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PubMed2004

Feasibility study of entrance in vivo dose measurements with mailed thermoluminescence detectors.

BACKGROUND AND PURPOSE: The aim of this work is to set-up mailed entrance in vivo dosimetry by means of thermoluminescence dosimeters (TLDs) in the form of LiF powder in order to assess the overall accuracy of patient treatment delivery by comparing the doses delivered to patients with the doses calculated by the treatment planning system (TPS) in different institutions. PATIENTS AND METHODS: Two millimeter thick copper (for 6 MV photon beams) and 1.3 mm thick aluminium (for (60)Co gamma beams) build-up caps are developed. The characteristics of these build-up caps are tested by phantom measurements: the response of the TLD inside the build-up cap is compared to the ionisation chamber (IC) signal in the same irradiation conditions. A pilot study using the copper build-up cap is performed on 8 patients, treated with a 6 MV photon beam at the radiotherapy department of the University Hospital of Leuven. Additionally, a first run of mailed entrance in vivo dosimetry is performed by 18 radiotherapy centres in Europe. RESULTS: For 80 different phantom set-ups using copper and aluminium build-up caps, the mean TLD dose compared to the IC dose is 0.993+/-0.015 (1SD). Regarding the patient measurements in the radiotherapy department of the University Hospital of Leuven, the mean ratio of the measured entrance dose (TLD) to the entrance dose calculated by the TPS, is equal to 0.986+/-0.017 (1SD) (N=8), after correction of an error detected in one of the patient treatments. For the 18 radiotherapy centres participating in the mailed in vivo TLD study, the mean measured versus stated entrance dose for patients treated in a (60)Co and 6 MV photon beam is 1.004+/-0.021 (1SD) (N=143). CONCLUSIONS: From the results, it can be deduced that the build-up caps and the proposed calibration methodology allow the use of TLD in the form of powder to be applied in large scale in vivo dose audits.

Calibration↗
PubMed2004

The dissemination of the British Guideline on the Management of Asthma 2003.

The BTS/SIGN British Guideline on the Management of Asthma was published in February 2003 (4). If health outcomes are to be influenced successfully, dissemination of the guideline and implementation of recommendations is essential. We report the dissemination activities undertaken during the 18 weeks following the guideline launch. To facilitate implementation a range of educational materials were produced reflecting the key messages from the guideline. In addition to postal mailing of the guideline to appropriate healthcare professionals, both educational materials and the guidelines were made freely available from the BTS and SIGN websites. In total, 135,710 copies of the guideline and 90,198 copies of the Quick Reference Guide were downloaded in the first 18 weeks, representing a considerable increase over the number of copies of the 1997 guidelines disseminated by mailing alone. Large quantities of educational materials were downloaded with many used for teaching purposes. An on-line survey suggested that most respondents rated the materials as useful or very useful. Using websites to disseminate guidelines is a cost-effective method of informing health professionals of their content and is a more active process than the passive receipt of mailed copies. The availability of interactive educational materials for use in teaching appears to have been popular.

Asthma↗
PubMed2006

Exceptions to the rule: healthy deprived areas and unhealthy wealthy areas.

In general, inhabitants of low socio-economic areas are unhealthier than inhabitants of high socio-economic areas, but some areas are an exception to this rule. These exceptions imply that other factors besides the socio-economic level of an area contribute to the health of the inhabitants of an area, e.g. environmental factors. In our study we concentrate on areas within the Netherlands that are healthier or unhealthier than could be expected based on their socio-economic level. This study first identifies these areas and secondly determines which area characteristics distinguish these areas from those areas where the level of health is in agreement with their socio-economic level. We used nation-wide data on neighbourhood differences in population composition (gender, age, marital status and ethnicity), urbanisation and two health indicators: mortality and hospitalisation rates. In the Netherlands, many areas are healthier or unhealthier than could be expected based on their income level alone. Areas with higher mortality rates than expected are mainly urban areas with high percentages of elderly people and persons living alone. Similar but opposite associations are observed for areas with lower mortality rates than expected, which are further characterised by a low percentage of non-western immigrants. Areas with lower hospitalisation rates than expected are mainly rural areas with few non-western immigrants. From these results, we conclude that urbanisation and residential segregation based on age, ethnicity and marital status might be important contributors to geographical health inequalities.

Adolescent↗
PubMedDate not supplied

Stage of adoption and impact of direct-mail communications with and without phone intervention on Chinese women's cervical smear screening behavior.

