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PubMed2006

Demographic and past screening behaviors of men attending a free community screening program for prostate cancer.

This study characterizes demographic and past prostate screening behaviors of men who participated in a free screening for prostate cancer. Demographics, past prostate screening behavior, perceived risk, and cancer worry were assessed in 1,680 men. Mean age was 58.2 years, 56% were White, and 76% had health insurance. Men with insurance were more likely to have had a previous prostate-specific antigen (PSA) test and digital rectal exam (DRE). White men were more likely to have had a previous PSA and DRE and to have discussed PSA testing with a physician than African American men. African American men reported greater perceived risk and more worry than White men. Screening differences between African American and White men were explained by insurance status. These results may help guide the development of and promotion for future screening programs. Future efforts should be directed at increasing awareness about screening procedures for prostate cancer.

Adult↗
PubMed2003

The New York State Minority Health Survey: determinants of oral health care utilization.

OBJECTIVES: To determine the factors associated with visits to a dentist and more specifically the role of dental insurance coverage and to explore the reasons for not visiting a dentist among minorities in New York State. METHODS: The Minority Health Survey was a one-time, statewide, random digit-dialed telephone survey. We drew a directed acyclic graph (DAG) of the potential determinants of oral health care utilization for our population of interest and modeled the independent variables as determinants of oral health care utilization. The data for this study were analyzed in SUDAAN using appropriate weights and variance adjustments that accounted for the complex sampling design. Hence, this report is generalizable to the New York State adult "minority" population. RESULTS: About 63 percent respondents had visited a dentist in the past one year. Having dental insurance (adjusted odds ratio [adj OR]=2.5), having more than high school education (adj OR=1.9), being younger (adj OR=2.3 for 18-25 years vs age 40 years or older), being married (adj OR=1.7), being dentate (adj OR=0.3 for edentulousness), and having higher income (adj OR=0.5 for middle vs high income) were significantly associated with having visited a dentist in the past year. Cost and awareness-related factors were the most common reasons for not visiting a dentist. Most of the year 2000 oral health objectives measurable in this survey were not met. CONCLUSION: Increasing dental insurance coverage and increasing awareness about oral health care would be the two biggest factors in meeting the goals of year 2010.

Adolescent↗
PubMed2004

Incorporating the International Classification of Functioning, Disability, and Health (ICF) into an electronic health record to create indicators of function: proof of concept using the SF-12.

OBJECTIVE: The purpose of this proof-of-concept study was to assess the feasibility of using a generic health measure to create coded functional status indicators and compare the characterization of a stroke population using coded functional indicators and using health-related quality-of-life summary measures alone. DESIGN: Multiple raters assigned International Classification of Functioning, Disability, and Health (ICF) codes to the items of the 12-Item Short Form Health Survey (SF-12). Data for comparing the information from the SF-12 and from ICF codes were derived from the Montreal Stroke Cohort Study that was set up to examine the long-term impact of stroke. Available for analysis were data from 604 persons with stroke, average age 69 years, and 488 controls, average age 62 years. MEASUREMENT: The SF-12 provides two summary scores, one for physical health and one for mental health. Domains of the ICF are coded to three digits, before the decimal; specific categorizations of impairments, activity limitations, and participation restrictions are coded to four digits before the decimal. RESULTS: Persons with stroke scored, on average, approximately 10 points lower than controls on physical and mental health. The ICF coding indicated that this was attributed, not surprisingly, to greater difficulty in doing moderate activities including housework, climbing stairs, and working and was not attributed to differences in pain. Differences in mental health were attributed most strongly to greater fatigue (impairment in energy), but all areas of mental health were affected to some degree. CONCLUSION: The ICF coding provided enhanced functional status information in a format compatible with the structure of administrative health databases.

Activities of Daily Living↗
PubMed1995

Health care automation companies.

