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  1. Article ; Online: Association between Obstructive Lung Disease and Cardiovascular Disease

    Maria E. Ramos-Nino / Charles D. MacLean / Benjamin Littenberg

    Journal of Respiration, Vol 1, Iss 16, Pp 165-

    Results from the Vermont Diabetes Information System

    2021  Volume 172

    Abstract: The association between obstructive lung disease and cardiovascular disease (CVD) has been suggested previously, but few studies have looked at this association in a diabetic cohort, a population highly susceptible to both comorbidities. A total of 1003 ... ...

    Abstract The association between obstructive lung disease and cardiovascular disease (CVD) has been suggested previously, but few studies have looked at this association in a diabetic cohort, a population highly susceptible to both comorbidities. A total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between obstructive lung disease and CVD. In a multivariate logistic regression model, obstructive lung disease was significantly associated with CVD, even after correcting for potential confounders, including gender, obesity, low income, cigarette smoking, alcohol problems, and high comorbidity (odds ratio = 1.96; 95% confidence interval 1.37–2.81; p < 0.01). All components of CVD, including coronary artery disease (CAD), congestive heart failure (CHF), peripheral vascular disease (PVD), and cerebrovascular accidents (CVA), were also significantly associated with obstructive lung disease. These data suggest an association between obstructive lung disease and CVD in patients with diabetes. Future studies are needed to identify the mechanism supporting this association
    Keywords asthma ; COPD ; cardiovascular disease ; diabetes ; Internal medicine ; RC31-1245 ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Use and Reported Helpfulness of Cannabinoids Among Primary Care Patients in Vermont

    Nicole Wershoven / Amanda G. Kennedy / Charles D. MacLean

    Journal of Primary Care & Community Health, Vol

    2020  Volume 11

    Abstract: Introduction: While cannabis has been medically legal in Vermont since 2004 and recreationally legal since 2018 there has been minimal published research regarding the use and practices in the adult population. This gap in understanding results in ... ...

    Abstract Introduction: While cannabis has been medically legal in Vermont since 2004 and recreationally legal since 2018 there has been minimal published research regarding the use and practices in the adult population. This gap in understanding results in primary care providers having difficulty navigating conversations surrounding cannabinoid use. The purpose of this research was to identify current use and perceptions of cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in adult primary care patients in Vermont. Methods: An anonymous written survey was given to 1009 Vermont primary care patients aged 18 years and older. All measures were patient-reported and included use of CBD and THC products, perceived helpfulness for certain medical conditions, knowledge of CBD and THC, perceived knowledge of their provider, and concerns regarding cannabis legalization. Results: 45% of adult primary care patients reported using cannabinoids in the past year. Only 18% of patients reported their provider as being a good source of information regarding cannabis. Of the patients who used cannabis in the past year, a majority reported it helpful for conditions such as anxiety and depression, arthritis, pain, sleep, and nausea. Conclusions: Primary care providers need to be knowledgeable about cannabinoids to best support patient care. In addition, with a significant number of patients reporting cannabinoids helpful for medical conditions common in primary care, it is important that research continue to identify the potential benefits and harms of cannabis.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7 ; Public aspects of medicine ; RA1-1270
    Language English
    Publishing date 2020-08-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Role of magnesium supplementation in the treatment of depression

    Emily K Tarleton / Benjamin Littenberg / Charles D MacLean / Amanda G Kennedy / Christopher Daley

    PLoS ONE, Vol 12, Iss 6, p e

    A randomized clinical trial.

    2017  Volume 0180067

    Abstract: Current treatment options for depression are limited by efficacy, cost, availability, side effects, and acceptability to patients. Several studies have looked at the association between magnesium and depression, yet its role in symptom management is ... ...

