Self-reported Doctor Research Articles

Debunking the ‘only 50%’ myth: prevalence of established risk factors in New Zealanders with self‐reported ischaemic heart disease

Objective: To estimate the prevalence of established risk factors for ischaemic heart disease (IHD) in New Zealand adults and compare the prevalence in adults with and without this disease.Design: Data were obtained from the 2002/03 New Zealand Health Survey. Risk factor prevalence was determined by: selfreported doctor diagnosis of high blood pressure, high cholesterol and diabetes; self‐report of smoking and physical inactivity; and measurement of obesity. Presence of IHD was based on self‐report of heart disease (doctor diagnosed at age 25 years or over) together with current medical or past surgical treatment for this disease. Multiple logistic regression was used to determine prevalence rate ratios (PRRs) for males and females separately, adjusting for age, ethnicity and deprivation.Results: The overall prevalence of IHD was 8%. Overall risk factor prevalences were in the range of 20–25% for each of high blood pressure, high cholesterol, smoking, obesity and physical inactivity, and approximately 5% for diabetes. Overall, 94–97% of adults with IHD had at least one risk factor (depending on how smoking was defined). The PRRs of IHD were highest for cholesterol (about 4.5), followed by blood pressure (about 2.3), with all other risk factors around 1.5. PAF estimates indicate that 80–85% of IHD was attributable to the presence of at least one risk factor for all age, gender and ethnic groups.Conclusions: Established risk factors account for 80–85% of the non‐fatal burden of IHD in New Zealand. Limited research resources would be better used to evaluate which interventions are effective and efficient at reducing exposure of all population groups to known risk factors, rather than on identification of additional risk factors.

Pain Among Children and Adolescents: Restrictions in Daily Living and Triggering Factors

Pain Among Children and Adolescents: Restrictions in Daily Living and Triggering Factors

Caregiving, alcohol use, and mental health symptoms among HMO members.

Using data from a survey of 5841 HMO members, we examined alcohol consumption, depression and anxiety symptoms, and health services use among 689 informal caregivers. Characteristics of caregivers included whom they cared for, types of care provided, number of people cared for, and whether care was provided in the caregiver's home. Outcome measures in hierarchical linear and logistic stepwise regression models included indicators of alcohol drinking pattern, symptoms of anxiety and depression, role limits due to emotional problems and self-reported doctor's visits. Adjusting for age and gender differences, caregivers reported more bodily pain, worse role functioning related to emotional problems, were more likely to screen as depressed, and were more likely to report symptoms of anxiety. Older caregivers, and those with greater vitality, had better mental health outcomes; caregivers with higher levels of education reported better psychological well-being and less interference with role functioning due to emotional problems. Caregivers did not make more doctor's visits than non-caregivers. No caregiving characteristics were consistently associated with both mental health and alcohol consumption outcomes. The relationship of the care recipient to the caregiver predicted mental health outcomes better than either the type of care, number cared for, or location of care. Both the type of care and relationship to the care provider were associated with alcohol consumption, and several gender interactions were identified. Our results confirm previous findings of greater mental health problems among caregivers, yet suggest that caregivers may not be seeking services commensurate to their needs.

The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization.

Previous research suggests that childhood sexual abuse is associated with high rates of retrospectively reported medical utilization and medical problems as an adult. The goal of this study was to determine if abused females have higher rates of medical utilization using self-report and objective measures, compared with non-abused females. A further goal was to determine whether findings of prior research would be replicated when childhood physical abuse level was controlled. This study also examined the moderating impact of depressed mood on current health measures in this population. Six hundred and eight women recruited from a health maintenance organization completed self-report measures of health symptoms for the previous month and doctor visits for the previous year. Objective doctor records over a 2 year period were examined for a subset of 136 of these women. Results showed significantly more self-reported health symptoms and more self-reported doctor visits in abused participants compared with those who reported no childhood history of sexual abuse. Objective doctor visits demonstrated the same pattern with abused participants exhibiting more visits related to out-patient surgery and out-patient internal medicine. In addition, persons who were both sexually abused and depressed tended to visit the emergency room more frequently and to have more in-patient internal medicine and ophthalmology visits than sexually abused participants who reported low depressed mood and non-abused controls. These results replicate prior studies and suggest that current depression may moderate the relationship between sexual abuse and medical problems in adulthood.

Evaluation of a cold/flu self-care public education campaign.

The purpose of the study was to evaluate an Ontario Ministry of Health (MOH) cold/flu self-care public education campaign to reduce unnecessary patient visits to doctors. The MOH campaign consisted of an information booklet delivered to every household in an Ontario city, newspaper ads and radio spots. The program ran during January-March 1994. The evaluation consisted of: (1) 2x2 telephone survey in London (experimental area) and Windsor (comparison area), before and during the campaign; and (2) a telephone survey of London family practitioners during the campaign. In addition, data on the incidence of cold/flu visits to three hospital emergency departments and a sample of family physicians' offices were gathered. The data suggest that program rationale may have been questionable because the majority of the surveyed public were knowledgeable and self-reported appropriate doctor visits for cold/flu. Campaign evaluation showed limited impact. Message penetration was low; only one-third of London residents knew of the campaign or read the booklet. Only two of 10 questions showed increases in knowledge in London and no changes were found for beliefs, attitudes, acquisition of new health practices or self-reported visits to the doctor. The physician survey, emergency room and family physician office visit data were consistent with the public survey findings.

Sex Differences in the Use of Physician Services: A Preliminary Test of the Fixed Role Hypothesis

Although women typically report using health services more frequently than do men, the reason for this difference is unclear. According to the role women report greater use of health services because, in the aggregate, they have fewer work and time constraints on their behavior, thus making it easier for them to reschedule activities in order to visit a doctor. Examining data from the 1976-1977 Los Angeles Health Survey, the proportion of chronic problems resulting in a self-reported doctor contact was initially 1/ percent higher for women (N = 988; p < .00/). As predicted by the fixed role hypothesis, controlling for differences in fixed roles (particularly employment status) reduced this differential to a nonsignificant 5 percent. No sex differences were found in reports of using health services for acute illness (N = 628). These findings suggest that the fixed role hypothesis may be most appropriate for explaining sex differences in behavioral responses to chronic symptoms.