BACKGROUND: The purposes of the study were to (1) assess the impact of direct-mail communications with and without phone intervention, and (2) examine the characteristics of women who were more likely to respond. METHODS: Women were recruited from female family members of inpatients admitted to one of the major teaching hospitals in Taiwan (n = 424), and were randomly assigned into an intervention group, who received direct-mails and a phone follow-up, or a control group, who received placebo messages. RESULTS: Logistic regression analysis showed that women in the intervention group (ORadj. = 2.31) and contemplation stage (ORadj. = 4.18) were more likely to receive a screening at the end of the program. Among women in the intervention group, contemplators were 5.58 times more likely to receive a screening before the phone intervention (early adopters); and 40% of the screening adopters responded after the phone intervention (late adopters). Late and early adopters were similar in their stage, age, and education. CONCLUSIONS: Stage and intervention are both significant predictors of screening adoption. The study provides justification for programs to target women in contemplation stage. It also suggests that the boost of a later phone intervention may be consequential for encouraging more women with similar demographics to take action.

Adult↗
PubMed2006

Food store availability and neighborhood characteristics in the United States.

OBJECTIVE: This study provides a multivariate analysis of the availability of food store outlets in the US and associations with neighborhood characteristics on race, ethnicity and socioeconomic status (SES). METHOD: Commercial food store outlet data are linked across 28,050 zip codes to Census 2000 data. Multivariate regression analyses are used to examine associations between the availability of chain supermarkets, non-chain supermarkets, grocery stores and convenience stores and neighborhood characteristics on race, ethnicity and SES including additional controls for population size, urbanization and region. RESULTS: Low-income neighborhoods have fewer chain supermarkets with only 75% (p<0.01) of that available in middle-income neighborhoods. Even after controlling for income and other covariates, the availability of chain supermarkets in African American neighborhoods is only 52% (p<0.01) of that in White neighborhoods with even less relative availability in urban areas. Hispanic neighborhoods have only 32% (p<0.01) as many chain supermarkets compared to non-Hispanic neighborhoods. Non-chain supermarkets and grocery stores are more prevalent in low-income and minority neighborhoods. CONCLUSION: The study results highlight the importance of various potential public policy measures for improving access to supermarkets that may serve to reduce systematic local area barriers that are shown to exist by race, ethnicity and income.

Censuses↗
PubMed1997

The impact of mail contact strategy on the effectiveness of driver license withdrawal.

The California Department of Motor Vehicles currently uses first-class mail to notify drivers of a suspension or revocation of their driving privilege. The served drivers are instructed to sign and return the order and any driver's license to the department, thereby establishing proof of the driver's knowledge of the order. The establishment of proof is considered essential in the prosecution of drivers cited for operating a motor vehicle while under a suspension or revocation (California Vehicle Code Section 14601). However, past research indicates that a majority of drivers fail to comply with the order. In an attempt to increase proof rates, the present study developed and evaluated a number of mailing strategies for various categories of suspensions and revocations. Among the mailing factors evaluated were (1) use of certified mail, (2) use of a follow-up contact, (3) use of a postage paid return envelope and (4) masking the Department of Motor Vehicles return address of the certified mail action notice. The results indicate that there are significant differences between the type of mail contact employed as well as between the different categories of suspension or revocation reason. The most effective strategies (certified mail, return receipt requested) resulted in proof rates of approximately 60-70% compared to approximately 25% for the current first-class mailing procedure. An analysis of subsequent driving records indicated that certified mail also increased the percentage of convictions which were prosecuted as 14601 violations, while decreasing the total number of entries (convictions and accidents) accumulated during suspension or revocation.

Automobile Driving↗
PubMed2003

Influence of follow-up methodology and completeness on apparent clinical outcome of fundoplication.

BACKGROUND: Outcomes after surgery can be determined by face-to-face interview, interviewing patients by telephone, or by mailing out questionnaires. For reasons of convenience, many clinical research studies use mail survey methods. Mail-out responses, however, are rarely complete, and patients returning mail-out questionnaires might be different from patients who do not return questionnaires. METHODS: We identified a group of 75 patients who were all sent a mail-out questionnaire 5 or more years after a laparoscopic fundoplication. Some of these patients returned questionnaires and some did not. All patients were subsequently interviewed by telephone. The responses to the two different data collection methods were compared as well as the interview responses of patients who returned questionnaires with those of patients who did not to determine the influence of follow-up methodology on apparent clinical outcome. RESULTS: Of the 75 patients interviewed, 49 patients (65%) had previously returned a mail-out questionnaire and 26 patients had not. The mean time difference between mail-out response and telephone interview was 1 month. When mail-out responses were compared with interview responses of the patients who had returned questionnaires, equivalent answers were obtained for all symptoms except for dysphagia, for which a higher incidence and greater scores were reported by patients in their mail-out questionnaire responses. When mail-out nonresponders were compared with responders, the nonresponders had a lower level of overall satisfaction with the outcome of surgery, a higher incidence of dysphagia, and greater levels of heartburn. CONCLUSIONS: The measurement of surgical outcomes using a mail-out questionnaire may not be an accurate method of assessing patient symptoms and satisfaction after surgery, particularly if follow-up is incomplete. In this study, patients not responding to mail-out questionnaires were more likely to have adverse symptoms and a lower level of satisfaction than patients returning questionnaires. This dissatisfaction could make patients less likely to return mail-out questionnaires, and for this reason studies with incomplete follow-up that rely on mail-out questionnaire responses may report erroneously higher surgical success rates.

