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PubMed2004

Impact of thimerosal-related changes in hepatitis B vaccine birth-dose recommendations on childhood vaccination coverage.

CONTEXT: In July 1999, the longstanding preference to begin hepatitis B vaccination of all US infants at birth was temporarily suspended because of concerns about exposure to mercury contained in the vaccine preservative thimerosal. The suspension was lifted in September 1999 when preservative-free hepatitis B vaccine became available. OBJECTIVE: To determine the effects of changes in recommendations regarding administration of a hepatitis B birth dose on vaccination coverage. DESIGN, SETTING, AND PARTICIPANTS: Cohort analysis of vaccination status of 41,589 US children born before, during, and after the recommendation to suspend the birth dose. MAIN OUTCOME MEASURES: Association between birth cohort and age at receipt of hepatitis B vaccine dose 1, and receipt by 19 months of age of all recommended vaccines. RESULTS: The proportion of US infants who received dose 1 of hepatitis B vaccine at birth declined from 47% among those born 7 to 12 months before the suspension to 11% among those born during the suspension. Birth-dose coverage remained significantly lower in the year after the suspension was lifted (23% in the first 6 months and 33% in months 7-12). Coverage with 3 doses of hepatitis B vaccine by 19 months of age declined from 88% among those born 7 to 12 months before the suspension to 81% among those born during the suspension and 85% among those born in the 6 months after the suspension, but returned to baseline levels for those born 7 to 12 months after the suspension was lifted. These reductions represent 750,000 fewer newborns vaccinated during 2000 compared with 1998, and an excess 182,000 children undervaccinated for hepatitis B at 19 months of age compared with 1998 coverage levels. Coverage with other recommended vaccinations did not decline over this time. CONCLUSIONS: Reductions in hepatitis B vaccine birth-dose coverage persisted after recommendations were made to resume previous newborn vaccination practices. Although the recommendation to complete the series by 19 months of age was never changed, infants born between July and December 1999 were less likely to have completed the series by 19 months, compared with infants born during the previous year. The lack of impact on other vaccinations suggests that public confidence in immunization remained strong.

Cohort Studies↗
PubMed2000

The work patterns of male and female dental practitioners in the United Kingdom.

AIM: The aim of the study was to determine differences between male and female dental practitioners in the type of dentistry they practice, and their working practice, and to compare these data to previously published studies of the working practices of female dentists in the United Kingdom. DESIGN: A postal questionnaire survey. PARTICIPANTS: A 1 in 10 sample of individuals taken from the UK Dentists Register. RESULTS: The data revealed that women dentists are more likely than male dentists to work in the Community Dental Service. Within general dental practice women are more likely to work part-time, to carry out National Health Service treatment and to specialize in orthodontics or paediatric dentistry. More women than men take career breaks, and the reasons for taking career breaks differ between male and females. Women take longer career breaks on average. However, differences between male and female practitioners in the total duration of their career breaks are largely accounted for by child rearing. Finally, male dental practitioners are more likely than female dental practitioners to report reading professional journals. The findings are analysed in the light of previous surveys of the working practices of female dental practitioners both within the United Kingdom and internationally. CONCLUSION: The main finding reported here is that there are no differences between men and women in the number and length of career breaks taken, if childcare is excluded.

Dentists↗
PubMed1994

Establishing an internal medicine practice: a model to determine economic feasibility.

To make informed career decisions, physicians must acquire a basic knowledge in medical management and health care economics as they evaluate the potential survival and growth of a primary care practice. Health care providers considering a specific community and local leaders and hospital administrators attempting to recruit internal medicine physicians need a method by which they can evaluate a community's potential for supporting a first or additional primary care physician. To develop this method, we conducted a detailed survey of nonmetropolitan internal medicine generalists and primary care physicians. Data collected from internal medicine physicians and their administrative staff reflected the volume of ambulatory and hospital visits and the direct and indirect costs of the practice over the previous 24 months. Using the fixed and operating cost data, as well as number of patient visits and patient care revenue, we designed a model to project the economic feasibility of establishing an internal medicine practice in a specific community. This model can be used to project the number of adult primary care visits a community can generate for a prospective physician, as well as to estimate the direct and indirect costs, annualized capital costs, gross revenue, and net income of the practice.

