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At least 37 records · Page 2Linked to original sources

Design issues addressed in published evaluations of adolescent HIV-risk reduction interventions: a review.

OBJECTIVE: This study was conducted to determine: (1) issues in intervention design that have been addressed in behavioral interventions targeting human immunodeficiency virus (HIV)-risk behaviors among adolescents; (2) specific choices made in intervention design; (3) historic changes in the likelihood that issues in intervention design will be addressed; and (4) if an association exists between quality of evaluation design and the number of intervention design issues addressed. DESIGN: Literature search employing five electronic databases and 11 journals for articles published from January 1983 through December 1993 reporting evaluations of adolescent HIV-risk reduction interventions. MAIN OUTCOMES MEASURES: The frequency with which 12 issues in intervention design were addressed: basing the intervention on a theory of behavioral change; specifying a target population; involving the targeted community in the formulation of the intervention; addressing developmental issues; providing facts; strengthening interpersonal skills; describing the media (format) for delivering the intervention; specifying potentially relevant characteristics of the interventionists; describing the duration of the intervention; providing boosters; pilot testing the intervention; and including other potentially augmentative elements. RESULTS: Twenty-eight published intervention articles were included in these analyses. The median number of intervention design issues addressed in any study was six (range three to nine), although this number increased significantly over time (p < .01). There was substantial variability in the frequency with which each individual design issue was addressed, with some design issues (e.g., inclusion of specific facts and the description of the channel employed) being addressed in all studies. Other design issues were addressed in less than one-quarter of studies [e.g., basing the intervention on a theory of behavioral change (18%) and addressing developmental issues (21%)]. The targeted community was involved in one-third of studies. More recent studies and studies employing a randomized evaluation design with both preintervention and postintervention assessments addressed more intervention design issues than did earlier studies and studies employing other evaluation designs (p = .01 and p = .03, respectively). CONCLUSION: The majority of published adolescent HIV-risk reduction studies have not addressed important issues in intervention design. However, more recent studies and studies employing a strong evaluation design have addressed a greater number of these issues. Frameworks to guide intervention efforts (e.g., to serve as "practice guidelines") are needed to allow for both accurate replication and meaningful comparison of differing intervention approaches.

Adolescent↗

The significance of addressing trauma in outpatient psychiatry.

Establishing post-traumatic stress disorder as a psychiatric diagnosis has only marginally increased awareness of traumatic experiences. Traumas are inconsistently recorded in initial psychiatric histories and, when observed, rarely reflected in the primary diagnosis and treatment. The present study aimed to investigate if there is an association between sufficiently addressing trauma and long-term outcome and what factors affect whether trauma, according to the patient's view, is sufficiently addressed or not. Socio-demographic data, experiences of trauma and treatment, and outcome, were collected retrospectively from Arabic, Iranian, Turkish and Swedish patients, who had visited a psychiatric clinic 3-4 years earlier. Fifty-one patients whose traumatic experiences had been sufficiently addressed were compared with 39 patients who perceived that their traumas had not been addressed. Logistic regression analyses were performed to examine relationships between clinical variables and whether or not traumas had been addressed. Patients with trauma sufficiently addressed reported high confidence in staff (odds ratio, OR=7.2, p<0.001), high self-rated health (OR=8.0, p<0.01) and low scores on the Self-rating Inventory for PTSD (OR=7.7, p<0.05) and Depression Scale (OR=3.0, p<0.15). Reporting less than five different traumas (OR=4.6, p<0.01) and being an ethnic Swede (OR=2.4, p<0.10) were the background variables independently related to having trauma sufficiently addressed. Addressing trauma may improve patients' confidence in staff, self-rated health and trauma-related symptoms. Multiplicity of traumas and belonging to an ethnic minority implied that trauma was less addressed.

Adult↗

Positional accuracy of geocoded addresses in epidemiologic research.

BACKGROUND: Geographic information systems (GIS) offer powerful techniques for epidemiologists. Geocoding is an important step in the use of GIS in epidemiologic research, and the validity of epidemiologic studies using this methodology depends, in part, on the positional accuracy of the geocoding process. METHODS: We conducted a study comparing the validity of positions geocoded with a commercially available program to positions determined by Global Positioning System (GPS) satellite receivers. Addresses (N = 200) were randomly selected from a recently completed case-control study in Western New York State. We geocoded addresses using ArcView 3.2 on the GDT Dynamap/2000 U.S. Street database. In addition, we measured the longitude and latitude of these addresses with a GPS receiver. The distance between the locations obtained by these two methods was calculated for all addresses. RESULTS: The distance between the geocoded point and the GPS point was within 100 m for the majority of subject addresses (79%), with only a small proportion (3%) having a distance greater than 800 m. The overall median distance between GPS points and geocoded points was 38 m (90% confidence interval [CI] = 34-46). Distances were not different for cases and controls. Urban addresses (median = 32 m; CI = 28-37) were slightly more accurate than nonurban addresses (median = 52 m; CI = 44-61). CONCLUSIONS: This study indicates that the suitability of geocoding for epidemiologic research depends on the level of spatial resolution required to assess exposure. Although sources of error in positional accuracy for geocoded addresses exist, geocoding of addresses is, for the most part, very accurate.

