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PubMed2000

A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I.

OBJECTIVE: To investigate the primary care, health promotion activities associated with what has historically been called "maintenance care" (MC) as used in the practice of chiropractic in the United States. This includes issues such as investigating the purpose of MC, what conditions and patient populations it best serves, how frequently it is required, what therapeutic interventions constitute MC, how often it is recommended, and what percent of patient visits are for prevention and health promotion services. It also investigates the economic impact of these services. DESIGN: Postal survey of a randomized sample of practicing US chiropractors. The questionnaire was structured with a 5-point ordinal Likert scale (28 questions) and brief fill-in questionnaire (12 questions). The 40-question survey was mailed to 1500 chiropractors selected at random from a pool of chiropractors with active practices in the United States. The National Directory of Chiropractic database was the source of actively practicing chiropractors from which doctor selection was made. The sample was derived by using the last numbers composing the zip codes assigned by the US Postal Service. This sampling method assured potential inclusion of chiropractors from all 50 states, from rural areas and large cities, and assured a sample weighting based on population density that might not have been afforded by a simple random sample. RESULTS: Six hundred and fifty-eight (44%) of the questionnaires were completed and returned. US chiropractors agreed or strongly agreed that the purpose of MC was to optimize health (90%), prevent conditions from developing (88%), provide palliative care (86%), and minimize recurrence or exacerbations (95%). MC was viewed as helpful in preventing both musculoskeletal and visceral health problems. There was strong agreement that the therapeutic composition of MC placed virtually equal weight on exercise (96%) and adjustments/manipulation (97%) and that other interventions, including dietary recommendations (93%) and patient education about lifestyle changes (84%), shared a high level of importance. Seventy-nine percent of chiropractic patients have MC recommended to them and nearly half of those (34%) comply. The average number of recommended MC visits was 14.4 visits per year, and the total revenue represents an estimated 23% of practice income. CONCLUSIONS: Despite educational, philosophic, and political differences, US chiropractors come to a consensus about the purpose and composition of MC. Not withstanding the absence of scientific support, they believe that it is of value to all age groups and a variety of conditions from stress to musculoskeletal and visceral conditions. This strong belief in the preventive and health promotion value of MC motivates them to recommend this care to most patients. This, in turn, results in a high level of preventive services and income averaging an estimated $50,000 per chiropractic practice in 1994. The data suggest that the amount of services and income generated by preventive and health-promoting services may be second only to those from the treatment of low-back pain. The response from this survey also suggests that the level of primary care, health promotion and prevention activities of chiropractors surpasses that of other physicians.

Adult↗
PubMed1992

Costs and benefits of preemployment drug screening.

OBJECTIVE: This study provides a cost-benefit analysis of preemployment drug screening and evaluates the sensitivity of this analysis to variation in its underlying assumptions. DESIGN: Cost-benefit analysis, based on a cohort analytic study previously reported. SETTING: Employees of the US Postal Service in Boston, Mass. PARTICIPANTS: Estimates of costs and benefit are based on a cohort of 2533 postal workers in Boston and on average costs for the Postal Service in Boston and nationwide. RESULTS: Drug screening would have saved the Postal Service $162 per applicant hired. However, these results were sensitive to the assumptions in the model. If the prevalence of drug use in the population screened were 1% rather than 12%, the program would lose money. Similarly, if the cost per urine sample screened were $95 rather than the $49 assumed, then the program would lose money, even if the prevalence of drug positives was as high as 9%. CONCLUSIONS: Because of the sensitivity of this analysis to changes in its underlying assumptions, any company considering preemployment drug screening should carefully weigh the costs and benefits in its own industry.

Adult↗
PubMed1976

[Preventive screening in two factories. II. Exactitude of laboratory tests and questionnaire (author's transl)].

