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Biomedical subjects

N J Thompson

Publications and source records attributed to N J Thompson.

At least 19 recordsLinked to original sources
PubMed2000

A randomized controlled trial of a clinic-based support staff intervention to increase the rate of fecal occult blood test ordering.

BACKGROUND: Colorectal cancer is the second most common fatal malignancy in the United States. Early detection using fecal occult blood tests has been shown to reduce mortality, but these tests are underutilized among those eligible for this screening. Attempts to increase use of fecal occult blood tests in eligible populations have focused on the provider, patient, or system. But none have examined whether a support-staff intervention is effective in achieving this aim. We therefore conducted a randomized controlled trial to test the impact of authorizing support staff to order fecal occult blood tests in a general internal medicine clinic organized into four teams. METHODS: A total of 1,109 patients were included in the study, 545 of whom were in the two teams randomized to treatment. Univariate and multivariate regression analyses were used to evaluate the impact of the intervention. RESULTS: The intervention resulted in significantly more fecal occult blood test ordering in the treatment group than in the control group for all patients (52% vs 15%, P < 0.001). Treatment fecal occult blood test cards were returned as frequently as the control cards for all patients (44% vs 48%, P = 0.571). CONCLUSION: Delegation of selected screening tasks to support staff can enhance patient access to preventive care.

Colorectal Neoplasms↗
PubMed1999

Partner abuse and posttraumatic stress disorder as risk factors for suicide attempts in a sample of low-income, inner-city women.

This study examined partner abuse and posttraumatic stress disorder (PTSD) as risk factors for suicidal behavior among women, and whether or not PTSD mediated the partner abuse-suicidal behavior association. Attempters (n = 119) were approximately three times more likely to be above clinical cut-points for physical partner abuse, nonphysical abuse, and PTSD than nonattempters (n = 85). Physical partner abuse, but not nonphysical partner abuse, was associated with an increased risk for PTSD. Further, PTSD mediated the link between physical partner abuse and suicidality, such that when PTSD was statistically controlled, the association between physical partner abuse and suicide attempt status was reduced to nonsignificance. Implications of findings for interventions for female victims of partner abuse, and women who make nonfatal suicide attempts are discussed.

Adult↗
PubMed1999

Predicting breast-feeding intention among low-income pregnant women: a comparison of two theoretical models.

This study examined the applicability of the transtheoretical model and a model derived from the theory of reasoned action for predicting breast-feeding intention among low-income pregnant women. Participants completed a 70-item self-report questionnaire assessing their breast-feeding attitudes, intentions, and support. A positive correlation existed between Stages of Change for breast-feeding and the number of Processes of Change used by respondents. A negative correlation existed between Stages of Change for breast-feeding and the number of negative breast-feeding beliefs held by respondents. Furthermore, women's normative beliefs and outcome beliefs were significantly correlated with breast-feeding intention in manners consistent with the model developed from the theory of reasoned action. After accounting for significant sociodemographic and lifestyle factors, the Processes of Change and outcome beliefs remained independently correlated with breast-feeding intention. These models are capable of predicting the intention to breast-feed and might offer an innovative approach for further breast-feeding research and intervention development.

Adolescent↗
PubMed1998

Health risk behaviors of adolescent participants in organized sports.

PURPOSE: To assess differences in health-related behaviors between athletes and nonathletes. METHODS: In Grades 9-12 in seven high schools during the 1991-1992 academic year, 7179 (82%) students were asked to complete a survey with six categories of health-related behaviors associated with adolescent morbidity and mortality. Of the 6849 students who completed the survey, 4036 (56%) were classified as athletes. Analyses of differences were controlled for age, race, and gender. RESULTS: Athletes and nonathletes differed in specific health-risk behaviors. Nonathletes were more likely than athletes ever to have smoked cigarettes (15% vs. 10%) or used marijuana (24% vs. 23%), and fewer ate breakfast daily (34% vs. 45%), never added salt to food (18% vs. 22%), consumed calcium (56% vs. 64%), or consumed fruit or vegetables (40% vs. 47%) daily. More nonathletes reported frequent feelings of hopelessness (15% vs. 10%) and rarely or never using seatbelts (24% vs. 20%), but more athletes reported exceeding the speed limit by 10 mph (39% vs. 35%) and riding bicycles (40% vs. 28%) and/or motorcycles (13% vs. 8%) without helmets. These differences were statistically significant. CONCLUSIONS: Because of their behaviors, adolescent athletes put themselves at significant risk for accidental injuries. However, athletes appear less likely to smoke cigarettes or marijuana, more likely to engage in healthy dietary behaviors, and less likely to feel bored or hopeless.

Adolescent↗
PubMed1998

Intention to breastfeed in low-income pregnant women: the role of social support and previous experience.

