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PubMed2002

Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores.

Bioelectrical impedance measurements were collected in the Third National Health and Nutrition Examination Survey (NHANES III), but their results have not been published. In the NHANES III population, resistance (R) and reactance (Xc) values at 50-kHz frequency were obtained with a Valhalla Scientific meter (model 1990B; San Diego, CA, USA). The RXc graph method was used to identify bivariate pattern distributions of mean vectors (95% confidence ellipses by sex, race, age, and body mass index [BMI]), and individual impedance vectors (50%, 75%, and 95% tolerance ellipses). Data from 10 222 adults (5261 men and 4961 women) formed 90 four-way classification groups, with two sexes, three races or ethnicities (non-Hispanic white, non-Hispanic black, Mexican American), five age classes (20-29, 30-39, 40-49, 50-59, and 60-69 y), and three BMI classes (19-24.9, 25-29.9, and 30-34.9 kg/m(2)). Sex, race or ethnicity, BMI and age, in decreasing order, influenced the vector distribution pattern. Mean vectors in women were significantly longer than those in men. Within each sex, the mean vector of non-Hispanic white subjects was shorter and with a smaller phase angle than that of corresponding BMIs from the two other race/ethnic populations. Tolerance ellipses were calculated from sex- and race-specific reference populations 20 to 69 y old and 19 < or = BMI < 30 kg/m(2) (8022 subjects, 4226 men and 3796 women). After transformation of impedance vector components into bivariate Z scores (standardized deviates, as differences from the mean divided by the standard deviation of the reference population), we constructed one standard, reference, RXc-score graph (50%, 75%, and 95% tolerance ellipses) that can be used with any analyzer in any population. The pattern of impedance vector distribution and reference bivariate intervals for the individual impedance vector are presented for comparative studies (free software at E-mail: apiccoli@unipd.it).

Adult↗
PubMed2004

Obesity as a risk factor for antipsychotic noncompliance.

OBJECTIVE: Weight gain is a common side effect of antipsychotic medications and is of particular concern with most of the newer "atypical" antipsychotics. It is, therefore, increasingly important to understand the impact of obesity and perceived weight problems on compliance with these medications. METHODS: A survey of treatment and health issues was mailed to local chapters of the National Alliance for the Mentally Ill (NAMI) and National Mental Health Association (NMHA), who distributed them to people with schizophrenia. Noncompliance was defined as a self-report of missing any antipsychotic medication in the previous month. The primary independent variables were (1) body mass index (BMI; weight [kg]/height [m2])-categorized as normal (< 25, n = 73), overweight (25-30, n = 104), or obese (> 30, n = 100)-and (2) subjective distress over weight gain. Other independent variables included demographics, medication attitudes, and treatment satisfaction. RESULT: BMI status and subjective distress from weight gain were predictors of noncompliance. Obese individuals were more than twice as likely as those with a normal BMI to report missing their medication (OR = 2.5; CI 1.1-5.5). A comprehensive model suggested that the primary mediator of noncompliance was distress over weight gain. CONCLUSIONS: There appears to be a significant, positive association between obesity and subjective distress from weight gain and medication noncompliance, even when accounting for other possible confounding factors.

Adult↗
PubMedDate not supplied

Ten years of police defibrillation: program characteristics and personnel attitudes.

