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Dayna S Alexander,1 Susan L Hogan,2 Joanne M Jordan,3 Robert F DeVellis,3 Delesha M Carpenter1 1UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Asheville, 2UNC Kidney Center, 3Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA Abstract: The information–motivation–behavioral skills (IMB) model has been used to explain and promote medication adherence among patients with diabetes and HIV. The objective of this study was to examine whether the IMB model predicted medication adherence among vasculitis patients. Adult vasculitis patients (n=228) completed online questionnaires at baseline and 3-month follow-up. Linear regressions were calculated to determine the direct effects of information and motivation on medication adherence (P

Our goals were to describe the balance of social support to negative social interactions (i.e. social constraint) for autoimmune disease patients and determine whether support and constraint from spouses and non-spousal family and friends interact to influence patients’ psychological adjustment. Using cross-sectional survey data from 109 married vasculitis and lupus patients, we found that patients reported that spouses and family/friends provided more social support than social constraint. In regression models, constraint from spouses (β= −0.45, p

Objectives To describe the information about medication risks/benefits that rheumatologists provide during patient office visits, the gist that patients with rheumatoid arthritis (RA) extract from the information provided, and the relationship between communication and medication satisfaction. Methods Data from 169 RA patients were analyzed. Each participant had up to three visits audiotaped. Four RA patients coded the audiotapes using a Gist Coding Scheme and research assistants coded the audiotapes using a Verbatim Coding Scheme. Results When extracting gist from the information discussed during visits, patient coders distinguished between discussion concerning the possibility of medication side effects versus expression of significant safety concerns. Among patients in the best health, nearly 80% reported being totally satisfied with their medications when the physician communicated the gist that the medication was effective, compared to approximately 50% when this gist was not communicated. Conclusion Study findings underscore the multidimensional nature of medication risk communication and the importance of communication concerning medication effectiveness/need. Practice implications Health care providers should ensure that patients understand that medication self-management practices can minimize potential risks. Communicating simple gist messages may increase patient satisfaction, especially messages about benefits for well-managed patients. Optimal communication also requires shared understanding of desired therapeutic outcomes.

Objective We used a multidimensional framework to describe the types of information about medication risks that rheumatologists provide to rheumatoid arthritis (RA) patients during routine office visits. Methods We analyzed 1,094 audiotaped rheumatology office visits involving 450 RA patients. Each patient had up to 3 visits audiotaped. In conjunction with each office visit, patients also completed a self-administered questionnaire and interview and the rheumatologists provided ratings of patient health status. Results The number of medication risks discussed per visit ranged from 0–18, with a mean ± SD of 3.23 ± 2.93. The rheumatologist initiated ∼80% of the medication risk discussions. Approximately one-fourth of the discussions (25.6%) were limited to an assessment of whether or not the patient was experiencing a medication side effect. More risks were discussed during visits when changes to the patient's regimen were discussed than when no changes were discussed (X= 3.93, SD = 3.10 and X = 2.20, SD = 2.34, respectively; P < 0.0001). When medications were being proposed for addition to the patient's regimen, the most frequently discussed risk dimensions were the importance of monitoring (30%), probability (29.8%), things the patient should do to minimize risk (25.5%), and risk severity (21.8%). Conclusion Most discussions of medication risks that we observed were quite limited and often restricted to an assessment of whether the patient was experiencing side effects from their current medications. The amount of information that is optimal and how to tailor information to the preferences and abilities of individual patients remain important areas for future research.

HIV testing in prison settings has been identified as an important mechanism to detect cases among high-risk, underserved populations. Several public health organizations recommend that testing across health-care settings, including prisons, be delivered in an opt-out manner. However, implementation of opt-out testing within prisons may pose challenges in delivering testing that is informed and understood to be voluntary. In a large state prison system with a policy of voluntary opt-out HIV testing, we randomly sampled adult prisoners in each of seven intake prisons within two weeks after their opportunity to be HIV tested. We surveyed prisoners' perception of HIV testing as voluntary or mandatory and used multivariable statistical models to identify factors associated with their perception. We also linked survey responses to lab records to determine if prisoners' test status (tested or not) matched their desired and perceived test status. Thirty-eight percent (359/936) perceived testing as voluntary. The perception that testing was mandatory was positively associated with age less than 25 years (adjusted relative risk [aRR]: 1.45, 95% confidence interval [CI]: 1.24, 1.71) and preference that testing be mandatory (aRR: 1.81, 95% CI: 1.41, 2.31) but negatively associated with entry into one of the intake prisons (aRR: 0.41 95% CI: 0.27, 0.63). Eighty-nine percent of prisoners wanted to be tested, 85% were tested according to their wishes, and 82% correctly understood whether or not they were tested. Most prisoners wanted to be HIV tested and were aware that they had been tested, but less than 40% understood testing to be voluntary. Prisoners' understanding of the voluntary nature of testing varied by intake prison and by a few individual-level factors. Testing procedures should ensure that opt-out testing is informed and understood to be voluntary by prisoners and other vulnerable populations.

Hope is a future expectancy characterized by an individual's perception that a desirable future outcome can be achieved. Though scales exist to measure hope, they may have limited relevance in low resource, high HIV prevalence settings. We developed and validated a hope scale among young women living in rural South Africa. We conducted formative interviews to identify the key elements of hope. Using items developed from these interviews, we administered the hope scale to 2533 young women enrolled in an HIV-prevention trial. Women endorsed scale items highly and the scale proved to be unidimensional in the sample. Hope scores were significantly correlated with hypothesized psycholosocial correlates with the exception of life stressors. Overall, our hope measure was found to have excellent reliability and to show encouraging preliminary indications of validity in this population. This study presents a promising measure to assess hope among young women in South Africa.

Despite their widespread use and extensive technical features, little is known about how to use online social networking sites to increase physical activity. This study aims to examine Facebook engagement among participants in the online social networking arm of a randomized controlled physical activity promotion trial (n = 67). Facebook communications were double coded and analyzed using ATLAS.ti. Regression procedures were used to determine predictors of Facebook use and associations between types of use and changes in perceived social support and physical activity. Changes in perceived social support and physical activity were more strongly associated with participants’ individual Facebook use than use of the Facebook intervention group. The way social media sites are used in intervention design could have an impact on their effects. Including existing friends in interventions and using applications that incorporate intervention activities into a more naturalistic use of Facebook may improve the efficacy of future interventions.