The exactitude of some widely used laboratory tests (triglycerids, cholesterol, glucose, uric acid, creatinine) is examined in a situation relevant for practising physicians. Different statistical methods for reporting errors are compared. Accuracy and precision are useful measures for the quality of analytic procedures. They are not sufficient for medical judgement for a single patient, since sampling procedures, type of sample or transport and storage of sample are not considered in accuracy and precision. Such sources of error can largely devaluate the quality of accuracy and precision and of the analytic procedures. Error coefficients are proposed as a new method of reporting laboratory errors. The mathematical model starts with an analysis of variance and total error, technical error and transport error are defined. The study shows that the error introduced by transporting serum via postal service compared to that conveyed in a cooled transport box by a special car is considerable. It is nearly impossible for a physican to use single laboratory value for a rational decision "normal-not normal" if the values are based on samples which are sent by postal service and if the values lie in the broad borderline between the normal and pathological area. This is especially true for creatinine (transport error 47.0 per cent) and uric acid (transport error 38.7 per cent), but not so much for cholesterol (22.9 per cent), triglicerids (14.3 per cent) and glucose (13.3 per cent). Variables with high transport error like creatinine should not be used in screening programs, as long as the transport is made by postal service and the method is not improved. The agreements between the answers of a questionnaire and of an interview are analysed with the same patients (n=235). These agreements lie between 98.7 per cent and 61.7 per cent depending on the single question. The exactitude of medical questionnaires is in the same size order as the exactitude of laboratory tests-at least when the sample is sent by postal service.

Clinical Laboratory Techniques↗
PubMed1990

Effect of milk sample delivery methods and arrival conditions on bacterial contamination rates.

A cross sectional study was performed of factors believed to contribute to the contamination of bovine milk sample cultures submitted to the Ithaca Regional Laboratory of the Quality Milk Promotion Services/New York State Mastitis Control. Of 871 samples entered in the study, 137 (15.7%) were contaminated. There were interactions between the sample source (veterinarian vs dairyman), delivery method, and time between sample collection and arrival at the laboratory. If only those samples collected and hand delivered by the dairyman within 1 day of collection were compared to a like subset of samples collected and hand delivered by veterinarians, no statistically significant differences in milk sample contamination rate (MSCR) were found. Samples were delivered to the laboratory by hand, US Postal Service, United Parcel Service, via the New York State College of Veterinary Medicine Diagnostic Laboratory, or Northeast Dairy Herd Improvement Association Courier. The MSCR was only 7.6% for hand delivered samples, while 26% of Postal Service samples were contaminated. These rates differed significantly from other delivery methods (P less than 0.0001). The USPS samples arrived a longer time after sampling than did samples sent by other routes, and time had a significant effect on MSCR (0 to 1 day, 8.9%; greater than 1 day, 25.9%; P less than 0.01). Samples packaged with ice packs sent by routes other than the Postal Service had a lower MSCR than those not packaged with ice packs, but ice packs did not reduce the MSCR for samples sent by the Postal Service.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

The management of psychopathology in the workplace.

This chapter is an outcome of an educational symposium held by the United States Postal Service to improve the management of medical and psychiatric problems by Postal Service physicians and their medical contractor cohorts. The proceedings have been edited to highlight psychiatric issues. The symposium begins with a case presentation, followed by a discussion, comments, questions and answers. The primary discussants were a faculty of distinguished psychiatrists with a wealth of academic and clinical experience. The symposium begins with an introduction by Ibrahim Farid, MD, senior area medical director for the United States Postal Service, who presents a rationale for holding the symposium.

Health Education↗
PubMed1984

Industrial low-back pain. A prospective evaluation of a standardized diagnostic and treatment protocol.

This investigation applied a diagnostic and treatment protocol to two groups of industrial workers: 5,300 employees at Potomac Electric Power Company ( PEPCO ) for two years and 14,000 United States Postal Service workers for one year. An "active" system in which patients were evaluated weekly was implemented at the power company, and a "passive" system in which patients were seen only once was instituted at the U.S. Postal Service. The physicians were unbiased , in that they could not take part in the patients' ongoing care. The results in both groups demonstrated significant and continuous reductions in number of incidents, in days lost from work, in low-back surgery, and in financial costs. The number of low-back pain patients at PEPCO decreased 29% the first year and 44% the second; days lost from work decreased 51% the first year and 89% the second; low-back surgery dropped 88% the first year and 76% the second year. Results for the U.S. Postal Service demonstrated a decrease in the number of low-back pain patients (41%), in days lost from work (60%), and in financial costs (55%). These results, along with our observations about the study, led us to the following conclusions: (1) Good medicine leads to cost savings in treating industrial low-back pain. (2) Use of a standardized medical approach and nomenclature is necessary and practical, for consistent care. (3) A good record keeping system is essential to perform useful medical analyses for identifying scientific problems. (4) Unbiased medical surveillance leads to changes in behavior of both treating physicians and patients. (5) The outcome for most low-back pain patients in industry is not as grim as previously perceived if their medical management is approached in an organized manner.