OBJECTIVE: In 1992,a study to evaluate the effectiveness of police defibrillation was initiated in seven suburban police departments. This paper describes the characteristics of those programs and the attitudes of chiefs and officers ten years after the commencement of that study. METHODS: A 32-item survey instrument including questions on department demographics, defibrillation program characteristics, and attitudes was mailed to the chiefs. A separate 25-item survey was developed to assess officers' attitudes; a non-management officer distributed and collected these surveys anonymously. Responses are reported descriptively. RESULTS: All seven chiefs and 78% of the officers completed surveys. Police arrive prior to emergency medical services on 80% or more of calls, with a mean +/- standard deviation response interval of 3.1 +/-1.7 minutes. All departments identify a program coordinator and six a medical director; three departments have a quality-improvement program. Five departments have liability coverage for the use of an automated external defibrillator (AED), and no department reported any liability-related problems. Five of the chiefs and 82% of the officers disagreed or strongly disagreed that liability issues are a concern or a source of hesitation in using the AED. Ninety-six percent of the officers agreed or strongly agreed that police AED use is beneficial to cardiac arrest victims. All seven police chiefs and 89% of the officers agreed or strongly agreed that AED use by police is appropriate. CONCLUSIONS: In these seven police departments with ten years of program experience, defibrillation has become integrated into the law-enforcement culture. Liability issues are not a prominent concern of chiefs or officers. Police chiefs and officers in these departments continue to support police-based defibrillation programs.

Adult↗
PubMed1985

Use of influenza vaccine in nursing homes.

The organization and outcome of influenza immunization programs were studied in 67 randomly or systematically selected nursing homes (8354 residents) in six states during the autumn of 1982 and/or 1983. In each home, influenza vaccine was usually offered to all residents on a voluntary basis, independent of their age, level of required nursing care, or underlying medical conditions. However, the proportion of residents who were vaccinated ranged from 8 to 98% (mean, 62% overall), with significantly lower rates in homes that also required consent from relatives (usually by return mail) than in homes that did not (P less than .00001; median, 57 versus 90%, respectively). These observations suggest that distribution of educational materials about the risks and benefits of influenza vaccine and systematic follow-up of relatives who fail to return the consent form may be useful strategies to further increase the number of nursing home residents who are immunized.

Aged↗
PubMed1999

Demographic characteristics of the equine population of northern Britain.

The size, composition and distribution of the equine population of Scotland and the five northernmost counties in England were estimated through a series of mailed questionnaire surveys of sentinel veterinary practices and horse owners. An estimated 96,622 equine animals were kept by an estimated 26,114 owners. The mean (sd) age of the population was 11.0 (7.5) years (range one month to 37 years). Thoroughbred or thoroughbred-cross animals were the most numerous, constituting 30 per cent (95 per cent confidence interval 27 to 33 per cent) of the total population. The ratio of males:females was 1:1.

Animals↗
PubMedDate not supplied

Survey of Iowa emergency medical services on the effects of the 1993 floods.

INTRODUCTION: From June through August 1993, extensive flooding in the Mississippi and Missouri River basins resulted in 50 deaths and 12 billion dollars [U.S.] in damages in nine Midwestern states. In Iowa (1990 population 2,777,000), the government declared all 99 counties Federal Disaster Areas. This study examines how this event impacted local emergency medical services (EMS). METHODS: All 797 registered prehospital ambulance, rescue, and first-response companies in Iowa received survey questionnaires. Two follow-up mailings were provided for non-responders. RESULTS: A total of 468 EMS companies (59%) returned completed questionnaires. The geographic distribution of responders and non-responders was similar. Of the companies responding, 132 (28%) reported an impact on their operations from the flood disaster. The most frequently reported operational changes included the use of non-traditional vehicles, providing aid to regions outside usual service areas, and involvement in non-medical rescue operations. CONCLUSION: A major flood provides unique challenges for emergency medical services. Cross-sectional surveys can identify areas of improvement for prehospital systems located in flood-prone areas. Results from this study provide a basis for constructing a more refined instrument to study future flood disasters.

Data Collection↗
PubMed1996

Exceeding the Healthy People 2000 goal for influenza vaccination through a collaborative effort at eight primary care clinics.