Objective Fuzzy trace theory was used to develop a coding scheme that captures the gist that patients extract from information about medication risks and benefits and to explore the extent to which different patients extract different gist representations from the same information. Methods Data were collected from 2003–2007 in a study that included audiotape recording office visits that rheumatoid arthritis (RA) patients had with their rheumatologists. Each patient (n = 365) had up to 3 visits audiotape recorded. The audiotapes were transcribed to facilitate content analysis. Four patients with RA who did not participate in the original study guided development of the coding scheme and used it to code the transcripts. Results The coding scheme contains 14 gist themes centering on medication effectiveness, need, and safety. There was considerable variation among the gist coders in the specific themes they extracted from individual transcripts. We observed the greatest intercoder agreement for the 4 gist theme variables related to whether the rheumatologist wanted to make changes to the medication regimen. Furthermore, the coders rarely used the “not clear” category to code these 4 variables. In contrast, intercoder agreement for the remaining gist themes, which were designed to capture issues central to the communication of information about medication risks and benefits, was low and the “not clear” category was used more frequently. Conclusion Our study findings suggest that different people exposed to the same information may form different gist representations. Patient–provider communication concerning medication risks and benefits might be enhanced by better understanding the factors that influence the gist extraction process.

ObjectiveFoot and ankle problems are common in adults, and large observational studies are needed to advance our understanding of the etiology and impact of these conditions. Valid and reliable measures of foot and ankle symptoms and physical function are necessary for this research. This study examined psychometric properties of the Foot and Ankle Outcome Score (FAOS) subscales (pain, other symptoms, activities of daily living [ADL], sport and recreational function [sport/recreation], and foot- and ankle-related quality of life [QOL]) in a large, community-based sample of African American and white men and women ages 50 years. MethodsJohnston County Osteoarthritis Project participants (n = 1,670) completed the 42-item FAOS (mean age 69 years, 68% women, 31% African American, mean body mass index [BMI] 31.5 kg/m(2)). Internal consistency, test-retest reliability, convergent validity, and structural validity of each subscale were examined for the sample and for subgroups according to race, sex, age, BMI, presence of knee or hip osteoarthritis, and presence of knee, hip, or low back symptoms. ResultsFor the sample and each subgroup, Cronbach's alpha coefficients ranged from 0.95-0.97 (pain), 0.97-0.98 (ADL), 0.94-0.96 (sport/recreation), 0.89-0.92 (QOL), and 0.72-0.82 (symptoms). Correlation coefficients ranged from 0.24-0.52 for pain and symptoms subscales with foot and ankle symptoms and from 0.30-0.55 for ADL and sport/recreation subscales with the Western Ontario and McMaster Universities Osteoarthritis Index function subscale. Intraclass correlation coefficients for test-retest reliability ranged from 0.63-0.81. Items loaded on a single factor for each subscale except symptoms (2 factors). ConclusionThe FAOS exhibited sufficient reliability and validity in this large cohort study. (Less)

Objective:The authors explored whether demographic and psychosocial variables predicted differences in physical activity for participants with arthritis in a trial of Active Living Every Day (ALED).Method:Participants (N = 280) from 17 community sites were randomized into ALED or usual care. The authors assessed participant demographic characteristics, self-efficacy, outcome expectations, pain, fatigue, and depressive symptoms at baseline and physical activity frequency at 20-wk follow-up. They conducted linear regression with interaction terms (Baseline Characteristic × Randomization Group).Results:Being female (p ≤ .05), less depressed (p ≤ .05), or younger (p ≤ .10) was associated with more frequent posttest physical activity for ALED participants than for those with usual care. Higher education was associated with more physical activity for both ALED and usual-care groups.Discussion:ALED was particularly effective for female, younger, and less depressed participants. Further research should determine whether modifications could produce better outcomes in other subgroups.

Conflicting medication information has been defined as contradictory information about a medication topic from two or more sources. The objective of this study was to determine whether arthritis patients are exposed to conflicting medication information, to document sources of conflicting information, and to explore whether conflicting information is associated with sociodemographic factors, clinical characteristics, and medication adherence. Using an online survey, arthritis patients (N = 328) reported how often they received conflicting information about 12 medication topics as well as sources of conflicting information, demographic/clinical characteristics, and medication adherence. A linear regression model, which controlled for various demographic/clinical factors, determined whether conflicting information was associated with medication adherence. The majority of patients (80.1%) received conflicting information and were most likely to receive conflicting information about medication risks. Physicians, media sources, and the Internet were the most common sources of conflicting information. Less conflicting information (B = −0.13, p < .05), more information source use (B = 0.22, p < .01), and lower perceived regimen complexity (B = −0.17, p < .05) were associated with better medication adherence. In conclusion, conflicting medication information is pervasive, comes from a variety of sources, and may negatively affect patient health outcomes. To potentially decrease exposure to conflicting information, providers should direct patients to high-quality medication information sources.

Objectives: To determine whether patients with a rare illness (1) use pharmacists for medication information more or less frequently than physicians and the Internet, (2) perceive pharmacists as a more or less credible medical information resource than physicians and the Internet, and (3) obtain different types of medication information from pharmacists, physicians, and the Internet. Design: Cross-sectional survey. Setting: Online data collected between 2008 and 2009. Patients: Adult, English-proficient vasculitis patients (n = 232) who were taking at least one medication to treat their vasculitis. Intervention: Administration of online survey. Main outcome measures: Patient use of pharmacists, physicians, and the Internet for medication information; perceived credibility of pharmacists, physicians, and the Internet as sources of medication information; and types of medication information obtained from pharmacists, physicians, and the Internet. Results: Participants consulted physicians and the Internet more than pharmacists for medication information; only 96 participants (41.4%) ever used pharmacists for vasculitis medication information. Females and participants who used community pharmacies were significantly more likely to consult pharmacists for medication information as compared with males and patients who did not use community pharmacies. Participants perceived pharmacists were a less credible source of medication information than physicians and the Internet. Participants used physicians and/or the Internet more than pharmacists for five of eight types of medication information, including adverse effects and drug effectiveness. Conclusion: Vasculitis patients consulted sources other than pharmacists for medication information. Several factors, including perceived pharmacist credibility and a noncommunity-based pharmacy, may contribute to infrequent patient use of pharmacists as a medication information source. Future qualitative research should document how patients with rare disease perceive and interact with pharmacists to understand why many view pharmacists as only moderately credible sources of medication information.