Health care automation companies: card transaction processing/EFT/EDI-capable banks; claims auditing/analysis; claims processors/clearinghouses; coding products/services; computer hardware; computer networking/LAN/WAN; consultants; data processing/outsourcing; digital dictation/transcription; document imaging/optical disk storage; executive information systems; health information networks; hospital/health care information systems; interface engines; laboratory information systems; managed care information systems; patient identification/credit cards; pharmacy information systems; POS terminals; radiology information systems; software--claims related/computer-based patient records/home health care/materials management/supply ordering/physician practice management/translation/utilization review/outcomes; telecommunications products/services; telemedicine/teleradiology; value-added networks.

Computer Communication Networks↗
PubMed2005

Teaching health assessment in the virtual classroom.

Health assessment skills are vital to professional nursing practice. Health assessment has traditionally been taught using lecture, teacher-developed tests, practice and live demonstration, and interactive and computer-based learning materials. Rapid advances in information technology during the past decade have greatly expanded distance learning options in higher education. Although much nursing education now uses the Internet, there has been limited use of the Web to teach psychomotor and clinical skills. This article describes how online instruction can be integrated into a health assessment course to teach physical examination skills. The development of instructional videos that can be digitally streamed onto the Web for ready and repeated access can also enhance online learning of technical and clinical skills. Student evaluation of this Web-enhanced course revealed that online assignments enabled them to pace their learning, thereby promoting greater flexibility and independence. Students were able to master the technical skills of working online with minimal difficulty and reported that working online was no more stressful than attending class. The most helpful aspect of the online course was the instructor-developed video that was digitally streamed online.

Attitude of Health Personnel↗
PubMed1999

Are health care professionals advising obese patients to lose weight?

CONTEXT: Implementation of the National Institutes of Health's 1998 guidelines, which recommended that health care professionals advise obese patients to lose weight, required baseline data for evaluation. OBJECTIVES: To describe the proportion and characteristics of obese persons advised to lose weight by their health care professional during the previous 12 months and to determine whether the advice was associated with reported attempts to lose weight. DESIGN: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. SETTING: Population-based sample from 50 states and the District of Columbia. PARTICIPANTS: A total of 12835 adults, 18 years and older, classified as obese (body mass index > or =30 kg/m2), who had visited their physician for a routine checkup during the previous 12 months. MAIN OUTCOME MEASURES: Reported advice from a health care professional to lose weight, and reported attempts to lose weight. RESULTS: Forty-two percent of participants reported that their health care professional advised them to lose weight. Using multivariate logistic regression analysis, we found that the persons who were more likely to receive advice were female, middle aged, had higher levels of education, lived in the northeast, reported poorer perceived health, were more obese, and had diabetes mellitus. Persons who reported receiving advice to lose weight were significantly more likely to report trying to lose weight than those who did not (OR, 2.79; 95% CI, 2.53-3.08). CONCLUSIONS: Less than half of obese adults report being advised to lose weight by health care professionals. Barriers to counseling need to be identified and addressed.

Adult↗
PubMed2002

Migraine in the United States: epidemiology and patterns of health care use.

OBJECTIVE: To determine the prevalence and distribution of migraine in the United States as well as current patterns of health care use. METHODS: A random-digit-dial, computer-assisted telephone interview (CATI) survey was conducted in Philadelphia County, PA, in 1998. The CATI identifies individuals with migraine (categories 1.1 and 1.2) as defined by the diagnostic criteria of the International Headache Society with high sensitivity (85%) and specificity (96%). Interviews were completed in 4,376 subjects to identify 568 with migraine. Those with 6 or more attacks per year (n = 410) were invited to participate in a follow-up interview about health care utilization and family impact of migraine; 246 (60.0%) participated. RESULTS: The 1-year prevalence of migraine was 17.2% in females and 6.0% in males. Prevalence was highest between the ages of 30 and 49. Whereas 48% of migraine sufferers had seen a doctor for headache within the last year (current consulters), 31% had never done so in their lifetimes and 21% had not seen a doctor for headache for at least 1 year (lapsed consulters). Of current or lapsed consulters, 73% reported a physician-made diagnosis of migraine; treatments varied. Of all migraine sufferers, 49% were treated with over-the-counter medications only, 23% with prescription medication only, 23% with both, and 5% with no medications at all. CONCLUSION: Relative to prior cross-sectional surveys, epidemiologic profiles for migraine have remained stable in the United States over the last decade. Self-reported rates of current medical consultation have more than doubled. Moderate increases were seen in the percentage of migraine sufferers who use prescription medications and in the likelihood of receiving a physician diagnosis of migraine.

