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At least 523 records · Page 29Linked to original sources
PubMed2006

Address-based versus random-digit-dial surveys: comparison of key health and risk indicators.

Use of random-digit dialing (RDD) for conducting health surveys is increasingly problematic because of declining participation rates and eroding frame coverage. Alternative survey modes and sampling frames may improve response rates and increase the validity of survey estimates. In a 2005 pilot study conducted in six states as part of the Behavioral Risk Factor Surveillance System, the authors administered a mail survey to selected household members sampled from addresses in a US Postal Service database. The authors compared estimates based on data from the completed mail surveys (n = 3,010) with those from the Behavioral Risk Factor Surveillance System telephone surveys (n = 18,780). The mail survey data appeared reasonably complete, and estimates based on data from the two survey modes were largely equivalent. Differences found, such as differences in the estimated prevalences of binge drinking (mail = 20.3%, telephone = 13.1%) or behaviors linked to human immunodeficiency virus transmission (mail = 7.1%, telephone = 4.2%), were consistent with previous research showing that, for questions about sensitive behaviors, self-administered surveys generally produce higher estimates than interviewer-administered surveys. The mail survey also provided access to cell-phone-only households and households without telephones, which cannot be reached by means of standard RDD surveys.

Adolescent↗
PubMed2026

A doubly robust framework for addressing outcome-dependent selection bias in multi-cohort EHR studies.

Selection bias can hinder accurate estimation of association parameters in binary disease risk models using non-probability samples like electronic health records (EHRs). The issue is compounded when participants are recruited from multiple clinics/centers with varying selection mechanisms that may depend on the disease/outcome of interest. Traditional inverse-probability-weighted (IPW) methods, based on constructed parametric selection models, often struggle with misspecifications when selection mechanisms vary across cohorts. This paper introduces a new Joint Augmented Inverse Probability Weighted (JAIPW) method, which integrates individual-level data from multiple cohorts collected under potentially outcome-dependent selection mechanisms, with data from an external probability sample. JAIPW offers double robustness by incorporating a flexible auxiliary score model to address potential misspecifications in the selection models. We outline the asymptotic properties of the JAIPW estimator, and our simulations reveal that JAIPW achieves up to 6 times lower relative bias and 5 times lower root mean square error (RMSE) compared to the best performing joint IPW methods under scenarios with misspecified selection models. Applying JAIPW to the Michigan Genomics Initiative (MGI), a multi-clinic EHR-linked biobank, combined with external national probability samples, resulted in cancer-sex association estimates closely aligned with national benchmark estimates. We also analyzed the association between cancer and polygenic risk scores (PRS) in MGI to illustrate a situation where the exposure variable is not measured in the external probability sample.

Selection Bias↗
PubMed2005

The costs of care in general practice: patients compared by the council tax valuation band of their home address.

BACKGROUND: It is difficult to measure and compare workload in UK general practice. A GP/health economist team recently proposed a means of calculating the unit cost of a GP consulting. It is therefore now possible to extrapolate to the costs of other clinical tasks in a practice and then to compare the workloads of caring for different patients and compare between practices. OBJECTIVES: The study aims were: (i) to estimate the relative costs of daily clinical activities within a practice (implying workload); and (ii) to compare the costs of caring for different types of patients categorized by gender, by age, and by socio-economic status as marked by the Council Tax Valuation Band (CTVB) of home address. METHODS: The study design was a cross-sectional cost comparison of all clinical activity aggregated, by patient, over one year in an English semi-rural general practice. The subjects were 3339 practice patients, randomly selected. The main outcome measures were costs per clinical domain and overall costs per patient per year; both then compared by gender, age group and by CTVB. RESULTS: CTVB is as significant a predictor of patient care cost (workload) as is patient gender and age (both already known). CONCLUSIONS: It is now possible to estimate the cost of care of different patients in such a way that NHS planning and especially resource allocation to practices could be improved.