Background Online social networks, such as Facebook™, have extensive reach, and they use technology that could enhance social support, an established determinant of physical activity. This combination of reach and functionality makes online social networks a promising intervention platform for increasing physical activity. Purpose To test the efficacy of a physical activity intervention that combined education, physical activity monitoring, and online social networking to increase social support for physical activity compared to an education-only control. Design RCT. Students ( n =134) were randomized to two groups: education-only controls receiving access to a physical activity–focused website ( n =67) and intervention participants receiving access to the same website with physical activity self-monitoring and enrollment in a Facebook group ( n =67). Recruitment and data collection occurred in 2010 and 2011; data analyses were performed in 2011. Setting/participants Female undergraduate students at a large southeastern public university. Intervention Intervention participants were encouraged through e-mails, website instructions, and moderator communications to solicit and provide social support related to increasing physical activity through a physical activity–themed Facebook group. Participants received access to a dedicated website with educational materials and a physical activity self-monitoring tool. Main outcome measures The primary outcome was perceived social support for physical activity; secondary outcomes included self-reported physical activity. Results Participants experienced increases in social support and physical activity over time but there were no differences in perceived social support or physical activity between groups over time. Facebook participants posted 259 times to the group. Two thirds (66%) of intervention participants completing a post-study survey indicated that they would recommend the program to friends. Conclusions Use of an online social networking group plus self-monitoring did not produce greater perceptions of social support or physical activity as compared to education-only controls. Given their promising features and potential reach, efforts to further understand how online social networks can be used in health promotion should be pursued. Trial registration This study is registered at clinicaltrials.gov NCT01421758.

Little is known about factors associated with the receipt of medication information among arthritis patients. This study explores information source receipt and associations between demographic and clinical/patient characteristics and the amount of arthritis medication information patients receive. Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA; n = 328) completed an online cross-sectional survey. Patients reported demographic and clinical/patient characteristics and the amount of arthritis medication information received from 15 information sources. Bivariate and multivariate linear regression analyses were used to investigate whether those characteristics were associated with the amount of medication information patients received. Arthritis patients received the most information from health professionals, followed by printed materials, media sources, and interpersonal sources. Greater receipt of information was associated with greater medication adherence, taking more medications, greater medication-taking concerns, more satisfaction with doctor medication-related support, and Black compared to White race. RA patients reported receiving more information compared to OA patients, and differences were found between RA patients and OA patients in characteristics associated with more information receipt. In conclusion, arthritis patients received the most medication information from professional sources, and both positive (e.g., greater satisfaction with doctor support) and negative (e.g., more medication-taking concerns) characteristics were associated with receiving more medication information.

Objective: The aim of this study was to investigate the relationship between the attentional coping styles (monitoring and blunting) of rheumatoid arthritis (RA) and osteoarthritis (OA) patients and: (a) receipt of medication information; (b) receipt of conflicting medication information; (c) ambiguity aversion; (d) medication-related discussions with doctors and spouse/partners; and (e) medication adherence. Method: A sample of 328 adults with a self-reported diagnosis of arthritis (RA n=159; OA n=149) completed an Internet-based survey. Coping style was assessed using the validated short version of the Miller Behavioral Style Scale. Measures related to aspects of medication information receipt and discussion and validated measures of ambiguity aversion and medication adherence (Vasculitis Self-Management Survey) were collected. Pearson correlation coefficients, ANOVA, independent samples t-tests and multiple regression models were used to assess associations between coping style and the other variables of interest. Results: Arthritis patients in our sample were more likely to be high monitors (50%) than high blunters (36%). Among RA patients, increased information-receipt was significantly associated with decreased monitoring (b = -1.06, p = .001). Among OA patients, increased information-receipt was significantly associated with increased blunting (b = .60, p = .02). Conclusion: In our sample of patients with arthritis, attentional coping style is not in accordance with the characteristic patterns outlined in the acute and chronic disease coping literature.

BACKGROUND Concurrent sexual partnerships (partnerships that overlap in time) may contribute to higher rates of HIV transmission in African Americans. Attitudes toward a behavior constitute an important component of most models of health-related behavior and behavioral change. We have developed a scale, employing realistic vignettes that appear to reliably measure attitudes about concurrency in young African American adults. METHODS Vignette-based items to assess attitudes about concurrency were developed following focus groups and cognitive testing of items adapted from existing scales assessing psychosocial constructs surrounding related sexual behaviors. The new items were included in a telephone survey of African American adults (18-34 years old) in Eastern North Carolina immediately before and after a radio campaign designed to discourage concurrency. We performed an exploratory factor analysis on each sample (pre- and post-campaign) to cross-validate results. We retained factors with a primary loading of ≥0.50 and no secondary loading >0.30. Cronbach's coefficient alpha was used to evaluate internal reliability. Associations in the predicted direction between the mean responses to items on the final factor and known correlates of concurrency validated the scale. RESULTS Factor analysis in a random pre-campaign subsample yielded a one-factor 6-item scale with acceptable internal consistency (Cronbach's α = 0.79). As expected, the attitude factor was positively associated with participation in concurrent partnerships, whether assessed by self-report (r = 0.298, p

Few studies have explored mediators between medication-related support and medication adherence for individuals with rare, systemic autoimmune conditions. Using the Information-Motivation-Behavioral Skills model, we tested whether depressive symptomatology and medication adherence self-efficacy mediated the relationship between adherence support and changes in medication adherence among vasculitis patients, and whether support from physicians and partners differentially affected medication adherence. Vasculitis patients (n = 172) completed baseline and follow-up questionnaires about their medication adherence and perceived adherence support. Bootstrapped mediation analyses tested the effects of physician and partner support on changes in medication adherence. Adherence self-efficacy mediated the relationship between physician support and changes in medication adherence (B = 0.05, SE = 0.03, 95% CI 0.01, 0.13). Neither self-efficacy nor depressive symptomatology mediated the effects of partner support. Although physicians spend little time with patients, they can increase patients' confidence about taking medications correctly and potentially improve health outcomes by bolstering medication adherence.

Although mood clarity has been found to negatively correlate with depressive symptoms (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995), little is known about why this relationship exists. Using two waves of longitudinal data collected from an older community sample, we tested whether mood clarity decreases depressive symptoms by mitigating the negative emotional impact of two different types of stressors: the experience of pain and the experience of loss. First, we found that older adults with higher levels of mood clarity had fewer depressive symptoms two years later than older adults with low levels of mood clarity. Second, we found that mood clarity attenuated the effect of pain on depressive symptoms, but did not attenuate the effect of loss on depressive symptoms. These latter findings suggest that mood clarity protects against depressive symptoms caused by stressors, but this protection may not generalize to all stressors.