Adolescent↗
PubMed2006

Podcasts--an emerging form of digital publishing.

Podcasting has recently emerged as an important information technology tool for health professionals and consumers around the world. Prestigious journals, international conferences, universities and government agencies among other entities are starting to publish digital informotion via audio and video podcasts. Podcosting is distinguished from other forms of digital audio-video content because it can be subscribed to (using Real Simple Syndication or RSS) and easily accessed from a personal computer. Further, it can be downloaded to a mobile device, such as an iPod where the user is able to listen to or watch it anywhere, anytime. Podcosting is used in new and evolving ways to publish information for healthcare education, patient care, professional continuing education, and in support of healthcare research. In addition to a description of what podcasting is, how podcasts are created, and how they are used, this paper addresses four critical issues that are emerging concerning podcasts. These issues are intellectual property and copyright, podcast preservation, podcast location, and podcast standards. As podcasting matures and new uses are discovered, we will see podcasting incorporated into our education, research and patient care publication paradigm.

Computers, Handheld↗
PubMed1995

Regional medical information network using optical memory cards and integrated services for digital network.

Since 1986, we have been developing a regional health and welfare system using optical memory cards. We have expanded the system and performed model experiments and evaluations this time. There are approximately 3000 card-holders and 23 card-reader terminals in use. They cover 50 percent of the medical facilities in the city of Isehara. Two medical clinics within neighboring cities have joined our project. Standard Deviation Index (SDI) has been introduced to standardize the numeric results of examinations. The terminals are connected with Integrated Services for Digital Network (ISDN) allowing remote access to the optical memory cards. This enhanced connectivity has allowed greater cooperation in delivering quality medical services.

Aged↗
PubMedDate not supplied

Computerized health information and the demand for medical care.

OBJECTIVE: Consumer health information, once the domain of books and booklets, has become increasingly digitized and available on the Internet. This study assessed the effect of using computerized health information on consumers' demand for medical care. METHODS: The dependent variable was self-reported number of visits to the doctor in the past year. The key independent variable was the use of computerized health information, which was treated as endogenous. We tested the effect of using computerized health information on physician visits using ordinary least squares, instrumental variables, fixed effects, and fixed-effects instrumental variables models. The instrumental variables included exposure to the Healthwise Communities Project, a community-wide health information intervention; computer ownership; and Internet access. Random households in three cities were mailed questionnaires before and after the Healthwise Communities Project. In total, 5909 surveys were collected for a response rate of 54%. RESULTS: In both the bivariate and the multivariate analyses, the use of computerized health information was not associated with self-reported entry into care or number of visits. The instrumental variables models also found no differences, with the exception that the probability of entering care was significantly greater with the two-stage conditional logit model (P <.05). CONCLUSIONS: Although providing people with health information is intuitively appealing, we found little evidence of an association between using a computer for health information and self-reported medical visits in the past year. This study used overall self-reported utilizations as the dependent variable, and more research is needed to determine whether health information affects the health production function in other important ways, such as the location of care, the timing of getting care, or the intensity of treatment.

Adolescent↗
PubMed2006

Social control of health behavior: associations with conscientiousness and neuroticism.

Despite considerable research demonstrating associations of conscientiousness and neuroticism with health-related behavior, our understanding of how and why these traits are related to lifestyle is limited. This study examined the social regulation of health behavior in a probability sample of 509 household residents who completed a Random Digit Dial (RDD) telephone survey. Results suggest that the social regulation of health behavior experienced by highly conscientious individuals has more to do with their own internalized notions of responsibility and obligation to others than to specific actions by others aimed at influencing their health habits. In contrast, individuals with higher neuroticism experience more overt attempts by others to influence their health habits but have more negative affective and behavioral responses to these social influence attempts. Findings suggest that elucidating the distinct social influence processes that operate for conscientiousness and neuroticism may further understanding of how these traits are related to health behaviors and status.