Adolescent↗
PubMed1985

Clinical application of a high-risk scoring system on a family practice obstetric service.

A previously described antepartum risk-scoring system was evaluated in 113 consecutive deliveries done by family physicians to determine whether a request for obstetric or pediatric assistance could be predicted. In the defined low-risk group (score less than or equal to 3) assistance was requested in 12 of 72 patients. In the defined high-risk group (score greater than 3) assistance was requested in 23 of 41 patients. Out of 28 requests for obstetric assistance, 22 requests were for a specific skill (cesarean sections, difficult forceps, premature deliveries, shoulder dystocia, and retained placenta). All of the 27 requests for pediatric assistance were for acute resuscitation of the newborn. Reinforced in this study was the finding that a relatively small segment of patients (36 percent of the population) gave rise to most (67 percent) of the morbidity. Knowledge of this simple, reliable method to predict high-risk obstetric patients should help family physicians reduce maternal and infant morbidity.

Family Practice↗
PubMedDate not supplied

A new practice analysis of hand therapy.

The Hand Therapy Certification Commission, Inc. (HTCC) conducted a role delineation in 2001 to characterize current practice in the profession of hand therapy. Building upon previous HTCC studies of practice (i.e., Chai, Dimick & Kasch, 1987; Roth, Dimick, Kasch, Fullenwider & Taylor, 1996), subject matter experts identified the clinical behaviors, knowledge, and technical skills needed by hand therapists. A large scale survey was conducted with therapists across the United States and Canada who rated the clinical behaviors, knowledge, and technical skills in terms of their relevance to practice, and provided information about their own patient populations. A high survey return rate (72%) was indicative of the professional commitment of CHTs to their profession. Results of the survey are discussed and practice trends are identified. A new test outline for the Hand Therapy Certification Examination was created based on the results of the survey, and the 1987 Definition and Scope of Hand Therapy was revised.

Arm↗
PubMed2001

Unsafe injecting practices among attendees of syringe exchange programmes in France.

AIMS: To describe syringe exchange programme attendees and their injection practices. DESIGN: Cross-sectional study (one week in 1998). Data were collected through a standardized questionnaire. SETTING: 60/74 syringe exchange programmes (SEPs) in France. PARTICIPANTS: Clients requesting syringes in 60 SEPs. MEASUREMENTS: Self-reports of drug use, injecting behaviour, sexual behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injecting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia. FINDINGS: 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% were males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20.8%. The mean duration of drug use was 11 years. Eighty-five percent were polydrug users and buprenorphine high-dosage was the substance most used (73%). In the previous month, 45% of the participants had re-used a syringe, 93% injected at least daily (mean 3.6 injections per day), 18% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated with heroin and cocaine use and with living in a couple. The cluster analysis identified five categories of IDUs: users of buprenorphine-HD (45% of the responders), morphine-sulphate (17%), benzodiazepines and other legal drugs (13%), methadone associated with other legal drugs (13%) and crack-cocaine (13%). The buprenorphine-HD group had better social status and safer injection practices. CONCLUSIONS: In France, despite an increase in the accessibility to syringes and substitution treatments, unsafe injecting practices persist among SEP attenders. Interventions should stress the importance of using sterile material for each injection, even with a steady sex partner.

Adult↗
PubMed1993

Antibiotic prophylaxis in cesarean section: use of cost per case comparison to influence prescribing practices.

Results of a previously conducted DUE revealed that 91% of obstetric patients received antibiotic prophylaxis with cefoxitin despite the existence of obstetric department guidelines recommending the use of cefazolin. In the present DUE, antibiotic selection in C-section prophylaxis was reviewed and individual prescribers, both compliant and noncompliant with guidelines, were identified. Over a 2-month period, physicians who prescribed other than cefazolin for C-section prophylaxis were issued "Dear Doctor" letters, reminding them of existing guidelines. A significant change in prescribing patterns following this intervention was not demonstrated. A multidisciplinary approach was then undertaken. Prescribers were stratified by number of procedures, antibiotic requested, and antibiotic cost per case (average and median). Results were reviewed with Co-chiefs of Ob/Gyn. Letters to both compliant and noncompliant prescribers were issued. A grand rounds presentation describing the results of the DUE was also given. A follow-up review showed that the conversion to cefazolin prophylaxis reached 80%, with accompanied extrapolated yearly cost avoidance of nearly $5,500.

