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PubMed1983

Nutrition knowledge of high school athletic coaches in Texas.

A study was conducted by mail questionnaire to assess concepts of nutrition as related to athletes that coaches in Texas accept and are likely to disseminate. Background information included training in nutrition, sources of nutrition information, and frequency of distribution of dietary advice. Eighty-five percent of the coaches scored below 70% on knowledge of nutrition. Seventy-three percent, however, believed they were adequately informed about nutrition, and 86% dispense nutrition information regularly. Results of the study indicate a need for better nutrition education for high school athletic coaches.

Adult↗
PubMed1993

Medical technologists' perceptions of their work: results of perception of work study in Sweden.

The subjective perceptions of autonomy, occupational hazards, job satisfaction, and work content were studied for a sample of medical technologists (MTs) employed in clinical chemistry in Sweden. The sample (N = 488) consisted of a randomized tenth of the members of the MT trade union. A mailed questionnaire was completed by 359 (73.6%) MTs. A further validation was performed through interviewing 48 MTs who had not participated in the survey. The answers in the validation study corresponded well to the distributions of the answers in the main study. The MTs' job satisfaction was high, which is in accordance with a European survey, but contradictory to American studies. However, the overall picture of the MTs' perception of their work in the present study was contradictory: an ideal of what they want the occupation to be, and a reflection of a reality that partly causes considerable dissatisfaction. This may suggest that medical technology is undergoing a process of professionalization.

Adult↗
PubMed1996

[Prevalence and sex distribution of different forms of migraine].

The aim of this study was to provide prevalence and sex-ratio of subtypes of migraine diagnosed by neurological interview according to the criteria of the International Headache Society. In all, 3000 males and 1000 females aged 40 years were randomly selected from the Danish population. They received a mailed questionnaire regarding migraine. The questionnaire response rate was 87%. People with self-reported migraine and a random sample of those reporting no migraine were invited to a headache interview, and a physical and a neurological examination. Those not reacting to the invitation were interviewed by telephone. Participation in the interview was 87%. Kappa was 0.77 validating self-reported migraine in the questionnaire against the diagnosis of the clinical interview. Lifetime prevalences of migraine without aura, migraine with aura, migraine aura without headache, and migrainous disorder were 8%, 4%, 1% and 1% in males and 16%, 7%, 3% and 2% in females. Overall lifetime prevalence of any type of migraine was 18%, 12% in males and 24% in females. This is lower than the sum of the prevalences since migraine diagnoses are not mutually exclusive. The male:female ratios of migraine without aura, migraine with aura, migraine aura without headache, and migrainous disorder were approximately 1:2.

Adult↗
PubMed2001

Monitoring patient satisfaction with university dental services under two fee-paying systems.

AIMS: The aim of this survey was to study patients' satisfaction with the dental service of a university in Hong Kong under a recently introduced item-based fee-paying system and reasons for non-attendance at the clinic; and to compare results of the present survey with that of a similar survey of the same dental service under a time-based fee-paying system in 1996. METHOD: A modified Dental Satisfaction Questionnaire was distributed to a random sample of students (n=194) in their lecture rooms and they were asked to complete the questionnaire on the spot. The same questionnaire was sent to a random sample of staff and their spouses (n=207) by mail. RESULTS: Dental Satisfaction Index (DSI) scores calculated from the returned questionnaires were 66 for students and 70 for staff and their spouses. Compared to the scores in 1996, there was no significant difference for that of the students (DSI=65 in 1996) but there was a significant improvement in that of the staff and their spouses (DSI=66 in 1996). Moreover, in the present survey, "busy/no time" and "no perceived dental problem" were the major reasons for non-attendance, in contrast to "long waiting time for an appointment" in the 1996 survey, were the major reasons for non-attendance. CONCLUSION: The recent attempts by the University Dental Clinic to shorten patient waiting time and the change in fee-paying system might have improved the patients' satisfaction with the service.

Chi-Square Distribution↗
PubMed2006

Geographical distribution of acute symptoms after a train collision involving epichlorohydrin exposure.