Absenteeism↗
PubMed1987

Monitoring maternity services by postal questionnaires to mothers.

There are a number of gaps in existing statistics about maternity services and no systematic collection of data about women's views and experiences of maternity care. Much useful information could be obtained by regular surveys of random samples of mothers obtained from birth registration. Results from a series of studies carried out by the Institute for Social Studies in Medical Care show that this is a practical and useful proposition.

Consumer Behavior↗
PubMed1976

Biomedical periodicals in Nigerian Medical Libraries: the medical librarian's dilemma.

The Nigerian medical librarian has an uphill task in his effort to satisfy the journal needs of users of his library. His problems stem from difficulties in the selection and acquisition of journals, delay in postal services, budgetary and other administrative controls, and the changing nature of medical education and health-care services in Nigeria. The librarian's attempts to solve these problems include increased subscriptions to journals and use of interlibrary loans, but the absence of union lists of holdings of other libraries, the heavy cost of photocopying services, and poor postal facilities present another dimension to his problems. Eventually his best solution seems to lie in the establishment of a national center for "least used" journals to serve as a source stock for the country's medical libraries.

Book Selection↗
PubMedDate not supplied

Monitoring maternity services by postal questionnaire: congruity between mothers' reports and their obstetric records.

The validity of information obtained from women about the medical aspects of their childbearing experiences has been assessed by comparing the responses of 223 mothers on a postal questionnaire with information extracted from their medical records. When discrepancies between the two sources were found, it was not assumed that the hospital records were correct. Instead, attempts were made to ascertain why the data might be inconsistent by re-checking the records and by contacting the mothers again. There appeared to be five main reasons for discrepancies: mothers' limited knowledge or understanding of certain procedures; problems of interpretation and definition; occasionally inaccurate or missing information in the medical records; under-reporting of sensitive information by mothers and, finally, questions which were misunderstood or misinterpreted by the mothers. For most items, however, good agreement between the mothers and hospitals was obtained, and the results indicate that valid information over a range of events can be obtained using postal surveys of mothers.

England↗
PubMed1999

Impact of a participatory organizational intervention on job characteristics and job stress.

Increased employee control and participation are recommended to achieve both "flexible organization" and improvements in health, as outlined in occupational stress intervention models. This study evaluates the impact of a participatory organizational intervention on job stress and job characteristics. The intervention was carried out in two post offices in the Norwegian Postal Service. "Local theories" were seen as the key drivers for organizational improvement and increased control. The underlying dynamics of the intervention were to manipulate employees' learning opportunity and decision authority so as to improve work environment and health. Work groups, in dialogue with a steering committee, conducted diagnosis, action planning, and action taking. Work conditions deteriorated during the observation period in the control groups. In one of the intervention groups, this negative trend was reduced by the intervention. Lack of positive results in the other intervention group may have been due to organizational restructuring and turbulence.

Adult↗
PubMed1998

Underlying and multiple cause mortality in a cohort of workers exposed to aromatic amines.

BACKGROUND: The National Institute for Occupational Safety and Health (NIOSH) has previously conducted studies of bladder cancer incidence and mortality at a synthetic dye plant that manufactured beta-naphthylamine from 1940 through 1979. This report extends the period of mortality follow-up 13 years and analyzes both underlying and nonunderlying causes of death. METHODS: The vital status of each cohort member, as of December 31, 1992, was determined by using the National Death Index and information from the Internal Revenue Service and the U.S. Postal Service. The NIOSH life table analysis system (LTAS) was used to generate person-year-at-risk and the expected numbers of death for 92 categories of death, using several referent rates (U.S. underlying, Georgia underlying, U.S. multiple cause). RESULTS: There were three bladder cancer deaths listed as underlying cause, yielding a standardized mortality ratio (SMR) based on U.S. rates of 2.4 (95% confidence interval (CI) = 0.5, 7.0) and a total of eight bladder cancers listed anywhere on the death certificates (SMR based on multiple cause referent rates = 5.6; 95% CI = 2.4, 11.1). Mortality from esophageal cancer, which had been significantly elevated in the previous study, was no longer significantly elevated (SMR = 2.0; 95% CI = 0.8, 4.1). Mortality from all causes was significantly higher than expected (SMR = 1.5; 95% CI = 1.3, 1.6). CONCLUSIONS: The elevated bladder cancer risk in this cohort was detected by the multiple cause, but not the underlying cause, analysis. Elevated mortality from other causes of death, especially among short-term workers, may be related to regional and lifestyle factors.