Objective: Vasomotor and psychosocial symptoms persist as common manifestations of menopause; their explicit association is unclear. We investigated this association among postmenopausal women over a 2-year period. Methods: The Menopause Epidemiology Study is a cross-sectional population-based study of women 40 to 65 years old in the United States. We followed participants who were postmenopausal at baseline and at 2-year follow-up (n = 1,506) in the analyses. The vasomotor and psychosocial domains of the Menopause-Specific Quality of Life Questionnaire were used to assess exposure and outcome. Change in symptoms was defined as the difference in the Menopause-Specific Quality of Life Questionnaire domain score from baseline to follow-up 2 years later. Demographic information, behavioral activities, reproductive history, and medication use were evaluated for effect modification and confounding. Covariate-adjusted linear regression was used to assess the relationship between the change in vasomotor symptoms and change in psychosocial symptoms. Results: One quarter (n = 375) of the women reported an increase in vasomotor symptoms over the 2-year study period. Twenty-two percent of the women reported an increase in both vasomotor and psychosocial symptoms. Current smoking status was found to be an effect modifier: a one-unit increase in the vasomotor domain was associated with a 0.21-unit (95% CI, 0.12-0.29) increase in the psychosocial domain among smokers; this was stronger (0.29, 95% CI, 0.20-0.39) among past or never smokers. Conclusions: This study provides further evidence of an association between vasomotor symptoms and psychosocial symptoms using a validated instrument in a population-based study. There is a small increase in psychosocial symptoms with increasing vasomotor symptoms. Clinicians may want to note this association when treating postmenopausal women with either condition.

To develop a social health measurement framework, to test items in diverse populations and to develop item response theory (IRT) item banks.A literature review guided framework development of Social Function and Social Relationships sub-domains. Items were revised based on patient feedback, and Social Function items were field-tested. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter IRT modeling and evaluation of differential item functioning (DIF).The analytic sample included 956 general population respondents who answered 56 Ability to Participate and 56 Satisfaction with Participation items. EFA and CFA identified three Ability to Participate sub-domains. However, because of positive and negative wording, and content redundancy, many items did not fit the IRT model, so item banks do not yet exist. EFA, CFA and IRT identified two preliminary Satisfaction item banks. One item exhibited trivial age DIF.After extensive item preparation and review, EFA-, CFA- and IRT-guided item banks help provide increased measurement precision and flexibility. Two Satisfaction short forms are available for use in research and clinical practice. This initial validation study resulted in revised item pools that are currently undergoing testing in new clinical samples and populations.

SummaryObjectiveThis study compared pain and function among African Americans and Caucasian with radiographic hip and/or knee osteoarthritis (OA), controlling for radiographic severity and other patient characteristics.MethodsParticipants were 1368 individuals (32% African American) from the Johnston County Osteoarthritis Project with only knee OA, only hip OA, and both knee and hip OA. Linear regression models examined racial differences in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores and pain and function subscales, adjusting for radiographic severity, age, gender, education, body mass index (BMI), depressive symptoms, and WOMAC pain (last variable in models of function).ResultsAmong those with only knee OA, African Americans had significantly worse mean WOMAC total scores than Caucasian (32.8 vs 24.3, P

Objective Chronic disease affects both patients and spouses, yet the effect of vasculitis on the spouses of patients has not been systematically examined. We addressed this research gap by describing 8 dimensions of health-related quality of life (HRQOL) for antineutrophil cytoplasmic antibody–associated vasculitis (AAV) patients and their spouses and compared patients and spouses with norms for the general US population. We also determined whether the impact of AAV on HRQOL differs by sex for patients or their spouses. Methods Ninety-seven patients with AAV and their spouses completed a mailed questionnaire that included demographic information and a measure of HRQOL (Medical Outcomes Study Short Form 36.) Using the RAND method, we calculated 8 HRQOL dimensions: general health, physical functioning, emotional role limitations, physical role limitations, social functioning, mental health, bodily pain, and energy/vitality. Using norm-based scores, we compared the HRQOL of patients and spouses with the general US population. We then used multivariate analysis of covariance (MANCOVA) test for sex differences in HRQOL for patients and spouses. Results Patients with AAV scored lower than the US norm on all HRQOL subscales with the exception of bodily pain. In contrast, spouses scored similarly to national norms. When age, education, race, illness duration, and disease severity were controlled, there were no significant sex differences in HRQOL for patients or spouses. Conclusion AAV negatively impacts HRQOL for patients; whereas, spouses do not appear to be as negatively impacted. Long-term marriages may attenuate the effect of sex on HRQOL. Quality of life should be assessed throughout the disease course for both patients and spouses.

Objective Shared decision making may increase satisfaction with health care and improve outcomes, but little is known about adolescents’ decision-making preferences. The primary purpose of this study is to describe the decision-making preferences of adolescents with chronic illnesses and their parents, and the extent to which they agree. Design Survey. Setting and participants Participants were 82 adolescents seen at one of four paediatric chronic illness subspecialty clinics and 62 of their parents. Main variables Predictor variables include sociodemographics, health parameters, risk behaviour, and physical and cognitive development. The main outcome variable is preferences for decision-making style. Results and conclusions When collapsed into three response categories, nearly equal percentages of adolescents (37%) and parents (36%) preferred shared decision making. Overall, the largest proportion of adolescents (46%) and parents (53%) preferred passive decision making compared to active or shared decision making. Across five response choices, 33% of pairs agreed. Agreement was slight and not significant. Improved general health perceptions (OR = 0.76, 95% CI = 0.59–0.99) and improved behaviour (OR = 0.75, 95% CI = 0.56–0.99) were significantly associated with parents’ preferences for less active decision making. Older age was significantly associated with agreement (OR 1.58, 95% CI = 1.09–2.30) between parents and adolescents. The paucity of significant predictor variables may indicate physicians need to inquire directly about patient and parent preferences.

Our aim was to assess the content validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) social health item banks by comparing a prespecified conceptual model with concepts that focus-group participants identified as important social-health-related outcomes. These data will inform the process of improving health-related quality-of-life measures. Twenty-five patients with a range of social limitations due to chronic health conditions were recruited at two sites; four focus groups were conducted. Raters independently classified participants’ statements using a hierarchical, nested schema that included health-related outcomes, role performance, role satisfaction, family/friends, work, and leisure. Key themes that emerged were fulfilling both family and work responsibilities and the distinction between activities done out of responsibility versus enjoyment. Although focus-group participants identified volunteerism and pet ownership as important social-health-related concepts, these were not in our original conceptual model. The concept of satisfaction was often found to overlap with the concept of performance. Our conceptual model appears comprehensive but is being further refined to more appropriately (a) distinguish between responsibilities versus discretionary activities, and (b) situate the outcome of satisfaction as it relates to impairment in social and other domains of health.

