Objective: Problem behavior theory hypothesizes that adolescent attitudinal tolerance of deviance (ATD) precedes health risk behaviors. We examined ATD patterns among early adolescents with prenatal drug exposure and associated the patterns with subsequent risk behaviors. The ATD patterns were further characterized by concurrent developmental contexts. Method: Participants were 306 urban adolescents (51% girls), primarily African American and of low socioeconomic status, from a prospective birth-cohort study on the effects of prenatal cocaine exposure. ATD was assessed at age 12. Substance use, via self-report and biologic assays, and sexual intercourse before age 15 were assessed at age 15. Adolescents reported on measures assessing their family, peer, and neighborhood environments at age 12. Results: Latent class analysis identified three patterns: intolerance (G1; 59%), tolerance of relational deviance (G2; 30%), and tolerance of all deviance (G3; 11%). The patterns with tolerant attitudes (G2, G3) and the intolerance pattern (G1) were differentially related to subsequent alcohol use and sexual risk behaviors. Adolescents' current developmental contexts were distinctively associated with the ATD patterns, demonstrating the validity of the extracted patterns. Conclusions: Identifying ATD patterns in early adolescence may facilitate etiology research and prevention strategies among at-risk urban adolescents with prenatal drug exposure. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
22. Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression
- Author
-
Bolen, Shari D., Chandar, Apoorva, Falck-Ytter, Corinna, Tyler, Carl, Perzynski, Adam T., Gertz, Alida M., Sage, Paulette, Lewis, Steven, Cobabe, Maurine, Ye, Ying, Menegay, Michelle, and Windish, Donna M.
- Published
- 2014
- Full Text
- View/download PDF
23. Evaluating and Modeling Neighborhood Diversity and Health Using Electronic Health Records.
- Author
-
Dalton, Jarrod E., Pfoh, Elizabeth R., Dawson, Neal V., Mourany, Lyla, Becerril, Alissa, Gunzler, Douglas D., Berg, Kristen A., Einstadter, Douglas, Krieger, Nikolas I., and Perzynski, Adam T.
- Abstract
Background: Electronic health records (EHRs) provide researchers with abundant sample sizes, detailed clinical data, and other advantages for performing high-quality observational health research on diverse populations. We review and demonstrate strategies for the design and analysis of cohort studies on neighborhood diversity and health, including evaluation of the effects of race, ethnicity, and neighborhood socioeconomic position on disease prevalence and health outcomes, using localized EHR data. Methods: Design strategies include integrating and harmonizing EHR data across multiple local health systems and defining the population(s) of interest and cohort extraction procedures for a given analysis based on the goal(s) of the study. Analysis strategies address inferential goals, including the mechanistic study of social risks, statistical adjustment for differences in distributions of social and neighborhood-level characteristics between available EHR data and the underlying local population, and inference on individual neighborhoods. We provide analyses of local variation in mortality rates within Cuyahoga County, Ohio. Results: When the goal of the analysis is to adjust EHR samples to be more representative of local populations, sampling and weighting are effective. Causal mediation analysis can inform effects of racism (through racial residential segregation) on health outcomes. Spatial analysis is appealing for large-scale EHR data as a means for studying heterogeneity among neighborhoods even at a given level of overall neighborhood disadvantage. Conclusions: The methods described are a starting point for robust EHR-derived cohort analysis of diverse populations. The methods offer opportunities for researchers to pursue detailed analyses of current and historical underlying circumstances of social policy and inequality. Investigators can employ combinations of these methods to achieve greater robustness of results. Highlights: EHR data are an abundant resource for studying neighborhood diversity and health. When using EHR data for these studies, careful consideration of the goals of the study should be considered in determining cohort specifications and analytic approaches. Causal mediation analysis, stratification, and spatial analysis are effective methods for characterizing social mechanisms and heterogeneity across localized populations. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
24. Neighborhood-Level Disparities in Hypertension Prevalence and Treatment Among Middle-Aged Adults.
- Author
-
Blazel, Madeleine M., Perzynski, Adam T., Gunsalus, Paul R., Mourany, Lyla, Gunzler, Douglas D., Jones, Robert W., Pfoh, Elizabeth R., and Dalton, Jarrod E.