The use of trivalent influenza vaccination has been shown to reduce hospitalizations and mortality in high risk persons receiving the vaccine prior to endemic periods. Despite the generally accepted benefit of this vaccine, its use remains relatively low, with less than 40% of high risk persons actually receiving the vaccination. Increasing the vaccination rate is particularly difficult for physicians in small groups, practicing without sophisticated information systems, and for those practices in which small percentages of the patients are in HMO's or capitated plans. The setting for our study was eight primary care clinics, in a predominantly fee for service environment. We used several interventions to achieve the Healthy People 2000 goal of vaccinating 60% of the high risk of population. Those interventions included: mailings to patients recommending they get vaccinated, empowering non physician clinic personnel to administer vaccines without specific physician orders, and distributing comparative data of the vaccination rates at all participating clinic sites. We found that by using these interventions at eight different primary care clinic sites, we were able to achieve an influenza vaccination rate of 66.4% for our high risk population. We concluded that through collaboration eight primary care clinics can exceed the Healthy people 2000 goal of 60% compliance with influenza vaccination.

Data Collection↗
PubMedDate not supplied

Physician conceptions of responsibility to individual patients and distributive justice in health care.

PURPOSE: Physicians' values may be shifting under managed care, but there have been no empirical data to support this claim. We describe physician conceptions of responsibility to individual patients and distributive justice in health care, and explore whether these values are associated with type of managed care practice and professional satisfaction. METHODS: We mailed a questionnaire to 500 primary care physicians from 80 out-patient clinics in 11 managed care organizations (MCOs) who were participating in 4 studies designed to improve the quality of depression care in primary care. RESULTS: We received 414 responses (response rate 83%). Twenty-eight percent of physicians strongly agreed that their main responsibility was to the individual patient rather than to society (strong sense of responsibility to individual patients). Physicians with a strong sense of responsibility to individual patients were older (43% of physicians older than 50 years reported a strong sense of responsibility to individual patients, compared with 26% of physicians aged 36 to 50 years, and 21% of physicians younger than 35 years, P = .009) and tended to practice in network- rather than staff-model MCOs (33% of physicians in network-model MCOs reported a strong sense of responsibility to individual patients compared with 24% in staff-model MCOs, P = .077). Scores on a scale measuring egalitarian conceptions of distributive justice within the health care system were similar for physicians regardless of whether they reported a strong sense of responsibility to individual patients. When we controlled for physician and practice characteristics, physicians with a strong sense of responsibility to individual patients and physicians with higher scores on an egalitarian scale were more likely to be very satisfied overall with their practices (adjusted odds ratio [AOR] = 2.23, 95% confidence interval [CI], 1.11-4.49, and AOR = 1.18, 95% CI, 1.09-1.29, respectively). CONCLUSIONS: Physicians with a strong sense of responsibility to individual patients are older and less likely to practice in staff-model MCOs. Stronger commitment to an egalitarian health care system and a strong sense of responsibility to individual patients are independently associated with greater practice satisfaction among physicians. The impact of these values on patient care should be a priority for future research and the subject of professional education and debate.

Adult↗
PubMed2000

Selection of control groups by using a commercial database and random digit dialing.

Identifying a control group when cases come from a specialized hospital is a challenge for epidemiologists. The authors compared controls recruited by using a commercial database with those recruited by random digit dialing in the context of a hospital-based case-control study of ovarian cancer. This part of the study was conducted in 1997-1998 among women aged 18 years or older who resided in the New York metropolitan area. A mailing list owner grouped cases into "lifestyle" clusters based on US zip+4 postal code microneighborhoods and generated a random sample of potential controls with the same distribution across the clusters. Controls recruited from the commercial database (n = 82) and from random digit dialing (n = 90) were similar in age and race. Women from the commercial database had somewhat more education and higher incomes and were more similar to the cases on these measures. The control groups resembled each other closely in terms of oral contraceptive use, nulliparity, and religion and differed from the cases on these measures. Response rates were similar for the two groups. Only 28% of the cases were included on the mailing list, indicating that it did not reflect the source population of the cases. Use of a commercial database provided a control group whose socioeconomic factors were similar to those of cases at a lower cost than when random digit dialing was used but did not result in a higher response rate.