In September 2002, two freight trains collided in a northern German town. The inhabitants were potentially exposed to the probable human carcinogen epichlorohydrin. As no objective data on the level of exposure were available, we aimed to assess the geographical distribution of acute symptoms among local residents and subjects occupationally involved in the accident (e.g., firemen). A random sample of 932 adult local residents and 342 occupationally involved subjects were invited to answer a mail-in questionnaire. The main outcome measures were self-reported acute symptoms potentially associated with combustion products (e.g., irritation of the eyes, nose, or throat) and stress-related nonspecific symptoms. The main location during the first 26 h after the accident served as exposure proxy. For occupationally involved subjects, the time spent at the accident site was also used. The overall prevalence of symptoms potentially associated with combustion products was 9.8% for residents and 25.4% for occupationally involved subjects. After adjustment, subjects whose main location was close to the accident site had an increased risk for such symptoms. Among occupationally involved subjects the risk increased with duration at the accident site. Neither main location nor time at the accident site was significantly associated with non-specific symptoms. We could provide an example for designing and carrying out an epidemiologic study shortly after a local accident with potential public health impact. We could define parts of the population at increased risk for symptoms potentially specific for the exposure under study.

Accidents↗
PubMed2004

The anatomical pattern and determinants of pain in the neck and upper limbs: an epidemiologic study.

Little is known about the distribution and determinants of pain at multiple sites in the neck and upper limb. To investigate the prevalence, pattern, and clustering of such pains and the association of extensive involvement with putative risk factors, we mailed a questionnaire to a community sample of 9696 working-aged adults. Age-sex specific prevalence rates for pain were estimated and the frequency of bilateral involvement, pairwise overlap at different sites, and extent to which reports clustered within individuals were explored. Associations of multi-site involvement with age, gender, psychological health, smoking, and employment status were assessed by logistic regression. Among 6038 responders, 2657 reported at least a day of neck or upper limb pain in the past 7 days, including 1843 whose symptoms rendered normal activities difficult or impossible. Pain was frequently bilateral or in the dominant arm. Significant associations were seen for pain at anatomically adjacent sites. Pain affecting every site considered (neck, shoulders, elbows, wrists/hands) was far more common than might be expected if each site were statistically independent (observed/expected ratio 8750). Being female, unemployed, a blue-collar worker, or a smoker were independent risk factors for such extensive pain, but the strongest association was with psychological ill-health (odds ratio for worst vs. best third of the SF-36 low vitality score, 30.3, 95% CI 7.1-129.0). Neck and upper limb pain commonly cluster, and frequently display symmetry and adjacent patterns of involvement. Extensive neck and upper limb pain is far more strongly associated with poor mental vitality than localised pain.

Adult↗
PubMed1995

World Wide Web resources for the biologist.

The World Wide Web is currently the major networking resource for biologists. It has passed Gopher and simple electronic mail (email) servers in popularity. In the 1990s, the advent of client-server software will be the main driving force in bioinformatics. During the past few years, biologists have used the Internet increasingly to distribute data, and the methods of doing this have become more and more sophisticated as the speed with which network links can be made has increased.

Biology↗
PubMed1997

A medical school for rural areas.

Jichi Medical School (JMS) was established in 1972 to supply graduates to rural areas where medical resources are scarce. JMS has several unique characteristics aimed at motivating graduates to work in a rural practice. These include financial aid for students, a home prefecture recruiting scheme, location in a non-urban area, management by prefectures and support from the national government. The achievements of JMS over the 24-year period since its foundation have been evaluated. A questionnaire has been mailed to all JMS graduates since the first year of graduation. Using a pro-active approach to follow-up, the return rate has been virtually 100%. The authors investigated annual changes in the distribution of the graduates as well as the present status of the graduates in 1995. At that time, JMS graduates were distributed all over Japan. Among the 1871 graduates, 792 (42%) were working in rural areas in 1995. Nine-hundred and twenty-four graduated in the period from the first to the ninth output of graduates. Among these, 858 (93%) completed the requisite 9 years of work contracted between JMS and the graduates, 620 (67%) had practised in the same prefecture, and 305 (33%) were still practising in a rural area. Although there are still improvements to be made, JMS has succeeded in achieving its aim of supplying doctors to rural areas. The recruiting system of JMS is an effective approach to overcoming the shortage of rural doctors, which has continued to be an unresolved global problem.