Adult↗
PubMed2000

Ethnicity and analgesic practice.

STUDY OBJECTIVE: We previously reported that Hispanic ethnicity was an independent risk factor for inadequate analgesic administration among patients presenting to a single emergency department. We then attempted to generalize these findings to other ethnic groups and EDs. Our current study objective is to determine whether black patients with extremity fractures are less likely to receive ED analgesics than similarly injured white patients. METHODS: We conducted the following retrospective cohort study at an urban ED in Atlanta, GA. All black and white patients presenting with new, isolated long-bone fractures over a 40-month period were studied. After abstracting demographic information from the medical record and subsequently removing ethnic identifiers, we submitted the medical record to a physician who recorded characteristics of the patients' injury and treatment. We then submitted the records to a nurse, again blinded to ethnicity, who recorded analgesic administration. We used multiple logistic regression to determine the independent effect of ethnicity on analgesic use while controlling for multiple potential confounders. Our main outcome measure was the proportion of black versus white patients receiving ED analgesics. RESULTS: The study group consisted of 217 patients, of whom 127 were black and 90 were white. White patients were significantly more likely than black patients to receive ED analgesics (74% versus 57%, P =.01) despite similar records of pain complaints in the medical record. The risk of receiving no analgesic while in the ED was 66% greater for black patients than for white patients (relative risk 1.66, 95% confidence interval, 1.11 to 2.50). This effect persisted after controlling for multiple potential confounders. CONCLUSION: Black patients with isolated long-bone fractures were less likely than white patients to receive analgesics in this ED. No covariate measured in this study could account for this effect. Our findings have implications for efforts to improve analgesic practices for all patients.

Adult↗
PubMed2001

Managing patient demand: a qualitative study of appointment making in general practice.

BACKGROUND: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY: A qualitative study using participant observation. SETTING: Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. METHOD: Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. RESULTS: Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. CONCLUSION: Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

Adolescent↗
PubMed1989

Health within illness: conceptual evolution and practice possibilities.

Health in terms of growth or change is being increasingly related to illness through health theory development and personal reports of illness. Clinicians in nursing often provide accounts of health within the experience of illness, and theorists in nursing incorporate health-within-illness ideas, but the concept has not been previously explicated for practice. Adoption of this perspective in current health care would initiate drastic changes and provide endless possibilities for a more positive, less judgmental attitude toward the experience of illness.

Disease↗
PubMed1998

Practice effects during repeated administrations of memory tests with and without alternate forms.

Previous research indicates that practice effects are large with repeated versions of memory tests. In contrast, administrations of the same tests using alternate forms typically yield much smaller practice effects. However, most studies do not compare alternate- and same-form conditions directly, and differ widely in terms of test-retest interval, modality of stimuli (verbal, spatial), format of the memory test, and number of examinations. The present study investigated practice effects during repeated administrations of verbal and nonverbal memory tests which have the same administration format. Two groups of healthy participants, matched for age, education, estimated IQ, and baseline memory test performance, were assigned to either a same- or alternate-forms condition. Participants taking the same form every two weeks improved significantly over four sessions. Participants completing alternate forms of the nonverbal memory test produced a small practice gain, but the verbal memory test was resistant to practice effects when alternate forms were used.

Aged↗
PubMed2005

Primary antibody deficiency and diagnostic delay.

AIMS: To assess the occurrence of diagnostic delay in primary antibody deficiency in the period 1989-2002, since a similar study in 1989, and to assess the impact of UK national guidelines communicated in 1995. METHODS: A retrospective case note review was performed of 89 consecutive patients with antibody deficiency referred to a regional referral centre for clinical immunology in north west England and north Wales. The delay in diagnosis and the estimated resulting morbidity in terms of infections were assessed. RESULTS: Fifty six of the 89 patients experienced delay in diagnosis. The overall median delay was 2 years (mean, 4.4), resulting in substantial morbidity (equivalent to two major infections and one minor infection). This shows a moderate improvement since the previous study in 1989 and since the introduction of UK national guidelines in 1995. Respiratory infections are the most frequent presenting infections, and respiratory physicians the most common source of referral. CONCLUSIONS: There is still considerable delay in the diagnosis of primary antibody deficiency, but the data suggest an improvement in practice since the previous study in 1989 and the distribution of national guidelines in 1995.

