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PubMed2005

Improving epidemiologic surveillance and health promoter training in rural Latin America through information and communication technologies.

This paper presents two technological developments oriented to increase the efficiency of the epidemiologic surveillance system and to improve the diagnostic and therapeutic capabilities of the rural establishments with only e-mail connectivity through wireless systems. The Telematics Department of the University of Cauca has developed a computerized epidemiologic surveillance system for the collecting, sending, processing, visualization, and feedback of epidemiologic information at national level. The use of the system in a pilot area has solved the problems of subregister, increasing the volume of data collection in 15%. The complete epidemiologic system is currently being implemented in 22 health care establishments in the Department of Cauca in Colombia. Likewise, the Technical University and Carlos III University of Madrid have developed a distance training system with a high-usability interface both for students and teachers. The system includes authoring, distribution, tracking, and visualization of courses synchronized through electronic mail messages in a clear way for the user. Both systems use a creative combination of e-mail and XML (eXtensible Markup Language)-based technologies, ready to be used through slow, intermittent, and asynchronous communication systems.

Communication↗
PubMed2005

Graduate orthodontic education: the residents' perspective.

INTRODUCTION: The purpose of this study was to identify current demographic trends of orthodontic residents, their goals for the future, and their perspectives on orthodontic training. METHODS: A 26-item survey was conducted at the Graduate Orthodontic Residency Program (GORP) at Harvard University in August 2003. Questionnaires were distributed to residents representing 51 orthodontic programs (of 58 in the United States). Surveys were sent to 5 of the 7 programs whose residents did not attend GORP. RESULTS: Of the 380 questionnaires distributed, 295 were completed and returned at the meeting for a 77% response rate. Additionally, 35 of the 50 mailed questionnaires were completed and returned, for a total response rate of 77% (330 completed/430 distributed). Most residents stated that clinical education was the most important factor when choosing a residency. Most residents planned to publish their research, complete American Board of Orthodontics certification requirements, and work 4 days a week after program completion. CONCLUSIONS: Several trends were identified since orthodontic residents were last surveyed in 1992. The most significant change reported was an increase in the number of those who plan to complete American Board of Orthodontics certification requirements.

Adult↗
PubMedDate not supplied

Self-reported comfort in athletic training of gender-specific and non-gender-specific injuries and issues.

CONTEXT: To assist athletes in maintaining optimal health, athletic trainers must work with athletes of both sexes. OBJECTIVE: To examine athletic trainers' comfort levels in providing care for gender-specific and non-gender-specific injuries and issues. DESIGN: We mailed 235 Gender Comfort in Athletic Training Questionnaires to program directors, who were asked to distribute and collect them. SETTING: We randomly selected 21 athletic training education program directors and invited them by e-mail to participate in the study. Fourteen program directors representing the 10 National Athletic Trainers' Association districts agreed to participate. PATIENTS OR OTHER PARTICIPANTS: A total of 192 participants returned completed questionnaires, for a response rate of 82% (103 women, 89 men; 101 senior athletic training students, 91 certified athletic trainers). MAIN OUTCOME MEASURE(S): The questionnaire consisted of 17 injuries and issues common to both female and male athlete scenarios. Three gender-specific items were added to each scenario. Responses were scored on a 5-point scale anchored by 1 (very uncomfortable) and 5 (very comfortable). Participants were asked to indicate the reason for any degree of discomfort. Internal consistency, determined by the Cronbach alpha, was .92 for the female athlete scenario and .93 for the male athlete scenario. RESULTS: We found significant differences between women and men certified athletic trainers for the female and male athlete scenarios. Overall, women were more comfortable caring for female injuries and issues, whereas men were more comfortable caring for male injuries and issues. Certified athletic trainers reported more comfort overall than athletic training students. The most common underlying reason reported for discomfort in caring for female and male injuries and issues was experience level. CONCLUSIONS: Athletic training education programs should provide early and more deliberate experiences with injuries and issues of a more intimate nature, including those that are gender specific and non-gender specific. These experiences may increase athletic trainers' level of comfort in providing care to athletes of the opposite sex.

Journal Article↗
PubMed2006

Correspondence patterns: mechanisms and models of human dynamics.