Education, Medical, Undergraduate↗
PubMed2005

Quality of life, depression and fatigue among persons co-infected with HIV and hepatitis C: outcomes from a population-based cohort.

The objective of the study was to describe the additional burden generated by hepatitis C (HCV) infection among HIV-infected individuals as measured by self-reported quality of life, depression and fatigue. The provincial HIV/AIDS Drug Treatment Program (DTP) distributes all antiretroviral medication in the province of British Columbia. Eligibility for accessing antiretrovirals is based on published guidelines commensurate with the International AIDS Society. Each participant is asked to complete a self-administered mailed questionnaire that includes patient sociodemographic information, quality of life measures (Medical Outcomes Study-Short Form (MOS-SF), mental health issues (Centre for Epidemiological Studies Depression scale (CESD) and fatigue information. HIV-HCV co-infected individuals were compared to HIV mono-infected individuals using parametric and nonparametric methods. Multivariate logistic regression was used to examine the impact of hepatitis C on quality of life, depression and fatigue, after controlling for sociodemographics and HIV-specific clinical characteristics. Of the 4,134 individuals who were sent a HIV/AIDS DTP survey in 1999, 2000 or 2001, 484 participants both returned one and had an HCV-antibody test result on file. Of the 484 participants eligible for this analysis, 105 (22%) were HCV-positive. In comparison to the 379 (78%) patients testing negative for HCV, a larger proportion of co-infected patients were female (18% versus 3%, p<0.001), aboriginal (20% versus 3%, p<0.001), had ever injected drugs (79% versus 5%, p<0.001), were unemployed (91% versus 49%, p<0.001) and lived in unstable housing (19% versus 1%, p<0.001) at the time they completed the survey. Co-infected patients reported more symptoms consistent with depression, increased fatigue and poorer quality of life. However, using multivariate modeling, it was determined that the impact of HCV on quality of life, depression and fatigue was better explained by the sociodemographic factors related to poverty and injection drug use, than by HCV itself. In conclusion, individuals co-infected with HIV and HCV represent a patient population with significant physical and mental health challenges. Although these patients experience poorer quality of life, increased depression and fatigue, this experience appears to be primarily related to socio-economic issues rather than HCV infection.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Pharmacist participation in the workforce: 1990, 2000, and 2004.

OBJECTIVE: To examine work variables for licensed pharmacists for 1990, 2000, and 2004. DESIGN: Three cross-sectional, descriptive studies. SETTING: United States. PARTICIPANTS: Licensed pharmacists: 1,623 in 1990; 2,092 in 2000; and 1,564 in 2004. These numbers of usable responses to the three respective surveys represented 54.0%, 42.7%, and 33.8% of those receiving surveys. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey; data from the national studies of the pharmacist workforce conducted in 1990 and 2000. MAIN OUTCOME MEASURES: Characteristics of pharmacists; work setting, work position and age distribution of actively practicing pharmacists. Work status of licensed pharmacists; proportion actively practicing pharmacy. Proportion of pharmacists working part-time overall and by age group, weekly hours worked by actively practicing pharmacists, and full-time equivalents (FTEs) by age group. Proportion of pharmacists with secondary pharmacy employment; work setting, hours worked, and weeks worked in secondary pharmacy employment. RESULTS: In each year studied, more than 86% of licensed pharmacists were actively practicing pharmacy. In 2004, the largest proportion of actively practicing women pharmacists was between the ages of 31 and 45, and the largest proportion of actively practicing men pharmacists was between the ages of 46 and 60. Across the survey years, the proportion of all actively practicing pharmacists working part-time increased, and the proportion of women working part-time was at least double that of men except in 2004. In 2004, the FTE contribution for women was 0.81 and 0.91 for men. CONCLUSION: The decrease in FTE contributions by all pharmacists and the aging of the male pharmacist population raise concerns about the adequacy of current and future pharmacist supply. As the demand for pharmacists continues to evolve, pharmacy must continue to monitor the pharmacist workforce to show how pharmacists react to changes to better inform projections of the pharmacist workforce.

