Modeling heart disease mortality with census tract rates and social class mixtures.
Humans; Regression Analysis; Ohio/epidemiology; Demography; Epidemiologic Methods; *Social Class; Heart Diseases/*mortality; Coronary Disease/mortality; Models; Statistical
The relationship between social class and 1980 heart disease (HD) mortality in eight urban U.S. counties was examined by regressing age and sex adjusted census tract specific HD rates (N = 1211) on tract social class characteristics. The regression model indicated that lower middle class residents experienced a HD mortality rate 1.9 (95% CI = 1.3, 2.8) times the rate in the upper middle/middle class, while the working poor experienced a HD rate 4.4 (95% CI = 3.5, 5.7) times the rate in the referent class. Similar class effects were seen for both black and nonblack residents. The crude race effect (1.3 with 95% CI = 1.2, 1.4) was explainable by the concentration of blacks in the lower classes. The methods illustrate the ecologic regression of mixtures of mortality rates on mixtures of exposure in the presence of random tract effects which eliminates some of the problems associated with small denominators or zero rates in some tracts.
Logue EE; Jarjoura D
Social science & medicine (1982)
1990
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0277-9536(90)90089-b" target="_blank" rel="noreferrer noopener">10.1016/0277-9536(90)90089-b</a>
The utility of hair cortisol concentrations in the prediction of PTSD symptoms following traumatic physical injury.
*Acute physical injury; *Avoidance; *Hair cortisol concentrations; *Numbing; *PTSD; *PTSD symptoms; 80 and over; Adult; Aged; Biological Markers; Female; Hair Analysis; Hair/*chemistry; Human; Humans; Hydrocortisone; Hydrocortisone/*analysis; Male; Middle Aged; Midwestern United States; Post-Traumatic – Risk Factors; Post-Traumatic/*diagnosis/*etiology; Prospective Studies; Regression; Retrospective Design; Retrospective Studies; Risk Factors; Saliva; Stress Disorders; Trauma Centers – Midwestern United States; Wounds and Injuries/*complications
RATIONALE: Although cortisol alterations have been associated with posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS), the direction of association is mixed. Cortisol which is measured in blood, saliva, or urine is subject to transient factors that may confound results. Recent advances in cortisol sampling techniques provide novel opportunities to address these inconsistencies. Hair cortisol sampling is a non-invasive method for the retrospective assessment of long-term integrated cortisol, yet its utility at predicting PTSS has not been assessed in acute injury victims. OBJECTIVE: The aim of this prospective study was to examine whether higher levels of hair cortisol concentrations (HCC) were associated with increases in PTSS following traumatic physical injury. METHOD: From January 2012 to May 2013, injury victims admitted to a level-1 Midwestern trauma center were recruited during their routine trauma clinic appointment within 30-days post-injury. Thirty participants had sufficient hair length to obtain 3-cm hair samples for cortisol assay. These participants completed PTSS assessments in relation to their recent injury at both the baseline and follow-up assessments (within 30- and 60-days post-injury, respectively). RESULTS: Hierarchical regression analyses - which controlled for baseline PTSS, age, and sex - revealed that higher HCC predicted significant increases in overall PTSS at follow-up. Higher HCC also predicted increases in the avoidance/numbing subscale symptoms of PTSS. Dividing the avoidance symptoms and numbing symptoms into two separate clusters (consistent with the 4-factor DSM-5 model of PTSD) revealed that HCC was only marginally associated with numbing, but not with avoidance symptoms. CONCLUSION: Hair sampling is a feasible method for assessing integrated cortisol levels soon after traumatic physical injury. This study suggests that elevated HCC may serve as a biomarker of risk for the development of posttraumatic symptomatology, and identifies specific symptoms that may be targeted for intervention in those with high HCC in the aftermath of injury.
Pacella Maria L; Hruska Bryce; Steudte-Schmiedgen Susann; George Richard L; Delahanty Douglas L
Social science & medicine (1982)
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.socscimed.2016.12.046" target="_blank" rel="noreferrer noopener">10.1016/j.socscimed.2016.12.046</a>
Heart specialists' art of care.
*Patient Satisfaction; *Physician-Patient Relations; Cardiology/*standards; Humans; Quality of Health Care; Thoracic Surgery/*standards
Primary care physicians who encourage patients to interact in the medical interview receive high ratings of patient satisfaction with art of care. To determine if this finding holds true in specialty medicine, we designed a two-factor [art of care (high/low); heart specialty (cardiology/cardiovascular surgery)] four-group analogue study. Videotapes for each of the four conditions depicted the first interview between (actor) patient with coronary artery disease and (actor) specialist. The high art of care physicians elicited the patient's story in his own words and encouraged questions and feedback during the interview; the low art of care physicians did not encourage patient interaction. The cardiologists discussed medical treatment and the cardiovascular surgeons discussed surgical treatment. A pilot study of the instrument we developed indicated that the Art of Care Scale, Technical Quality of Care Scale, and Willingness to be Treated Scale demonstrated high internal consistency and that the Art of Care Scale and the Technical Quality of Care Scale defined two dimensions. In the final study, 124 graduate students in education in a midwestern United States university each viewed one videotape and used the instrument to evaluate the physician. Subjects rated the specialists who encouraged patients to interact higher on the Art of Care Scale than specialists who did not encourage interaction. Art of Care Scale Scores predicted subjects' willingness to be treated by the physician they viewed on the videotape. No significant differences in ratings of Art of Care could be attributed to specialty.
Speight J D; Blixt S L
Social science & medicine (1982)
1995
1995-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0277-9536(94)e0097-c" target="_blank" rel="noreferrer noopener">10.1016/0277-9536(94)e0097-c</a>