Adult↗
PubMedDate not supplied

Health benefits in 2005: premium increases slow down, coverage continues to erode.

This paper reports findings on the state of job-based health insurance in spring 2005 and how it has changed during recent years. Premiums rose 9.2 percent, the first year of single-digit increases since 2000. The percentage of firms offering health benefits has fallen from 69 percent in 2000 to 60 percent in 2005. Cost sharing did not grow appreciably in the past year. Enrollment in preferred provider organizations (PPOs) grew from 55 percent in 2004 to 61 percent in 2005, while enrollment in health maintenance organizations (HMOs) fell from 25 percent to 21 percent of the total.

Cost Sharing↗
PubMed2006

Reasons, assessments and actions taken: sex and age differences in uses of Internet health information.

The Internet is transforming the way in which consumers approach their health care needs. Sex and age are influential aspects of one's health as well as disease risk and are thus integral components of the emerging picture of health information seekers. Using data from Surveying the Digital Future, Year 4, a nationally representative, longitudinal telephone survey of Americans 12 years of age and older (n = 2010), we examine the reasons for, assessments of and actions taken as a result of health information found online among men and women and older and younger people. Although we tend to think of the Internet as a young person's technology, the percent of adults 60 years of age and older is similar to that of adolescents using the Internet as a health care information resource, thus suggesting an untapped opportunity with online interventions for older adults. Nonetheless, as age increases so too does the report of frustration with the experience. Men are more likely to report a positive seeking experience than women. Differences in Internet use fail to explain these observed sex and age differences in the seeking experience. Across the spectrum of age, sex and Internet skill, Internet health information seeking appears to enhance the patient-provider relationship.

Adolescent↗
PubMed2006

Drug information resources used by nurse practitioners and collaborating physicians at the point of care in Nova Scotia, Canada: a survey and review of the literature.

BACKGROUND: Keeping current with drug therapy information is challenging for health care practitioners. Technologies are often implemented to facilitate access to current and credible drug information sources. In the Canadian province of Nova Scotia, legislation was passed in 2002 to allow nurse practitioners (NPs) to practice collaboratively with physician partners. The purpose of this study was to determine the current utilization patterns of information technologies by these groups of practitioners. METHODS: Nurse practitioners and their collaborating physician partners in Nova Scotia were sent a survey in February 2005 to determine the frequency of use, usefulness, accessibility, credibility, and current/timeliness of personal digital assistant (PDA), computer, and print drug information resources. Two surveys were developed (one for PDA users and one for computer users) and revised based on a literature search, stakeholder consultation, and pilot-testing results. A second distribution to nonresponders occurred two weeks following the first. Data were entered and analysed with SPSS. RESULTS: Twenty-seven (14 NPs and 13 physicians) of 36 (75%) recipients responded. 22% (6) returned personal digital assistant (PDA) surveys. Respondents reported print, health professionals, and online/electronic resources as the most to least preferred means to access drug information, respectively. 37% and 35% of respondents reported using "both print and electronic but print more than electronic" and "print only", respectively, to search monograph-related drug information queries whereas 4% reported using "PDA only". Analysis of respondent ratings for all resources in the categories print, health professionals and other, and online/electronic resources, indicated that the Compendium of Pharmaceuticals and Specialties and pharmacists ranked highly for frequency of use, usefulness, accessibility, credibility, and current/timeliness by both groups of practitioners. Respondents' preferences and resource ratings were consistent with self-reported methods for conducting drug information queries. Few differences existed between NP and physician rankings of resources. CONCLUSION: The use of computers and PDAs remains limited, which is also consistent with preferred and frequent use of print resources. Education for these practitioners regarding available electronic drug information resources may facilitate future computer and PDA use. Further research is needed to determine methods to increase computer and PDA use and whether these technologies affect prescribing and patient outcomes.

Journal Article↗
PubMed2002

Measuring disease activity and functional status in patients with scleroderma and Raynaud's phenomenon.