A stochastic queue model of human behaviour developed on the basis of the distribution of timing of tasks, as studied in a sample of e-mail messages at a university and in the written correspondence of Albert Einstein, may not be as simple as it seems. Although this model reproduces the apparently non-Poisson distribution of correspondence delays, its interpretation is more complicated than suggested by Barabási, who claims that humans execute their tasks based on some perceived priority, setting up queues that generate very uneven waiting-time distributions for different tasks. Such an explanation is intuitively appealing in the context of the queue metaphor, but does not exclude other mechanisms. By attributing delays in the correspondence to task priorities, this explanation ignores two important classes of mechanism that also contribute to the apparent distributions of task timings: the semantic content of an individual's correspondence and the social context in which this correspondence occurs.

Algorithms↗
PubMed2006

Evaluation of ProMED-mail as an electronic early warning system for emerging animal diseases: 1996 to 2004.

OBJECTIVE: To identify emerging animal and zoonotic diseases and associated geographic distribution, disease agents, animal hosts, and seasonality of reporting in the Program for Monitoring Emerging Diseases (ProMED)-mail electronic early warning system. DESIGN: Retrospective study. SAMPLE POPULATION: 10,490 disease reports. PROCEDURES: Descriptive statistics were collated for all animal disease reports appearing on the ProMED-mail system from January 1, 1996, to December 31, 2004. RESULTS: Approximately 30% of reports concerned events in the United States; reports were next most common in the United Kingdom, Canada, Australia, Russia, and China. Rabies, bovine spongiform encephalopathy, and anthrax were reported consistently over the study period, whereas avian influenza, Ebola virus, and Hantavirus infection were reported frequently in approximately half of the study years. Reports concerning viral agents composed more than half of the postings. Humans affected by zoonotic disease accounted for a third of the subjects. Cattle were affected in 1,080 reports, and wildlife species were affected in 825 reports. For the 10,490 postings studied, there was a retraction rate of 0.01 and a correction rate of 0.02. CONCLUSIONS AND CLINICAL RELEVANCE: ProMED-mail provided global coverage, but gaps in coverage for individual countries were detected. The value of a global electronic reporting system for monitoring emerging diseases over a 9-year period illustrated how new technologies can augment disease surveillance strategies. The number of animal and zoonotic diseases highlights the importance of animals in the study of emerging diseases.

Animals↗
PubMed1983

The grapefruit diet.

According to major research studies, 50 percent of all distributed data processing is really distributed document delivery. Up to 70 percent of all telephone calls do not reach the intended party, resulting in what has been aptly called, "telephone tag." Electronic mail is a rapidly emerging technology using computers and telecommunications networks to transmit notes, messages and documents instantaneously. Online information systems for document management, distribution and retrieval is an area of electronic mail far more powerful. Computer teleconferencing, as it is often called, allows for ongoing meetings online with persons from remote locations without regard to time zone limitations. This article will focus on the definitions of computer teleconferencing and other new "online" technologies, and how they will impact document development, management and distribution. It is based on the author's presentation at the 1983 NMA Annual Conference & Exposition in Philadelphia.

Computers↗
PubMed2004

Reaction to epilepsy in the workplace.

PURPOSE: The purpose of this study was to determine the characteristics of epilepsy that produce avoidant behavior in the workplace and therefore contribute to the actual stigma that persons with epilepsy are subjected to on the job. METHODS: We developed a survey consisting three vignettes briefly describing a coworker with either depression, multiple sclerosis, or epilepsy. Each vignette was followed by eight identical questions addressing the level of comfort during interactions with the vignette subject. The epilepsy vignette did not describe a seizure. The surveys were hand-distributed in two companies in New York City and returned anonymously by mail. The results of the responses to each illness were compared by chi2, and the responses were correlated with demographic information by using Pearson's correlation. RESULTS: Seventy-four of 200 distributed questionnaires were returned. Respondents reported more anxiety at the thought of interacting with a coworker with epilepsy than with depression or multiple sclerosis, but this difference did not reach significance. Worry about sudden, unpredictable behavior for the coworker with epilepsy was significantly greater than that with multiple sclerosis (p = 0.014). The level of comfort regarding providing first aid for the coworker with epilepsy was significantly less (p = 0.018) than that for depression and multiple sclerosis. Lower job level and lower income level correlated with more social discomfort for all three illnesses. CONCLUSIONS: The idea of a having a coworker with epilepsy may produce some social avoidance. However, the worry about a sudden, unpredictable event and the discomfort regarding providing first aid for a coworker with epilepsy is significant when compared with that with depression or multiple sclerosis. These findings suggest that education about first aid for epilepsy will reduce the worry and discomfort surrounding persons with epilepsy in the workplace.