- Published
- 2024
- Full Text
- View/download PDF
25. Communicating about Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives
- Author
-
Blixen, Carol E., Webster, Noah J., Hund, Andrew J., Perzynski, Adam T., Kanuch, Stephanie W., Stoller, Eleanor Palo, McCormick, Richard A., and Dawson, Neal V.
- Published
- 2008
- Full Text
- View/download PDF
26. The impact of ethnic involvement and migration patterns on long-term care plans among retired Sunbelt migrants: plans for nursing home placement
- Author
-
Stoller, Eleanor Palo and Perzynski, Adam T.
- Subjects
Nursing homes -- Research ,Health ,Psychology and mental health ,Seniors - Abstract
Department of Sociology, Case Western Reserve University, Cleveland, Ohio. Objectives. We examine anticipated preferences for nursing home placement as a strategy for meeting possible future long-term care needs among a sample of community-dwelling elderly European Americans who migrated to Florida after retirement. We synthesize prior research on ethnicity in late life, retirement migration patterns, and informal networks of retired migrants. Methods. We gathered data through structured personal interviews with 578 retired migrants identified through screening from telephone listings, supplemented with snowball sampling techniques. Results. Lifetime migration patterns and current ethnic involvement are significant predictors of mentioning nursing home placement as a strategy for possible long-term care needs. Discussion. We interpret these results within the framework of Rowles's emphasis on the permeability of community-nursing home boundaries.
- Published
- 2003
27. Pandora's briefcase: unpacking the retirement migration decision
- Author
-
Longino, Charles F., Jr., Perzynski, Adam T., and Stoller, Eleanor P.
- Subjects
Gerontology -- Research ,Retirement -- Research ,Psychology and mental health ,Seniors - Abstract
This is an exploratory study of the decision process leading to retirement migration. It uses a unique national study of a sample (n = 255) of retirees who were aging in place in a city in the upper Midwest, and a sample (n = 593) of retired migrants to a Southeastern community in Florida. Both sets of respondents were asked an extensive set of questions (1) about their potential move (or the experience of having moved), and how destinations are chosen; (2) about their attachments to people and places in their lives; and (3) their images of the advantages and disadvantages of living in their current and other locations. These data were sorted in a spirit of exploration; serious attempts were made to minimize advanced expectations. Pushes and pulls were found both at the origin and at the destination of retirement moves although satisfaction with current residence was very high in both places.
- Published
- 2002
28. ALCOHOL CONSUMPTION WITHIN THE CONTEXT OF HEPATITIS C: A QUALITATIVE STUDY OF NON-PROBLEMATIC DRINKERS
- Author
-
Stoller, Eleanor PALO, Hund, Andrew J., Webster, Noah J., Blixen, Carol E., Perzynski, Adam T., Mccormick, Richard A., Kanuch, Stephanie W., and Dawson, Neal V.
- Published
- 2006
29. Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations.
- Author
-
Dalton, Jarrod E., Gunzler, Douglas D., Jain, Vardhmaan, Perzynski, Adam T., Dawson, Neal V., Einstadter, Douglas, Tarabichi, Yasir, Imrey, Peter B., Lewis, Michael, Kattan, Michael W., Yao, James, Taksler, Glen, Berg, Kristen A., Krieger, Nikolas I., Kaelber, David, Jehi, Lara, and Kalra, Ankur
- Subjects
COVID-19 pandemic ,SARS-CoV-2 ,CARDIOVASCULAR diseases ,OUTPATIENT medical care ,HOSPITAL care ,COVID-19 ,ETHNICITY - Abstract
Background: Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. Objective: To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. Design: Observational cohort study. Setting: Outpatient and emergency care. Patients: 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. Interventions: Nasopharyngeal PCR test for SARS-CoV-2 infection. Measurements: Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. Results: We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91–3.59] times (at age 20) to 2.37 [1.54–3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. Limitations: Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. Conclusion: Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
30. Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research.
