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At least 271 records · Page 15Linked to original sources
PubMed2006

Community wide electronic distribution of summary health care utilization data.

BACKGROUND: In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be a complicated and expensive undertaking. This study described the development and implementation of a community wide system for electronic sharing of summary health care utilization data. METHODS: The development of the community wide data system focused on the following objectives: ongoing monitoring of the health care system, evaluation of community wide individual provider initiatives, identification and development of new initiatives. The system focused on the sharing of data related to hospital acute care, emergency medical services, long term care, and mental health. It was based on the daily distribution of reports among all health care providers related to these services. RESULTS: The development of the summary reports concerning health care utilization produced a system wide view of health care in Syracuse, New York on a daily basis. It was not possible to isolate the results of these reports because of the impact of specific projects and other factors. At the same time, the reports were associated with reduction of hospital inpatient stays, improvement of access to hospital emergency departments, reductions in stays for patients discharged to nursing homes, and increased access of mental health patients to hospital inpatient units. CONCLUSION: The implementation of the system demonstrated that summary electronic utilization data could provide daily information that would support the improvement of health care outcomes and efficiency. This approach could be implemented in a simple, direct manner with minimal expenses.

Catchment Area, Health↗
PubMed2006

Purposes of health identification cards and role of a secure access platform (Be-Health) in Belgium.

Although other alternatives may exist, identification cards have been chosen as an acceptable and adequate tool to be used to identify patients and health professionals. It is planned to use these for digital signature and for access to electronic health records: for searching various databases as well as for health information exchange. Local applications might exist independently, but the Belgian federal state has now developed Be-Health, a platform for health professionals, social security personnel and the general public, designed to facilitate a secure common uniform access to certain health data.

Access to Information↗
PubMed2005

Health information seeking and its effect on the doctor-patient digital divide.

A survey of 224 individuals using SureStart services (for young families) within an inner-London area was complemented by qualitative data from five focus groups of parents and general practitioners in the same area. Descriptive and multivariate statistics were used to identify and describe discrete geographical districts with differing patterns of health information seeking. A geographically defined group of 'information hungry'/'online' health seekers was identified. This group contrasted with those acquiring information through 'assimilation' ('offline' information seekers). Qualitative data revealed the processes underpinning these characteristics and professional attitudes towards the Internet as a source of health information.

Adult↗
PubMed2026

Financial incentives and health coaching to improve glycemic outcomes among young adults with type 1 diabetes: A factorial randomized trial (SweetGoals).

AIM: This study aimed to improve glycemic control among young adults with type 1 diabetes (T1D), an at-risk and understudied population. METHOD: N = 300 young adults with T1D recruited nationally were randomized to the factorial combination of (1) financial incentives targeting glucose checking and mealtime behaviors and (2) web health coaching focused on increasing motivation and goal setting for self-management behaviors. All received a smartphone app that accessed device data and provided weekly goal feedback. The intervention lasted 6 months. HbA1c (A1c) was assessed at baseline, +6 months, and +12 months. The mean number of glucose checking and mealtime goals met per week during the intervention were tested as mediators of intervention effects on A1c at 12 months. RESULTS: A1c was significantly reduced from baseline to +12 months across all participants. Indirect effects of both incentives and coaching on A1c reductions were significant and partially mediated by mealtime but not glucose checking goal achievement. There was no synergistic (interaction) effect of incentives and coaching. CONCLUSION: Incentives and coaching both improved critical mealtime behavior but through different strategies. These results suggest that either intervention would be suitable for future testing and dissemination, and that lower cost of incentives may favor their prioritization.

Adolescent↗
PubMed2026

Cognitive Behavioral Therapy vs Media Literacy for Prevention of Gaming Disorder and Unspecified Internet Use Disorder: A Randomized Clinical Trial.