Objective: To characterize similarities and differences in illness perceptions between women with rheumatoid arthritis (RA) and their husbands, and examine whether illness perception congruence predicted wives' subsequent psychological adjustment. Design: Women with RA and their husbands (N = 190 couples) recruited from community and clinical settings completed mailed surveys at baseline and 4-month follow-up. Main Outcome Measures: Data for this investigation included illness perceptions in partners and illness severity, marital variables, and psychological adjustment in wives. Results: In general, wives and husbands had similar views of RA. Couple congruence concerning women's personal control over RA and its cyclic nature predicted better psychological adjustment in women 4 months later. Post hoc tests showed better psychological adjustment in wives from couples with similar optimistic beliefs about personal control, illness coherence, and RA consequences, when compared to those in couples with similar pessimistic beliefs. Furthermore, when partners disagreed about RA's consequences, wives fared better when husbands overestimated rather than underestimated their beliefs. In contrast, couple congruence about the emotions and timeline of RA was unrelated to adjustment. Conclusion: It may be important for husbands to understand wives' views on their control over RA and its cyclic nature. Furthermore, wives may benefit when they share optimistic views with their husbands about RA, and when their husbands avoid underestimating RA's consequences. Developing interventions to enhance partners' illness understanding may be beneficial.

Objective To examine if patients with arthritis who reported using complementary and alternative medicine (CAM) were more likely to tell their physicians about their CAM use if they rated their rheumatologist as using a more participatory decision-making style and what reasons patients gave for telling or not telling their rheumatologist about their CAM use. Methods A survey that asked about CAM use, health status, demographics, physician use of a participatory decision-making style, and medical skepticism was sent to individuals with arthritis who saw 23 rheumatologists at universities and private practice clinics in North Carolina. Generalized estimating equations were used to analyze the data. Results A total of 92% of patients reported using CAM for their arthritis and 54% of these patients discussed their CAM use with their rheumatologist. Women, patients who used more types of CAM, and patients who rated their rheumatologist as using a more participatory decision-making style were significantly more likely to tell their physicians about their CAM use. Conclusion Our findings suggest that if rheumatologists use more participatory styles of decision making with patients and involve them when making treatment decisions, patients are more likely to tell them about their CAM use.

Purpose The purpose of this systematic review is to assess the literature pertinent to healthy coping in diabetes management and to identify effective or promising interventions and areas needing further investigation. Methods A PubMed search identified 186 articles in English published between January 1, 1990, and July 31, 2006, addressing diabetes and emotion, quality of life, depression, adjustment, anxiety, coping, family therapy, behavior therapy, psychotherapy, problem solving, couples therapy, or marital therapy. Results Connections among psychological variables, behavioral factors, coping, metabolic control, and quality of life are appreciable and multidirectional. Interventions for which well-controlled studies indicate benefits for quality of life and/or metabolic control include general self-management, coping/problem-solving interventions, stress management, support groups, cognitive-behavioral therapy, behavioral family systems therapy, cognitive-analytic therapy, multisystemic therapy, medications for depression, and the Pathways intervention integrating case management, support of medication, and problem-solving counseling. Conclusions Psychological, emotional, related behavioral factors, and quality of life are important in diabetes management, are worthy of attention in their own right, and influence metabolic control. A range of interventions that achieve benefits in these areas provide a base for developing versatile programs to promote healthy coping.

Objective To develop a measure of illness self-management for adults living with antineutrophil cytoplasmic antibody (ANCA)–associated small-vessel vasculitis (ANCA-SVV) and to gather evidence of its reliability and validity. Methods Development of the Vasculitis Self-Management Scale (VSMS) was guided by previous research on self-management in other chronically ill populations, a review of the current treatment literature for ANCA-SVV, interviews with patients, and consultation with experts. A total of 205 patients living with ANCA-SVV or a closely related condition then completed the VSMS, along with measures of sociodemographic and clinical variables, social desirability bias, and general adherence to medical recommendations, using a self-administered mailed questionnaire. A principal components analysis was conducted on the VSMS items. Internal consistency reliability and construct validity of the resulting subscales were assessed. Forty-four patients completed the VSMS a second time, for the purpose of assessing test–retest reliability. Results Analyses suggested an 8-factor solution. The final VSMS consisted of 43 items representing these 8 behavioral domains. Correlations among the 8 domains were null to modest in magnitude. The internal consistency reliability of the 8 subscales ranged from minimally acceptable (α = 0.67) to excellent (α = 0.94), and correlations between subscale scores at time 1 and time 2 suggested good temporal stability. Preliminary evidence for validity was mixed. Conclusion These findings suggest that the VSMS is a promising method for assessing illness self-management in adults with ANCA-SVV. More research exploring the validity of the measure is warranted.

Summary Objective The AUStralian CANadian Osteoarthritis Hand Index (AUSCAN) is a self-report assessment of hand pain, stiffness, and function. Prior studies have examined its validity in small clinical samples and family-based samples. This study examined measurement properties of the AUSCAN in a large, community-based sample, extending knowledge about the scale's generalizability. Methods Participants ( N =1730, mean age=61 years, 65% female, 30% African American) were enrolled in the Johnston County Osteoarthritis Project. We examined the internal consistency, construct validity, and factor structure of the AUSCAN among the total sample, as well as in subgroups according to gender, race, presence of hand pain, and presence of radiographic hand osteoarthritis (OA). Results Internal consistency was high for the total scale and subscales among the full study sample and all subgroups (Cronbach's alphas=0.89–0.96). Construct validity was also supported, as grip and pinch strength were more strongly correlated with the AUSCAN function subscale than with the pain and stiffness subscales. Factor analysis showed that for the full sample and most subgroups, all pain items loaded on one factor (standardized regression coefficients 0.59–0.81) and all function items loaded on another (standardized regression coefficients 0.61–0.78), supporting the intended subscale structure of the scale. However, for African Americans, a different factor pattern emerged, with three function items loading on a factor with the pain items. Conclusions Results support the validity of the AUSCAN in a general sample of adults, as well as across demographic and clinical subgroups, although the subscale structures differed slightly by race.