- Author
-
Taksler, Glen B., Dalton, Jarrod E., Perzynski, Adam T., Rothberg, Michael B., Milinovich, Alex, Krieger, Nikolas I., Dawson, Neal V., Roach, Mary J., Lewis, Michael D., and Einstadter, Douglas
- Abstract
Electronic health records (EHRs) offer the potential to study large numbers of patients but are designed for clinical practice, not research. Despite the increasing availability of EHR data, their use in research comes with its own set of challenges. In this article, we describe some important considerations and potential solutions for commonly encountered problems when working with large-scale, EHR-derived data for health services and community-relevant health research. Specifically, using EHR data requires the researcher to define the relevant patient subpopulation, reliably identify the primary care provider, recognize the EHR as containing episodic (i.e., unstructured longitudinal) data, account for changes in health system composition and treatment options over time, understand that the EHR is not always well-organized and accurate, design methods to identify the same patient across multiple health systems, account for the enormous size of the EHR, and consider barriers to data access. Associations found in the EHR may be nonrepresentative of associations in the general population, but a clear understanding of the EHR-based associations can be enormously valuable to the process of improving outcomes for patients in learning health care systems. In the context of building 2 large-scale EHR-derived data sets for health services research, we describe the potential pitfalls of EHR data and propose some solutions for those planning to use EHR data in their research. As ever greater amounts of clinical data are amassed in the EHR, use of these data for research will become increasingly common and important. Attention to the intricacies of EHR data will allow for more informed analysis and interpretation of results from EHR-based data sets. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
31. Failure of Traditional Risk Factors to Adequately Predict Cardiovascular Events in Older Populations.
- Author
-
Dalton, Jarrod E., Rothberg, Michael B., Dawson, Neal V., Krieger, Nikolas I., Zidar, David A., and Perzynski, Adam T.
- Subjects
HEALTH risk assessment of older people ,AGE differences ,MYOCARDIAL infarction ,STROKE ,RISK assessment -- Mathematical models ,CARDIOVASCULAR diseases risk factors - Abstract
BACKGROUND: Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk across heterogeneous populations is needed for effective primary prevention. Little is known about the performance of standard cardiovascular risk factors in older adults. OBJECTIVE: To evaluate the performance of the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) risk model, as well as the underlying cardiovascular risk factors, among adults older than 65 years. DESIGN AND SETTING: Retrospective cohort derived from a regional referral system's electronic medical records. PARTICIPANTS: A total of 25 349 patients who were 65 years or older at study baseline (date of the first outpatient lipid panel taken between 2007 and 2010). MEASUREMENTS: Exposures of interest were traditional cardiovascular risk factors, as defined by inclusion in the PCE model. The primary outcome was major ASCVD events, defined as a composite of myocardial infarctions, stroke, and cardiovascular death. RESULTS: The PCE and internally estimated models produced similar risk distributions for white men aged 65 to 74 years. For all other groups, PCE predictions were generally lower than those of the internal models, particularly for African Americans. Discrimination of the PCE was poor for all age groups, with concordance index (95% confidence interval) estimates of 0.62 (0.60‐0.64), 0.56 (0.54‐0.57), and 0.52 (0.49‐0.54) among patients aged 65 to 74, 75 to 84, and 85 years and older, respectively. Reestimating relationships within these age groups resulted in better calibration but negligible improvements in discrimination. Blood pressure, total cholesterol, and diabetes either were not associated at all or had inverse associations in the older age groups. CONCLUSION: Traditional clinical risk factors for cardiovascular disease failed to accurately characterize risk in a contemporary population of Medicare‐aged patients. Among those aged 85 years and older, some traditional risk factors were not associated with ASCVD events. Better risk models are needed to appropriately inform treatment decision making for the growing population of older adults. J Am Geriatr Soc 68:754–761, 2020 [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
32. Facilitating reproducible project management and manuscript development in team science: The projects R package.
- Author
-
Krieger, Nikolas I., Perzynski, Adam T., and Dalton, Jarrod E.
- Subjects
- *
SCIENCE projects , *RECORDS management , *PROJECT management , *SCIENTIFIC community , *REPRODUCIBLE research , *PROJECT management software - Abstract
The contemporary scientific community places a growing emphasis on the reproducibility of research. The projects R package is a free, open-source package created in the interest of facilitating reproducible research workflows. It adds to existing software tools for reproducible research and introduces several practical features that are helpful for scientists and their collaborative research teams. For each individual project, it supplies a framework for storing raw and cleaned study data sets, and it provides script templates for protocol creation, data cleaning, data analysis and manuscript development. Internal databases of project and author information are generated and displayed, and manuscript title pages containing author lists and their affiliations are automatically generated from the internal database. File management tools allow teams to organize multiple projects. When used on a shared file system, multiple researchers can harmoniously contribute to the same project in a less punctuated manner, reducing the frequency of misunderstandings and the need for status updates. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
33. Risk-period-cohort approach for averting identification problems in longitudinal models.
- Author
-
Gunzler, Douglas D., Perzynski, Adam T., Dawson, Neal V., Kauffman, Kelley, Liu, Jintao, and Dalton, Jarrod E.