Adult↗
PubMed2000

Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer.

CONTEXT: Multiple treatment options are available for men with prostate cancer, but therapeutic recommendations may differ depending on the type of specialist they consult. OBJECTIVE: To define and contrast the distribution of management recommendations by urologists and radiation oncologists for a spectrum of men with prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: Mail survey sent in 1998 to a random sample of physicians in the United States, who were listed as urologists (response rate 64%, n=504) and radiation oncologists (response rate 76%, n=559) in the American Medical Association Registry of Physicians and practicing at least 20 hours per week. MAIN OUTCOME MEASURE: Questionnaire addressing beliefs and practices regarding prostate cancer management. RESULTS: Forty-three percent of radiation oncologists vs 16% of urologists would recommend routine prostate-specific antigen testing for men aged 80 years and older. For men with moderately differentiated, clinically localized cancers, and a more than 10-year life expectancy, 93% of urologists chose radical prostatectomy as the preferred treatment option, while 72% of radiation oncologists believed surgery and external beam radiotherapy were equivalent treatments. For most tumor grades and prostate-specific antigen levels, both specialty groups were significantly more likely to recommend the treatment in their specialty than the other treatment. Both groups reported giving patients similar estimates of the risks of complications due to surgery and radiation. Neither group favored watchful waiting in their treatment management except for a subset of men with life expectancies of less than 10 years and cancers with very favorable prognoses (Gleason score of 3 or 4 and prostate-specific antigen level </=5 ng/mL). CONCLUSIONS: Based on this study, while urologists and radiation oncologists do agree on a variety of issues regarding detection and treatment of prostate cancer, specialists overwhelmingly recommend the therapy that they themselves deliver. JAMA. 2000;283:3217-3222

Adult↗
PubMedDate not supplied

Current national trends in the posttreatment follow-up of patients with squamous cell carcinoma of the head and neck.

INTRODUCTION: Follow-up of individuals treated for a primary squamous carcinoma of the upper aerodigestive tract is critical because of the high risk of development of either recurrent disease or a new primary tumor. A mail survey of physicians actively practicing head and neck surgery was undertaken. MATERIALS AND METHODS: A multiple-choice survey was distributed to 400 members of the American Society for Head and Neck Surgery. Respondents indicated approach to post-treatment follow up. RESULTS: Surveys were returned from 290 members (73%). Routine monthly follow up is advocated by 73% of respondents during the first postoperative year. Patients are followed every 2 to 3 months in the second postoperative year by 90% of respondents. During postoperative years, 3 to 5 patients are seen every 4 to 6 months by 97% of respondents. All respondents see patients either semiannually or annually for the remainder of their lives. Sixty percent of respondents advocate annual screening chest radiographs, whereas 14% do not order routine chest radiographs. The overwhelming majority of respondents reserve barium swallow and computed tomographic (CT) scans for evaluation of symptomatic patients. Similarly, nuclear imaging is reserved for patients with specific symptoms or abnormal laboratory tests. Blood tests most frequently monitored include complete blood cell count (CBC) (43%), thyroid function test (22%), and liver function test (20%). Follow-up endoscopic evaluation under anesthesia is reserved for symptomatic patients by over 95% of respondents. CONCLUSION: These data demonstrate that head and neck surgeons rarely use supplemental studies other than chest radiograph during routine follow up. The authors speculate that routine chest radiograph may be valuable in screening for a second primary carcinoma. Techniques to screen for esophageal tumors remain contentious.

Audiometry↗
PubMedDate not supplied

Motivational strategies used by dietitians to counsel individuals with diabetes.