OBJECTIVE: To document disease activity and functional status in patients with scleroderma (systemic sclerosis [SSc]) and Raynaud's phenomenon (RP) and to determine the sensitivity to change, reliability, ease of use, and validity of various outcome measures in these patients. METHODS: Patients with SSc and moderate-to-severe RP participating in a multicenter RP treatment trial completed daily diaries documenting the frequency and duration of RP attacks and recorded a daily Raynaud's Condition Score (RCS). Mean scores for the 2-week periods prior to baseline (week 0), end of trial (week 6), and posttrial followup (week 12) were calculated. At weeks 0, 6, and 12, physicians completed 3 global assessment scales and performed clinical assessments of digital ulcers and infarcts; patients completed the Health Assessment Questionnaire (HAQ), the Arthritis Impact Measurement Scales 2 (AIMS2) mood and tension subscales, 5 specific SSc/RP-related visual analog scales (VAS), and 3 other VAS global assessments. We used these measures to document baseline disease activity and to assess their construct validity, sensitivity to change, and reliability in trial data. RESULTS: Two hundred eighty-one patients (248 women, 33 men; mean age 50.4 years [range 18-82 years]) from 14 centers participated. Forty-eight percent had limited cutaneous SSc; 52% had diffuse cutaneous SSc. Fifty-nine patients (21%) had digital ulcers at baseline. Patients had 3.89 +/- 2.33 (mean +/- SD) daily RP attacks (range 0.8-14.6), with a duration of 82.1 +/- 91.6 minutes/attack. RCS for RP activity (possible range 0-10) was 4.30 +/- 1.92. HAQ scores (0-3 scale) indicated substantial disability at baseline (total disability 0.86, pain 1.19), especially among the subscales pertaining to hand function (grip, eating, dressing). AIMS2 mood and tension scores were fairly high, as were many of the VAS scores. Patients with digital ulcers had worse RCS, pain, HAQ disability (overall, grip, eating, and dressing), physician's global assessment, and tension, but no significant difference in the frequency of RP, duration of RP, patient's global assessment, or mood, compared with patients without digital ulcers. VAS scores for digital ulcers as rated by the patients were not consistent with the physician's ratings. Factor analysis of the 18 measures showed strong associations among variables in 4 distinct domains: disease activity, RP measures, digital ulcer measures, and mood/tension. Reliability of the RCS, HAQ pain and disability scales, and AIMS2 mood and tension subscales was high. The RP measures demonstrated good sensitivity to change (effect sizes 0.33-0.76). CONCLUSION: Our findings demonstrate that the significant activity, disability, pain, and psychological impact of RP and digital ulcers in SSc can be measured by a small set of valid and reliable outcome measures. These outcome measures provide information beyond the quantitative metrics of RP attacks. We propose a core set of measures for use in clinical trials of RP in SSc patients that includes the RCS, patient and physician VAS ratings of RP activity, a digital ulcer/infarct measure, measures of disability and pain (HAQ), and measures of psychological function (AIMS2).

Affect↗
PubMed2001

Teledermatology in the Waikato region of New Zealand.

Teledermatology consultations over a video-link began at Health Waikato in 1995. Clinical trials involving about 500 patients have demonstrated the diagnostic accuracy and economic gains of these teleconsultations, and patient satisfaction with them. Yet, six years on, out-of-date equipment remains under-used. There has been no expansion of the network and no additional clinical teleconsultation services. Possible reasons include the excessive capital cost of videoconferencing equipment, clinician overwork, inconvenience, lack of reimbursement, administrative and governmental inertia, and little demand from patients and their doctors. To widen our referral base without the inconvenience of videoconferencing, we decided to offer a secure browser-based dermatology tele-advice service to referring general practitioners who owned digital cameras. With the increase in online health information and electronic communication, we assumed it would be popular. But, despite up to six-month waits for patients to be seen in the dermatology outpatient clinic, few patients have been referred to the service. Explanations have included time constraints, unavailability of a camera, no Internet access at the time of consultation and lack of reimbursement. Can we look forward to a future in which all doctors have high-speed access to the Internet at their desktop through their practice management systems? Who will pay? Will they continue to prefer conventional referral?

Dermatology↗