- Subjects
- *
AGE , *LONGITUDINAL method , *GERONTOLOGY , *CYTOLOGY , *MONTE Carlo method - Abstract
In epidemiology, gerontology, human development and the social sciences, age-period-cohort (APC) models are used to study the variability in trajectories of change over time. A well-known issue exists in simultaneously identifying age, period and birth cohort effects, namely that the three characteristics comprise a perfectly collinear system. That is, since age = period−cohort, only two of these effects are estimable at a time. In this paper, we introduce an alternative framework for considering effects relating to age, period and birth cohort. In particular, instead of directly modeling age in the presence of period and cohort effects, we propose a risk modeling approach to characterize age-related risk (i.e., a hybrid of multiple biological and sociological influences to evaluate phenomena associated with growing older). The properties of this approach, termed risk-period-cohort (RPC), are described in this paper and studied by simulations. We show that, except for pathological circumstances where risk is uniquely determined by age, using such risk indices obviates the problem of collinearity. We also show that the size of the chronological age effect in the risk prediction model associates with the correlation between a risk index and chronological age and that the RPC approach can satisfactorily recover cohort and period effects in most cases. We illustrate the advantages of RPC compared to traditional APC analysis on 27496 individuals from NHANES survey data (2005–2016) to study the longitudinal variability in depression screening over time. Our RPC method has broad implications for examining processes of change over time in longitudinal studies. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
34. Primary Care Practice Workplace Social Capital: A Potential Secret Sauce for Improved Staff Well-Being and Patient Experience.
- Author
-
Perzynski, Adam T, Caron, Aleece, Margolius, David, and Sudano, Joseph J
- Published
- 2019
- Full Text
- View/download PDF
35. Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position: A Retrospective Cohort Study.
- Author
-
Dalton, Jarrod E., Perzynski, Adam T., Zidar, David A., Rothberg, Michael B., Coulton, Claudia J., Milinovich, Alex T., Einstadter, Douglas, Karichu, James K., and Dawson, Neal V.
- Subjects
- *
CARDIOVASCULAR diseases , *HEALTH services accessibility , *HEALTH status indicators , *RESEARCH funding , *RISK assessment , *RESIDENTIAL patterns , *SOCIOECONOMIC factors , *RETROSPECTIVE studies - Abstract
Background: Inequality in health outcomes in relation to Americans' socioeconomic position is rising.Objective: First, to evaluate the spatial relationship between neighborhood disadvantage and major atherosclerotic cardiovascular disease (ASCVD)-related events; second, to evaluate the relative extent to which neighborhood disadvantage and physiologic risk account for neighborhood-level variation in ASCVD event rates.Design: Observational cohort analysis of geocoded longitudinal electronic health records.Setting: A single academic health center and surrounding neighborhoods in northeastern Ohio.Patients: 109 793 patients from the Cleveland Clinic Health System (CCHS) who had an outpatient lipid panel drawn between 2007 and 2010. The date of the first qualifying lipid panel served as the study baseline.Measurements: Time from baseline to the first occurrence of a major ASCVD event (myocardial infarction, stroke, or cardiovascular death) within 5 years, modeled as a function of a locally derived neighborhood disadvantage index (NDI) and the predicted 5-year ASCVD event rate from the Pooled Cohort Equations Risk Model (PCERM) of the American College of Cardiology and American Heart Association. Outcome data were censored if no CCHS encounters occurred for 2 consecutive years or when state death data were no longer available (that is, from 2014 onward).Results: The PCERM systematically underpredicted ASCVD event risk among patients from disadvantaged communities. Model discrimination was poorer among these patients (concordance index [C], 0.70 [95% CI, 0.67 to 0.74]) than those from the most affluent communities (C, 0.80 [CI, 0.78 to 0.81]). The NDI alone accounted for 32.0% of census tract-level variation in ASCVD event rates, compared with 10.0% accounted for by the PCERM.Limitations: Patients from affluent communities were overrepresented. Outcomes of patients who received treatment for cardiovascular disease at Cleveland Clinic were assumed to be independent of whether the patients came from a disadvantaged or an affluent neighborhood.Conclusion: Neighborhood disadvantage may be a powerful regulator of ASCVD event risk. In addition to supplemental risk models and clinical screening criteria, population-based solutions are needed to ameliorate the deleterious effects of neighborhood disadvantage on health outcomes.Primary Funding Source: The Clinical and Translational Science Collaborative of Cleveland and National Institutes of Health. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
