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Selected AbstractsInfluence of Temporal Scale of Sampling on Detection of Relationships between Invasive Plants and the Diversity Patterns of Plants and ButterfliesCONSERVATION BIOLOGY, Issue 6 2004RALPH MAC NALLY But monitoring is often neglected because it can be expensive and time-consuming. Accordingly, it is valuable to determine whether the temporal extent of sampling alters the validity of inferences about the response of diversity measures to environmental variables affected by restoration actions. Non-native species alter ecosystems in undesirable ways, frequently homogenizing flora and fauna and extirpating local populations of native species. In the Mojave Desert, invasion of salt-cedar (Tamarix ramosissima Ledeb.) and human efforts to eradicate salt-cedar have altered vegetation structure, vegetation composition, and some measures of faunal diversity. We examined whether similar inferences about relationships between plants and butterflies in the Muddy River drainage (Nevada, U.S.A.) could have been obtained by sampling less intensively (fewer visits per site over the same period of time) or less extensively (equal frequency of visits but over a more limited period of time). We also tested whether rank order of butterfly species with respect to occurrence rate (proportion of sites occupied) would be reflected accurately in temporal subsamples. Temporal subsampling did not lead to erroneous inferences about the relative importance of six vegetation-based predictor variables on the species richness of butterflies. Regardless of the temporal scale of sampling, the species composition of butterflies was more similar in sites with similar species composition of plants. The rank order of occurrence of butterfly species in the temporal subsamples was highly correlated with the rank order of species occurrence in the full data set. Thus, similar inferences about associations between vegetation and butterflies and about relative occurrence rates of individual species of butterflies could be obtained by less intensive or extensive temporal sampling. If compromises between temporal intensity and extent of sampling must be made, our results suggest that maximizing temporal extent will better capture variation in biotic interactions and species occurrence. Resumen:,El monitoreo es un componente importante de los esfuerzos de restauración y de manejo adoptivo. Pero el monitoreo a menudo es desatendido porque puede ser costoso y consume tiempo. En consecuencia, es valioso determinar si la extensión temporal del muestreo altera la validez de inferencias sobre la respuesta de medidas de diversidad a variables ambientales afectadas por acciones de restauración. Las especies no nativas alteran a los ecosistemas de manera indeseable, frecuentemente homogenizan la flora y fauna y extirpan poblaciones locales de especies nativas. En el Desierto Mojave, la invasión de Tamarix ramosissima Ledeb. y los esfuerzos humanos para erradicarla han alterado la estructura y composición de la vegetación y algunas medidas de diversidad de fauna. Examinamos si se podían obtener inferencias similares sobre las relaciones entre plantas y mariposas en la cuenca Muddy River (Nevada, E.U.A.) muestreando menos intensivamente (menos visitas por sitio en el mismo período de tiempo) o menos extensivamente (igual frecuencia de visitas pero sobre un período de tiempo más limitado). También probamos si el orden jerárquico de especies de mariposas con respecto a la tasa de ocurrencia (proporción de sitios ocupados) se reflejaba con precisión en las submuestras temporales. El submuestreo temporal no condujo a inferencias erróneas acerca de la importancia relativa de seis variables predictivas basadas en vegetación sobre la riqueza de especies de mariposas. A pesar de la escala temporal del muestreo, la composición de especies de mariposas fue más similar en sitios con composición de especies de plantas similar. El orden jerárquico de ocurrencia de especies de mariposas en las muestras subtemporales estuvo muy correlacionado con el orden jerárquico de ocurrencia de especies en todo el conjunto de datos. Por lo tanto, se pudieron obtener inferencias similares de las asociaciones entre vegetación y mariposas y de las tasas de ocurrencia relativa de especies individuales de mariposas con muestreo temporal menos intensivo o extensivo. Si se deben hacer compromisos entre la intensidad y extensión de muestreo temporal, nuestros resultados sugieren que la maximización de la extensión temporal capturará la variación en interacciones bióticas y ocurrencia de especies más adecuadamente. [source] The Impact of HIV on Oral Health and Subsequent Use of Dental ServicesJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2003Aram Dobalian PhD Abstract Objective: This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use. Methods: This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits. Results: More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits. Conclusions: Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health. [source] How well do patients report noncompliance with antihypertensive medications?: a comparison of self-report versus filled prescriptionsPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 