Environmental Health↗

How patients and physicians address each other in the office.

Six hundred four patients in three primary care office settings were asked whether they preferred to be addressed by their physician by their first or last name and whether they preferred to address their physician by first or last name. Actual use of first vs last name by the physician addressing the patient and the patient addressing the physician was also recorded. Of the patients expressing a preference, 96 percent preferred that their physician address them by first name while 87 percent noted that this gesture actually occurred. Forty percent of the patients preferred to address the physician by first name while 14 percent actually did so. These findings suggest that physicians can feel comfortable addressing almost all of their patients by first name and that many of their patients may desire to address them by their first name. It is suggested that the physician at the time of the patient's first visit clarify the manner in which each addresses the other.

Adolescent↗

'I would if I could': how oncologists and oncology nurses address spiritual distress in cancer patients.

Medical providers are called upon to address a wide range of psychosocial issues, under increasing time constraints. Spiritual/existential distress was one of 18 issues covered in a survey of oncologists' (n=94) and oncology nurses' (n=267) attitudes and practices regarding psychosocial issues. The survey included patient vignettes at good, moderate and poor prognosis levels, and questions regarding attitudes toward patient care, typical and ideal services, and expectation for impact. A substantial proportion of both oncologists (37.5%) and nurses (47.5%) identified themselves as primarily responsible for addressing spiritual distress in their setting. However, over 85% of both MDs and RNs felt that ideally a chaplain should address such issues. Working in an inpatient setting predicted that nurses, but not doctors, would confer with chaplains. When ranking spiritual distress as important to address in comparison to 17 other issues, only 11.8% of MDs and 8.5% of RNs ranked it in the top three for the poor prognosis vignette, with yet lower values with better prognoses. For the poor prognosis, younger MDs were more likely to address spirituality (r=-0.26) and were also more likely to address anxiety or depression (r=0.25) and family distress (r=0.20). For RNs, no such relationships appeared. Perceived impact was also a predictor of whether spirituality issues were addressed. These results suggest that spiritual distress experienced by cancer patients may be under-addressed due to time constraints, lack of confidence in effectiveness, and role uncertainty.

Adaptation, Psychological↗

How do residents prioritize smoking cessation for young "high-risk" women? Factors associated with addressing smoking cessation.

BACKGROUND: Sixty-seven percent of physicians report advising their smoking patients to quit. Primary care residents' priorities for preventive health for a young "high-risk" female are unknown. Factors related to residents addressing smoking also need examining. METHODS: One hundred residents completed a survey about preventive health issues for a woman in her 20s "who leads a high-risk lifestyle." Residents indicated which topics they would address, and the likelihood that they would address each of 12 relevant preventive health topics, their outcome expectancies that the patient would follow their advice on each topic, their confidence that they could address the topic, and perceived barriers for addressing the topic. RESULTS: Residents listed STD prevention most frequently. Drug use and smoking cessation were second and third most frequently listed. Residents who believed that the patient would follow their advice were more likely to list smoking cessation than residents who had lower outcome expectancies for that patient. Higher barriers were negatively related to addressing smoking cessation. CONCLUSIONS: When time is not a barrier, residents are likely to address smoking cessation. Teaching residents how to incorporate this subject into their clinical practice is needed. Raising residents' outcome expectancies may increase their likelihood of addressing smoking cessation.

Adult↗

Missed opportunities in addressing drinking behavior in medical and mental health services.

BACKGROUND: Epidemiological and clinical literature point to the importance of screening for alcohol problems in medical and psychiatric settings. However, little is known about which problem drinkers seek help from those services or about the characteristics of those who have their drinking addressed. METHODS: We interviewed a probability sample of adult dependent and problem drinkers in the general population (n = 672) and consecutive admissions to chemical dependency programs in a northern California county (n = 926). We reinterviewed them 1 year later and measured medical and mental health visits and whether their drinking was addressed during the visit. RESULTS: Almost two-thirds of problem drinkers had a medical visit, and approximately one-third had a mental health visit, yet drinking was not often discussed, especially during medical visits. Many of those more likely to have a visit were not more likely to have their drinking addressed. Women and individuals older than 40 years had more medical and mental health visits [odds ratio (OR), 1.71; p < 0.001 and OR, 1.55; p < 0.001, respectively, for women; OR, 1.57; p < 0.05 and OR, 1.64; p < 0.05, respectively, for age >/=40 years], but were not more likely to have their drinking addressed in either setting, and women were less likely than men to have their drinking addressed in mental health settings (OR, 0.62; p < 0.05). Those with higher alcohol severity and those who had attended chemical dependency treatment during the previous year were more likely to have their drinking addressed in each setting. Insurance status predicted medical, but not mental health, visits and was not related to having drinking addressed in either setting. CONCLUSIONS: Drinking behavior was not routinely addressed by medical and mental health practitioners for dependent and problem-drinking men and women who presented in public and private medical and mental health settings.