Studies of low energy reporting in the elderly are limited, yet changes in energy balance and the incidence of chronic disease make this a critical time to assess energy intake in this population. The objective of this study was to assess low energy reporting on 24-h recalls (24HR), a FFQ, a picture sort FFQ (PSFFQ), and a meal pattern questionnaire (MPQ), and to relate low energy reporting status to personal characteristics and dietary characteristics, including the Healthy Eating Index. Monthly 24HR were completed over 6 mo, followed by 3 interviewer-administered questionnaires. The Goldberg equation was used to determine reporting status for the dietary assessment methods among older, rural, low socioeconomic status, white, African American, and Native American men and women. The relations of variables of interest to low energy reporting were considered one at a time and in multiple logistic regression models. The percentage of participants classified as accurate reporters varied from 40% (FFQ) to 63% (PSFFQ) among men and 60% (24HR, PSFFQ, MPQ) to 63% (FFQ) among women; high energy reporting was observed on the MPQ. Low energy reporters on the FFQ tended to be men and to be overweight or obese (P < 0.05). Underreporting seemed to be due to omitting foods from major food groups as well as from omitting discretionary energy foods. There was a high degree of low energy reporting in this population, particularly by men, even with six 24HR.

Doctors must understand patients' priorities to create an effective treatment partnership. Little is known about whether subspecialist pediatricians understand chronically ill adolescents' preferences.A survey was conducted of 155 adolescents with chronic illnesses and 52 subspecialty physicians recruited from the same clinics of a children's hospital. Adolescents and physicians rated the importance that adolescents place on items relating to quality of care and physician-patient communication styles using a previously validated measure.For quality of care items, rank order correlation between physicians and patient responses was high (r = .63, p.001) and both rated pain management items as most important. Physicians underestimated the importance adolescents placed on communicating with the physician as a friend and medical-technical aspects of care. For communication items, physicians' responses were significantly different than adolescents for 13 of 17 items. Except for three items pertaining to autonomy, physician and patient responses were in the same direction, but adolescent responses were less extreme.Physicians understood the importance of pain management to adolescents with chronic illnesses, but overestimated their desired level of autonomy. Asking adolescents for their preferences may be the first step in improving adolescents' experience of care.

Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we developed an 8-week, automated, Internet-based PCST program called PainCOACH and evaluated its potential efficacy and acceptability in a small-scale, 2-arm randomized controlled feasibility trial. Participants were 113 men and women with clinically confirmed hip or knee OA and associated pain. They were randomized to a group completing PainCOACH or an assessment-only control group. Osteoarthritis pain, pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect were measured before intervention, midway through the intervention, and after intervention. Findings indicated high acceptability and adherence: 91% of participants randomized to complete PainCOACH finished all 8 modules over 8 to 10 weeks. Linear mixed models showed that, after treatment, women who received the PainCOACH intervention reported significantly lower pain than that in women in the control group (Cohen d = 0.33). Intervention effects could not be tested in men because of their low pain and small sample size. Additionally, both men and women demonstrated increases in self-efficacy from baseline to after intervention compared with the control group (d = 0.43). Smaller effects were observed for pain-related anxiety (d = 0.20), pain-related interference with functioning (d = 0.13), negative affect (d = 0.10), and positive affect (d = 0.24). Findings underscore the value of continuing to develop an automated Internet-based approach to disseminate this empirically supported intervention.

We describe the medication information-seeking behaviors of arthritis patients' partners and explore whether partner medication information-seeking and information-sharing are associated with patient medication adherence.Arthritis patients and their partners (n = 87 dyads) completed an on-line questionnaire. Partners indicated how often they obtained medication information from 14 sources, how much they trusted these sources, and whether they shared medication information with the patient. Patients reported their medication adherence. Bivariate associations were calculated to explore the relationships between partner information-seeking, information-sharing, and patient medication adherence.Partners sought little information about the patient's medications. Partners sought more information if the patient's medication regimen was more complex (r = 0.33, p = 0.002). Most partners (∼ 98%) shared medication information with the patient; older partners shared more information with the patient (r = 0.25, p = 0.03). Neither partner information-seeking (r = 0.21, p = 0.06) nor partner information-sharing (r = 0.12, p = 0.31) were significantly associated with patient medication adherence.Although partners of arthritis patients do not seek large amounts of medication information, the vast majority share this information with the patient.Involving partners in medical consultations can help them better understand the patient's medications, have questions answered by providers, and engage in more informed discussions with patients about their medications.

Health literacy has been found to be a crucial component of successful communication and navigation in health care. Various tools have been developed to measure health literacy skills, but few have been developed specifically for adolescents, and most require in-person administration. This study sought to develop a self-report health literacy scale for adolescents to assess four key health literacy domains: the ability to obtain, communicate, understand, and process health information.We collected data from 272 youth aged 12-19 recruited from a pediatrics clinic (37%) and the community (63%). We administered the Rapid Estimate of Adolescent Literacy in Medicine-Teen, Newest Vital Sign, and three surveys, and used factor analysis to identify scale items.Using multiple health literacy assessments, it was clear that many teens struggle with low health literacy skills. When identifying items that can be used as self-report items in future research, factor analysis identified three subscales; a 5-itemSelf-report items can be used to assess health literacy skills for adolescents when in-person administration is not possible or feasible. Such items will allow for greater study of how health literacy impacts communication in not only health care settings, but for all levels of health communication. The tool will also allow researchers to better understand how adolescent health literacy is related to a variety of health outcomes. Further testing of these scales with different populations is warranted.

Classical test theory (CTT) comprises a set of concepts and methods that provide a basis for many of the measurement tools currently used in health research. The assumptions and concepts underlying CTT are discussed. These include item and scale characteristics that derive from CTT as well as types of reliability and validity. Procedures commonly used in the development of scales under CTT are summarized, including factor analysis and the creation of scale scores. The advantages and disadvantages of CTT, its use across populations, and its continued use in the face of more recent measurement models are also discussed.

