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Chewning, B., Boh, L., Wiederholt, J., and others (2001, June). "Does the concordance concept serve patient medication management?" (AHRQ grant HS07773). International Journal of Pharmacy Practice 9, pp. 71-79.

For patients with chronic medical conditions, selecting and managing treatment regimens can be as challenging as the chronic condition itself. To assess how people with arthritis evaluate and calibrate their complex medication regimens, these researchers used questionnaires and telephone interviews every 6 months for 2 years with 689 patients diagnosed with arthritis. About half of the patients had complex regimens with eight or more medications at any one time. The majority of doctors altered patients' medication orders every 6 months. Most patients said they evaluated the effectiveness and side effects of individual medicines based largely on symptoms. There were 248 reported deviations in the scheduled medications at baseline, and 61 percent were intentional, largely based on symptoms. The researchers conclude that providers and patients each had unique expertise and were engaged in a dynamic partnership to calibrate patients' ever-changing regimens to manage chronic illness.

Kirby, J.B. (2001). "Exposure, resistance, and recovery: A three- dimensional framework for the study of mortality from infectious disease." Social Science & Medicine 53, pp. 1205-1215.

Current debate surrounding the study of mortality could benefit from a framework that integrates social and economic variables with the biological mechanisms of illness and death, suggest several scholars. This AHRQ researcher outlines such a framework for infectious disease mortality. The framework is built around three processes: exposure to potentially lethal pathogens, resistance to disease pathogens after exposure (including nutritional status and availability of curative services), and recovery from disease episodes after contraction (related to literacy). He then applies the framework to morbidity and mortality from cholera across 41 less-developed nations. He suggests that women's literacy could reduce the cholera case fatality rate, since treated cholera is fatal for less than 1 percent of people compared with the 50 percent fatality rate of untreated cholera. On the other hand, maternal literacy cannot prevent exposure, given the overwhelming exposure to infectious agents in the most affected countries.

Reprints (AHRQ Publication No. 02-R003) are available from the AHRQ Publications Clearinghouse.

Livingston, D.H., Lavery, R.F., Passannante, M.R., and others (2001). "Free fluid on abdominal computed tomography without solid organ injury after blunt abdominal injury does not mandate celiotomy." American Journal of Surgery 182, pp. 6-9.

A continuing diagnostic conundrum for the surgeon is the presence of free fluid without solid organ injury on abdominal computed tomography (CT) scan in patients with blunt abdominal injury. Recommendations on care of these patients include mandatory celiotomy in order to not miss blunt intestinal injury, which is associated with increased morbidity and mortality. However, this study does not follow this approach but instead recommends serial observation with the possible use of other adjunctive tests. The multicenter study examined all patients with blunt abdominal trauma admitted to four level I trauma centers over 22 months. Of 2,299 patients evaluated, free fluid was present in 265. Of these, 90 patients had isolated free fluid with only 7 having a blunt intestinal injury. Conversely, 91 percent of patients with free fluid had no injury. All patients with free fluid were observed for a mean of 8 days. There were no missed injuries.

Rebok, G., Riley, A., Forrest, C., and others (2001). "Elementary school-aged children's reports of their health: A cognitive interviewing study." Quality of Life Research 10, pp. 59-70.

Children have a unique perspective on their own health, and may be able to provide invaluable information to health care professionals, planners, and policymakers. However, there are no standard methods for assessing the quality of young children's perceptions of their health and well-being and their ability to comprehend the tasks involved in reporting their health. These researchers used three cross-sectional studies involving cognitive interviews of children aged 5 to 11 to determine their ability to respond to various presentations of pictorially illustrated questions about their health. They concluded that children as young as 8 are able to report on all aspects of their health experiences and can use a 5-point response format. Children aged 6-7 had difficulty with some health-related terms and tended to use extreme responses, but they understood the basic task requirements and were able to report on their health experiences. These results provide the guidance needed to develop and test a pediatric health status questionnaire for children 6 to 11 years old.

Wells, K.B., Kataoka, S.H., and Asarnow, J.R. (2001, June). "Affective disorders in children and adolescents: Addressing unmet need in primary care settings." (AHRQ grant HS09908). Biological Psychiatry 49(12), pp. 1111-1120.

About one in five young people in the United States will suffer from a depressive episode by the age of 18. Also, bipolar (manic-depressive) disorder commonly begins in adolescence or early adulthood. These disorders are major risk factors for suicide among adolescents and lead to dysfunctional behavior that persists through adulthood. Despite the prevalence of affective disorders among young people, less than half of them receive any mental health services. For this study, the researchers examined how primary care practices treat affective disorders in children and adolescents and found that pediatricians identified mental health needs in only 1 to 16 percent of children, even though 17 to 27 percent of pediatric primary care patients may need care. Also, only 56 percent of young people diagnosed with a mental health problem received any treatment, and only half of those referred to a specialist received specialty care. Besides short medical visits that don't allow enough time for detection or treatment of affective disorders, other factors—such as lack of insurance or limited coverage, separation of physical and mental health services, limited practice infrastructure to integrate primary with mental health care, and a relative lack of child mental health specialists—also play a role.

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Current as of December 2001
AHRQ Publication No. 02-0010

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