BACKGROUND: The purpose of this study was to describe the relationship between breastfeeding intention among socioeconomically disadvantaged pregnant women and maternal demographics, previous breastfeeding experience, and social support. METHODS: A cross-sectional, convenience sampling strategy was employed for data collection. Low-income women (n = 1001) in a public hospital completed a six-page questionnaire about their infant feeding plans, demographics, and social support. Simple regression analyses were conducted to compare maternal breastfeeding intention with the hypothesized correlates. RESULTS: Breastfeeding intention was positively correlated with older maternal age, higher education, more breastfeeding experience, Hispanic ethnicity, and hearing about breastfeeding benefits from family members, the baby's father, and lactation consultants, but not from other health professionals. Health professionals' attitudes were less influential on women's infant feeding decisions than the attitudes and beliefs of members of women's social support networks. When controlling for breastfeeding experience (none vs any), some findings, varied, indicating a need for breastfeeding interventions tailored to women's level of experience. CONCLUSION: Use of peer counselors and lactation consultants, inclusion of a woman's family members in breastfeeding educational contacts, and creation of breastfeeding classes tailored to influential members of women's social support networks may improve breastfeeding rates among low-income women, especially those with no breastfeeding experience, more effectively than breastfeeding education to pregnant women that is solely conducted by health professionals.

Adolescent↗
PubMed1997

The relationship of sexual abuse and HIV risk behaviors among heterosexual adult female STD patients.

Some effects of sexual abuse, for example, heightened sexual activity, are also risk factors for infection with the human immunodeficiency virus (HIV). Moreover, Social Cognitive theory suggests that the reduced self-esteem and increased sexual arousal that can result from abuse might alter self-efficacy for performing a behavior and expected outcomes of the behavior, making adoption of preventive behavior more difficult. Studies in the general population, adolescents, and male clients of sexually transmitted disease (STD) clinics, have found associations between childhood sexual abuse and HIV risk behaviors. This study was designed to measure: (a) whatever the association persists among female STD clinic clients; and (b) whether sexual abuse is associated with self-efficacy for condom use or condom use outcome expectations. Among the 83 female STD clinic clients studied, those sexually abused before age 18 had more sexual partners (p < .05), more positive hedonic outcome expectations for condom use (p < .01), and fewer positive partner-related outcome expectations for condom use (p < .05) than those never forced to have sex against their will. In summary, HIV risk behavior among female STD clients varies with childhood sexual abuse and Social Cognitive Theory suggests future directions for prevention.

Adolescent↗
PubMed1997

Early detection of Alzheimer disease: methods, markers, and misgivings.

There is at present no reliable predictive test for most forms of Alzheimer disease (AD). Although some information about future risk for disease is available in theory through ApoE genotyping, it is of limited accuracy and utility. Once neuroprotective treatments are available for AD, reliable early detection will become a key component of the treatment strategy. We recently conducted a pilot survey eliciting attitudes and beliefs toward an unspecified and hypothetical predictive test for AD. The survey was completed by a convenience sample of 176 individuals, aged 22-77, which was 75% female, 30% African-American, and of which 33% had a family member with AD. The survey revealed that 69% of this sample would elect to obtain predictive testing for AD if the test were 100% accurate. Individuals were more likely to desire predictive testing if they had an a priori belief that they would develop AD (p = 0.0001), had a lower educational level (p = 0.003), were worried that they would develop AD (p = 0.02), had a self-defined history of depression (p = 0.04), and had a family member with AD (p = 0.04). However, the desire for predictive testing was not significantly associated with age, gender, ethnicity, or income. The desire to obtain predictive testing for AD decreased as the assumed accuracy of the hypothetical test decreased. A better short-term strategy for early detection of AD may be computer-based neuropsychological screening of at-risk (older aged) individuals to identify very early cognitive impairment. Individuals identified in this manner could be referred for diagnostic evaluation and early cases of AD could be identified and treated. A new self-administered, touch-screen, computer-based, neuropsychological screening instrument called Neurobehavioral Evaluation System-3 is described, which may facilitate this type of screening.

Adult↗
PubMed1997

Methodologies for informing beneficiaries of their rights: evaluating the Important Message from Medicare.

The Important Message from Medicare, a letter given to US Medicare patients upon hospital admission, was originally designed to allay the concerns of the Health Care Financing Administration (HCFA), Peer Review Organizations (PROs), and the beneficiary community that patients did not know their rights under Medicare and the PRO program. The effectiveness of the current Message may be adversely affected by the complexity of its language, the multifaceted admissions process, priorities of sick patients, and the demand for hospital resources. This study evaluated the effectiveness of the Message and various alternatives for informing beneficiaries of their rights. With HCFA financing, PROs in 10 states surveyed random samples of Medicare beneficiaries to measure knowledge of their rights under the current system and after the implementation of alternatives. This study found that there are alternative ways of informing Medicare beneficiaries of their rights which are more effective than the current Important Message from Medicare.