Patients with antineutrophil cytoplasmic antibody–associated systemic vasculitis (AASV) have recently benefited from treatment advances that prolong life. AASV refers to a range of rare disorders characterized by small blood vessel inflammation and the production of antibodies against specific components within the neutrophils (e.g., Wegener’s granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome) (1). The inflammatory process can adversely affect organs, including the skin, lungs, and kidneys. AASV is marked by periods of remission and relapse, making its course highly uncertain. When critical organs are compromised, patients experience severe symptoms, including death. Treatment with corticosteroids and immunosuppressive drugs has proven beneficial, and has increased the likelihood of patient survival and sustained remission. Patients with AASV and their family members are now concerned with enhancing quality of life in addition to prolonging quantity of life (2). One central issue is chronic illness management (CIM), or efforts that patients and family members undertake to control AASV and minimize its negative impact on health status and functioning. AASV and its consequences are managed through activities, which may include strict adherence to medication regimens, visits to health professionals, nutrition changes, mild exercise, fatigue management, symptom monitoring, emotion management, and in some cases dialysis. Understanding the determinants of patients’ CIM is important because these behaviors affect illness progression (3,4) and could inform interventions. Here we focus on the interpersonal context of the lives of patients with AASV. There is considerable evidence demonstrating that support provided by persons who are close to these patients is associated with improved health behavior (5) and psychosocial functioning (6); however, interventions designed to increase support have been disappointing (7). Emerging literature on dyadic coping in the context of chronic illness (8) and rheumatic disease (9–11) integrates concepts from the field of relationship science into health-related research on social support. This literature offers a potentially useful process-oriented approach for examining support in couples facing chronic illness. The purpose of our article is to introduce a conceptual model of dyadic CIM that draws on recent theoretical and empirical work in relationship science and dyadic coping. This article is not meant to be a comprehensive review of social support and dyadic coping in rheumatic illness, but aims to introduce concepts from this emerging area and apply them to CIM in the context of AASV. We therefore do not report data, but instead use examples from our previous studies, and a current longitudinal study of CIM in couples coping with AASV, to illustrate the importance of the couple relationship to CIM. Three factors motivate our choice for focusing on marital partners in the context of CIM. First, prevailing CIM perspectives acknowledge that the interpersonal context may affect patient self-management efforts and, thus, patient outcomes (12). Second, research across diverse populations shows that marriage is strongly related to many beneficial health outcomes (13,14) and that spouses influence health-related perceptions and behaviors of partners (15– 17). These associations are well documented in couples coping with rheumatic diseases (9,17–21). Studies show that spouses can be effectively engaged in rheumatic illness coping interventions (10,22,23). Third, couples likely find AASV challenging to manage because of unpredictable periods of flares and remissions, treatment with medications that may have serious side effects, and the need for strict adherence to a variety of health behaviors (24). Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant P60-AR-49465-03), the National Cancer Institute (grant R21-CA-108744), and Wegener’s Granulomatosis Association. Megan A. Lewis, PhD, Carolyn T. Kalinowski, MPH, Tracy M. Barrett, PhD, Robert F. DeVellis, PhD: Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Katherine R. Sterba, PhD: School of Public Health, University of Texas at Houston. Address correspondence to Megan A. Lewis, PhD, Department of Health Behavior and Health Education, Campus Box 7440, University of North Carolina, Chapel Hill, NC 275997440. E-mail: megan.lewis@unc.edu. Submitted for publication August 25, 2005; accepted in revised form January 19, 2006. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 55, No. 4, August 15, 2006, pp 670–675 DOI 10.1002/art.22092 © 2006, American College of Rheumatology

Background: Many medications present special risks when used by older adults (ie, those aged ≥65 years) and are considered potentially inappropriate for this population. The Beers criteria are often used to identify such medications. Past research has documented that use of Beers drugs is common among older adults. Objective: The aim of this work was to examine factors associated with potentially inappropriate drug use among rural community-dwelling older adults using a conceptual framework adapted from the Andersen-Newman behavioral model of health service use. Methods: This was a population-based, cross-sectional survey. Data were collected via face-to-face home interviews between 2002 and 2004. Rural community-dwelling older adults residing in a single county in North Carolina were eligible. Potentially inappropriate drug use was operationalized using the Beers criteria. Data concerning predisposing (ie, age, sex, race, education, and marital status), enabling (ie, social support and insurance status), need (ie, disability and history of major depression, hypertension, osteoarthritis, back problems, or other comorbidities), and utilization factors (ie, number of medications used) were collected. Results: Data were gathered from 892 people, with information on medication use available for 800. Two hundred thirteen of these 800 participants (26.6%) used ≥1 Beers drug. Compared with individuals who used no Beers drugs, those who used ≥1 Beers drug reported lower levels of social support (odds ratio [OR], 0.94; 95% CI, 0.90–0.99) and higher levels of disability (OR, 1.48; 95% CI, 1.11–1.97), used more medications (OR, 1.07; 95% CI, 1.01–1.13), and were more likely to have a history of major depression (OR, 1.67; 95% CI, 1.05–2.66), hypertension (OR, 1.58; 95% CI, 1.07–2.33), osteoarthritis (OR, 1.58; 95% CI, 1.09–2.29), and back problems (OR, 1.72; 95% CI, 1.19–2.47). Conclusion: As suggested by the Andersen-Newman model, the risk of potentially inappropriate drug use is highest among those with the greatest medication needs, as evidenced by poorer health status in this sample of rural community-dwelling older patients.

Background and Purpose. Physical therapy is faced with the challenge of producing evidence that physical therapy interventions are effective. The fundamental question confronting physical therapy is whether or not physical therapy interventions make a contribution to function, health, and well-being. The individual's ability to perform actions can serve as a theoretical construct related to movement and health around which physical therapy interventions can be assessed. To this end, the aims of this study were: (1) to develop a self-report instrument to assess ability to perform mobility actions in an adult outpatient population and (2) to assess the psychometric properties of such an instrument in the appropriate population. Subjects and Methods. An instrument was developed to assess difficulty and confidence related to 24 actions. Descriptive statistics and measures of reliability, validity, and responsiveness were computed. A total of 391 patients participated in the study. Results. The coefficient for reliability was in the required range, and measures of validity and responsiveness were established as well. Three factors were identified. Discussion and Conclusion. The instrument provides the beginning of documentation of outcomes in movement to identify the unique contributions of physical therapist practice.

Background: This study was designed to translate, culturally adapt, and validate a Brazilian Portuguese version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-BR). Methods: The SMFA was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and then submitted to a committee of clinical, psychometric, and language experts. The questionnaire was then administered to 220 trauma patients at a midsize hospital in southern Brazil. Test-retest reliability was examined at one and seven days. Scale reliability and validity were assessed, and factor structure was analyzed. Results: Patients with only one region of dysfunction reported less dysfunction than did patients with two or three regions of dysfunction. Both the SMFA-BR dysfunction and the SMFA-BR bother scores had significant correlations with all Brazilian Short Form-36 (SF-36) subscales except for bodily pain. Test-retest reliabilities, as determined by intraclass correlation analyses, were 0.99 (95% confidence interval, 0.97, 1.00) at one day (n = 10) and 0.99 (95% confidence interval, 0.96, 1.00) at seven days (n = 17) for the dysfunction index and 0.99 (95% confidence interval, 0.98, 1.00) at one day (n = 10) and 0.97 (95% confidence interval, 0.97, 1.00) at seven days (n = 17) for the bother index. Cronbach alpha reliabilities were 0.95 (95% confidence interval, 0.93, 0.97) and 0.91 (95% confidence interval, 0.89, 0.94) for the dysfunction and bother indices, respectively. Minimal ceiling and floor effects were observed for the bother subscale only. Exploratory factor analysis yielded a three-factor structure: upper-extremity dysfunction, lower-extremity dysfunction, and bother. Conclusions: A reliable and valid Brazilian Portuguese version of the SMFA was developed. It will facilitate the examination of functional performance within a large patient population as well as allow cross-cultural comparisons.