IMPORTANCE: Mitigating the harmful effects of digitalization on youth mental health is essential. OBJECTIVES: To evaluate the effectiveness of cognitive behavioral therapy (CBT) compared with a media literacy-based intervention for gaming disorder and unspecified internet use disorder and to determine whether universal or indicated prevention yields stronger benefits. DESIGN, SETTING, AND PARTICIPANTS: PROTECTconfirm was a randomized clinical trial conducted from July 1, 2020, to August 31, 2024, across 44 secondary schools in Baden-Württemberg, Germany, with 1-, 4-, and 12-month follow-up. All students were included in universal prevention analyses, whereas indicated prevention analyses included a subgroup of adolescents at high risk meeting 2 or more Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for gaming disorder or unspecified internet use disorder at baseline. INTERVENTIONS: Students were individually randomized within 90 classes to PROTECTtraining, a CBT-based program; or PROTECTinfo, a structurally parallel media literacy program. Both consisted of four 90-minute sessions delivered weekly during school hours by trained local prevention professionals under live supervision and adherence protocols. MAIN OUTCOMES AND MEASURES: The primary outcome was gaming disorder symptom severity and unspecified internet use disorder symptom severity, assessed at 12 months with a modified version of the Video Game Dependency Scale. Secondary outcomes included internalizing, externalizing, and transdiagnostic symptoms. Primary and secondary outcomes were analyzed according to the intention-to-treat principle. RESULTS: A total of 1793 students were randomized to PROTECTtraining (n = 896; mean [SD] age, 13.1 [1.5] years; 498 male students [56.1%]) or PROTECTinfo (n = 897; mean [SD] age, 13.1 [1.5] years; 484 male students [54.8%]). Participants in the subsample of 205 adolescents at high risk showed significantly lower 12-month severity of gaming disorder and unspecified internet use disorder symptoms with PROTECTtraining than with PROTECTinfo (mean [SD] Modified Video Game Dependency Scale score: 14.7 [9.7] vs 17.7 [10.3]; within-group Cohen d = -0.91 [95% CI, -1.10 to -0.72] vs Cohen d = -0.61 [95% CI, -0.80 to -0.42]; between-group Cohen d = -0.30 [95% CI, -0.55 to -0.05]), but not in the total sample (mean [SD] Modified Video Game Dependency Scale score: PROTECTtraining, 8.8 [8.3] vs PROTECTinfo, 9.4 [8.4]; within-group Cohen d = -0.11 [95% CI, -0.18 to -0.05] vs Cohen d = -0.04 [95% CI, -0.11 to 0.02]; between-group Cohen d = -0.07 [95% CI, -0.16 to 0.01]). Secondary outcomes did not differ significantly between groups. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of 1793 adolescents, the CBT-based intervention reduced gaming disorder symptoms and unspecified internet use disorder symptoms more effectively than the media literacy-based intervention among adolescents at high risk. These findings support the use of CBT-based approaches primarily within indicated, rather than universal, prevention. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) trial registration: DRKS00033989.

Humans↗
PubMed2002

Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region.

BACKGROUND: The healing of free vascular grafts in a pre-irradiated graft bed is characterized by an increased risk of wound healing disorders. For that reason, the aim of this study was to examine quantitative vascularization pattern between free vascular grafts and the pre-irradiated graft bed as a function of the preoperative irradiation dose. METHODS: A total of 217 free microvascular hard and soft tissue grafts were used within 199 patients in the head and neck region to cover defects after ablative tumor surgery. Seventy-six patients (group 1) had no prior radiation (RT), 50 patients (group 2) were treated with preoperative radiochemotherapy using 40 to 50 Gy and 5-FU/cisplatin, and 73 patients (group 3) had prior RT (60-70 Gy) between 1 and 7 years before surgery. After healing of the grafts, samples were taken from 42 patients from the graft, the irradiated graft bed, and the transition area between graft and irradiated graft bed. Samples were analyzed as follows: capillary sprouting, structural changes, and distribution patterns were analyzed by immunohistochemical staining (CD34 labeling of capillary endothelium). Three histological sections (2-4 microm) per sample were examined histomorphometrically (ratio capillary area/total area, capillary lumen, and the number of capillaries) by (National Institute of Health) NIH-image-digitized measurements. A statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney test (two-tailed p <.05). RESULTS: The success rate of vascular grafts in group 1 (0 Gy) was 94%, in group 2 (40-50 Gy/5-FU/cisplatin) 90%, in group 3 (60-70 Gy) 84%. In contrast to groups 1 and 2, group 3 showed qualitatively reduced and more irregular capillary distribution with more marked pericapillary fibrosis in the irradiated tissue. Quantitatively, the ratio capillary area/total area, as a marker of improved capillarization, was significantly reduced in group 3 (median 0.01; IQR 0.02) compared with group 1 (median 0.53; IQR 0.32) and group 2 (median 0.44; IQR 1.40) (p <.001). CONCLUSION: After preoperative RT, vascularization of the graft bed decreased continuously as a function of the total dose and time after RT. The results strongly advocate the use of a primary reconstruction after a time interval between 4 and 6 weeks following preoperative RT and suggest the use of a total radiation dose of 40 to 50 Gy.

Adult↗
PubMed1988

Fluid intake and bladder cancer in Utah.