Aged↗
PubMed1997

Do not resuscitate orders in the perioperative period: patient perspectives.

The purpose of this study was to determine the perspectives and opinions of terminally ill patients regarding the management of their do not resuscitate (DNR) orders in the perioperative period. Eighteen patients who had DNR orders and were willing to discuss those orders and their intentions were identified by hospital nurses or hospice workers. An in-depth interview was conducted with each patient. Patients' intentions for DNR orders focused on themes of "being ready to die" and concern regarding financial and emotional cost to themselves and their families. Fifteen of 18 patients would agree to some type of surgery, some to palliative procedures, others to procedures unrelated to their primary disease. After a brief explanation of the different types of anesthesia and their risks, patients were asked how they would like their DNR orders to be respected during the perioperative period. Some would allow procedures in the operating room that ordinarily would be prohibited by a DNR order and felt that DNR orders should be suspended. Many felt that their DNR orders should be discussed with them preoperatively. Some wanted to be involved with decisions regarding specific procedures. Others were satisfied with discussing the intent of their orders. For various reasons and for various procedures, many patients with DNR orders are willing to undergo anesthesia and surgery. Anesthesiologists' awareness of the variety of opinions and perspectives held by patients regarding their DNR orders will enhance their preoperative discussion.

Adult↗
PubMed1995

A survey of knowledge and attitudes about HIV and AIDS among medical students.

Researchers have found that a significant number of medical students harbor attitudes that have a negative impact on their willingness to care for persons who are HIV positive or have AIDS. To assess current HIV and AIDS knowledge and attitudes, the authors administered a 25-item survey tailored for medical professionals to 63 preclinical medical students. Respondents' mean score on the knowledge scale was 6.25 (SD 1.63) out of a possible score of 10. Factor analysis suggested three major groupings of medical students with regard to attitudes. The largest group had generally positive attitudes about patients with HIV and AIDS; two subgroups, however, would tend to refer such patients to another physician. One subgroup reported feeling more uncomfortable with homosexual behavior and with HIV-seropositive patients than they did with patients with other infectious diseases. This group also expressed discomfort with physically touching HIV-seropositive clients. The other group expressed discomfort with taking a patient's sexual history. Effective educational interventions must take these findings into account.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Unintended pregnancy and sex education in Chile: a behavioural model.

This study analysed factors associated with unintended pregnancy among adolescent and young adult women in Santiago, Chile. Three variations of a behavioural model were developed. Logistic regression showed that the effect of sex education on unintended pregnancy works through the use of contraception. Other significant effects were found for variables reflecting socioeconomic status and a woman's acceptance of her sexuality. The results also suggested that labelling affects measurement of 'unintended' pregnancy.

Adolescent↗
PubMed1994

Predicting injury risk in adolescent football players: the importance of psychological variables.

Explored the relationship of anger/aggression, attention, and stressful life events to injury while addressing the methodological limitations of prior studies. An additional objective was to determine whether the relationship of stressful life events to injury is mediated either by anger (directed either inward or outward) or by impaired attention, either vigilant (broad, external) or focused (narrow, internal). At the beginning of summer practice, 120 first-string high school football players completed measures of anger (Framingham Anger Scale), vigilant attention (Symbol Digit Modalities test), focused attention (Pursuit subtest, MacQuarrie Test of Mechanical Ability), and stressful life events (abbreviated form of the Social Readjustment Rating Scale as modified for use with adolescents by Coddington, 1972). Players were then followed through one season to identify those injured. Logistic regression indicated that high anger directed outward (p < .05) and low focused attention (p < .01) increased injury risk, while stressful life events and vigilant attention interacted. Injury risk was elevated when recent stress was present (p < .05), and increased as vigilance decreased, suggesting that stressful life events elevate injury risk by reducing vigilance.

Adolescent↗
PubMed1994

"Do not resuscitate" (DNR) orders in the perioperative period--a comparison of the perspectives of anesthesiologists, internists, and surgeons.