Adult↗
PubMedDate not supplied

Medical conditions and the risk of motor vehicle crashes in men.

OBJECTIVE: To determine whether men aged 45 to 70 years with any medical condition are at an increased risk of involvement as drivers in police-reported motor vehicle crashes. DESIGN: Case-control study. SETTING: Province-wide population-based sampling. PARTICIPANTS: A total of 2504 drivers randomly selected from those involved as a driver in a motor vehicle crash (cases) and 2520 men not involved in a crash (controls) during a 6-month period. DATA COLLECTION: The Societé de l'assurance automobile du Quebec (SAAQ) computerized files provided data on crashes, age, and medical conditions. A mailed questionnaire elicited information on usual mileage and driving conditions. RESULTS: Data from the SAAQ files were obtained for all 5024 drivers. The overall response rate to the mailed survey was 35.5% with no statistically significant differences in the distribution of characteristics between respondents and nonrespondents. There was no increase in crude (odds ratio, 0.99; 95% confidence interval, 0.85-1.17) or age-adjusted risk of crashes for men with a medical condition in the entire sample of subjects (N = 5024). Among respondents to the mailed questionnaire only, men with a medical condition showed no increased crude risk of crashes (odds ratio, 0.99; 95% confidence interval, 0.76-1.27); no difference was observed after adjustment for age, mileage driven, driver behaviors, and sociodemographic characteristics (odds ratio, 0.91; 95% confidence interval, 0.64-1.31). CONCLUSIONS: Unlike previous studies, the risk estimate was derived from a population-based sample of drivers and adjusted for age, mileage driven, driver behaviors, and sociodemographic characteristics in multivariate analyses. The adjusted estimates failed to show an increased risk of motor vehicle crashes for drivers with a medical condition.

Accidents, Traffic↗
PubMed2000

Recruiting participants for community-based research: the Diabetic Retinopathy Awareness Program.

PURPOSE: Recruiting participants is a major challenge for population studies. We present the recruitment methods followed by the Diabetic Retinopathy Awareness Program (DRAP), a community-based, randomized, masked, controlled trial to meet and exceed its sample size goals. METHODS: A county-wide multi-media promotional campaign to recruit and enroll participants in the trial was planned and executed from October 1993 through April 1994, with the assistance of the local news media and community and professional groups. A toll-free 800 number recruitment line was established, and postage-paid recruitment postcards distributed. The trial was designed to examine whether a mailed educational intervention could increase compliance with vision care guidelines among persons with diabetes in the community. RESULTS: A total of 2308 persons with diabetes were interviewed for eligibility and 813 enrolled in the intervention trial, exceeding the original recruitment goals of 1800 and 600, respectively. Those who completed the enrollment interview reflected county demographics. During recruitment, newspaper, television and radio stories featured the study; pharmacies and physician offices displayed study materials; public service announcements appeared in local print and broadcast media. The largest single recruitment response was a local television news report, followed by a newspaper story. CONCLUSIONS: These experiences substantiate the need for a comprehensive coordinated approach, using planned multiple sources, to achieve recruitment success. By engaging the lay and professional communities along with the media, recruitment costs can be kept to a minimum. Participant costs can be minimized by employing a toll-free number and eliminating study participant travel, thus allowing for inclusion of traditionally underserved populations. This approach is applicable to other studies, where community-based participation is desired.

Adolescent↗
PubMed1990

Free molecular biological software available from the EMBL file server.

A new service provided by EMBL (EMBL Software File Server) is described that will make free molecular biology software available to anyone with computer network access. MS-DOS, Apple Macintosh and VAX/VMX are supported at the moment. The programs will be delivered by normal electronic mail; conversion mechanisms will transform binary files to ASCII to allow mail transfer. This service will also help authors to distribute their software conveniently.