1 2004Philip S. Wang MD Abstract Purpose To address poor patient compliance with antihypertensives, clinicians and researchers need accurate measures of adherence with prescribed regimens. Although self-reports are often the only means available in routine practice, their accuracy and agreement with other data sources remain questionable. Methods A telephone survey was conducted on 200 hypertensive patients treated with a single antihypertensive agent in a large health maintenance organization (HMO) or a Veterans Affairs medical center (VAMC) to obtain self-reports of the frequency of missing antihypertensive therapy. We then analyzed records of all filled prescriptions to calculate the number of days that patients actually had antihypertensive medications available for use. Agreement between the two data sources was measured with correlation coefficients and kappa statistics. Logistic regression models were used to identify demographic, clinical and psychosocial correlates of overstating compliance. Results There was very poor agreement between self-reported compliance and days actually covered by filled prescriptions (Spearman correlation coefficient,=,0.15; 95%CI: 0.01, 0.28). Very poor agreement was also observed between a categorical measure of self-reported compliance (ever vs. never missing a dose) and categories of actual compliance defined by filled prescriptions (<,80% vs >,80% of days covered; kappa,=,0.12, 95%CI: ,0.02, 0.26). Surprisingly, few factors were associated with inaccurate self-reporting in either crude or adjusted analyses; fewer visits to health care providers was significantly associated with overstating compliance. Conclusions Compliance was markedly overstated in this sample of patients and few characteristics identified those who reported more versus less accurately. Clinicians and researchers who rely on self-reports should be aware of these limits and should take steps to enhance their accuracy. Copyright © 2003 John Wiley & Sons, Ltd. [source] Clinician-Assigned and Parent-Report Questionnaire-Derived Child Psychiatric Diagnoses: Correlates and Consequences of DisagreementAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2010Jesse B. Klein The objectives of this study were to determine (a) if child characteristics relate to disagreement between clinician-assigned diagnoses and diagnoses derived from parent-report questionnaire, which were available to clinicians, and (b) if disagreement predicts subsequent number of clinic visits attended. This study evaluated the odds of agreement versus disagreement for internalizing and externalizing problems as a function of child age, gender, race, public-aid status, symptom severity, and impairment among 900 children (3,19 years) in a large, urban, child psychiatry clinic. A mixed-effects regression approach was used to evaluate the relationship between disagreement and visit attendance. Internalizing problem disagreement was more likely for children who were males, older, less symptomatic, and receiving Medicaid. Externalizing problem disagreement was more likely for children who were female, older, less impaired, and less symptomatic. Internalizing disagreement predicted significantly fewer visits; externalizing disagreement did not. Clinician,parent disagreement about the nature of child problems may have clinical consequences, especially for internalizing disorders. Attention to child characteristics that predict agreement may diminish discrepancies and reduce attrition from treatment. [source] Is screening for abdominal aortic aneurysm bad for your health and well-being?ANZ JOURNAL OF SURGERY, Issue 12 2004Carole A. Spencer Background: The purpose of the present paper was to investigate whether screening for abdominal aortic aneurysm (AAA) causes health-related quality of life to change in men or their partners. Methods: A cross-sectional case,control comparison was undertaken of men aged 65,83 years living in Perth, Western Australia, using questionnaires incorporating three validated instruments (Medical Outcomes Study Short Form,36, EuroQol EQ-5D and Hospital Anxiety and Depression Scale) as well as several independent questions about quality of life. The 2009 men who attended for ultrasound scans of the abdominal aorta completed a short prescreening questionnaire about their perception of their general health. Four hundred and ninety-eight men (157 with an AAA and 341 with a normal aorta) were sent two questionnaires for completion 12 months after screening, one for themselves and one for their partner, each being about the quality of life of the respondent. Results: Men with an AAA were more limited in performing physical activities than those with a normal aorta (t -test of means P = 0.04). After screening, men with an AAA were significantly less likely to have current pain or discomfort than those with a normal aorta (multivariate odds ratio: 0.5; 95% confidence interval (CI): 0.3,0.9) and reported fewer visits to their doctor. The mean level of self-perceived general health increased for all men from before to after screening (from 63.4 to 65.4). Conclusions: Apart from physical functioning, screening was not associated with decreases in health and well-being. A high proportion of men rated their health over the year