Carolyn T. Kalinowski

Bio: Carolyn T. Kalinowski is an academic researcher from University of North Carolina at Chapel Hill. The author has contributed to research in topics: Health education & Public health. The author has an hindex of 2, co-authored 2 publications receiving 83 citations.

Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States.

Abstract: Objective: The presence of psychologic distress in older adults may be associated with decreased adherence to recommended preventive-care services. This analysis aimed to measure the association between psychologic distress and adherence to United States Preventive Services Task Force (USPSTF)-recommended preventive-care services among older adults in the United States. Design: We undertook a cross-sectional analysis of 3655 U.S. community-dwelling elderly from the 2001 Medical Expenditure Panel (MEPS) survey. Measurements: The presence of psychologic distress was captured by the Mental Component Survey (MCS) of the SF-12. The receipt of 9 preventive care services were captured using MEPS: hypertension screening, influenza vaccination, fecal occult blood testing or sigmoidoscopy, mammography, clinical breast examination, cholesterol screening, prostate-specific antigen test, routine check-up, and dental checkup. Results: Elderly reporting psychologic distress were 30% less likely than nondistressed elderly to receive influenza vaccination (OR = 0.70, 95% CI = 0.55-0.88) and 23% less likely to receive annual dental check-ups (OR= 0.77, 95% CI = 0.61-0.97). Women with psychologic distress were 27% less likely to receive a clinical breast examination (OR = 0.73, 95% CI = 0.57-0.94). Psychologic distress was not significantly associated with screening for hypertension, colon cancer, high cholesterol, or prostrate cancer, mammography, or routine check-ups. Conclusions: Elderly reporting psychologic distress were less likely to adhere to some, but not all, recommended preventive care guidelines. These results suggest that adherence to recommended preventive care guidelines may be improved, indirectly, by improving recognition and treatment of emotional health problems in the elderly.

Interpersonal processes and vasculitis management.

Abstract: 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

Health beliefs, disease severity, and patient adherence: a meta-analysis.

Abstract: Background:A large body of empirical data exists on the prediction of patient adherence from subjective and objective assessments of health status and disease severity. This work can be summarized with meta-analysis.Objectives:Retrieval and summary analysis of r effect sizes and moderators of the re

A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study

Abstract: Objective: Poor quality of healthcare contributes to impaired health and excess mortality in individuals with severe mental disorders. The authors tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings. Method: A total of 407 subjects with severe mental illness at an urban community mental health center were randomly assigned to either the medical care management intervention or usual care. For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education, and support in overcoming system-level fragmentation and barriers to primary medical care. Results: At a 12-month follow-up evaluation, the intervention group received an average of 58.7% of recommended preventive services compared with a rate of 21.8% in the usual care group. They also received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% versus 27.7%) and were more likely to have a primary care provider (71.2% versus 51.9%). The intervention group showed significant improvement on the SF-36 mental component summary (8.0% [versus a 1.1% decline in the usual care group]) and a nonsignificant improvement on the SF36 physical component summary. Among subjects with available laboratory data, scores on the Framingham Cardiovascular Risk Index were significantly better in the intervention group (6.9%) than the usual care group (9.8%). Conclusions: M edical care management was associated with significant improve ments in the quality and outcomes of primary care. These findings suggest that care management is a promising approach for improving medical care for patients treated in community mental health settings.

Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies

Abstract: Background Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.

Does the Perception that Stress Affects Health Matter? The Association with Health and Mortality

Abstract: Objective This study sought to examine the relationship among the amount of stress, the perception that stress affects health, and health and mortality outcomes in a nationally-representative sample of US adults

Premature Mortality From General Medical Illnesses Among Persons With Bipolar Disorder: A Review

Abstract: Objective: Despite recent evidence that patients with bipolar disorder are at increased risk of premature mortality resulting from general medical disorders, there has been no systematic review of published studies. The authors reviewed the literature to determine whether there is evidence of increased risk of mortality from general medical causes among patients with bipolar spectrum disorders. Methods: MEDLINE was searched from 1959 to 2007 with a focus on bipolar disorder and medical mortality. Published studies in English with more than 100 patients were included. Results: Seventeen studies were identified involving 331,000 patients with bipolar disorder, affective psychosis, affective disorder severe enough to require inpatient psychiatric care or treatment with lithium, or schizoaffective disorder (that is, bipolar spectrum disorders) meeting the inclusion criteria. Compared with age- and sex-matched control samples without mental illness in the general population, mortality ratios for death from natural causes and from specific general medical conditions, such as cardiovascular, respiratory, cerebrovascular, and endocrine disorders, were significantly higher among patients with bipolar spectrum disorders in most studies. This finding was more consistent in larger studies with more than 2,500 patients with bipolar spectrum disorders. Cumulatively, cardiovascular disorder appeared to be the most consistent cause of excess mortality in larger studies. Conclusions: The available evidence suggests that bipolar spectrum disorders are associated with increased premature mortality secondary to general medical illnesses. Unhealthy lifestyle, biological factors, adverse pharmacologic effects, and disparities in health care are possible underlying causes for this excess mortality. (Psychiatric Services 60:147–156, 2009)