Catchment Area, Health↗
PubMed2001

Health literacy: addressing the health and education divide.

Health literacy as a discrete form of literacy is becoming increasingly important for social, economic and health development. The positive and multiplier effects of education and general literacy on population health, particularly women's health, are well known and researched. However, a closer analysis of the current HIV/AIDS epidemics, especially in Africa, indicates a complex interface between general literacy and health literacy. While general literacy is an important determinant of health, it is not sufficient to address the major health challenges facing developing and developed societies. As a contribution to the health literacy forum in Health Promotion International, this paper reviews concepts and definitions of literacy and health literacy, and raises conceptual, measurement and strategic challenges. It proposes to develop a set of indicators to quantify health literacy using the experience gained in national literacy surveys around the world. A health literacy index could become an important composite measure of the outcome of health promotion and prevention activities, could document the health competence and capabilities of the population of a given country, community or group and relate it to a set of health, social and economic outcomes.

Community Health Planning↗
PubMed2004

Innovative techniques to address retention in a behavioral weight-loss trial.

Given that retention rates for weight-loss trials have not significantly improved in the past 20 years, identifying effective techniques to enhance retention is critical. This paper describes a conceptual and practical advance that may have improved retention in a behavioral weight-loss trial-the novel application of motivational interviewing techniques to diffuse ambivalence during interactive group-based orientation sessions prior to randomization. These orientation sessions addressed ambivalence about making eating and exercise behavior changes, ambivalence about joining a randomized controlled trial, and unrealistic weight-loss expectations. During these sessions, overweight and obese men and women learned about the health benefits of modest weight loss as well as trial design, the importance of a control condition, random assignment and the impact of dropouts. Participants were then divided into groups of three or four, and asked to generate two pros and two cons of being assigned to a control condition and an active condition. Participants shared their pros and cons with the larger group, while the investigator asked open-ended questions, engaged in reflective listening and avoided taking a 'pro-change' position. Retention was high, with 96% of the participants (N = 162) completing 18-month clinic visits.

Adult↗
PubMed2006

Addressing the soy and breast cancer relationship: review, commentary, and workshop proceedings.

The impact of soyfood intake on breast cancer risk has been investigated extensively. Much of this focus can be attributed to the soybean being a dietary source that is uniquely rich in isoflavones. The chemical structure of isoflavones is similar to that of estrogen, and isoflavones bind to both estrogen receptors (ER alpha and ER beta) (although they preferentially bind to and activate ER beta) and exert estrogen-like effects under some experimental conditions. Isoflavones also possess nonhormonal properties that are associated with the inhibition of cancer cell growth. Thus, there are several possible mechanisms by which soy may reduce the risk of breast cancer. However, the role of isoflavones in breast cancer has become controversial because, in contrast to the possible beneficial effects, some data from in vitro and animal studies suggest that isoflavones, especially genistein, the aglycone of the main soybean isoflavone genistin, may stimulate the growth of estrogen-sensitive tumors. Limited human data directly address the tumor-promoting effects of isoflavones and soy. Because the use of soyfoods and isoflavone supplements is increasing, it is important from a public health perspective to understand the impact of these products on breast cancer risk in women at high risk of the disease and on the survival of breast cancer patients. To this end, a workshop was held in November 2005 to review the existing literature and to make research recommendations. This paper summarizes the workshop findings and recommendations. The primary research recommendation is that the impact of isoflavones on breast tissue needs to be evaluated at the cellular level in women at high risk for breast cancer.

Animals↗
PubMed1998

Targeting of nucleic acid junctions: addressing to a branch point an oligodeoxynucleotide conjugated with an intercalator.