Bias↗
PubMed2001

Identification of risk factors and countermeasures for slip, trip and fall accidents during the delivery of mail.

Risk factors for slip, trip and fall accidents (STFA) during the delivery of mail were identified using a range of accident-centred and accident-independent methods. Key factors included slippery underfoot conditions, non-weather related environmental hazards (e.g., uneven paving, steps, inadequate lighting), poor slip resistance from footwear, unsafe working practices, management safety practices, and underlying organisational influences. Intervention measures were recommended that target STFA risks at three levels: slip resistance, exposure to hazardous conditions, and employee behaviour in the face of hazardous conditions. The use of a participative approach to intervention selection and design enabled allowance for the organisational context to be made.

Accidental Falls↗
PubMed1998

The muscular load on the lower back and shoulders due to lifting at different lifting heights and frequencies.

The aim of the study was to investigate the muscular load on the lower back and shoulders and the circulatory load on employees at a post center during repetitive lifting of mail transport boxes. A mock-up was designed in the laboratory, a total of nine combinations of lifting height and frequency were studied. Surface EMG was recorded bisymmetrically from m. erector spinae (L3-level) and m. trapezius. The circulatory load was evaluated by measuring the heart rate. The results show a trade off between the low back and shoulders. The maximum load on the low back occurred at the low lifting height (363 and 54.4 cm) whereas the maximum load on the shoulders occurred at the high lifting height (144.9 and 163.0 cm).

Adult↗
PubMed1998

Efficacy of postal communication with patients who have cryopreserved pre-embryos.

OBJECTIVE: To compare the characteristics of patients who did and did not respond to a request for information regarding their cryopreserved pre-embryos. DESIGN: Mail survey. SETTING: Academic-assisted reproductive technology program. PATIENT(S): One hundred thirty-six patients with cryopreserved pre-embryos. INTERVENTION(S): Patients were surveyed by first-class mail regarding their plans for their cryopreserved pre-embryos and their interest in embryo donation. MAIN OUTCOME MEASURE(S): Age, number of stored pre-embryos, and duration of storage of responders and nonresponders at 6 weeks after mailing. RESULT(S): Eighty-three patients (62%) did not respond to the survey. Compared with responders, nonresponders were significantly older at the time of embryo cryopreservation, had fewer pre-embryos cryopreserved, and had the pre-embryos cryopreserved for a longer duration. Five responders (9%) expressed an interest in embryo donation. Three patients requested disposal of pre-embryos. Sixteen surveys (12%) were returned as undeliverable. As a group, these patients had the fewest pre-embryos cryopreserved and had the longest duration of storage. CONCLUSION(S): A disturbing number of patients with cryopreserved pre-embryos ignored efforts by our program to maintain contact. Older patients with few cryopreserved pre-embryos may require special attention to avoid abandonment.

Adult↗
PubMed2000

Sexual function after vaginal surgery for stress incontinence: results of a mailed questionnaire.

OBJECTIVES: To address the issue of sexual dysfunction after vaginal surgery for incontinence based on responses to a mailed questionnaire. METHODS: A sexual function questionnaire was mailed to 93 women who underwent anterior vaginal wall suspension for stress urinary incontinence alone (group 1) or in conjunction with a concomitant posterior repair (group 2) at least 1 year previously. RESULTS: A total of 56 (60%) women responded. Following surgery, 10 (37%) women in group 1 reported themselves as sexually active and 12 (41%) in group 2, which was similar to preoperative values. Only 1 woman in group 1 and 3 women in group 2 attributed their sexual inactivity to their own lack of desire or inability to have intercourse. Overall, 20% of women noted pain during intercourse, a finding slightly lower than the preoperative incidence (29%). No difference in the incidence of dyspareunia was noted between groups. Still, several women (18%) reported intercourse to be worse following surgery. Women who were either premenopausal or on hormone replacement therapy were more likely to be sexually active following surgery (46%) than those not on hormone replacement (17%). CONCLUSIONS: Overall, the percentage of women who were sexually active did not appear to be affected by a vaginal suspension procedure for incontinence. Symptomatic vaginal narrowing was rare, even among women undergoing simultaneous posterior repair. Still, nearly 20% of women considered intercourse to be worse postoperatively, although not all women reported dyspareunia. The possible causes for postoperative sexual dysfunction require further investigation.

