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Neck pain and disability following motor vehicle accidents--a cohort study.

The primary aim of the study was to compare the prevalence of neck pain and disability in a group exposed to motor vehicle accidents (MVAs) with those in the general population. The secondary aim was to assess the prevalence of a past history of exposure to an MVA with sequelae of neck pain in the general population. The exposed group consisted of 121 patients with neck complaints following an MVA in 1983. The control group, consisting of 1,491 subjects, was randomly selected, with attention to the distribution of age and gender in the exposed group. A neck-pain questionnaire was mailed to the subjects. In the control group, it included enquiry about a history of exposure to an MVA with sequelae of neck pain. The Neck Disability Index (NDI) was used to assess neck-related disability. In the exposed group 108 subjects (89%) responded, and in the control group 931 (62%) did. Seventeen years after the MVA, 59 subjects (55%) reported neck pain in the exposed group, with no gender differences. In the control group 270 (29%) reported neck pain with a higher frequency among women (34%) than men (19%) (p<0.01). There was a significant difference between the exposed group and the control group regarding the occurrence of neck pain (p<0.001). In the control group 34% recalled a history of an MVA, among whom one-third reported neck pain in connection with the accident and 28% had persistent neck pain referable to the accident. The exposed group scored significantly higher on the NDI (p<0.001) and reported significantly higher neck pain intensity than did the control group (p<0.001). In conclusion, a past history of exposure to an MVA with sequelae of neck pain appears to have a substantial impact on future persistent neck pain and associated disability.

Accidents, Traffic↗

Is the grass greener? A survey of female pediatric surgeons in the United Kingdom.

BACKGROUND/PURPOSE: Since 1990, at least 50% of UK medical school entrants have been females, although women comprise only 2% of surgical consultants. If women continue to reject surgical careers, recruitment will be limited to a decreasing pool of male applicants. A recent North American study suggested lack of mentorship and role models may be contributory factors. We undertook a survey of UK female pediatric surgeons to ascertain career satisfaction and professional development. METHODS: UK female pediatric surgeons were identified from the British Association of Pediatric Surgeons members' handbook 2004 and via personal communication. Postal or e-mail questionnaires were sent and anonymized responses were analyzed. RESULTS: Thirty-three questionnaires were distributed to all 16 female consultants (13% of BAPS consultant workforce) and 17 trainees (SpRs [specialist registrars/higher surgical trainees]). Twenty-seven (82%) replies were received. Of 27 (85%) respondents, 23 worked full time; "on-call" commitments range from 1 in 2 (2 consultants) to 1 in 8, with several trainees working shifts. Eighteen (67%) respondents had taken a career break-11 for maternity leave. Twelve (44%) are planning further "time-out," of whom 10 are SpRs. Ninety-three percent are contented with their career and would choose pediatric surgery again. However, 19 (70%) reported factors that had hindered their development, 13 (68%) included insufficient research time, whereas only 3 cited a lack of mentorship. CONCLUSIONS: Female representation in medicine is increasing. In contrast to North American experience, very few UK female pediatric surgeons felt hampered by lack of mentorship or role models. Education and training committees need to work proactively to ensure training programs achieve clinical excellence to continue to attract women into pediatric surgery. For women in the United Kingdom, pediatric surgery challenges will also be met by ensuring healthy "work-life balance," along with flexibility in training and established consultant practice.

Career Choice↗

Responses of older adults to theory-based nutrition newsletters.

OBJECTIVE: To evaluate the effect of a theory-based newsletter on knowledge, attitude, and behavior change in older adults. DESIGN: Pretest-posttest, random assignment, and treatment-control design with 2 treatment groups: 1 that received newsletters only and 1 that received newsletters with follow-up telephone interviews. Control group completed pretest-posttest surveys only. SUBJECTS/SETTING: Four hundred eighty men and women, aged 60 to 74 years, were recruited to participate in a home-based educational intervention using a patient list generated from a rural tertiary care hospital database, Geisinger Medical Center in Danville, Pa. INTERVENTION: Five nutrition newsletters designed using the nutrition communication model and adult learning theory principles were mailed biweekly. Telephone interviews followed each of the 5 newsletters 10 to 14 days after distribution. OUTCOME MEASURES: Nutrition knowledge and interest, food behavior related to dietary fat, and stages of change for dietary fat and fiber. STATISTICAL ANALYSES PERFORMED: Analysis of covariance was used to determine group differences in posttest outcome measures using pretest as covariate. RESULTS: In addition to achieving higher scores than the control group, the treatment groups were significantly different from each other in correct and perceived nutrition knowledge at posttest. Those in the treatment group receiving telephone calls scored higher (mean change = 19.0% for correct and 20.3% for perceived) than those who received the newsletters only (mean change = 12.5% for correct and 14.3% for perceived; P < .05). Treatment groups also rated their interest in nutrition higher than the control group did; there was no between-treatment difference. Treatment groups performed significantly better than the control group for dietary fiber stage of change (P < .05). Those receiving only newsletters scored significantly better than the control for the "avoid fat" food behavior (P < .05). APPLICATIONS/CONCLUSIONS: This study provides an example of the incorporation of a theoretical model in development and evaluation of newsletters. Home-delivered nutrition newsletters based on this model can communicate health and nutrition information to older adults. Consumers today have more opportunities than ever before to access nutrition information quickly and inexpensively. Newsletters can help dietetics professionals filter and limit what consumers must process, saving clients time and improving the accuracy of information obtained. Dietetics professionals in both clinical and community practice are uniquely positioned to provide highly focused and understandable information to consumers via a newsletter format.