It is possible to enhance targeting of a DNA stem flank domain with a complementary DNA when it is conjugated with diphenyl ether at the branch point. The nucleoside 2'-deoxy-5-methyl- N 4-(4-phenoxyphenyl)cytidine (5) was synthesized from thymidineby tritylation, acetylation, amination via 2,4, 6-trimethylbenzenesulfonyl activation and subsequent de-protection. When a three-way junction is formed with a bulged nucleoside 5 at the branch point, the thermal melting temperature was increased by 9 degreesC when compared with wild-type DNA. When hybridizing to one of the flanks at a stem allowing coaxial stacking to the stem, modification at the branch point resulted in DeltaTm= 5.8 degreesC. For targeting to RNA the results were more ambiguous. RNase H activity was observed in some cases when an intercalating aromatic ring was addressed at the branch point. RNase H activity was observed even for a short 7mer ODN.

Base Sequence↗
PubMed1998

How I address quality and teamwork issues in the occupational health department.

To be successful in today's climate an occupational health provider needs well-trained and motivated staff who are both professional and focused on delivering quality services that meet the needs of their customers. Achieving this goal is facilitated by having a clear sense of mission with systems in place within the organization of the department that support this and encourage continuous improvement. Good communication, performance measures and teamwork are identified as key elements in realizing the goal of a quality department. This article, in sharing the experiences of addressing quality and teamwork, discusses important issues relevant to many occupational health departments.

Communication↗
PubMed1987

Migration biases in address tracing by commercial firms.

The results of a small experiment in address tracing have shown that subjects who were found by commercial tracing were less apt to have moved and were especially apt to have remained in the same state. The documented relation of migration and health status means that differential success in subject tracing can lead to subsequent study bias. Therefore, those who use commercial tracing of epidemiologic study subjects must carefully consider the possibility of a "missing migrant" effect, and that it may, in turn, produce a subsequent survey bias.

Epidemiologic Methods↗
PubMedDate not supplied

A community approach to addressing excess breast and cervical cancer mortality among women of African descent in Boston.

In 2000, the REACH Boston 2010 Breast and Cervical Cancer Coalition conducted a community needs assessment and found several factors that may have contributed to disproportionately high breast and cervical cancer mortality among black women: (a) Focus group participants reported that many women in their communities had limited awareness about risk factors for cancer as well as about screening. (b) Black women experienced barriers to care related to the cultural competence of providers and of institutions. (c) Black women were not receiving adequate follow-up for abnormal mammograms and Pap smears. The Coalition's Community Action Plan to address disparities includes a model primary care service for black women; scholarships to increase the number of black mammogram technologists; primary care provider and radiology technologist training about disparities and cultural competence; and education to increase awareness among black women and to increase leadership and advocacy skills.

Adult↗
PubMedDate not supplied

Teaching physicians-in-training to address racial disparities in health: a hospital-community partnership.

Racial and ethnic disparities in health care continue to be a major impediment to improving the health of many communities in the United States. Efforts must be directed at the multiple social, economic, and historic determinants of health disparities. In addition, health care providers must be aware of these determinants and must have the tools to address them in their individual relationships with patients. This article describes a partnership that arose out of the mutual recognition by a community organization and public hospital of the need to (a) teach physicians how to recognize the root causes of health disparities, (b) improve their cross-cultural understanding and communication, and (c) enhance their awareness of the capacity of community resources to positively impact their patients' lives.

Black or African American↗
PubMedDate not supplied

Addressing the potential risks associated with ephedra use: a review of recent efforts.

The appropriate amount of oversight for dietary supplements has been a subject of debate for over a decade. This debate has come to a head recently with herbal ephedra, which may be associated with adverse events including heart attack, stroke, seizure, and death. This article reviews and puts into context recent findings on the safety concerns related to ephedra, based primarily on adverse event reports. It presents the response from industry and the FDA in light of this evidence, and describes additional steps taken by other groups who believe that more restrictive action is required. The article concludes by observing the lack of explicit, shared criteria for determining whether a supplement is unsafe, and pointing out ways in which the experience with ephedra can be used constructively to address that problem.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Addressing health inequalities in the United Kingdom: a case study.