Computer Communication Networks↗
PubMedDate not supplied

Measuring the culture of medical group practices.

OBJECTIVE: To develop an instrument that can be used to assess the organizational culture of medical group practices. DATA SOURCES AND STUDY SETTING: Study participants were primary care physicians in 267 medical group practices. The iterative process began in Minnesota and then expanded to practices in 21 other states. DATA COLLECTION METHODS: Practice culture statements were collected using questionnaires distributed at a national medical group practice meeting and mailed questionnaires sent to a broader set of participants identified by the Medical Group Management Association. STUDY DESIGN: Using a framework developed earlier, physicians in medical groups were asked to react to statements that described the basic assumptions and patterns of behavior characteristic of their practices. An iterative process involving over 500 physicians in 267 practices was used to identify and refine statements. Factor analysis was used to group the statements into cohesive cultural dimensions. PRINCIPAL FINDINGS: Thirty-nine statements correlated with nine cultural dimensions were identified and a test of this instrument found that it successfully identified differences in the cultures of medical groups. CONCLUSIONS: Although there is increasing agreement that the culture of medical group practices is one of the most important factors influencing the cost and quality of care, efforts to understand and manage these cultures have been hampered by the lack of a measurement instrument. This article presents an instrument that has broad face validity in the group practice field and successfully differentiates the cultures of different types of practices.

Attitude of Health Personnel↗
PubMed2002

Otolaryngology residents' objectives in entering the workforce.

OBJECTIVES: To determine the priorities of current otolaryngologists-in-training in considering their first employment opportunities. STUDY DESIGN: Twenty-one-item survey measuring the importance of various first job issues, with all items scored on a five-point Likert-type ordinal scale. METHODS: The resident membership of the American Academy of Otolaryngology-Head and Neck Surgery was anonymously surveyed by means of mail-in questionnaires. Results were stratified by years of training. RESULTS: Responses from 242 of 1174 mail-in surveys (21% response rate) exhibited a wide distribution of responses for all 21 questions. The availability of free time to spend with one's family was regarded by more than half of the respondents to have the highest overall importance. As years of training increased, priorities shifted toward geographic location, away from issues such as the on-call schedules. The availability of research time and resources received the overall lowest priority, with more than half of the respondents ranking it as only somewhat important or lower. CONCLUSIONS: Otolaryngologists-in-training feel strongest about the availability of free time to spend with their families as they finish formal training and consider employment opportunities. By acknowledging the concerns of graduating residents, including the ability to pursue their primary interests when they start working, we can better adapt conditions to create a more comfortable and stable entry into the workforce.

Attitude of Health Personnel↗
PubMed2001

The silent consumer: women's reports and ratings of abortion services.

BACKGROUND: Abortion is one of the most common surgical procedures performed on women in the United States, and its safety has been demonstrated. Little research has focused, however, on women's reports and ratings of the service. OBJECTIVES: This study explored the association of demographic factors, medical outcomes, and client ratings of service dimensions with global satisfaction. RESEARCH DESIGN: For this cross-sectional study, permission to access clinic medical records was obtained. Surveys were distributed after the procedure, with instructions to return by mail. SUBJECTS: Study subjects were 797 women who underwent an outpatient surgical abortion at 1 of 2 New England health centers in 1996 and 1997. MEASURES: Demographic data, pregnancy history, and information on the procedure were collected from medical records. Survey items measured reports of access, medical outcomes, and satisfaction ratings with service domains. RESULTS: Women with positive ratings of staff sensitivity and of the counseling process and information received and those who had the procedure at a younger gestational age were less likely to report that care could be better. Although very few women reported a medical complication, this was associated with agreement that care could have been better, as was reporting agreement that the wait between the preexamination visit and the procedure was too long. CONCLUSIONS: Satisfaction with abortion services is high. Education and counseling play very important roles. Survey items could routinely be used to monitor services.

Abortion, Induced↗
PubMed2004

Management of tongue-tie in children: a survey of paediatric surgeons in Australia.

