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R R Faden

Publications and source records attributed to R R Faden.

At least 37 records · Page 2Linked to original sources
PubMed1993

Physicians' knowledge of genetics and genetic tests.

PURPOSE: To assess primary care physicians' and psychiatrists' knowledge of genetics and genetic tests and the factors associated with differences in these physicians' knowledge. METHOD: Questionnaires were mailed in 1991 to 1,795 primary care physicians (family physicians, internists, pediatricians, obstetrician-gynecologists) and psychiatrists who had graduated from medical school between 1950 and 1985 (67.6% of the sample had graduated after 1970) and who were members of professional societies. The questions elicited demographic and practice characteristics as well as knowledge of genetics concepts and facts and awareness of the availability of genetic tests. To validate the questionnaire, 360 medical geneticists and genetic counselors received questionnaires. Statistical analysis involved arc-sine function transformation, t-tests, analyses of variance, F-tests, Tukey's HSD, and stepwise multiple regression. RESULTS: A total of 1,140 (64.8%) of the non-geneticist physicians responded. They correctly answered an average of 73.9%, SD, 13.9%, of the knowledge items, compared with 94.6%, SD, 4.2%, for the genetics professionals (p < .001). The most significant predictors of knowledge were recency of graduation from medical school and practicing in primary care specialties in which exposure to genetics problems is likely. Other significant predictors (from most to least important) were graduation from a U.S. medical school, willingness to adopt a new predictive test before it becomes standard practice, not using pharmaceutical companies as a source of information about new medical practices, and taking a required genetics course in medical school. CONCLUSIONS: The results suggest that knowledge of genetics and genetic tests is increasing among physicians, particularly among more recent graduates and physicians who are exposed to genetics problems in their practices, but deficiencies remain. Although a medical school course in genetics may improve knowledge, it is not sufficient. Greater emphasis is needed at all levels of medical education to reduce the chance of physician error as more genetic tests become available.

Analysis of Variance↗
PubMed1993

Genetic screening technology: ethical issues in access to tests by employers and health insurance committees.

Whereas the introduction of new technologies previously has raised the ethical question of who ought to have access to a new procedure or device, genetic testing technology raises the new ethical question of to whom access to a new technology ought to be limited. In this article we discuss the implications of employers and private health insurance companies having access to genetic testing technology. Although there may be legitimate business interests in allowing employers and insurers to conduct genetic screening, there are other valid societal interests in regulating or limiting the use of this technology by third parties. Public policy developed in the area of new genetic technology must reflect such interests.

Employment↗
PubMed1993

A randomized trial of ethics education for medical house officers.

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series (Limited Intervention or LI), 25 per cent received lectures and case conferences, with an ethicist in attendance (Extensive Intervention or EI), and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group (3.9 on a 1 to 5 scale) compared to the control group (3.6). Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls (4.0 v 2.8). Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile (EI = 57 per cent, LI = 87 per cent, Controls = 82 per cent). We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency.

Baltimore↗
PubMed1993

Improving response rates through incentive and follow-up: the effect on a survey of physicians' knowledge of genetics.

OBJECTIVES: This study assessed efforts to increase response rates to a mailed physician survey and examined whether, as a result, nonresponse bias was reduced. METHODS: Randomly selected physicians and geneticists were mailed a questionnaire concerning genetics knowledge and attitudes. In the final but not the pilot survey, a $25 incentive and intensive follow-up were used to increase the response rate. RESULTS: The response rate from physicians in the final survey was 64.8% (n = 1140), compared with 19.6% in the pilot test (n = 69). Sample representatives in sociodemographic and practice characteristics was improved by follow-up. Respondents recruited with more difficulty did not differ on the principal outcome variable, genetics knowledge, except on one subscore. Pilot study and final survey respondents did not differ in knowledge. CONCLUSIONS: Although the effect of increased response rates on the principal outcome variable in this study was minimal, this may not be the case for other studies. Every effort should be made to attain as high a response rate as is practical and to establish that respondents are representative of the population being sampled.

Adult↗
PubMed1992

Prenatal factors associated with breastfeeding duration: recommendations for prenatal interventions.

This study of 198 urban breastfeeding women examined the psychosocial, demographic, and medical factors identified prenatally that may be associated with longer breastfeeding duration and may serve as suitable areas for prenatal breastfeeding promotion interventions. Of 11 psychosocial and demographic factors examined, 5 were important influences on breastfeeding duration: anticipated length of breastfeeding, normative beliefs, maternal confidence, social learning, and behavioral beliefs about breastfeeding. Methods of multivariate linear regression were used to identify prenatal factors that influenced anticipated length. Of the 10 factors entered into the regression model, parity, plans to return to work or school by six months postpartum, and maternal confidence were the most significant factors affecting anticipated length of breastfeeding. Our data suggest several factors amenable to intervention during the prenatal period that appear to influence breastfeeding duration. Prenatal promotion efforts could easily incorporate strategies that influence factors such as normative and behavioral beliefs and maternal confidence.

Adult↗
PubMed1992

Determinants of breastfeeding in a rural WIC population.