Health inequalities research has a long history in the United Kingdom, and the development of government policies that are intended to explicitly address the existing health inequalities has been gathering pace since the Labour Party returned to power in 1997. In this paper, using the influential Acheson Report as a reference point, one of us (D.N.) describes how health inequalities policies have been developed, and the other (A.O.) assesses how, ideally, such policies ought to be developed. Although progress in the development of health inequalities policies has been made, the policies, and the evidence that has informed them, have been less than ideal.

Delivery of Health Care↗
PubMed1999

Hospice access and use by African Americans: addressing cultural and institutional barriers through participatory action research.

This article describes a participatory action research project addressing the problem of African American access to and use of hospice. Qualitative interviews conducted with six African American pastors resulted in the identification of major themes used for development of a scale to measure barriers to hospice. A subsequent quantitative study documenting these barriers was conducted with 127 African American and European Americans. Results of both studies, which were used to further social action efforts in the community, indicated the cultural barriers of differences in values regarding medical care and differences in spiritual beliefs between African Americans and European Americans. Results also indicated institutional barriers, including lack of knowledge of services, economic factors, lack of trust by African Americans in the health care system, and lack of diversity among health care staff. Implications for social work practice and policy are discussed.

Black or African American↗
PubMed1996

Addressing the challenges of emerging infectious disease.

Through the recent examples of diphtheria in the former Soviet Union, plague in India, and trends in pneumonia mortality in the United States, the author, in this article, illustrates issues in emerging infectious diseases. The Centers for Disease Control's plan, Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States, is summarized. Initial efforts to implement this plan are described, with particular focus on the development of Emerging Infections Programs, which are conducting epidemiologic and laboratory projects on several infectious diseases, including invasive bacterial diseases, unexplained deaths, foodborne diseases, and ehrlichiosis in four population-based sites in the United States.

Adult↗
PubMed2002

An interdisciplinary approach to addressing patient activity and mobility in the medical-surgical patient.

Patient functional activity and mobility are essential to recovery and minimization of the risks associated with immobility in hospitalized patients. In practice, there is inconsistency in attending to this aspect of patient care and limited information in the literature to guide clinicians caring for medical-surgical patients. An interdisciplinary quality improvement team of nurses, physical therapists, occupational therapists, and patient care assistants developed a programmatic approach to the assessment, planning, and implementation of patient activity criteria in this patient population. Increased awareness and application of the patient activity criteria have improved the consistency with which patient activity is addressed and reduced the incidence of immobility-associated complications.

Activities of Daily Living↗
PubMed2003

Sharing digital teaching resources: breaking down barriers by addressing the concerns of faculty members.

PURPOSE: Regional and institutional databases have been created to improve access to educational resources and to avert unnecessary duplication. The growth and success of these databases depend upon the willingness of faculty members to contribute their materials. This qualitative study seeks to identify the barriers that block the free exchange of educational multimedia and the incentives that could be created to overcome educators' concerns. METHOD: In 2001, 34 faculty members from 13 U.S. medical schools each participated in one of five focus groups. They responded to three hypothetical scenarios depicting opportunities for sharing educational resources. Participants' responses were categorized hierarchically and sent back to them for feedback. RESULTS: Participants strongly supported multimedia databases, particularly those that serve a national audience. Obstacles for contributing materials included the lack of institutional recognition for educational innovation, confusing intellectual property policies, the hassle involved in sharing materials, and the perceived commercial potential of the materials. Peer review of educational materials was seen as an important incentive. CONCLUSIONS: Medical schools could benefit from the free exchange of high-quality educational multimedia but need to address the concerns of faculty by clarifying institutional copyright rules, streamlining the donation process, and providing assistance with cataloging assets. Removing departmental pressures to commercialize materials and recognizing peer-reviewed donations as academic achievement could foster a culture of sharing.

Attitude of Health Personnel↗