Adolescent↗
PubMed1987

Experimental Pneumocystis carinii pneumonia in the ferret.

Pneumocystis carinii pneumonia (PCP) was provoked in the ferret, Mustela pulorius furo, by immunosuppression with daily long-term administration of cortisone acetate, 10-20 mg/kg subcutaneously for 9 to 10 weeks, Microscopically P. carinii was observed in the lungs of all 11 treated animals: mild to moderate in five and extensive disease in six. The histopathological features of PCP in the ferret included interstitial pneumonitis, scant mononuclear cell alveolitis, with abundant cysts and trophozoites visible in a focal distribution. There were few neutrophils present. Electron microscopy showed large numbers of both cysts and trophozoites in close association with type I cells. No bacterial pathogens were isolated from the lungs of immunosuppressed animals but an unexplained eosinophilic enteritis was present in treated animals. P carinii pneumonia developed without significant body weight loss during corticosteroid administration, unlike previously described studies using corticosteroid-treated rodents. Ferrets thus appear to be a 'steroid resistant' animal, like man, and therefore a more suitable model for immunological studies of host response to PCP than rodents. This new model also has practical advantages over previously described animal models of PCP, including larger lung and airway size.

Animals↗
PubMed2004

Do doctors act on their self-reported intention to computerize? A follow-up population-based survey in Hong Kong.

BACKGROUND AND OBJECTIVES: We performed a follow-up survey to document changes in the level of computerization among physicians in Hong Kong between 2000 and 2001, specifically examining whether their self-reported intention to computerize various clinical or administrative tasks actually translated into computerization of these tasks 1 year later. Determining such a relationship will indicate the reliability, and thus the utility of questions regarding self-reported intention to computerize clinical practice. METHODS: A self-completed follow-up postal questionnaire was sent to all 949 physicians who responded to the original questionnaire. Pairwise repeated dichotomous responses from 2000 and 2001 on the computerization of specific functions were compared using McNemar test. Wilcoxon sign-ranked test was employed to compare the total number of tasks computerized in the 2 years. Multivariate logistic regression modeling was carried out to determine predictors for the translation of intention to computerize into actual computerization. RESULTS: The response rate was 77.0%. There was a significant increase in the number of tasks computerized for both "corporate" and "individual" practices between 2000 and 2001. The proportion of physicians who intended to computerize and actually computerized ranged from 7.7 to 51.0% for different tasks. For five clinical tasks, more than 50% respondents in corporate practices translated the intention to implementation, compared to fewer than 20% in individual practices. Predictors found to be associated with the translation of intention to computerize into actual computerization included higher number of tasks intended to computerize, higher number of tasks already computerized, and more positive physicians' attitudes on the impact of computerization to clinical practice. CONCLUSIONS: We conclude that physicians' self-reported intention to computerize the clinical practice 12 months previously was moderately associated with actual implementation, with varying degrees of concordance for different clinical and administrative tasks. The identified predictors for the translation of intention to actual computerization may be useful in targeting specific strategies to promote computerization of clinical practice.

Adult↗
PubMed1994

Religiosity and Psychosocial Adjustment Among 100 Homng Refugees.