36. Patient portals and broadband internet inequality.
- Author
-
Perzynski, Adam T., Roach, Mary Joan, Shick, Sarah, Callahan, Bill, Gunzler, Douglas, Cebul, Randall, Kaelber, David C., Huml, Anne, Thornton, John Daryl, and Einstadter, Douglas
- Abstract
Background: Patient portals have shown potential for increasing health care quality and efficiency. Internet access and other factors influencing patient portal use could worsen health disparities.Methods: Observational study of adults with 1 or more visits to the outpatient clinics of an urban public health care system from 2012 to 2015. We used mixed effects logistic regression to evaluate the association between broadband internet access and (1) patient portal initiation (whether a patient logged in at least 1 time) and (2) messaging, controlling for demographic and neighborhood characteristics.Results: There were 243 248 adults with 1 or more visits during 2012-2015 and 70 835 (29.1%) initiated portal use. Portal initiation was 34.1% for whites, 23.4% for blacks, and 23.8% for Hispanics, and was lower for Medicaid (26.5%), Medicare (23.4%), and uninsured patients (17.4%) than commercially insured patients (39.3%). In multivariate analysis, both initiation of portal use (odds ratio [OR] = 1.24 per quintile, 95% confidence interval [CI], 1.23-1.24, P < .0001) and sending messages to providers (OR = 1.15, 95%CI, 1.09-1.14, P < .0001) were associated with neighborhood broadband internet access.Conclusions: The majority of adults with outpatient visits to a large urban health care system did not use the patient portal, and initiation of use was lower for racial and ethnic minorities, persons of lower socioeconomic status, and those without neighborhood broadband internet access. These results suggest the emergence of a digital divide in patient portal use. Given the scale of investment in patient portals and other internet-dependent health information technologies, efforts are urgently needed to address this growing inequality. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
37. A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus.
- Author
-
Sajatovic, Martha, Gunzler, Douglas D., Kanuch, Stephanie W., Cassidy, Kristin A., Tatsuoka, Curtis, Mccormick, Richard, Blixen, Carol E., Perzynski, Adam T., Einstadter, Douglas, Thomas, Charles L., Lawless, Mary E., Martin, Siobhan, Falck-Ytter, Corinna, Seeholzer, Eileen L., Mckibben, Christine L., Bauer, Mark S., and Dawson, Neal V.
- Subjects
PEOPLE with mental illness ,DIABETES ,RANDOMIZED controlled trials ,PSYCHIATRIC rating scales ,ANTIPSYCHOTIC agents - Abstract
Objectives: A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus.Methods: The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control.Results: Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group.Conclusions: TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
38. Barriers and facilitators to epilepsy self-management for patients with physical and psychological co-morbidity.
- Author
-
Perzynski, Adam T., Ramsey, Riane K., Colón-Zimmermann, Kari, Cage, Jamie, Welter, Elisabeth, and Sajatovic, Martha
- Subjects
EPILEPSY ,MENTAL illness ,RESEARCH - Abstract
Objectives This exploratory study identifies barriers and facilitators to self-management to inform future epilepsy self-management interventions for persons who have epilepsy complicated by co-morbid mental health conditions and serious medical events. Methods Focus group methods were used in a series of community advisory board meetings. Analysis was conducted using a thematic, constant comparative approach aiming to describe the range of barriers and facilitators salient to participants. There were a total of 22 participants, including 8 health professionals, 9 patients with epilepsy, and 5 care partners. Mean age was 49.1 (SD = 11.0, range 32–69), 11 (50%) were female, and 11 (50%) were male. For those with epilepsy, mean years having epilepsy was 24.7 (SD = 19.9, range 1–58 years). Results Individual psychological barriers (mental illness, fatigue, and psychological distress) prominently interfered with health behaviors. Community and family barriers included stigma, lack of epilepsy knowledge, and poor social support. Facilitators included planning for seizures, learning about medications, stress management, socializing with others, and talking with other epilepsy patients. Discussion Qualitative evidence in this study suggests a linkage between social integration and positive health behaviors. Future efforts to embed patients with epilepsy and their caregivers into clinical care processes could offset barriers and enhance facilitators. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
39. Modeling Individual Patient Preferences for Colorectal Cancer Screening Based on Their Tolerance for Complications Risk.