Aged↗

Emergency departments and crowding in United States teaching hospitals.

STUDY OBJECTIVES: To assess the extent and distribution of hospital and emergency department crowding nationally. DESIGN: The research design consisted of a mailed questionnaire disseminated in the fall of 1988 to the member institutions of the National Association of Public Hospitals (NAPH) and the Council of Teaching Hospitals (COTH). TYPE OF PARTICIPANTS: Study participants included hospital administrators and ED directors from 239 of the non-Veterans Administration, general acute care, US members of COTH and NAPH. MEASUREMENTS: Key measures of hospital and ED crowding including mean ED holding times for floor and ICU beds. MAIN RESULTS: Three fourths of responding hospitals reported increases in ED visits over the preceding three years. Mean ED holding times for admitted patients were 3.5 hours (median, 2.0 hours) for a floor bed and 2.9 hours (median, 1.5 hours) for an ICU bed. Half of all hospitals noted maximum waits for floor and ICU beds of ten hours or more and seven hours or more, respectively. Measures taken by hospitals to manage crowding during August 1988 included restricting access to some types of patients (mean, 3.6 days), actively transferring patients to other hospitals (mean, 2.2 days), transfer refusal (mean, 2.8 days), and total ambulance diversion (mean, 1.6 days). CONCLUSIONS: Our study strongly suggests that ED crowding is not an isolated phenomenon; ED crowding and its attendant problems appear to affect hospitals with similar adverse effects regardless of ownership. Although our results suggest that ED crowding is concentrated in metropolitan areas and in a smaller subset of hospitals, we found instances of crowding among hospitals nationwide.

Bed Occupancy↗

How to improve communication on vaccine issues at the national level? INFOVAC-PED: an example from Switzerland.

For physicians in private practice, rapid access to relevant and up-to-date objective information is required to better meet their clients' concerns on vaccine-related issues. To meet this need, INFOVAC-PED, an academic network of on call pediatric infectious diseases experts who can be reached free of charge at a central e-mail address, now answers Swiss physicians' questions within 24-48h. INFOVAC-PED also distributes monthly bulletins including news from the Federal Office of Public Health, vaccine producers, literature survey, and answers to most frequently asked questions. The rapid success of this novel initiative underlines the need to better support front line physicians.

Communication↗

Alcoholic beverage licensing practices in California: a study of a regulatory agency.

A mail survey sent to all 25 State of California Alcoholic Beverage Control (ABC) offices and distributed to all 167 investigators assessed investigators' decisions to recommend issuance or denial of alcoholic beverage license applications. Investigators responded to three hypothetical vignettes that involved applications for liquor licenses. Findings show that although ABC investigators are influenced by public protests, illegal applications, and an applicant's moral character, they consistently favor licensing the applicant. The two formal rules that were designed specifically to respond to the community's welfare do not present serious barriers to obtaining an alcohol license. As a state regulatory organization, ABC is influenced greatly by the industry that it is supposed to regulate.

Alcohol Drinking↗

Attitudes of college football coaches regarding NCAA mouthguard regulations and player compliance.