Objectives.—To develop a new measure of parental discipline of children encompassing a broad array of types of discipline and modes of administration. Methods.—Parents of 12- to 19-month-old children were interviewed using a new 45-item structured survey about discipline in general pediatric clinics in North Carolina and Alabama. Demographic data describing the population studied were linked from another study in which these families were participating. Principal component analysis and confirmatory reliability analysis were used to define subscales and determine which items were retained in the survey. Results.—One hundred eighty-two parents were interviewed about disciplinary practices. Disciplinary subscales were robust for a number of disciplinary types (monitoring, verbal communication, modeling behavior, corporal punishment, and ignoring) and modes of administration (follow-through, consistency, positive demeanor, negative demeanor). Conclusions.—The Discipline Survey is a promising new measure of parental discipline. A survey instrument to assess disciplinary practices like the one developed fills a gap and can enhance research methodology for those interested in the effects of interventions on parental discipline.

Ecological studies implicate a “Western” diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982–84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4–1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.

Introduction Notions of self care and self management of common, but serious, health conditions were once viewed with skepticism by clinicians. However, over time, enlightened health care professionals have come to embrace the idea of informed, participative collaboration with patients as a key strategy for enhancing the effectiveness of clinical diagnostic and therapeutic interventions (1). Although these ideas are being absorbed into mainstream contemporary medicine and health care, our understanding of the range of self-initiated actions consumers use and the factors related to use of these actions is inadequate. Sobel (2) suggests that self care is the “hidden” health care system and that self care, rather than primary, secondary, or tertiary care, comprises the majority of health care. Others suggest that self-management activities are determinants of well being, potentially intervening between health status and health outcomes (3–5). If these assertions are true, we must have a clear understanding of the factors related to and outcomes associated with strategy use so people with chronic conditions can be guided in effective self-management practices. The terms self management and self care, often used interchangeably among lay and professional persons, are broadly defined as the activities people engage in to promote health and/or manage chronic conditions (6–9). These activities are usually self initiated and often undertaken with little to no supervision from health care professionals. For this article we use both phrases (self care and self management) to refer to the wide range of activities people use to promote personal health and to detect, prevent, and treat common health problems. The use of self-initiated actions to manage arthritis conditions is well recognized in the scientific literature and among health care providers. Applying the above definition of self management to arthritis, a variety of strategies could be used to manage the symptoms and consequences of the disease, such as taking medication, exercising, wearing splints or braces, taking herbs or supplements, or seeking care from alternative care providers. Two review articles by Ernst (10,11) show that use of complementary and alternative strategies is common but variable among people with rheumatic disease, with most people using at least 1 type of complementary therapy (e.g., special diets, jewelry, vitamins, herbs, prayer, relaxation, or massage). Little is known, however, about the broad range of strategies that could be used to manage arthritis, the degree to which people with arthritis use various strategies, and factors related to use of specific strategies. The purpose of this article is to address these gaps in the scientific literature.

PURPOSE General measure of perceived diabetes and dietary competence (PDDC) was developed to assess a person's sense of confidence and perceived behavioral control in diabetes and dietary self-management. Internal structure, reliability, and construct validity were evaluated. METHODS There were 2 samples of African American women with type 2 diabetes; 226 patients in the development sample and 225 patients in the validation sample. Factor analysis, Cronbach's coefficient alpha, and correlation analysis were used to assess reliability and validity of the PDDC measure. RESULTS Three subscales were empirically determined by factor analysis: positive competence, negative dietary competence, and negative control. Cronbach's alphas for all subscales were good. Predicted relationships with measures of perceived health competence, self-efficacy, social support, and perceived dietary barriers were largely supported in construct validation. CONCLUSIONS This study provides initial support for the internal reliability and validity of a perceived diabetes and dietary competence measure. Further research is needed to determine its validity in other samples of African Americans with type 2 diabetes and its clinical utility in evaluating diabetes self-management training.

The types of violence subsumed under the term intimate partner violence include physical assault, sexual assault, psychological abuse, and battering. This study is the first to estimate the prevalence of intimate partner violence by type (battering, physical assaults, and sexual assaults) in a population-based sample of women aged 18 to 45. The authors describe the prevalence of partner violence by type as well as the demographic, health behavior, and health status correlates of intimate partner violence by type. Findings support the empirical distinction of battering and assault. Battering as measured by the Women's Experiences With Battering (WEB) Scale provided the most comprehensive measure of intimate partner violence.

Purpose: Evidence concerning the effect of circumcision on sexual function is lacking. Men circumcised as adults are potentially in a unique position to comment on the effect of a prepuce on sexual intercourse. We examine sexual function outcomes in men who have experienced sexual intercourse in the uncircumcised and circumcised states.Materials and Methods: Men 18 years old or older when circumcised were identified by billing records during a 5-year period at an academic medical center. Medical charts were reviewed for confirmation of the procedure and to identify the indication(s). These men were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Data were analyzed using paired t tests to compare category scores before and after circumcision.Results: A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rat...

Study design A systematic review was conducted. Objective To identify, evaluate, and compare standard scales for assessing neck pain or dysfunction. Summary of background data The degree of a patient's neck pain or dysfunction can be evaluated using standardized scales at the time of a clinical encounter or during the performance of clinical research protocols. The choice of a scale with the most appropriate characteristics, however, is always a challenge to clinicians and researchers. Methods Articles concerning scales for functional evaluation of neck pain or dysfunction were identified by computer searching of MEDLINE (January 1966 to June 1999) and CINAHL (1985 to 2000), citation tracking using the Citation Index, hand searching of relevant journals, and correspondence with experts. Results Five standard scales were found. Three scales were remarkably similar in terms of structure and psychometric properties: the Neck Disability Index, the Copenhagen Neck Functional Disability Scale, and the Northwick Park Scale. However, only the first instrument has been revalidated in different study populations. The Neck Pain and Disability Scale provides a visual template for collection of information, but its usefulness is limited if the questionnaire must be read to the patient. The Patient-Specific Functional Scale is very sensitive to functional changes in individual patients, but comparisons between patients are virtually impossible. Conclusions The five scales identified in this study have similar characteristics. The Neck Disability Index, however, has been revalidated more times for evaluation of patient groups. For individual patient follow-up evaluation, the Patient-Specific Functional Scale has high sensitivity to change, and thus represents a good choice for clinical use. The final choice should be tailored according to the target population and the purpose of the evaluation.