BACKGROUND: The purpose of this study was to evaluate the effect of physician recommendation on whether to enroll in a randomized controlled chemoprevention trial for breast cancer. METHODS: We surveyed 360 women who were at increased risk for breast cancer regarding social and behavioral factors that could influence their decision to enroll or not to enroll in the Breast Cancer Prevention Trial (BCPT). Respondents completed a questionnaire following attendance at an informational session about the trial. The analysis was restricted to 175 women who discussed the possibility of their participation in the trial with their primary care physician (PCP) and who reported what their physician advised them to do regarding participation. RESULTS: Logistic regression modeling showed that among women who discussed the trial with their physician, physician recommendation was the most important factor that influenced the respondent's decision to enroll in the BCPT. Women who reported that their physician advised them to enroll in the trial were 13 times more likely to participate than were women who reported that their physicians advised them not to participate. CONCLUSIONS: The results of our study show that PCPs play an important role in influencing preventive health behavior, specifically, regarding enrollment in a randomized breast cancer chemoprevention trial. Efforts to increase recruitment to a trial should include enlisting the support of PCPs.

Adult↗

PubMedDate not supplied

Depressive disorders in childhood. III. A longitudinal study of comorbidity with and risk for conduct disorders.

As part of a longitudinal nosologic study of major depressive disorder (MDD), dysthymic disorder, and adjustment disorder with depressed mood in 104 school-aged probands, the prevalence and consequences of comorbid conduct disorders (CD) were examined. During the index depressive episodes, 16% of the patients had comorbid CD; during the full study observation 23% had CD; and the estimated time-dependent risk of conduct disorder developing was 36% by age 19. For most cases, comorbid CD developed as a complication of the depression and persisted after the depression remitted. Comorbid CD was not differentially associated with the type of depression at study entry, did not affect depressive symptom presentation, was similarly distributed among boys and girls, and was unrelated to demographic factors. Additionally, comorbid CD did not affect recovery from the index depressive episodes and did not influence the symptom-free interval before a recurrent depression among cases with MDD. The risk of CD developing was not altered by chronologically earlier family variables or demographic factors. But girls who had attention deficit disorder, compared to those who did not, seemed to be at higher risk for CD during study observation. Finally, in this depressed cohort, having CD any time was associated with an increased rate of long-term functional problems.

Adjustment Disorders↗

PubMedDate not supplied

Wheelchair karate.

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder.

Our purpose was to compare the effectiveness of traditional treatment with immediate arthroscopic stabilization in young patients who have sustained a first traumatic anterior dislocation of the shoulder. Forty skeletally mature patients younger than 30 years of age were randomly allocated to immobilization for 3 weeks followed by rehabilitation (group T) or arthroscopic stabilization (within 4 weeks of injury) followed by an identical immobilization and rehabilitation protocol (group S). A blinded research assistant performed all follow-up evaluations. The dominant arm was involved in 35% of subjects. The injury occurred in a sporting event in 70% of subjects. At 24 months, there was a statistically significant difference in the rate of redislocation (T = 47%, S = 15.9%, P = .03). An intention-to-treat analysis comparing disease-specific quality of life using the validated Western Ontario Shoulder Instability (WOSI) index showed statistically significantly better results in the surgically treated group at the 33 months (T = 633.93 v S = 287.1, P = .03) and no significant difference in range of motion. At an average 32 months follow-up, a significant reduction in redislocation and improvement in disease-specific quality of life is afforded by early arthroscopic stabilization in patients less than 30 year of age with a first, traumatic, anterior dislocation of the shoulder.

Adolescent↗

PubMedDate not supplied

Patient satisfaction with dental care in a municipal hospital.

Quality assurance activities are an important part of a hospital dental department. This study reports the results of a patient satisfaction questionnaire distributed as part of the quality assurance activities at a municipal hospital. The results show patient satisfaction questionnaires are applicable to the hospital setting, patients report relative satisfaction with the care received, and they can identify specific areas of satisfaction and dissatisfaction. The number of visits, easy access and convenience to the clinic, and out-of-pocket payment for dental care are predictive of satisfaction with the dental care received at this clinic.

Adolescent↗

PubMedDate not supplied

Impact of hospital care on incidence of bloodstream infection: the evaluation of processes and indicators in infection control study.

The Evaluation of Processes and Indicators in Infection Control (EPIC) study assesses the relationship between hospital care and rates of central venous catheter-associated primary bacteremia in 54 intensive-care units (ICUs) in the United States and 14 other countries. Using ICU rather than the patient as the primary unit of statistical analysis permits evaluation of factors that vary at the ICU level. The design of EPIC can serve as a template for studies investigating the relationship between process and event rates across health-care institutions.

Bacteremia↗