OBJECTIVES: The purpose of this study was to assess the attitudes of Division 1-A college head football coaches regarding the NCAA mouthguard regulations, current patterns of use by players, and responsibility for enforcement; and to compare the coaches' responses with those of officials studied previously. METHODS: A 15-item questionnaire was mailed to all 106 Division 1-A football coaches to assess their attitudes. Percent frequency distributions of coaches' responses to each item were computed and compared to the officials' responses. RESULTS: Responses were received from 98 coaches (92.45%). While 87 percent of coaches reported having a team dentist, the majority reported that the team trainer was responsible for selecting the type of mouthguard used. Most coaches (53%) reported that all players wore mouthguards, but that quarterbacks were least compliant. Most coaches reported that mouthguard rules were beneficial in determining player compliance and resulted in more frequent use. Seventy-four percent would warn the player of a violation themselves, yet only 26 percent felt the coach had the greatest influence on players wearing mouthguards. Seventy-six percent felt the current enforcement of the rules is appropriate. Coaches opinions varied from those of officials. CONCLUSIONS: Coaches view themselves, the players, or the trainer as most responsible for players wearing mouthguards, not referees. This finding coincides with the officials' opinion that the coaches should be accountable.

Adult↗

Heart murmurs recorded by a sensor based electronic stethoscope and e-mailed for remote assessment.

BACKGROUND: Heart murmurs are common in children, and they are often referred to a specialist for examination. A clinically innocent murmur does not need further investigation. The referral area of the University Hospital is large and sparsely populated. A new service for remote auscultation (telemedicine) of heart murmurs in children was established where heart sounds and short texts were sent as an attachment to e-mails. AIM: To assess the clinical quality of this method. METHODS: Heart sounds from 47 patients with no murmur (n = 7), with innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor based stethoscope and e-mailed to a remote computer. The sounds were repeated, giving 100 cases that were randomly distributed on a compact disc. Four cardiologists assessed and categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded the assessment time per case, their degree of certainty, and whether they recommended referral. RESULTS: On average, 2.1 minutes were spent on each case. The mean sensitivity and specificity were 89.7% and 98.2% respectively, and the inter-observer and intra-observer variabilities were low (kappa 0.81 and 0.87), respectively. A total of 93.4% of cases with a pathological murmur and 12.6% of cases with an innocent murmur were recommended for referral. CONCLUSION: Telemedical referral of patients with heart murmurs for remote assessment by a cardiologist is safe and saves time. Skilled auscultation is adequate to detect patients with innocent murmurs.

Adolescent↗

Retired physicians: a survey study by the Turkish Medical Association.

BACKGROUND: The aim of this study was to assess the quality of life of retired Turkish physicians. The focus was on their working conditions, their health status, and the impact of their disabilities on activities of daily life. METHODS: The survey was conducted using a 35 item questionnaire, which was distributed to the local medical chambers allied with the Turkish Medical Association and thereafter was mailed to retirees aged 65 years and older. RESULTS: Out of 680 physicians, 391 (57.5%) responded, and percentages are expressed according to the number of physicians answering each question. The ages of the physicians ranged between 65 years and 91 years with a mean of 72.57+/-5.22 years. Overall, 236 physicians (60.8%) were still actively carrying on their profession, and 152 (39.2%) were not. Of the physicians who were working, 0.8% classified their working conditions as very bad, 9.7% as unsatisfactory, 37.7% as satisfactory, 33.6% as good, and 18.2% as excellent. The number of physicians with a disability was 42 (11.8%). The number of days on which physicians were hindered in their daily tasks ranged between 0 and 30 days with a mean (SD) of 1.55 (4.88) days, and the amount of sick leave ranged between 0 and 365 days with a mean of 2.25 (21.08) days. CONCLUSION: It is believed that planning for retirement in all its aspects should be a legitimate concern of all physicians. Recommendations for future retirees or the construction of guidelines for making this time of life enriching and a period of intellectual growth are awaited.

Aged↗

Recognition and management of teething diarrhea among Florida pediatricians.

According to current medical opinion, teething diarrhea (TD) is a myth; yet cross-cultural data document a worldwide distribution of popular belief in the association of frequent, loose stools with tooth eruption. A mail survey in 1990 of 215 pediatricians practicing in Florida investigated beliefs and practices related to TD. Thirty-five percent of respondents believed there is a real association between diarrhea and tooth eruption. When compared with pediatricians who do not believe in TD, these respondents were more likely to be more recent graduates of medical school, to be in general pediatric practice, to be female, to see more patients per week, and to practice in metropolitan areas. The most common explanations for the link between dentition and diarrhea were changes in eating habits, increased salivation, and stress. Respondents reported that both they and the parents of their patients tended to view TD as less serious than other types of diarrhea, and both managed it accordingly. When compared with earlier studies, our findings indicate that belief in TD among pediatricians may have increased since the 1970s. The results suggest a need for more empirical research on the effects of tooth eruption on bowel function.

Diagnosis, Differential↗

Effect on survey return rates of having a signed or unsigned postcard as the third-wave mailing.