    Abstract Current treatment options for depression are limited by efficacy, cost, availability, side effects, and acceptability to patients. Several studies have looked at the association between magnesium and depression, yet its role in symptom management is unclear. The objective of this trial was to test whether supplementation with over-the-counter magnesium chloride improves symptoms of depression. An open-label, blocked, randomized, cross-over trial was carried out in outpatient primary care clinics on 126 adults (mean age 52; 38% male) diagnosed with and currently experiencing mild-to-moderate symptoms with Patient Health Questionnaire-9 (PHQ-9) scores of 5-19. The intervention was 6 weeks of active treatment (248 mg of elemental magnesium per day) compared to 6 weeks of control (no treatment). Assessments of depression symptoms were completed at bi-weekly phone calls. The primary outcome was the net difference in the change in depression symptoms from baseline to the end of each treatment period. Secondary outcomes included changes in anxiety symptoms as well as adherence to the supplement regimen, appearance of adverse effects, and intention to use magnesium supplements in the future. Between June 2015 and May 2016, 112 participants provided analyzable data. Consumption of magnesium chloride for 6 weeks resulted in a clinically significant net improvement in PHQ-9 scores of -6.0 points (CI -7.9, -4.2; P<0.001) and net improvement in Generalized Anxiety Disorders-7 scores of -4.5 points (CI -6.6, -2.4; P<0.001). Average adherence was 83% by pill count. The supplements were well tolerated and 61% of participants reported they would use magnesium in the future. Similar effects were observed regardless of age, gender, baseline severity of depression, baseline magnesium level, or use of antidepressant treatments. Effects were observed within two weeks. Magnesium is effective for mild-to-moderate depression in adults. It works quickly and is well tolerated without the need for close monitoring for toxicity.
    Keywords Medicine ; R ; Science ; Q
    Subject code 150 ; 310
    Language English
    Publishing date 2017-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Utilization Outcomes of a Pilot Primary Care Team Redesign

    Alison R. Landrey / Valerie S. Harder / Marie B. Sandoval / John G. King / David S. Ziegelman / Charles D. MacLean

    Health Services Research & Managerial Epidemiology, Vol

    2018  Volume 5

    Abstract: Objectives: To evaluate the effect of a team-based primary care redesign on primary care, emergency department (ED) and urgent care (UC) utilization, and new patient access to primary care. Study Design: A retrospective pre–post difference-in-differences ...

    Abstract Objectives: To evaluate the effect of a team-based primary care redesign on primary care, emergency department (ED) and urgent care (UC) utilization, and new patient access to primary care. Study Design: A retrospective pre–post difference-in-differences analysis of utilization outcomes for patients on a redesigned primary care team compared to a standard primary care group. Methods: Within a patient-centered medical home, a pilot team was developed comprising 2 colocated “teamlets” of 1 physician, 1 nurse practitioner (NP), 1 registered nurse (RN), and 2 licensed practical nurses (LPNs). The redesigned team utilized physician–NP comanagement, expanded roles for RNs and LPNs, and dedicated provider time for telephone and e-mail medicine. We compared changes in number of office, ED, and UC visits during the implementation year for patients on the redesigned team compared to patients receiving the standard of care in the same clinic. Proportion of new patient visits was also compared between the pilot and the control groups. Results: There were no differences between the redesign group and control group in per-patient mean change in office visits (Δ = −0.04 visits vs Δ = −0.07; P = .98), ED visits (Δ = 0.00 vs Δ = 0.01; P = .25), or UC visits (Δ = 0.00 vs Δ = 0.05; P = .08). Proportion of new patient visits was higher in the pilot group during the intervention year compared to the control group (6.6% vs 3.9%; P < .0001). Conclusions: The redesign did not significantly impact ED, UC, or primary care utilization within 1 year of follow-up. It did improve access for new patients.
    Keywords Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
    Language English
    Publishing date 2018-08-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Inter-library loan at ZB MED

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  5. Article: Change in Health Literacy Over 2 Years in Older Adults With Diabetes

    Morris, Nancy S / Benjamin Littenberg / Charles D. MacLean

    Diabetes educator. 2013 Sept., v. 39, no. 5

    2013  

    Abstract: The purpose of this study was to evaluate the stability of health literacy in adults with diabetes over time. Understanding the dynamic nature of health literacy is important when tailoring health messages, especially those targeted at the management of ... ...