The purpose of the current research was to identify demographic and psychosocial factors important in the decision to breastfeed among a sample of WIC participants in a rural area. One hundred and ninety-eight women completed both a prenatal interview during their third trimester of pregnancy and a second interview within one to three weeks postpartum. Twenty-seven percent of these WIC participants initiated breastfeeding. Multiple logistic regression analysis revealed that prenatal behavioral beliefs about the consequences of breastfeeding and formula feeding were the strongest predictors of breastfeeding initiation. The results suggest that education to improve the current low rates of breastfeeding among WIC participants should emphasize that formula feeding is neither more convenient nor easier than breastfeeding, and that breastfeeding need not limit mothers in public or social settings.

Adult↗
PubMed1992

Homosexual and bisexual men's perceptions of discrimination in health services.

Questionnaires were distributed to homosexual and bisexual male participants in the Multicenter AIDS Cohort Study and to homosexual and bisexual male patients with acquired immunodeficiency syndrome (AIDS) to determine whether the men believed they had been refused medical or dental treatment because of their sexual orientation or a condition related to the human immunodeficiency virus (HIV). Men with AIDS were significantly more likely (18%) to report being refused treatment by a doctor or dentist on the basis of a known or suspected HIV-related condition than were men who were seropositive (5%) or seronegative (1%). Significantly more respondents reported refusal of dental care than of medical care.

Baltimore↗
PubMed1991

Loss of private health insurance among homosexual men with AIDS.

In this study we analyze information on self-reported health insurance coverage, HIV screening by insurers, and loss of health insurance. We distributed questionnaires to gay male participants in the Baltimore and Los Angeles sites of the Multicenter AIDS Cohort Study and to leukemia patients and gay AIDS patients seen at the Johns Hopkins Hospital. In this unusually well-educated and well-insured group, 90% of participants without AIDS had private health insurance coverage, compared with only 64% of participants with AIDS. Persons with AIDS (PWAs) were 33 times as likely to have Medicaid as persons without AIDS, and PWAs were 5 times as likely to have lost health coverage altogether as persons without AIDS.

AIDS Serodiagnosis↗
PubMed1991

Maternal employment during the early postpartum period: effects on initiation and continuation of breast-feeding.

This study sought to determine whether and to what extent maternal employment in the early post-partum period is associated with the initiation and continuation of breast-feeding in a heterogeneous, urban population. A panel of women were interviewed twice during the first 3 months postpartum. In analyses adjusted for maternal demographic characteristics, there was no association between planning to be employed within the first 6 months postpartum and initiation of breast-feeding. However, actually being employed was significantly associated with cessation of breast-feeding as early as 2 or 3 months postpartum, even after adjustment for maternal demographic variables. Less than one half of mothers who were employed were still breast-feeding at the second postpartum interview, whereas two thirds of those who were not employed were still breast-feeding. Among employed mothers, working no more than 20 hours per week appeared to be protective for continued breast-feeding.

Adult↗
PubMed1990

Tolerance for ambiguity among medical students: implications for their selection, training and practice.

The practice of medicine has always been characterized by uncertainty. Yet, attempts to study tolerance for uncertainty in medicine have been few, and limited to its influence on specialty preferences and test-ordering behavior. In particular, studies have not investigated how the process of socialization into the medical profession affects tolerance for uncertainty. Based on the assumption that uncertainty and ambiguity are related concepts, a modified version of a tolerance for ambiguity scale was used to study Johns Hopkins medical students' (N = 386) tolerance for ambiguity (TFA) through 4 yr of medical school. In addition, using alcoholism as an example of a clinically ambiguous condition, the association between students' tolerance for ambiguity and their perceived role in diagnosing and treating alcoholism was also investigated. Results indicate that tolerance for ambiguity (1) does not change throughout medical school, (2) is lower among men, whites and students who are younger when they begin medical school, (3) is higher among prospective psychiatrists than surgeons, and (4) is lower among students who do not feel responsible for diagnosing and treating alcoholism. These findings suggest that tolerance for ambiguity may, indeed, affect practitioners' career choices and performance and that selection of medical students may be more important than medical training per se in influencing students' tolerance for ambiguity. If medical schools admitted students who possess a high tolerance for ambiguity, quality of care for ambiguous conditions might improve, imbalances in physician supply and practice patterns might be reduced, and the increasing ambiguity in medical practice might be better acknowledge and accepted.

Alcoholism↗
PubMed1990

Risk reduction from low osmolality contrast media. What do patients think it is worth?

Decisions regarding the use of and reimbursement for new medical technologies frequently involve complex cost-quality trade-offs. Among physicians, hospital administrators, and insurers, interindividual variation in the value of benefits attributable to these technologies often leads to conflicting opinions about their appropriate use. Although society now encourages patient involvement in such decisions, few methods for obtaining patient valuations have been developed and systematically applied. In order to assess patient valuations of a particular new technology, low osmolality contrast media (LOM), a survey of 100 outpatients was conducted. Participants were asked about their willingness to pay (WTP) for the benefits of this expensive medical technology. Of the 95 subjects who completed the study questionnaire, a majority were unwilling to pay the minimum extra per procedure cost of LOM ($50) in return for a reduced risk of minor side effects alone (pain, nausea, hives, and flushing). For a reduced risk of both major side effects (death, renal insufficiency, severe allergic reaction, and cardiac arrhythmia) and minor side effects, the median WTP was $50; patient income and education were directly associated with WTP $50 or more. We conclude that similar WTP surveys may be helpful in addressing other difficult cost-quality issues.

Adult↗