PURPOSE OF THE PAPER. The purpose of this paper is to study the relationship between religiosity and psychosocial adjustment in a group of Asian refugees from Laos. SUMMARY OF METHODS UTILIZED. Subjects consisted of 100 adult Hmong refugees from Laos who had relocated one decade earlier to Minnesota. At the time of the interview, about 80% remained in Minnesota; the remainder were interviewed in their respective communities. Five measures of religiosity were operationalized: Religious Belief (animism versus monotheism); recent Religious Practice (present/absent in previous monthrpar;; Religious Conversion lpar;present/absent in the U.S.rpar;; having a Home Altar (present/absent today); and having a shamanistic Trance Ritual (present/absent in the last five years). These five indices of religiosity were then compared against four general areas of psychosocial adaptation as follows: demographic characteristics lpar;5 itemsrpar;; sociocultural indices of adaptation lpar;5 items, including 2 scales) health care seeking over the previous five years (6 items); and psychiatric signs and symptoms (4 psychiatric scales). SUMMARY OF METHODS UTILIZED. Methods of data collection were as follows: (1) questionnaire-based interviewing by Hmong research assistants to provide data on religion affiliation, belief and practice; demographic information; psychosocial function; cultural affiliations and behaviors; and health care seeking; (2rpar; a psychiatric interview by the senior author followed by completion of two psychosocial scales (Axis 4 Psychosocial Stressors and Axis 5 Psychosocial Function using DSM-III criteriarpar; and several psychiatric rating scales lpar;Hamilton Anxiety Scale, Hamilton Depression Scale, Brief Psychiatric Rating Scale, and Global Assessment Scalerpar;. PRINCIPAL FINDINGS. Religious Pracitice in the last month was highly associated with several measures of psychosocial adaptation. Conversely, any Trance Ritual in the last five years was associated with increased anxiety and health care seeking. Religious Belief (animism versus monotheism) and having a Home Altar were associated with the other cultural factors, but not with psychosocial, heatlh and mental health measures. CONCLUSIONS. Aspects of religiosity among Hmong refugees were related to psychosocial adaptation in diverse ways, with some factors associated with better adaptation, some factors associated with maladaptation, and some factors related to other cultural dimensions but not psychosocial adaptation. KEY WORDS. Hmong; psychosocial adjustment.

Journal Article↗
PubMed2006

Film/tablet adhesion, film thickness, internal stresses and bridging of the intagliations--a unified model with practical implications.

Building on previous work carried out over the past two decades, a unified and integrated model relating film/tablet adhesion, film thickness, internal stresses and the defect bridging of the intagliations has been developed. The model can explain the apparently anomalous results seen when measuring the adhesion of film coatings to tablet substrates as well as providing an insight into possible ways of preventing or minimising the incidence of bridging.

Adhesiveness↗
PubMed1997

The moderating effects of children's fear and activity level on relations between parenting practices and childhood symptomatology.

Parenting practices have been previously linked to childhood symptomatology. However, little consideration has been given to the potential effect of individual differences within the child on this relation. The current study assessed the moderating effects of children's activity level and fear on relations between parenting practices and childhood aggression and depressive symptoms using a sample of 64 fourth-, and fifth-grade boys. The findings showed that poorly monitored active boys and fearful boys who were exposed to harsh discipline exhibited high levels of aggression. Boys characterized by high fear who were exposed to harsh discipline or whose parents were extremely overinvolved showed elevated levels of depressive symptoms. These findings suggest that integrating children's individual differences with parenting models enhances our understanding of the etiology of childhood symptomatology. The intervention implications of such an integration are discussed.

Aggression↗
PubMed1996

Computed tomography using algebraic reconstruction techniques (ARTs) with different projection access schemes: a comparison study under practical situations.

In a previous report we presented a novel ART technique with the projections arranged and accessed in a multilevel scheme (MLS) for efficient algebraic image reconstruction, but whether the scheme is still superior in real situations where the data are noisy is unknown. In this paper, we make a detailed comparison between MLS and the other two conventional projection access orderings in ART: the random permutation scheme (RPS) and the sequential access scheme (SAS). By simulating reconstructions of a human head using different sizes of detector, taking different numbers of projections, each measurement under a different number of photons, a full mapping of the reconstruction accuracy measured by correlation coefficient for the three schemes has been made. Test results demonstrate that one-iteration MLS produces the best reconstruction in many situations. It outperforms one-iteration RPS when the noise level is low. SAS in many cases can never attain the image quality of one-iteration MLS, even with many more iterations. A convergence test using different initial guesses also demonstrates that MLS has less initial dependence. In the Fourier domain, it also represents an efficient and fast implementation of the Fourier slice theorem.

Adult↗