    Abstract The purpose of this study was to evaluate the stability of health literacy in adults with diabetes over time. Understanding the dynamic nature of health literacy is important when tailoring health messages, especially those targeted at the management of chronic health conditions. This was a descriptive longitudinal study of 751 adults with diabetes randomly selected from primary care practices in the Vermont Diabetes Information System study between July 2003 and December 2007. Participants were interviewed and completed questionnaires upon entrance into the study and again 24 months later. Health literacy was measured with the Short Test for Functional Health Literacy of Adults. Participants also completed the SF-12 and the Self-Administered Comorbidity Questionnaire and self-reported their sex, income, education, marital status, race/ethnicity, health insurance, duration of diabetes, and problems with vision. A significant decrease in health literacy was noted over 24 months. The largest decrease was in adults ≥65 years of age and those with higher physical function at baseline. Smaller declines were noted for women and participants who were white, higher educated, poly-pharmacy users, and with fair to excellent vision. Health literacy exhibits decline with increasing age among adults with diabetes. Individual variability in health literacy has implications for the best timing and approach to provide self-management education and support.
    Keywords comorbidity ; diabetes ; elderly ; health information ; health insurance ; income ; information systems ; literacy ; longitudinal studies ; marital status ; nationalities and ethnic groups ; questionnaires ; vision ; women ; Vermont
    Language English
    Dates of publication 2013-09
    Size p. 638-646.
    Publishing place SAGE Publications
    Document type Article
    ZDB-ID 2173745-9
    ISSN 1554-6063 ; 0145-7217
    ISSN (online) 1554-6063
    ISSN 0145-7217
    DOI 10.1177/0145721713496871
    Database NAL-Catalogue (AGRICOLA)

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  6. Article ; Online: Take the money and run? Redemption of a gift card incentive in a clinician survey

    Jane S. Chen / Brian L. Sprague / Carrie N. Klabunde / Anna N. A. Tosteson / Asaf Bitton / Tracy Onega / Charles D. MacLean / Kimberly Harris / Marilyn M. Schapira / Jennifer S. Haas / on behalf of the PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) Consortium

    BMC Medical Research Methodology, Vol 16, Iss 1, Pp 1-

    2016  Volume 5

    Abstract: Abstract Background Clinician surveys provide critical information about many facets of health care, but are often challenging to implement. Our objective was to assess use by participants and non-participants of a prepaid gift card incentive that could ... ...

    Abstract Abstract Background Clinician surveys provide critical information about many facets of health care, but are often challenging to implement. Our objective was to assess use by participants and non-participants of a prepaid gift card incentive that could be later reclaimed by the researchers if unused. Methods Clinicians were recruited to participate in a mailed or online survey as part of a study to characterize women’s primary health care provider attitudes towards breast and cervical cancer screening guidelines and practices (n = 177). An up-front incentive of a $50 gift card to a popular online retailer was included with the study invitation. Clinicians were informed that the gift card would expire if it went unused after 4 months. Outcome measures included use of gift cards by participants and non-participants and comparison of hypothetical costs of different incentive strategies. Results 63.5 % of clinicians who responded to the survey used the gift card, and only one provider who didn’t participate used the gift card (1.6 %). Many of those who participated did not redeem their gift cards (36.5 % of respondents). The price of the incentives actually claimed totaled $3700, which was less than half of the initial outlay. Since some of the respondents did not redeem their gift cards, the cost of incentives was less than it might have been if we had provided a conditional incentive of $50 to responders after they had completed the survey. Conclusions Redeemable online gift card codes may provide an effective way to motivate clinicians to participate in surveys.
    Keywords Survey methods ; Provider surveys ; Medicine (General) ; R5-920
    Language English
    Publishing date 2016-02-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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