A population-based, incident case-control study was conducted in Utah to assess the relationship between fluid intake and bladder cancer. Cancer cases (n = 419) were identified through the Utah Cancer Registry, and controls (n = 889) were obtained through random digit dialing and the Health Care Financing Administration. After adjustment for cigarette smoking, age, sex, history of diabetes, and history of bladder infections using multiple logistic regression analysis, total fluid intake was not found to be related to bladder cancer development. Specific fluids related to bladder cancer risk were milk intake (OR = 0.64) and caffeinated coffee intake (OR = 1.60). A linear trend for a dose-response protective effect was observed for milk, while coffee increased risk only when 40 or more cups were consumed per week. Alcohol increased risk only when consumed at high levels (over 3.64 ounces or 103 g per week) by people who never smoked cigarettes (OR = 2.37). Likewise, tea consumption in non-cigarette smokers increased bladder cancer risk (OR = 2.25). Results from this study suggest that types of fluids consumed may play a role in the development of bladder cancer. Furthermore, it is hypothesized that the dietary components of these beverages may be related to the development of bladder cancer.

Adult↗
PubMed1992

Assessing response bias in random-digit dialling surveys: the telephone-prefix method.

Knowledge of the characteristics of survey non-respondents is important to determine generalizability to the population of interest. In a recent random-digit dialling survey of health behaviours only 73 per cent of the households contacted provided any information about household composition, and only 74 per cent of those actually completed the extended interview, for an overall response rate of 54 per cent. To identify possible biases we grouped all attempted phone numbers by their prefix, and looked for the association between the response rate for that prefix and other summary variables known about the prefix. A simulation study showed that the method can identify non-response biases if certain assumptions are correct. The analysis suggested that our survey data under-represent older people and those with a college education. We found no significant biases in health behaviours, possibly because the basic assumptions did not hold. This method may assist in identification of non-response bias in other studies.

Adult↗
PubMed2000

Gastroesophageal reflux disease, use of H2 receptor antagonists, and risk of esophageal and gastric cancer.

OBJECTIVE: The incidence of esophageal adenocarcinoma has risen rapidly in the past two decades, for unknown reasons. The goal of this analysis was to determine whether gastroesophageal reflux disease (GERD) or the medications used to treat it are associated with an increased risk of esophageal or gastric cancer, using data from a large population-based case-control study. METHODS: Cases were aged 30-79 years, newly diagnosed with esophageal adenocarcinoma (n = 293), esophageal squamous cell carcinoma (n = 221), gastric cardia adenocarcinoma (n = 261), or non-cardia gastric adenocarcinoma (n = 368) in three areas with population-based tumor registries. Controls (n = 695) were chosen by random digit dialing and from Health Care Financing Administration rosters. Data were collected using an in-person structured interview. RESULTS: History of gastric ulcer was associated with an increased risk of non-cardia gastric adenocarcinoma (OR 2.1, 95% CI 1.4-3.2). Risk of esophageal adenocarcinoma increased with frequency of GERD symptoms; the odds ratio in those reporting daily symptoms was 5.5 (95% CI 3.2-9.3). Ever having used H2 blockers was unassociated with esophageal adenocarcinoma risk (OR 0.9, 95% CI 0.5-1.5). The odds ratio was 1.3 (95% CI 0.6-2.8) in long-term (4 or more years) users, but increased to 2.1 (95% CI 0.8-5.6) when use in the 5 years prior to the interview was disregarded. Risk was also modestly increased among users of antacids. Neither GERD symptoms nor use of H2 blockers or antacids was associated with risk of the other three tumor types. CONCLUSIONS: Individuals with long-standing GERD are at increased risk of esophageal adenocarcinoma, whether or not the symptoms are treated with H2 blockers or antacids.

Adenocarcinoma↗
PubMed2004

Introducing new technology: handheld computers and drug databases. A comparison between two residency programs.

There have been numerous efforts to introduce and increase the use of handheld computers, also called personal digital assistants (PDA), in health care, one of which is the distribution of PDAs to Neurology residents at the University of Illinois at Chicago. The authors examined the success of this intervention by comparing PDA use and user attitudes between residents of the intervention group and residents in another residency program where the use of PDAs is neither encouraged nor discouraged. The authors examined in particular the use of drug databases on the PDA as its currently most popular application in health care. The use of PDAs for purposes not related to health care was widespread among individuals in both programs, but the use of drug databases was significantly more common in the control group, which can be interpreted as a success of the intervention.

Adult↗
PubMed2003

Population- and community-based recruitment of African Americans and Latinos: the San Francisco Bay Area Lung Cancer Study.