This study assessed differences in response rates to a three-wave mail survey when signed or unsigned postcards were the third wave of the mailing (after two mailings of the questionnaire). A total of 259 signed postcards and 259 unsigned postcards were mailed as the third-wave mailing. There were 34 signed postcards and 30 unsigned postcards returned, a not significantly different distribution by chi-square test.

Humans↗

National Study of Internal Medicine Manpower. XVIII: Subspecialty fellowships with a special look at hematology and oncology, 1988-1989.

OBJECTIVE: To determine the number and distribution of internists in subspecialty training and compare with data collected since 1976; to determine the distribution of activity of subspecialty fellows; and to focus on hematology and oncology. DESIGN: Repeated mail survey with telephone follow-up. PARTICIPANTS: All directors of subspecialty training programs in internal medicine in the United States. RESULTS: The 1988-1989 census identified 7530 fellows in training, 55 more than in 1987-1988. There are 24 more first-year fellows. Reports on the activities of subspecialty fellows show that, overall, 53% of fellows' time is spent in direct patient care, 20% on basic research, 15% on patient-related research, and 12% in teaching. CONCLUSIONS: The number of internists entering subspecialty training has risen at a considerably slower rate in the last 5 years compared with the 5 years before that. The length of subspecialty training has increased significantly since 1976. There has been a shift in subspecialty choice from hematology to oncology and toward joint programs offering both subspecialties.

Education, Medical↗

Appraisal of the dental school learning environment: the students' view.

The majority of studies examining dental school curriculum have addressed organization, structure, and content issues from the perspectives of administrators, faculty, practitioners/alumni, and professional organizations. However, few studies have focused on students' opinions of dental school. The purpose of this study was to determine students' perceptions of the learning environment, intellectual climate, and teacher-student relationships in dental school. This report describes how the "dental version" of the Medical Student Learning Environment Survey (MSLES) was used to identify students' perceptions of their dental education. Freshman and junior dental students' perceptions were measured with the Dental Student Learning Environment Survey (DSLES), which evaluates learning environment, intellectual climate, and relationships among students and teachers in seven areas: flexibility, student-to-student interaction, emotional climate, supportiveness, meaningful experience, organization, and breadth of interest. The DSLES was mailed to twenty-three dental schools in North America with eighteen of the schools distributing the inventory. A total of 619 dental students responded. Results were differentiated between freshman and junior dental students. Both freshman and junior students provided the highest (most positive) ratings for the DSLES subscales of "breadth of interest" (interest in dentistry and outside interests are encouraged) and "meaningful learning experience" (significance of courses to dentistry). Freshman students provided the lowest (least positive) ratings for "emotional climate" (students' responses to the way their courses were conducted and stress levels), and junior students provided the least positive ratings for "faculty supportiveness" (extent of faculty support and encouragement provided to students). The DSLES identified students' perceptions of their educational experience and localized areas for improvement. By addressing these areas of concern, faculty can increase student satisfaction with their dental education.

Curriculum↗

Data storage and retrieval.

The entire face of modern medical and surgical practice is being significantly affected by the application of technologic developments to the practice of surgery--developments that will tie together such areas as information management and processing, robotics, communication networks, and computerized surgical equipment. The achievements in these areas will create a sophisticated, fully automatic system that will assist the plastic surgeon in many aspects of work, such as regular office activities, doctor-patient interaction, professional updating, communication, and even assistance during the operational process itself. It will be as simple as dialing a telephone today. When it is necessary to consult with other colleagues, a combined vocal and visual consulting network in other medical centers as well as consulting computerized expert systems will be available all day and night as part of the communication services. The plastic surgical expert systems will store valuable information, based on the knowledge of the best human experts, on any important subtopics and will be accessed in a very friendly way. This will be an invaluable tool for the residents in training, for emergency room work, and for just getting a second opinion, even for the more experienced practitioner. All the electronic mail, professional magazines, and any other required professional information will flow between central and personal retrieval systems. The doctor, at a desired time in the privacy and comfort of his or her own home or office, can read the mail, make required changes to suit his or her needs, and store, send back, or distribute information, all in a speedy and efficient manner. The simulation of a planned surgery will give the surgeon the ability to prepare and will prevent difficulties during complicated procedures through the luxury of a dry run, without any sequelae if certain expected outcomes fail to materialize. The preprogrammed control of sophisticated surgical equipment and the use of robotics would generate new operational possibilities for more complicated surgeries, which are now prevented owing to the surgeon's physical limitations. Information urgently required during the operation as a result of an unexpected situation will be available immediately from storage and retrieval systems, and real-time vocal and visual consulting with expert colleagues, often in remote locations, will bring the operations process itself to a new era.(ABSTRACT TRUNCATED AT 400 WORDS)

Artificial Intelligence↗

[Graduates from Tromsø--do they stay in Northern Norway? Geographic origin determines selection of professional practice location in Northern Norway].