- Author
-
Taksler, Glen B., Perzynski, Adam T., and Kattan, Michael W.
- Abstract
Introduction. Recommendations for colorectal cancer screening encourage patients to choose among various screening methods based on individual preferences for benefits, risks, screening frequency, and discomfort. We devised a model to illustrate how individuals with varying tolerance for screening complications risk might decide on their preferred screening strategy. Methods. We developed a discrete-time Markov mathematical model that allowed hypothetical individuals to maximize expected lifetime utility by selecting screening method, start age, stop age, and frequency. Individuals could choose from stool-based testing every 1 to 3 years, flexible sigmoidoscopy every 1 to 20 years with annual stool-based testing, colonoscopy every 1 to 20 years, or no screening. We compared the life expectancy gained from the chosen strategy with the life expectancy available from a benchmark strategy of decennial colonoscopy. Results. For an individual at average risk of colorectal cancer who was risk neutral with respect to screening complications (and therefore was willing to undergo screening if it would actuarially increase life expectancy), the model predicted that he or she would choose colonoscopy every 10 years, from age 53 to 73 years, consistent with national guidelines. For a similar individual who was moderately averse to screening complications risk (and therefore required a greater increase in life expectancy to accept potential risks of colonoscopy), the model predicted that he or she would prefer flexible sigmoidoscopy every 12 years with annual stool-based testing, with 93% of the life expectancy benefit of decennial colonoscopy. For an individual with higher risk aversion, the model predicted that he or she would prefer 2 lifetime flexible sigmoidoscopies, 20 years apart, with 70% of the life expectancy benefit of decennial colonoscopy. Conclusion. Mathematical models may formalize how individuals with different risk attitudes choose between various guideline-recommended colorectal cancer screening strategies. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
40. Patients’ perceptions of barriers to self-managing bipolar disorder: A qualitative study.
- Author
-
Blixen, Carol, Perzynski, Adam T., Bukach, Ashley, Howland, Molly, and Sajatovic, Martha
- Subjects
- *
HEALTH self-care , *CONTENT analysis , *HEALTH services accessibility , *INTERVIEWING , *BIPOLAR disorder , *PERSONAL space , *PHYSICIAN-patient relations , *PSYCHOTHERAPY patients , *QUALITATIVE research , *SOCIAL support , *THEMATIC analysis , *PATIENTS' attitudes , *PSYCHOLOGY - Abstract
Background: Self-management of bipolar disorder (BD) is challenging for many individuals. Material: Interviews were used to assess perceived barriers to disease self-management among 21 high-risk patients with BD. Content analysis, with an emphasis on dominant themes, was used to analyze the data. Results: Three major domains of barriers emerged: individual barriers (psychological, knowledge, behavioral and physical health); family/community-level barriers (lack of support and resources); and provider/healthcare system (inadequate communication and access to care). Conclusion: Care approaches providing social and peer support, optimizing communication with providers and integrating medical and psychiatric care may improve self-management of BD in this vulnerable population. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
41. Barriers to Self-management of Serious Mental Illness and Diabetes.
- Author
-
Blixen, Carol E., Kanuch, Stephanie, Perzynski, Adam T., Thomas, Charles, Dawson, Neal V., and Sajatovic, Martha
- Subjects
TREATMENT of diabetes ,MENTAL illness treatment ,CONTENT analysis ,MENTAL depression ,HEALTH services accessibility ,INTERVIEWING ,BIPOLAR disorder ,PHENOMENOLOGY ,RESEARCH funding ,SCHIZOPHRENIA ,HEALTH self-care ,DESCRIPTIVE statistics - Abstract
The article presents a study on the obstacles to self-management of serious mental illness (SMI) and diabetes mellitus (DM). It discusses findings on the domains of barriers to such self-management including personal level barriers such as stress, isolation and stigma, family and community level barriers such as lack of support from family and friends and provider and health care system level barriers such as poor relationships and communication with providers as well as fragmentation of care.