The purposes of this study were to determine the use and perceived effectiveness of motivational strategies used by dietitians and to evaluate dietitians' perceptions of barriers to client compliance. A three-part questionnaire with 32 motivational strategies, 16 barriers to adherence, and demographic information was designed and mailed to 862 members of the American Dietetic Association's Diabetes Care and Education Dietetic Practice Group. Statistical analyses included frequency distributions, chi-square analysis, and factor analysis. Only 13 of the 32 motivational strategies were used frequently by 50% or more of the dietitians. The main strategy based on perceived effectiveness was "Tailor the diet to the client's lifestyle." Strategies perceived as effective also were used frequently by a majority of the dietitians. There were differences in use of strategies based on practice setting, CDE certification, and education level. The most significant barrier to adherence was "Complications with lifestyle/competing demands." Factor analysis revealed nine factors for motivational strategies and five factors for barriers to adherence.

Attitude of Health Personnel↗
PubMed1999

Use of complementary therapies in a rural cancer population.

PURPOSE/OBJECTIVES: To document how people living in rural areas use of intend to use complementary therapies and to determine demographic factors related to the use of these therapies. DESIGN: Descriptive, cross-sectional survey. SETTING: Three cancer treatment clinics and one support group located in the rural Midwest. SAMPLE: 53 people with cancer, predominantly Caucasian, ages 42-91. METHODS: Nurses distributed the previously tested investigator-developed Complementary Therapy Rating Scale (CTRS). Clients who wished to participate completed the survey and mailed it to the primary researcher. MAIN RESEARCH VARIABLES: Use of complementary therapies, client ratings of effectiveness, and demographic variables. FINDINGS: 87% of the clients were using at least one complementary therapy. Prayer, humor, and support group attendance were the most popular. Women, younger clients, support group members, and those who lived closer to town had significantly higher scores on the CTRS. CONCLUSIONS: More rural people with cancer reported using complementary therapies than could have been predicted from the available literature. However, most literature focuses on alternative cancer treatment as opposed to use of complementary therapies were easily available and inexpensive and have no known side effects. More research is needed on the effectiveness of these therapies. IMPLICATIONS FOR NURSING PRACTICE: Workshops or research projects involving complementary therapies should include those therapies that people with cancer frequently use. Younger clients and women may be most interested in participating, and projects should be scheduled to avoid frequent trips into town.

Adaptation, Psychological↗
PubMed2005

Student retention practices in associate degree, entry-level dental hygiene programs.

PURPOSE: The main purpose of this study was to investigate student retention strategies and practices implemented in associate degree, entry-level dental hygiene programs. Included are student attrition issues, academic standards, re-entry policies, and clinical remediation strategies. METHODS: A survey consisting of forced choice and open-ended questions was mailed to 31 randomly selected associate degree, entry-level dental hygiene programs. Surveys were analyzed using descriptive statistics and frequency distributions. Open-ended questions were analyzed using the constant comparative qualitative method to identify recurring themes. RESULTS: There was an 80% (n=25) return response to the survey. The findings of this study determined that dental hygiene programs are graduating, on average, a higher percentage (83%) of students when compared to two-year, associate degree programs in general (46%). The primary reasons reported by respondents for student attrition included: academic difficulties (88%), dissatisfaction with career choice (76%), family/personal responsibilities (72%), and clinical skill difficulties (56%). A wide variety of retention strategies were reported. Those most often cited were academic remediation (92%), clinical skill development/remediation (84%), academic advising (84%), financial aid assistance (84%), and tutoring (80%). Participating programs also reported setting high academic and ethical standards. Specific criteria for student re-entry were discussed. CONCLUSION: The findings of this study suggest that associate degree, entry-level dental hygiene programs are committed to student retention and make considerable efforts to help students succeed. Student retention efforts could be enhanced for those student groups identified as possibly being at high risk for attrition. The findings and recommendations in this investigation may assist associate degree, entry-level dental hygiene programs in their efforts to retain a higher percentage of students.

Career Choice↗
PubMed1995

Screening guidelines for Chlamydia trachomatis infection. Evaluating physician awareness, agreement, and use.