The impact of the Medical School, University of Tromsø on the distribution of physicians in rural areas in North Norway was evaluated by means of a mailed questionnaire. The survey covered eleven graduation classes (417 physicians), and the response rate was 84.2%. The establishment of a new medical school in North Norway has clearly had beneficial effects: A total of 56.1% of the graduates stay on as doctors in these areas. Among those who also grew up in the northern parts of Norway, the proportion is 82.0%, compared with graduates who grew up in the southern parts where the proportion is 37.7%. The results clearly demonstrate that one of the main objectives of the Medical School at the University of Tromsø, to educate physicians who prefer to work in these areas, has been achieved.

Arctic Regions↗

Task analysis of home care pharmacy.

The demographics of home care pharmacists and the frequency and perceived importance of home care pharmacy tasks were studied. Two questionnaires were mailed in August 1994 to each of 1420 sites that provide home care pharmacy services. Home care pharmacists were asked to provide information on themselves and their companies and to rate 47 home care pharmacy tasks (administrative, clinical, distributive, and miscellaneous) on how often they are performed as part of the job and how essential they are for successful job performance. Of the 2840 surveys mailed to the 1420 sites, questionnaires for 87 sites were not deliverable, leaving an adjusted gross sample of 1333 sites. A total of 393 usable questionnaires were received from 326 sites (net site response rate 24.5%). Respondents tended to be male, have a B.S. degree only, and have more than six years' home care experience. The most commonly identified type of employer was an independent company. Some 34% of respondents said their company had only 1 site; another 33% stated more than 50 sites. Forty-three percent of locations had 2 pharmacist full-time equivalents. Distributive tasks had the highest frequency scores; clinical tasks were performed second most frequently. Distributive and clinical tasks also received high importance scores. The data suggests that, despite other demands on their time, home care pharmacists give considerable attention to tasks consistent with pharmaceutical care. A survey of home care pharmacists provided baseline information on demographics and the frequency and perceived importance of specific tasks.

Female↗

What does the public ask of the JATs? Results and feedback about insufficient public information distribution.

In order for the Japanese Association for Thoracic Surgery (JATS) to undertake appropriate internal reforms, civil receptiveness and sensitivity to the needs of the public are required. Although the JATS is conscious of the needs of physicians, the needs of the public has almost never been addressed. The JATS should place a priority on its mission to advance medicine, to contribute to the public welfare, to distribute information to the public, and to be publicly accountable over seeking the members' well-being. The web site of the "Lung Cancer Medical Treatment Network" (Haigan Chiryo Net), which was launched by one of us 5 years ago, is one example of information distribution. Visitors to the web site have gradually increased to more than 20,000 people per month, totaling 753,000 visits. More than 1200 persons have requested second opinions by e-mail or facsimile. We propose that the nature and purpose of the JATS's civic activities be specified and that the JATS consider and establish methods for public information distribution. Using a web site is an effective method for these activities, but an opinion document about medical problems and the medical system of chest surgery should be created and distributed. The establishment of a consultation service for second opinions should also be considered.

Humans↗

Distribution of fasciolosis in Kansas, with results of experimental snail susceptibility studies.

A total of 278 veterinarians throughout Kansas were sent mail-in survey forms asking specific questions relating to their experience with fasciolosis in their practice area. Replies were received from 178 (64%) veterinarians representing six practice types; one-third reported having seen cases of fasciolosis in their practice. The results of our survey indicate that the majority of the cattle diagnosed with liver fluke disease in Kansas are imported from other areas of the USA. However, in both central and southeastern regions of Kansas, some cattle that had never been out of the state were infected with Fasciola hepatica. Thus, these areas of Kansas should be considered endemic for liver fluke disease. Methods of diagnosis, types of operations, and improvements seen after treatment were also discussed. In order to ascertain the existence of one or more possible snail intermediate hosts within Kansas, five species of lymnaeid snails were collected from central and southeastern parts of the state and tested for their susceptibility to infection by Fasciola hepatica. The snails collected included Pseudosuccinea columella, Fossaria obrussa, Fossaria bulimoides, Fossaria parva and Fossaria dalli. Of these, Pseudosuccinea columella and Fossaria bulimoides proved susceptible to experimental infection by Fasciola hepatica. Metacercariae obtained from experimentally infected snails were used to infect both a weanling calf thereby completing the life cycle of the parasite. This report is the first to identify the existence of suitable snail intermediate hosts for Fasciola hepatica in Kansas.

Animals↗