- Published
- 2016
- Full Text
- View/download PDF
42. Children's Exposure to Violence: The Underlying Effect of Posttraumatic Stress Symptoms on Behavior Problems.
- Author
-
Yoon, Susan, Steigerwald, Stacey, Holmes, Megan R., and Perzynski, Adam T.
- Subjects
CHILDREN & violence ,POST-traumatic stress ,SYMPTOMS in children ,BEHAVIOR disorders in children ,VICTIMS of violent crimes ,PSYCHOLOGY ,FAMILY violence & psychology ,POST-traumatic stress disorder ,CHILD abuse & psychology ,AGGRESSION (Psychology) ,ANXIETY ,COMPARATIVE studies ,MENTAL depression ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,PSYCHOLOGY of crime victims ,EVALUATION research - Abstract
Copyright of Journal of Traumatic Stress is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2016
- Full Text
- View/download PDF
43. No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status.
- Author
-
Bolen, Shari D., Sage, Paulette, Perzynski, Adam T., and Stange, Kurt C.
- Abstract
AimTo better understand the type and range of health issues initiated by patients and providers in ‘high-quality’ primary-care for adults with diabetes and low socio-economic status (SES).BackgroundAlthough quality of care guidelines are straightforward, diabetes visits in primary care are often more complex than adhering to guidelines, especially in adults with low SES who experience many financial and environmental barriers to good care.MethodsWe conducted a qualitative study using direct observation of primary-care diabetes visits at an exemplar safety net practice in 2009–2010.FindingsIn a mainly African American (93%) low-income population with fair cardiovascular control (mean A1c 7.5%, BP 134/81 mmHg, and low-density lipoprotein cholesterol 100 mg/dL), visits addressed a variety of bio-psychosocial health issues [median: 25 problems/visit (range 13–32)]. Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior. Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior.ConclusionsPrimary-care visits by diabetes patients with low SES address a surprising number and diversity of problems. Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients. [ABSTRACT FROM PUBLISHER]
- Published
- 2016
- Full Text
- View/download PDF
44. Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes*.
- Author
-
Bajor, Laura A., Gunzler, Douglas, Einstadter, Douglas, Thomas, Charles, McCormick, Richard, Perzynski, Adam T., Kanuch, Stephanie W., Cassidy, Kristin A., Dawson, Neal V., and Sajatovic, Martha
- Abstract
Objective While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden. Methods Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score. Results Anxiety disorders were seen in 33.1% (N = 52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden. Conclusion One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are needed to better understand the relationship between depression, anxiety, and health management in people with serious mental illness and diabetes mellitus type II. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
45. Playing the numbers: how hepatitis C patients create meaning and make healthcare decisions from medical test results.
- Author
-
Perzynski, Adam T., Terchek, Joshua J., Blixen, Carol E., and Dawson, Neal V.
- Subjects
- *
PATIENTS , *DECISION making , *DISEASE progression , *CHRONIC hepatitis C , *RESEARCH funding , *SOUND recordings , *THEMATIC analysis , *CROSS-sectional method , *HEALTH literacy , *LABORATORY test panels , *DATA analysis software , *MEDICAL coding , *PSYCHOLOGY , *THERAPEUTICS - Published
- 2013
- Full Text
- View/download PDF
46. Simplifying the 360-Degree Peer Evaluation in a Physical Medicine and Rehabilitation Residency Program.
- Author
-
Song, John C., Wilson, Richard D., Perzynski, Adam T., Tran, Daniel, and Vargo, Mary M.
- Published
- 2012
- Full Text
- View/download PDF
47. Psychosocial Correlates of Alcohol Use and Reduction for Individuals With Hepatitis C.
- Author
-
PERZYNSKI, ADAM T., McCORMICK, RICHARD, WEBSTER, NOAH J., BLIXEN, CAROL E., KANUCH, STEPHANIE, THOMAS, CHARLES L., MULLEN, KEVIN D., and DAWSON, NEAL V.