Empiric data on recruitment of minorities into clinical or population studies are limited. The authors evaluated population- and community-based recruitment methods in a 1998-2001 case-control study of lung cancer among African Americans and Latinos. For lung cancer cases in the San Francisco Bay Area of California, rapid case ascertainment by the tumor registry combined with telephone screening identified 470 (9%) African Americans and 262 (5%) Latinos. When random digit dialing (RDD) and Health Care Financing Administration (HCFA) records failed to yield adequate numbers of controls in appropriate age-gender-ethnicity groups, community-based recruitment methods were used. Demographic characteristics and behavioral and occupational risk factors for controls, by recruitment method, were compared with those for lung cancer cases to evaluate potential bias. The average numbers of hours spent per control recruited were 18.6 for RDD, 11.4 for HCFA, and less than 1 for the community-based methods. The prevalence of smoking-related lung cancer risk factors was significantly higher among African-American community-based controls than for those identified through RDD (p < 0.005). Compared with HCFA controls, Latino RDD controls reported significantly higher cumulative smoking exposure (p < 0.05). Further assessment of strategies for successful recruitment of minority participants into epidemiologic studies is warranted.

Adult↗
PubMed1997

Diet and the risk of salivary gland cancer.

Cancer of the major salivary glands is relatively rare, and little is known about its etiology. The only established risk factors are radiation exposure and a prior cancer. The role of diet in the development of salivary gland tumors has not been addressed previously. The results from a population-based case-control study conducted in the greater San Francisco-Monterey Bay area examining the association between dietary intake and salivary gland cancer risk are presented. Of 199 cases diagnosed with salivary gland tumors between 1989 and 1993, 150 (75%) were interviewed. Nine cases were subsequently excluded based on review of pathology specimens. Of 271 controls identified through random-digit dialing and the Health Care Finance Administration files, 191 (70%) were interviewed. Eight cases and seven controls who over- or underreported dietary intake were excluded from analysis. Vitamin C intake of > 200 mg/day compared with < or = 100 mg/day was associated with a 60% decrease in salivary gland cancer risk (odds ratio (OR) = 0.40, 95% confidence interval (CI) 0.22-0.70). Inverse associations observed for carotene, vitamin E, and fiber from fruits and vegetables were diminished when adjusted for vitamin C intake. Fiber from been sources was associated with a 51% decrease in risk after adjusting for vitamin C intake (OR = 0.49, 95% CI 0.26-0.92 for > 1.4 g/day compared with < or = 0.4 g/day). Cholesterol intake was associated with elevated risk (OR = 1.67, 95% CI 1.2-2.4 for a 10% increase in calories from cholesterol). These findings suggest that preventive strategies developed for common chronic diseases, such as increased consumption of fruits and vegetables and limiting foods high in cholesterol, also may be effective in preventing these rare tumors.

Adult↗
PubMed1997

Environmental factors and the risk of salivary gland cancer.

Cancer of the major salivary glands is rare, and little is known about its etiology. We conducted a population-based case-control study to elucidate the risk factors for these tumors. Of 199 cases diagnosed with salivary gland tumors between 1989 and 1993, 150 (75%) were interviewed. We subsequently excluded nine cases based on review of pathology specimens. We identified 271 controls through random-digit dialing and the Health Care Finance Administration files; 191 (70%) were interviewed. Therapeutic medical radiation treatment to the head or neck [odds ratio (OR) = 2.6; 95% confidence interval (CI) = 0.84-8.1], full mouth dental x-rays (OR = 1.6; 95% CI = 1.0-2.7), and ultraviolet light treatment to the head or neck (OR = 1.9; 95% CI = 0.89-4.3) were associated with increased risk. These elevations in risk were largely limited to those exposed before 1955, when the exposure dose was substantially higher. Occupational exposure to radiation/radioactive materials (OR = 2.4; 95% CI = 1.0-5.4) and nickel compounds/alloys (OR = 6.0; 95% CI = 1.6-22.0), as well as employment in the rubber industry (OR = 7.0; 95% CI = 0.80-60.3), increased risk. In men, current smoking (OR = 2.1; 95% CI = 0.98-4.7) and heavy alcohol consumption (OR = 2.5; 95% CI = 1.1-5.7) were associated with risk, but these factors were not strongly related to salivary gland cancer in women.

Adult↗
PubMed1997

Caffeine intake in relation to the risk of primary cardiac arrest.