Adolescent↗

Positional error in automated geocoding of residential addresses.

BACKGROUND: Public health applications using geographic information system (GIS) technology are steadily increasing. Many of these rely on the ability to locate where people live with respect to areas of exposure from environmental contaminants. Automated geocoding is a method used to assign geographic coordinates to an individual based on their street address. This method often relies on street centerline files as a geographic reference. Such a process introduces positional error in the geocoded point. Our study evaluated the positional error caused during automated geocoding of residential addresses and how this error varies between population densities. We also evaluated an alternative method of geocoding using residential property parcel data. RESULTS: Positional error was determined for 3,000 residential addresses using the distance between each geocoded point and its true location as determined with aerial imagery. Error was found to increase as population density decreased. In rural areas of an upstate New York study area, 95 percent of the addresses geocoded to within 2,872 m of their true location. Suburban areas revealed less error where 95 percent of the addresses geocoded to within 421 m. Urban areas demonstrated the least error where 95 percent of the addresses geocoded to within 152 m of their true location. As an alternative to using street centerline files for geocoding, we used residential property parcel points to locate the addresses. In the rural areas, 95 percent of the parcel points were within 195 m of the true location. In suburban areas, this distance was 39 m while in urban areas 95 percent of the parcel points were within 21 m of the true location. CONCLUSION: Researchers need to determine if the level of error caused by a chosen method of geocoding may affect the results of their project. As an alternative method, property data can be used for geocoding addresses if the error caused by traditional methods is found to be unacceptable.

Journal Article↗

[VDT worker's posture and workload in free-address office system].

A free-address system is a new office layout in which a worker can freely sit in their favorite place with a computer and materials. Since this layout has recently been introduced in offices, we conducted a questionnaire survey which aimed to clarify the effects of the free-address system on visual display terminals (VDT) workers' posture and workload. A total of 203 male VDT workers who were system engineers aged 20 to 59 using a notebook computer were evaluated, of whom 150 used the free-address layout, and 53 used the fixed-address layout. The free-address layout was effective in the improvement of individual work space compared with the fixed-address layout. Also, in this layout the worker did not feel dissatisfaction with communication or support between workers. However, workers using the free-address layout assumed an unsuitable work posture, without adjusting the height of their chairs. Furthermore, this layout might have risk factors which increase neck/shoulder and low back stiffness and/or pain. Therefore, the free-address layout may have incipient problems, and it will be necessary to examine further the effects of this layout on VDT worker's health.

Adult↗

Barriers to addressing patient sexuality concerns across five areas of specialization.

PURPOSE AND OBJECTIVES: The aim of this study was to examine the barriers to addressing patient sexuality across areas of specialization. DESIGN: A descriptive correlational design was used in this study. SAMPLE AND SETTING: A convenience sample of nurses (N = 302) was recruited from a large Midwestern medical center. METHOD: In this study, a survey using the Sexuality Attitudes and Beliefs Survey and a demographic questionnaire was conducted. FINDINGS: The number one barrier to addressing patient sexuality concerns across all areas of specialization was the nurses' perceptions that patients do not expect nurses to address their sexuality concerns. Other high-ranking barriers included a lack of comfort and confidence in addressing sexuality and failure to make time to discuss patient sexuality concerns. IMPLICATIONS FOR PRACTICE: Educational programs with both general and specific content are needed to help nurses across areas of specialization overcome barriers to addressing patient sexuality concerns. In addition, clinical nurse specialists are challenged to think of ways in which their practice competencies might be used creatively to overcome barriers to addressing patient sexuality concerns and promote the sexual health of individuals and groups. CONCLUSIONS: Further research is needed to determine whether the assumption that patients do not expect nurses to address sexuality concerns matches the reality of patients' expectations.

Adult↗

A novel system to obtain addresses of out-patients--assessment in routine clinic practice in Madras, S. India.

A novel method of obtaining accurate home addresses from out-patients was introduced as a routine procedure in 6 chest clinics of Madras City, following highly satisfactory results under study conditions. In this method, the patient is given a card (the address card), and asked to get his exact address entered on it by any knowledgeable person of his choice such as a landlord or neighbour. An assessment of the system was undertaken after it had been in operation for about 8 months. A complete and legible address was available for 82% of 3956 patients, the range in the 6 clinics being 74% to 91%. The main causes for failure were: not giving address card to patient (7%), patient not reattending the clinic (6%), and patient reattending but not returning the address card (3%). Corrective measures have now been introduced, and a re-assessment will be undertaken in due course.

Ambulatory Care Facilities↗