- Subjects
- *
ALCOHOL drinking , *HEPATITIS C , *SUBSTANCE abuse , *SOCIAL status , *MARITAL status , *PATIENTS - Abstract
Objective: Patients with hepatitis C virus (HCV) are advised to refrain from alcohol consumption. A questionnaire was developed to measure concepts associated with alcohol use for individuals with HCV Method: Subjects with HCV (N = 527) completed a telephone survey. Eligible respondents had screened negative for current abuse/dependence disorders (Alcohol Use Disorders Identification Test [AUDIT] < 10). Measures of personality, self-efficacy, knowledge, readiness, coping styles, stigma, and symptoms were examined for associations with alcohol use. Results: Factor analysis supported a measurement structure of 105 items in 35 subdomains. A total of 26 subdomains had significant bivariate associations with alcohol use. Higher self-efficacy for resisting drinking in social situations was associated with lower alcohol use (r = -.68, p < .001), as was knowledge of alcohol and HCV (r = -.27, p < .001). Although agreeableness and marital status are typically associated with lower current drinking in samples of those with alcohol use problems, in our study agreeableness (P = .13, p < .01) and marital status (P = .08, p < .05) were modestly associated with higher current drinking. The final multivariate R2 was .55. Conclusions: The pattern of associations suggests the importance of the social aspects of drinking for drinking decisions. Existing brief interventions will need to be tailored to a contextualized psychosocial model for medical patients with HCV and AUDIT scores < 10 to optimize effectiveness. Such future interventions should emphasize the potential medical hazards of drinking for persons with HCV, the maintenance of social relationships in the absence of alcohol use, and strategies for building confidence for resisting drinking in specific situations. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
48. Lay Management of Chronic Disease: A Qualitative Study of Living with Hepatitis C Infection.
- Author
-
Stoller, Eleanor Palo, Webster, Noah J., Blixen, Carol E., McCormick, Richard A., Perzynski, Adam T., Kanuch, Stephanie W., and Dawson, Neal V.
- Subjects
CHRONIC diseases ,HEPATITIS C ,HEALTH self-care ,HEALTH behavior ,LAY analysis (Psychoanalysis) ,MEDICAL care research - Abstract
Objectives: To examine management strategies and goals reported by people diagnosed with chronic hepatitis C. Methods: We analyzed data from semistructured interviews (N=42) and from electronic sources [illness narratives (N=79) and Internet threaded discussions (N=264)]. Line-by-line coding, comparisons, and team discussions generated catalogs of lay management strategies and goals. We analyzed code-based files to identify informants' selection of specific strategies for each goal. Results: We classified lay management strategies into 3 categories: medical self-care, behavior change, and coping. These strategies were used selectively In addressing multiple goals, categorized as fighting the virus, strengthening the body, and managing consequences. Conclusions: Results underscore the diversity of strategies for living with a disease characterized by uncertain prognosis and variable expression of symptoms. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
49. Alcohol Consumption Decisions Among Nonabusing Drinkers Diagnosed with Hepatitis C.
- Author
-
Stoller, Eleanor Palo, Webster, Noah J., Blixen, Carol E., McCormick, Richard A., Hund, Andrew J., Perzynski, Adam T., Kanuch, Stephanie W., Thomas, Charles L., Kercher, Kyle, and Dawson, Neal V.
- Abstract
Most studies of decisions to curtail alcohol consumption reflect experiences of abusing drinkers. An exploratory sequential research design is used to explore the applicability of this research to the experience of nonabusing drinkers advised to curtail alcohol consumption after a hepatitis C diagnosis. A qualitative component identified 17 new decision factors not reflected in an inventory of factors based on synthesis of existing scales. Qualitative data were triangulated by supplementing semistructured interviews with Internet postings. A quantitative component estimated prevalence and association with current drinking of these new decision factors. Patients who quit drinking tended to attribute postdiagnosis drinking to occasional triggers, whereas patients who were still drinking were more likely to endorse rationales not tied to specific triggers. [ABSTRACT FROM PUBLISHER]
- Published
- 2009
- Full Text
- View/download PDF
50. Priorities for oral health goals in a sample of older adults.
- Author
-
Stoller, Eleanor Palo, Pyle, Marsha A., and Perzynski, Adam T.
- Published
- 2004
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.