We conducted a population-based case-control study in King County, WA, to evaluate the association between usual caffeine intake and primary cardiac arrest. We identified primary cardiac arrest cases (N = 362) without a history of clinical heart disease or major comorbidity through paramedic incident reports during the period 1988-1994. We identified controls (N = 581), individually matched to cases on age (+/-7 years) and gender and meeting the same general health criteria, through random digit dialing. We interviewed the spouses of cases and controls to obtain information on usual caffeine intake from coffee, tea, and cola during the prior year. After adjusting for cigarette smoking and other risk factors, we observed little association between daily consumption of the caffeine equivalent of fewer than 5 cups per day of drip coffee (< 687 mg per day) and primary cardiac arrest. High usual caffeine consumption (> or = 687 mg per day) was associated with a modestly elevated risk of primary cardiac arrest [odds ratio = 1.44; 95% confidence interval (CI) = 0.82-2.53]. The elevated risk associated with high caffeine consumption appeared to be restricted to never-smokers (odds ratio for > or = 687 mg per day = 3.2; 95% CI = 1.3-8.1).

Adult↗
PubMed2005

Attitudes and beliefs of primary care physicians regarding prostate and colorectal cancer screening in a rural state.

BACKGROUND: Screening for prostate cancer (PC) is paradoxically more prevalent than for colorectal cancer (CRC). METHODS: Primary care physicians (PCPs) in Vermont were surveyed concerning PC and CRC screening. RESULTS: Aggressive screening for PC and CRC remains widespread. PCPs reported that they controlled screening decisions for the majority of their patients. A belief that evidence favored PC screening for no patients was associated with less aggressive screening for PC as well as CRC. CONCLUSIONS: Aggressive screening behavior is frequent, physician-driven and correlates with physician beliefs. Better education of PCPs is the key to changing screening behavior.

Adult↗
PubMed2004

Pregnancy information and advice on Sky television: an evaluation.

This paper is one of a series produced as part of an evaluation of a number of digital interactive television (DiTV) health pilots funded by the Department of Health during 2001/2002. This paper is concerned with two pregnancy health services produced by Channel Health and hosted on Sky television. The study aimed to discover the success or otherwise of health information on pregnancy in this form and on this medium or "platform". In particular we were interested in what kinds of people on the broader national stage viewed the Bush Babies programme. Data were obtained through a telephone questionnaire of Channel Health users. More than 250 people took part. More than 175 000 households watched the programmes, a large audience for this type of programme. Bush Babies attracted a sizeable audience with over a quarter of Channel Health viewers in this study having seen it. There proved to be marked differences between the types of people using the service and in the patterns of their use--and not always in the ways one might have expected. As expected, people who were single, older or male were less likely to view Bush Babies, while younger, married or cohabitants and females were more likely to watch the programme. More unexpectedly, perhaps, the fact that the person was pregnant was not a predictor of whether they saw a Bush Babies programme or the number of the programmes watched.

Adult↗
PubMed2003

Distributive justice and rural healthcare: a case for e-health.

People living in rural areas make up 20 percent of the U.S. population, but only 9 percent of physicians practice there. This uneven distribution is significant because rural areas have higher percentages of people in poverty, elderly people, people lacking health insurance coverage, and people with chronic diseases. As a way of ameliorating these disparities, e-health initiatives are being implemented. But the rural e-health movement raises its own set of distributive justice concerns about the digital divide. Moreover, even if the digital divide is overcome, e-health services may be of an inferior quality compared to face-to-face medical encounters. In this paper, I argue that before we can fully understand the distributive justice implications of e-health, we must first understand what distributive justice means. I argue that five elements--fairness, quality, accessibility, availability, and efficiency--constitute a general conception of justice and that all of these elements must be considered when evaluating e-health for rural health profession shortage areas. In doing so, it may be necessary to make important tradeoffs among these elements. I then examine the development of e-health programs in light of Rawls's principle of equal opportunity and Daniel's notion of species-typical functioning. I conclude that in the context of e-health, Rawls's principle should be expanded to include geography as a prima facie morally relevant criterion for allocating healthcare benefits. I also conclude that Daniel's notion of species-typical functioning provides grounds for thinking of health and some healthcare services as special goods.

Health Services Accessibility↗
PubMed1989

Outlook for 1989: high inflation, zero margins, rising wages.

Double-digit inflation in health-care zero margins for hospitals, and increased wage rates will be among the trends for 1989. But hospitals will see inpatient care begin to grow again this year. Institutions that install financial controls and systems, trim staff and management, and achieve tighter cost discipline will become financially stronger and ensure their survival.

Bed Occupancy↗