OBJECTIVE: To assess whether physicians were aware of, agreed with, and followed the "1989 Canadian Guidelines for Screening for Chlamydia Trachomatis Infection "as they applied to screening asymptomatic women. DESIGN: A survey consisting of direct questions and case scenarios was scored according to the responses given in the guidelines. SETTING: Six hospital family practice teaching units in downtown Toronto. PARTICIPANTS: Of 153 staff physicians and residents surveyed (all staff and residents registered with the Department of Family and Community Medicine of the University of Toronto for the 1990-1991 academic year), a volunteer sample of 118 responded to a questionnaire through the mail. MAIN OUTCOME MEASURES: Reported awareness, agreement, and use of C trachomatis guidelines for screening asymptomatic women were analyzed using frequency distributions and cross-tabulations. RESULTS: Most (69%) respondents were unaware of the guidelines. Of those who were aware, 46% agreed with the guidelines and 39% claimed to follow the guidelines. Staff physicians appeared to be more aware of guidelines than family medicine residents (P = 0.0175, psi 2 = 11.98); P values less than 0.05 were considered statistically significant. There was no statistically significant association between total scores and physicians' reported awareness of guidelines (P = 0.2287, psi 2 = 4.321). CONCLUSIONS: Most physicians in the sample were unaware of the guidelines. Of physicians who reported awareness of the guidelines, less than half agreed with or routinely followed them. Better methods of influencing physician behaviour must be developed before more guidelines are designed and distributed.

Adult↗
PubMedDate not supplied

Dentists' perceptions of selected characteristics of their child patients.

The purpose of this project was to examine the perceptions of both general and pediatric dentists regarding selected characteristics of the children they treat. A survey including questions on patients' ages, caries activity estimates, and types of patients treated was mailed once to a national random sample of 2,000 general and 1,000 pediatric dentists. The respondents provided a reasonable distribution by age and location, with the majority (69%) in practice more than 10 years. The pediatric dentists who responded perceive that they treat a younger population of child patients with more caries activity (P < 0.001), except in those patients older than 12 years. They also perceive that their patients pools include a larger percentage of patients with handicapping conditions (P < 0.01), behavior problems (P < 0.001) and patients who require treatment with general anesthesia (P < 0.001) than do the general dentists.

Adolescent↗
PubMed1993

Profile of Canadian physicians: results of the 1990 Physician Resource Questionnaire.

OBJECTIVE: To determine the supply, mix and distribution of physicians in Canada and to compare data with those of the 1982 and 1986 physician surveys. DESIGN: National census mail survey. SETTING: Canada. PARTICIPANTS: All physicians licensed to practise medicine in Canada, excluding interns and residents. A total of 52,422 questionnaires were mailed, of which 771 were ineligible. There were 38,313 valid responses (response rate 74.2%). MAIN OUTCOME MEASURES: Activity status, workload, specialty certification, practice setting and demographic profiles. MAIN RESULTS: A total of 88.7% of the respondents were active physicians; 19.4% were women, compared with 16.8% in 1986. Physicians reported working on average 4.1 fewer hours per week in total activities than in 1986 and 5.7 fewer hours per week than in 1982. As was found in 1982, about 50% of active physicians were certified specialists; 30% of specialists and 21% of general/family practitioners were 55 years of age or more. Approximately 11% of active physicians were in rural practice, as was reported in 1986. Similar proportions of foreign graduates and Canadian graduates were located in rural areas (10.9% and 11.4% respectively). CONCLUSIONS: Factors such as aging and retirement will affect specific specialty groups (e.g., general surgery and obstetrics/gynecology) in the near future. Specialty groups must address the issue of the future supply of physicians and the demand for their services when developing targeted needs within their specialties. The increasing proportion of women in medicine is changing the specialty mix and practice profiles of physicians as a whole. The issues associated with the recruitment and retention of physicians in rural areas remain complex.

Adult↗