Amines↗
PubMed2004

Certified mail fails to reach an Emergency Department population.

The objective of this study was to determine if correspondence sent by regular mail would be delivered more often than correspondence sent by certified mail. Correspondence was prospectively randomized and mailed by United States Postal Service using either regular mail service or certified mail service. Mailings were analyzed based on patient demographic information, whether or not mail was returned, and the reason for the return. Certified mail was sent to 145 patients; 58 (40%) of the mailings were returned. Wrong addresses accounted for only 23 (16%) of these, whereas the addressee never claimed 35 (24%). Regular mail was sent to 126 patients, and 19 (15%) of the letters were returned. Wrong addresses accounted for 18 (14%) of these letters, and only 1 (1%) was refused for delivery. In conclusion, when compared with certified mail, regular mail is a more effective means of reaching patients with follow-up information after an Emergency Department visit.

Correspondence as Topic↗
PubMed2005

Postal workers' perspectives on communication during the anthrax attack.

In 2001, the nation experienced its first bioterrorism attack, in the form of anthrax sent through the U.S. Postal Service, and public health professionals were challenged to communicate with a critical audience, U.S. postal workers. Postal workers, the first cohort to receive public health messages during a bioterrorist crisis, offer a crucial viewpoint that can be used in the development of best practices in crisis and emergency risk communication. This article reports results of qualitative interviews and focus groups with 65 postal workers employed at three facilities: Trenton, New Jersey; New York City; and Washington, DC. The social context and changing messages were among the factors that damaged trust between postal workers and public health professionals. Lessons learned from this attack contribute to the growing body of knowledge available to guide communications experts and public health professionals charged with crisis and emergency risk communication with the public.

Adult↗
PubMed2005

Anthrax in New Jersey: a health education experience in bioterrorism response and preparedness.

The anthrax attack in 2001 created new challenges to health educators working on the response effort in New Jersey. Never before had there been a need for educating a group of people who had been exposed to a biological weapon. Coming on the heels of the catastrophic World Trade Center collapse on September 11, 2001, the New Jersey Department of Health and Senior Services was entrenched in the response to, and management of, the anthrax attack that placed a heavy emphasis on educating the postal workers of the United States Postal Service Trenton Processing and Distribution Center. This article provides an account of the preparation and delivery of educational materials and activities in the midst of a biological emergency, emphasizes the role health educators play in responding to bioterrorism events, and encourages health educators to become involved in bioterrorism preparedness efforts.

Anthrax↗
PubMed2004

Improving geocoding practices: evaluation of geocoding tools.

This study examined the sources of error involved in geocoding, by systematically evaluating the strengths and weaknesses of three widely used tools for geocoding. We tested them against a random sample of addresses from a state administrative address master file and found considerable variation in identification of census block geocodes of addresses. This high variation was mainly attributable to differences in preprocessing of addresses before geocoding and the reference street data used for geocoding. Preprocessing includes not only parsing and standardizing, but also correcting addresses against the US Postal Service Zip+4 Database, the master mailing address database maintained and updated regularly by USPS.

Epidemiologic Studies↗
PubMed1990

Fate of incorrectly addressed mailed questionnaires.

Mail surveys are a widely used and often inexpensive method for conducting epidemiologic studies, but may suffer from poor response rates. Some of this nonresponse may be due to letters that never reach study subjects rather than nonparticipation. We mailed letters to invalid addresses and to fictitious occupants at valid addresses in order to determine the proportion of letters that were not returned to us by the postal service as undeliverable. All letters mailed to invalid addresses were returned, whereas 13.3% (95% Cl 2.0-24.7%) of letters sent to fictitious occupants were not. Because some undeliverable mail is not returned, investigators may erroneously assume nonresponse for some subjects who never have the opportunity to participate.

Epidemiologic Methods↗