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Biomedical subjects

J M Hickner

Publications and source records attributed to J M Hickner.

36 records · Page 2Linked to original sources
PubMed1997

Smoking cessation interventions in rural family practices: an UPRNet study.

BACKGROUND: Primary care physicians are urged to offer smoking cessation counseling to their patients. Many studies have sought to determine which smoking interventions are most effective in medical office settings. As a result, routine identification of smokers, brief counseling, referral to smoking cessation programs, and nicotine replacement therapy are advocated. The context of patient visits during which smoking cessation advice is given, however, has received little attention. The objective of this study was to determine if patients' reasons for visits and self-reported readiness to quit smoking are associated with likelihood and type of smoking cessation intervention offered by family physicians. METHODS: The study was conducted in the Upper Peninsula Research Network (UPRNet), a voluntary association of family physicians in 15 medical clinics located in rural areas of northern Michigan. Practice coordinators administered a 1-page exit questionnaire to every other adult patient seen by a participating physician immediately after the office visit. Clinicians were blinded to the specific purpose of the questionnaire. During the study, 2317 questionnaires were administered, yielding information on 455 smokers. RESULTS: The overall rate of physicians' providing any smoking cessation intervention at any type of visit was 47%. There was a significant association between frequency of smoking cessation intervention and reasons for visits (chi 2 = 10.46, P = .01). There was a statistically significant difference between stages of readiness to quit and frequency of smoking cessation intervention offered (chi 2 = 26.5, P < .001). Clinicians offered smoking cessation interventions to smokers in the precontemplative stage significantly less often than to smokers in the contemplation, preparation, or action stages. CONCLUSIONS: UPRNet practitioners vary the frequency of smoking cessation interventions according to patients' reasons for the medical visit and their readiness to quit smoking.

Acute Disease↗
PubMed1995

Effect of distance and travel time on rural women's compliance with screening mammography: an UPRNet study. Upper Peninsula Research Network.

BACKGROUND: The purpose of this study was to determine whether the distance and time required for rural women to travel for a mammogram is associated with their compliance with screening mammography recommendations. METHODS: Women who were > or = 40 years old and visiting family physician offices for any reason were given a questionnaire regarding their frequency of mammography during the past 4 years, the distance and travel time from their homes to the nearest mammography unit, their attitudes and knowledge about mammography, and demographics. The study was conducted in the 12 family practices of the Upper Peninsula Research Network (UPRNet), a Michigan rural family practice research network. RESULTS: Eighty-eight percent (N = 416) of the women in the study had previously had mammography, but 41% were not compliant with American Cancer Society guidelines regarding mammography screening. After controlling for confounding, none of the measures of travel time or distance were associated with mammography compliance. CONCLUSIONS: In this rural population, mammography compliance is not affected by distance, travel time, or transportation. A population-based study in a more remote area is needed to further explore geographic barriers to mammography compliance among rural women.

Adult↗
PubMed1993

Prevalence and severity of urinary incontinence in ambulatory adults: an UPRNet study.

BACKGROUND: Although urinary incontinence (UI) is a common and costly problem, its prevalence and severity in ambulatory patients is not well established. The main objectives of this study were to define the prevalence and severity of urinary incontinence in adult men and women who came to a primary care office for health care, to determine if these patients had ever told a health care provider about this problem, and to determine if they would be interested in treatment if it were available and effective. METHODS: Men and women aged 20 years and over who came to family physicians' offices seeking health care for any reason during an 11-week period were the subjects of a survey by an anonymous questionnaire. Five family practice offices in UPRNet (the Upper Peninsula Research Network), a research network in Michigan, participated. We defined "current urinary incontinence" as any degree of incontinence in the past 12 months. RESULTS: Of the 2830 study participants, 33% had current urinary incontinence (95% confidence interval [CI] 31% to 35%). Incontinence was experienced by 11% of the men and 43% of the women. Urinary incontinence constituting a social or hygienic problem was reported by 5% of the men and 23% of the women (17% overall). Of those with current UI, 72% had not told a health care provider. Of the patients who had not told a physician, 37% said they would seek care if they knew tests and effective treatment were available. CONCLUSIONS: Urinary incontinence is a common problem among those seen in primary care settings, and its presence is often not known to the health care provider.

Adult↗
PubMed1991

Training for rural practice in Australia 1990.

There is a shortage of general practitioners in rural Australia. Several recent State and federal government reports have highlighted the difficulties of rural practice. One of the reasons commonly cited for the shortage of country doctors is the lack of appropriate training in Australia's medical schools and the Family Medicine Programme. This survey of the heads of departments of community medicine/general practice of Australia's 10 medical schools and of the State directors of the Family Medicine Programme documents the present efforts to train doctors for rural general practice. A 100% response was achieved. The responses indicate much interest and effort from the Family Medicine Programme in developing rural training schemes. Though the community medicine/general practice departments demonstrate considerable interest and innovation, they are hampered by lack of resources and negative attitudes of some specialist colleagues. Overall, the main impediments are: lack of "affirmative action" admissions policies to recruit rural students; insufficient curricular time for teaching the principles of general practice; students' lack of confidence in the procedural aspects of rural practice; lack of appropriate training posts in anaesthetics; lack of appropriate general practice training posts at regional hospitals; and lack of financial resources. Some suggestions are given to improve training for rural practice in Australia.