OBJECTIVES: To explore the beliefs and practices of Australian surgeons regarding surgical intervention to release tongue-tie and to determine the main referral sources. In addition, we aimed to ascertain if there were differences in beliefs and practices according to surgical specialty. METHODS: Four hundred surgeons in three different surgical specialties were surveyed via questionnaire. Multiple choice response questions and open ended questions were used to explore beliefs and practices surrounding tongue-tie assessment, management and follow up. The questionnaires were distributed by email (where available), followed by fax and mail. RESULTS: A response rate of 80.8% (n = 323) was obtained. Of these, 236 (73%) reported they practised surgery to release tongue-tie; 46% were oral and maxillofacial surgeons, 37% were plastic surgeons and 17% were paediatric general surgeons. Indications for surgical management and follow up varied according to surgical specialty. There was no clear consensus regarding clinical indicators for surgery or functional outcomes following surgery. CONCLUSIONS: It appears that until a prospective study designed to address some of the controversial issues outlined is undertaken, we will remain ignorant about the need for surgery to release tongue-tie in children.

Articulation Disorders↗
PubMed1996

Equality in satisfaction, perceived need, and utilization of dental care in a 50-year old Swedish population.

Satisfaction with dental care, perceived need for dental care, and dental care utilization were analyzed as to equality in geographical, socio-economic, and gender distributions. The study base was a cross-sectional mail questionnaire sent in 1992 to all 50-year old persons (totally 8890) in Orebro and Ostergötland counties in Sweden. Measures of the variables were all based on self-assessments. The response rate was 71.3%. The results showed no large inequalities as to satisfaction, except the aspect travel time for rural residents. They also had higher perceived need for dental care. For utilization of dental care, workers were relatively fewer among "high" consumers. Controlling for socio-economic group, there were twice as many men than women among "low" consumers. In conclusion, there was relative equality in the dental care delivery in this 50-year old Swedish population, with some remaining social differences, primarily socio-economically contingent.

Age Factors↗
PubMed2004

Cytologic diagnosis: expression of probability by clinical pathologists.

BACKGROUND: Clinical pathologists use descriptive terms or modifiers to express the probability or likelihood of a cytologic diagnosis. Words are imprecise in meaning, however, and may be used and interpreted differently by pathologists and clinicians. OBJECTIVES: The goals of this study were to 1) assess the frequency of use of 18 modifiers, 2) determine the probability of a positive diagnosis implied by the modifiers, 3) identify preferred modifiers for different levels of probability, 4) ascertain the importance of factors that affect expression of diagnostic certainty, and 5) evaluate differences based on gender, employment, and experience. METHODS: We surveyed 202 clinical pathologists who were board-certified by the American College of Veterinary Pathologists (Clinical Pathology). Surveys were distributed in October 2001 and returned by e-mail, fax, or surface mail over a 2-month period. Results were analyzed by parametric and nonparametric tests. RESULTS: Survey response rate was 47.5% (n = 96) and primarily included clinical pathologists at veterinary schools (n = 58) and diagnostic laboratories (n = 31). Eleven of 18 terms were used "often" or "sometimes" by >/= 50% of respondents. Broad variability was found in the probability assigned to each term, especially those with median values of 75 to 90%. Preferred modifiers for 7 numerical probabilities ranging from 0 to 100% included 68 unique terms; however, a set of 10 terms was used by >/= 50% of respondents. Cellularity and quality of the sample, experience of the pathologist, and implications of the diagnosis were the most important factors affecting the expression of probability. CONCLUSION: Because of wide discrepancy in the implied likelihood of a diagnosis using words, defined terminology and controlled vocabulary may be useful in improving communication and the quality of data in cytology reporting.

Adult↗
PubMed1995

Newspaper advertising versus direct mail marketing in a family practice: a hands-on approach.

This study compares newspaper advertising and direct mail marketing to attract private patients. Newsletter advertising was distributed to 92,251 homes throughout 1991 at a cost of $20,827.13. Newspaper advertising was conducted from August 28 to October 9, 1991 at a cost of $2,261.94. The newsletter attracted 101 new patients at a cost of $206.21 per patient and a mean response rate of 0.11%. No new patients were attracted through newspaper advertising.

Advertising↗