Susan J Bartlett

Publications (67) View all

• Article: Patient adherence in COPD.

  J Bourbeau, S J Bartlett
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  ABSTRACT: Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients' perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients' beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients.
  Thorax 10/2008; 63(9):831-8. · 6.84 Impact Factor
• Article: Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988-1994.

  C J Crespo, E Smit, R P Troiano, S J Bartlett, C A Macera, R E Andersen
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  ABSTRACT: To examine the relationship between television watching, energy intake, physical activity, and obesity status in US boys and girls, aged 8 to 16 years. We used a nationally representative cross-sectional survey with an in-person interview and a medical examination, which included measurements of height and weight, daily hours of television watching, weekly participation in physical activity, and a dietary interview. Between 1988 and 1994, the Third National Health and Nutrition Examination Survey collected data on 4069 children. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. The prevalence of obesity is lowest among children watching 1 or fewer hours of television a day, and highest among those watching 4 or more hours of television a day. Girls engaged in less physical activity and consumed fewer joules per day than boys. A higher percentage of non-Hispanic white boys reported participating in physical activity 5 or more times per week than any other race/ethnic and sex group. Television watching was positively associated with obesity among girls, even after controlling for age, race/ethnicity, family income, weekly physical activity, and energy intake. As the prevalence of overweight increases, the need to reduce sedentary behaviors and to promote a more active lifestyle becomes essential. Clinicians and public health interventionists should encourage active lifestyles to balance the energy intake of children.
  Archives of Pediatrics and Adolescent Medicine 04/2001; 155(3):360-5. · 4.14 Impact Factor
• Article: Maternal depressive symptoms and emergency department use among inner-city children with asthma.

  S J Bartlett, K Kolodner, A M Butz, P Eggleston, F J Malveaux, C S Rand
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  ABSTRACT: Inner-city minority children with asthma use emergency departments (ED) frequently. To examine whether maternal depressive symptoms are associated with ED use. Baseline and 6-month surveys were administered to mothers of children with asthma in inner-city Baltimore, Md, and Washington, DC. Use of the ED at 6-month follow-up was examined. Independent variables included asthma morbidity, age, depressive symptoms, and other psychosocial data. Among mothers, nearly half reported significant levels of depressive symptoms. There were no demographic or asthma-related differences between the children of mothers with high and low depressive symptoms. However, in bivariate analyses, mothers with high depressive symptoms were 40% (prevalence ratio [PR], 1.4; 95% confidence interval [CI], 1.0-3.6; P =.04) more likely to report taking their child to the ED. Mothers aged 30 to 35 years were more than twice as likely (PR, 2.2; 95% CI, 1.9-9.3; P =.001) to report ED use, as were children with high morbidity (PR, 1.9; 95% CI, 1.4-7.1; P =.006). Child age and family income were not predictive of ED use. After controlling for asthma symptoms and mother's age, mothers with depressive symptoms were still 30% more likely to report ED use. Depression is common among inner-city mothers of children with asthma. Beyond asthma morbidity, maternal age and depressive symptoms are strong predictors of reports of ED visits. Identifying and addressing poor psychological adjustment in mothers may reduce unnecessary ED visits and optimize asthma management among inner-city children.
  Archives of Pediatrics and Adolescent Medicine 04/2001; 155(3):347-53. · 4.14 Impact Factor
• Article: Access and use of medical care among obese persons.

  K R Fontaine, S J Bartlett
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  ABSTRACT: The prevalence of obesity and severe obesity is growing rapidly, along with obesity-related comorbidities and mortality. Given the increased health risks associated with obesity, it is vital that obese persons have adequate access to, and make consistent use of, medical care services. Assuming obese persons have access to medical care that is comparable to non-obese persons, one would expect to observe greater use of medical services among obese persons. In this article we briefly review empirical evidence of the access to and use of medical care among obese persons. Although certain subgroups that tend to have disproportionately high prevalences of obesity (i.e., low socioeconomic status, minority groups) have reduced access to care, no studies have specifically examined whether or not obese persons have the same access to health care as do their lean counterparts. With respect to use of health care services, however, obesity has been consistently linked with greater rates of utilization and increased health care expenditures. Both the increased use and cost appear to be largely a function of treating obesity-associated comorbidities such as diabetes and hypertension. We conclude that, although it is clear that obesity is associated with both greater use and cost of medical care, the relationship between obesity and access to medical care has not been determined.
  Obesity research 09/2000; 8(5):403-6. · 4.95 Impact Factor
• Article: Health-related quality of life among obese persons seeking and not currently seeking treatment.

  K R Fontaine, S J Bartlett, I Barofsky
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  ABSTRACT: To compare sociodemographic characteristics and health-related quality of life (HRQL) between groups of obese persons who sought and did not seek university-based treatment for overweight. Three-hundred twelve consecutive obese persons sought outpatient university-based weight management treatment. The sample of obese persons (N = 89) who indicated that they were not currently trying to lose weight was derived from a larger convenience sample (N = 232) of persons surveyed in a hospital setting. Both groups completed sociodemographic and brief medical history questionnaires and the HRQL as measured by the Medical Outcomes Study Short-Form-36 Health Survey (SF-36). Obese persons who had sought treatment tended to be heavier, older, Caucasian, married, in white collar employment, and reported a higher prevalence of diabetes, hypertension, and pain. In multivariate analyses, both adjusted and unadjusted for these differences, obese persons who had sought treatment were significantly more impaired on the bodily pain, general health, and vitality HRQL domains than those who were not trying to lose weight. Although differences on sociodemographic and medical variables between the two groups may attenuate the obesity-HRQL relationship somewhat, obesity appears to have a pronounced impact on important dimensions of HRQL independent of whether or not the person is attempting to lose weight
  International Journal of Eating Disorders 02/2000; 27(1):101-5. · 2.95 Impact Factor