Attitude of Health Personnel↗
PubMed1991

Prevalence and prediction of chlamydial cervical infection in a rural area: an UPRNet project.

BACKGROUND: Though many studies have described the prevalence of genital Chlamydia trachomatis infections in urban and suburban populations, no data on a rural general practice population have been published. Knowledge of the prevalence of infection is necessary to develop screening strategies. METHODS: The Upper Peninsula Research Network (UPRNet) is a rural primary care research group composed of five family practice offices. Cervical cultures for C trachomatis were taken on all women under the age of 36 years who presented to UPRNet physicians for a pelvic examination for any reason between August 15 and November 10, 1989. Demographic and clinical variables were analyzed for correlation with infection, and the best predictors of infection were identified by logistic regression. Previously published screening protocols were then tested on our data to develop the best predictive model for our rural population. RESULTS: C trachomatis was cultured from 25 (4.7%, 95% CI 2.9% to 6.5%) of 530 consecutive women. Infection was significantly more common among younger and single women, women with a new sex partner, and women with mucopurulent cervical discharge or increased cervical friability. No symptoms were predictive of an increased risk of infection. Based on the clinical presentation alone, the physicians correctly predicted only 28% of the infections. Using a modified Rosenthal protocol, we would have identified 80% of the infections while testing only 31% of the women. The protocols of Magder and Handsfield and their respective colleagues performed reasonably well, too. Other published screening protocols were less useful. CONCLUSIONS: The prevalence of C trachomatis cervical infection in our rural primary care office population is relatively low. In rural primary care we recommend testing all high-risk women using a modification of Rosenthal's protocol instead of relying on symptoms or clinical suspicion.

Adolescent↗
PubMed1991

Incidental blood pressure elevations: a MIRNET project.

BACKGROUND: A prospective study was undertaken to determine the prevalence of hypertension in office patients with an incidental diastolic blood pressure greater than or equal to 90 mm Hg. METHODS: During routine screening of 14,890 patients, 174 patients with elevated diastolic blood pressures but no previous diagnosis of hypertension were identified over a 3-month period. Only 115 (64%) returned as requested for two subsequent blood pressure readings. RESULTS: Sixty percent of those returning fit the definition for hypertension using the criteria of the Joint National Committee on Detection, Evaluation, and Treatment of Hypertension. Sixty-nine percent (43/62) of the men and 49% (26/53) of the women were hypertensive. Women under 40 years old were less likely to be hypertensive, but age did not predict hypertension in men. Among those patients with a diastolic pressure reading below 105 mm Hg, progressively higher diastolic readings on the first visit did not predict a higher probability of hypertension. Among those patients with a diastolic pressure reading above 105 mm Hg, however, 90% (9/10) were hypertensive. CONCLUSIONS: Physicians should take incidental elevation of diastolic pressure seriously because of the high prevalence of confirmed hypertension in this group of patients.

Adult↗
PubMed1989

A comparison of two antismoking interventions among pregnant women in eleven private primary care practices.

Despite the dangers of smoking during pregnancy having been widely publicized, few studies have actually examined the effectiveness of antismoking interventions among pregnant women in the private primary care obstetric setting. A randomized experimental study involving 24 private physicians and 109 pregnant smokers was conducted comparing the American Lung Association's Because You Love Your Baby smoking intervention (ALA) to a standard-of-care protocol (non-ALA). The non-ALA protocol was based upon the smoking interventions that study physicians said they commonly used among pregnant women. Self-reported smoking rates were obtained by questionnaire at the first prenatal visit, at 32 to 36 weeks' gestation, and at the six-week postpartum visit. By the time of the first prenatal visit, both groups reduced by half the number of cigarettes smoked. By 32 to 36 weeks, the groups decreased the daily average by an additional 2.3 (ALA) and 1.8 (non-ALA) cigarettes, a nonsignificant difference between the groups. Fifteen (28 percent) of the ALA group compared with 9 (16 percent) of the non-ALA group reported quitting at the 32- to 36-week visit (P = .10). Only 9 percent of the ALA group and 10 percent of the non-ALA were nonsmokers at the postpartum visit. Pregnancy alone is a powerful motivator for women to decrease their smoking. Although the difference between the ALA and non-ALA protocols did not attain statistical significance, the percentage of those who quit was comparable to the results obtained in other controlled trials. The ALA Because You Love Your Baby protocol should be used until more effective methods are available.

Adult↗
PubMedDate not supplied

The Upper Peninsula Program: a successful model for increasing primary care physicians in rural areas.

In 1974, Michigan State University established the Upper Peninsula Medical Education Program (UP) to improve the physician supply in rural areas of Michigan by training students in a rural, practice-based setting. Practicing graduates of the program (N = 28) were surveyed by mail and their responses compared to a random sample of downstate MSU graduates (N = 57) with regard to practice location, specialty choice, hometown, and medical education and training. UP Program graduates showed a tendency to rural origin and chose rural practice and primary care specialties, especially family practice, more often than did their downstate colleagues. Responses of UP graduates suggested that rural residency locations would lead to increased numbers of rural practitioners. The rural UP Program has been successful to date in training medical students who ultimately pursue careers in rural primary medicine.

Career Choice↗