Adult↗
PubMed2001

Practice patterns in the treatment of female urinary incontinence: a postal and internet survey.

OBJECTIVES: To survey American urologists to assess practice patterns in treating female incontinence. Advances in the treatment of female incontinence have changed the way urologists practice. METHODS: Postal and e-mail surveys were sent to 2502 members of the American Urological Association. RESULTS: From the postal group (n = 1000), 419 (42%) responses were obtained; from the e-mail group (n = 1502), 160 (11%) responses were obtained. For types I, II, and III stress urinary incontinence (SUI), 239 (44%) of 546, 388 (68%) of 570, and 512 (94%) of 547 urologists, respectively, recommended a sling procedure. For type I SUI, 75 (53%) of the 143 respondents in practice for less than 10 years recommended a sling procedure. The sling was recommended by 62 (35%) of the 176 respondents in practice for longer than 20 years (P <0.001). Most urologists (75%, 358 of 480) referred patients with significant vaginal prolapse to a gynecologist; however, urologists in full-time academic practice were more likely to offer surgical treatment (56%, 29 of 52). Most urologists recommended medical treatment for urge incontinence (94%, 461 of 491), and the medications most commonly selected were tolterodine (41%, 202 of 491), oxybutynin (26%, 129 of 491), and extended-release oxybutynin (25%, 125 of 491). CONCLUSIONS: Overall, a sling procedure was the most commonly recommended surgical procedure for all types of SUI. Most urologists referred patients with significant vaginal prolapse to a gynecologist. For type I SUI, older urologists were more likely than younger urologists to perform needle bladder neck suspension.

Female↗
PubMed2002

Recruitment for a clinical trial of drug treatment for benign prostatic hyperplasia.

OBJECTIVES: To evaluate the effectiveness of various recruitment strategies for a 6-year multicenter clinical trial of medical therapy for benign prostatic hyperplasia, the Medical Therapy of Prostatic Symptoms Trial. METHODS: How participants learned about the trial was obtained during initial contact with clinical centers and at the first screening visit. The yield of randomized participants from the initial contact and first screening visit was calculated for each of the recruitment techniques. RESULTS: During a period of 28 months, 16,723 potential trial participants made an initial contact with the 17 clinical centers, and 2931 men were randomized. An average of four initial contacts were required for each first screen visit and six per randomized participant. Newspaper (29.9%) and mail (26.7%) were the two leading sources of randomized participants. Medical sources (9.6%), radio (8.8%), and newsletters (8.4%) were also important sources. All clinical centers achieved or exceeded their recruitment goals. CONCLUSIONS: Mass mail and newspaper were the most effective recruitment techniques to enlist the interest of men with urinary symptoms for a long-term trial of drug therapy for benign prostatic hyperplasia.

Humans↗
PubMed2003

Does methodology affect the ability to monitor tobacco control activities? implications for HEDIS and other performance measures.

BACKGROUND: It is unclear whether methodological differences in sample size, survey methods, and analysis approach significantly affect the ability to accurately monitor tobacco control activities and to make rate comparisons. METHODS: Questionnaires were sent to 64,764 members of nine health plans in diverse settings soon after their visit to a primary care clinician. Of these 41,677 completed responses were received. We compared responses received by mail and by telephone follow-up for the percentage of smokers, characteristics of smokers, and their rates of reporting physician cessation counseling. RESULTS: Overall, 10.2% were current cigarette smokers, but the proportion was 8.6% for mail responders and 17.2% for phone follow-up responders. Smokers identified by phone follow-up were different from mail responders in most demographic and smoking characteristics and their reports of clinical smoking cessation activities differed for six of nine clinician smoking cessation actions. Calculating advice rates as a proportion of visits produced lower rates with more dispersion among plan rates than doing so without accounting for visit variation. CONCLUSIONS: Smoking surveys using only mailed questionnaires dramatically undersample smokers, especially in some demographic groups. Comparisons of tobacco counseling among health plans can be improved by ensuring an adequate sample size and response rate and by analyzing by frequency of quit advice.

Adult↗