The purpose of this descriptive study is to compare and contrast the experience, perceptions, and opinions of practicing anesthesiologists, internists, and surgeons regarding "do not resuscitate" (DNR) orders in the perioperative period. A questionnaire was mailed to 600 internists and 600 surgeons. Responses from these two groups were analyzed and compared with the results of a previously reported survey of 420 anesthesiologists. One hundred ninety-two of 570 (34%) and 199/584 (34%) acknowledged responses were received from internists and surgeons, respectively. Anesthesiologists (114/190; 60%) were more likely than internists (61/182; 34%) or surgeons (71/194; 37%) to assume DNR suspension in the perioperative period and were less likely than their colleagues to discuss with the patient the implications of their DNR order during anesthesia and surgery. This assumption of DNR suspension by anesthesiologists was underestimated by both surgeons and internists. Anesthesiologists and surgeons were more similar than internists in their manner of utilization of resuscitative measures in the setting of a cardiopulmonary arrest. All groups were more likely to require DNR suspension for elective than for palliative cases. The majority of all groups concurred that physician responsibility for defining DNR status in the perioperative period should be shared by the anesthesiologist, surgeon, and primary care physician and not prescribed by hospital policy. The manner in which a DNR order is perceived in the perioperative period varies considerably among specialties and warrants further discussion among these groups.

Anesthesiology↗
PubMed1993

"Do not resuscitate" (DNR) orders and the anesthesiologist: a survey.

Anesthesiologists were surveyed to determine their experience and opinions regarding "Do Not Resuscitate" (DNR) orders in the perioperative period. Four hundred fifteen questionnaires were mailed and 193 (47%) were returned. One hundred sixty-one (87%) of 186 respondents had been requested to provide (and more than two-thirds had provided) monitored anesthesia care, regional anesthesia, or general anesthesia to a patient with a DNR order. Almost two-thirds of the respondents assume DNR suspension in the perioperative period and only half discuss this assumption with the patient/guardian. Less than 50% of respondents would require DNR suspension for a palliative procedure contrasted with > 60% for an elective procedure. After agreeing to a patient's decision to retain their DNR status, > 67%, > 58%, < 49%, and < 33% would utilize positive pressure ventilation with a mask, vasoactive drugs, endotracheal intubation, or defibrillation, respectively, in the event of a cardiopulmonary arrest in the perioperative period. These findings suggest much ambiguity regarding DNR orders in the perioperative period. Further discussion among physicians and patients is warranted.

Adult↗
PubMed1989

An outbreak of hookworm infection associated with military operations in Grenada.

During 1983, a multinational military intervention took place on Grenada. After deployment, troops from several U.S. Army units noted signs and symptoms consistent with soil-transmitted helminthic infection. Of 684 soldiers screened five to seven weeks post-deployment, over 20% reported abdominal pain and/or diarrhea during or after the action. Eosinophilia of at least 10% was observed in 119 (22.5%) of 529 soldiers evaluated further; eosinophilia of 5-9% was documented in another 126 (23.8%) of the 529 soldiers. Stool examinations confirmed hookworm infection in 35 soldiers. One case of strongyloidiasis was also documented. Infection was attributed to ground exposure near homes with compromised sanitation. Units that joined the operation after the initial assault phase were at low risk of hookworm infection.

Disease Outbreaks↗
PubMed1985

Variations in national health care practices and behaviours and their influence on international research.

Multinational clinical trials are valuable to the understanding of global health problems, but they pose special problems. Our experience with a multinational trial of isoniazid (INH) preventive therapy for tuberculosis revealed marked variation among the seven participating countries in the amount of tuberculosis screening prior to the trial; this variation contributed to the observed differences in the risk of tuberculosis among the countries. The incidence of 'uncooperativeness' and drug side-effects, and the proportion of participants who complied with and completed treatment also varied significantly from country to country. These differences in completion and compliance served to differentially alter the expected risk of tuberculosis among the three regimens being studied. For all factors investigated, variation from country to country was greater than variation from dispensary to dispensary within a country. This suggests that cultural and other national characteristics are more potent determinants of health care practices and behaviours than patient and health care practitioner characteristics.

Clinical Trials as Topic↗
PubMed1985

Infection and disease among contacts of tuberculosis cases with drug-resistant and drug-susceptible bacilli.

Three hundred ninety-eight tuberculosis patients with tubercle bacilli resistant to isoniazid and/or streptomycin were matched by age, race, sex, and geographic area to an equal number of patients with tubercle bacilli susceptible to 9 drugs, including isoniazid and streptomycin, in an effort to determine whether the risk of infection and disease among contacts of patients with resistant bacilli is different from the risk among contacts to patients with susceptible bacilli. The risk of infection among contacts of previously untreated patients was not significantly different, regardless of whether the bacilli were drug-resistant or susceptible. However, the risk of infection increased if the index patient with resistant bacilli had been previously treated. We found no evidence of a lower risk of infection among contacts exposed to bacilli resistant to the highest concentration of isoniazid tested or among contacts exposed to bacilli resistant to both isoniazid and streptomycin. There was a strong association between infection risk among contacts and the age of the index case; younger patients were more infectious. Index cases tended to infect most (or all) or few (or none) of their contacts. The investigation of contacts of patients excreting drug-resistant bacilli should be given high priority.

Adolescent↗