after screening as being either the same or improved, regardless of whether or not they were found to have an AAA. [source] Regional variation in the survival and health of older Australian women: a prospective cohort studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2009Dimitrios Vagenas Abstract Objective: Older people may act as sensitive indicators of the effectiveness of health systems. Our objective is to distinguish between the effects of socio-economic and behavioural factors and use of health services on urban-rural differences in mortality and health of elderly women. Methods: Baseline and longitudinal analysis of data from a prospective cohort study. Participants were a community-based random sample of women (n=12778) aged 70-75 years when recruited in 1996 to the Australian Longitudinal Study on Women's Health. Measures used were: urban or rural residence in Australian States and Territories, socio-demographic characteristics, health related behaviour, survival up to 1 October 2006, physical and mental health scores and use of medical services. Results: Mortality was higher in rural than in urban women (hazard ratio, HR 1.14; 95% CI, 1.03,-1.26) but there were no differences between States and Territories. There were no consistent baseline or longitudinal differences between women for physical or mental health, with or without adjustment for socio-demographic and behavioural factors. Rural women had fewer visits to general practitioners (odds ratio, OR=0.54; 95% CI, 0.48-0.61) and medical specialists (OR=0.60; 95% CI, 0.55-0.65). Conclusions: Differences in use of health services are a more plausible explanation for higher mortality in rural than urban areas than differences in other factors. Implications: Older people may be the ,grey canaries' of the health system and may thus provide an ,early warning system' to policy makers and governments. [source] Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care OrganizationBIRTH, Issue 1 2003Arden Handler DrPH ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source] Differences in the Annual Incomes of Emergency Physicians Related to GenderACADEMIC EMERGENCY MEDICINE, Issue 5 2007William B. Weeks MD ObjectivesTo examine the association between physician gender and income for emergency physicians (EPs) after correcting for factors likely to influence income. MethodsThe authors used survey responses collected during the 1990s from 392 actively practicing white EPs. Linear regression modeling was used to determine the association between provider gender and annual income after controlling for workload, provider characteristics, and practice characteristics. ResultsWhite female EPs reported seeing 7% fewer visits but worked 3% more annual hours than their white male counterparts. White female EPs had practiced medicine for fewer years than white male EPs, although the distribution of respondents across categories of years practicing medicine was not dramatically different. Female EPs were more likely to be employees, as opposed to having an ownership interest in the practice. Female EPs were less likely than their male counterparts to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, the mean annual income of white female EPs was 193,570, or 47,854 (20%) lower than that for white male EPs (95% confidence interval =,82,710 to ,12,997; p = 0.007). ConclusionsDuring the 1990s, female gender was associated with lower annual income among EPs. These findings warrant further exploration to determine what factors might cause the gender-based differences in income that were found. [source] Web-based consultations for parents of children with atopic dermatitis: results of a randomized controlled trialACTA PAEDIATRICA, Issue 2 2009Trine S Bergmo Abstract Aim: To analyse how web-based consultations for parents of children with atopic dermatitis affect self-management behaviour, health outcome, health resource use and family costs. Methods: Ninety-eight children with atopic dermatitis were randomly assigned to intervention and control groups. The intervention group received remote dermatology consultations through a secure web-based communication system. The control group was encouraged to seek treatment through traditional means such as general practitioner visits and hospital care. Both groups received an extensive individual educational session prior to the intervention. Results: Thirty-eight percent of the intervention group used web-based consultations 158 times ranging from 1 to 38 consultations per patient. We found no change in self-management behaviour, health outcome or costs. The intervention group tended to have fewer visits to practitioners offering complementary therapies than the control group, and we found a positive correlation between emergency visits at baseline and messages sent. Both groups, however, reduced the mean number of skin care treatments performed per week and had fewer total health care visits after the intervention. Conclusion: We found no effect of supplementing traditional treatment for childhood dermatitis with web-based consultations. This study showed that web consultations is feasible, but more research is needed to determine its effect on self-management skills, health outcome and resource use. [source] | ||||||||||