Adult↗
PubMed1987

Interdisciplinary andrology. STDs. AIDS research.

Multidisciplinary andrology deals with clinical application and modern technology for the evaluation and differential diagnosis of male infertility with emphasis on morphological, anatomical, biochemical, immunological, hereditary, and microbiological parameters. Little is known about the effects of diet, disease, stress, environmental, and drugs on male-related unexplained infertility of couples. Regional, national, and international centers of multidisciplinary andrology should provide (1) extensive and unique clinical services; (2) a computerized "patient referral center," (3) self-learning packages (slides/tape programs) for patients; and (4) a computer link to the National Library of Medicine and the Drug Information Center. Specialized laboratories and clinics can be served by expert consultants, visiting professors, bilingual and well-trained clinicians, nurses, laboratory technologists, computer operators, and related allied health personnel. Patient education pamphlets, updated every few years, can be distributed during training workshops when an extensive network of remote teleprinters can be utilized. Qualified client location may install a printer to allow on-site printing of reports in the shortest possible time. Special mailing containers are provided to clients who wish to mail their laboratory specimens. Other clinical services may include the following: 1. Central source of communication and information in andrology; 2. International roster of multidisciplinary andrology centers; 3. Patient referral to centers and consultations for developing countries; 4. Screening of husbands and wives for in vitro fertilization/embryo transfer (IVF/ET); 5. Screening of couples with unexplained infertility for sexually transmitted diseases (STDs) including AIDS; 6. Exchange of research material and methodology; 7. Coordination of multicenter research; 8. Organizing training workshops for clinicians, nurses, and laboratory technicians; 9. Establishing a repository of films, video tapes, slides, catalogs, instrumentation, books, SEM photos, and atlases; 10. Publication and editorial assistance; 11. Consultation for the appropriate selection, purchase, and quality control of instrumentation (all on one computer system); 12. Evaluation of new diagnostic tools for idiopathic infertility and fertility regulation; 13.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1997

Reported general practitioner vaccination procedures, 1994 and 1996.

OBJECTIVE: To determine general practitioner (GP) vaccination procedures during the first two years of implementation of the National Childhood Immunisation Program. DESIGN: Two cross-sectional self-completion mail surveys of Australian GPs, in October/November 1994 (Survey 1) and April/May 1996 (Survey 2). PARTICIPANTS: 1417 systematically selected (Survey 1) and 1482 randomly selected (Survey 2) GPs. INTERVENTION: Mailing of a package of publications on immunisation to all GPs, a community education campaign, and the introduction of the Australian Childhood Immunisation Register. State and Territory and local initiatives on immunisation, changes in vaccine distribution and funding, and media coverage of vaccination issues may also have affected GPs' procedures. MAIN OUTCOME MEASURES: Reported vaccination procedures consistent with National Health and Medical Research Council (NHMRC) recommendations. RESULTS: Response rates were 77% (Survey 1) and 78% (Survey 2). There were statistically significant rises in the proportions of GPs who reported vaccination procedures consistent with NHMRC recommendations for simultaneous administration of vaccines, injection site, vaccination of children taking antibiotics or those with mild upper respiratory tract infection, and vaccine storage. There was a reduction in reported opportunistic vaccination, and no change in reported procedures regarding pertussis vaccination. CONCLUSIONS: Many factors may have contributed to these changes in GP vaccination procedures. While the changes mostly show an improvement in adherence to NHMRC guidelines, further progress needs to be made, particularly in the areas of opportunistic vaccination, pertussis vaccination and vaccine storage. The best method of informing GPs of current vaccination recommendations needs to be explored.

Adult↗
PubMed1995

Physical activity, obesity, and risk for colon cancer and adenoma in men.

OBJECTIVE: To determine whether physical inactivity and obesity increase risk for colon cancer and adenomas, which are precursors of cancer, and whether the abdominal distribution of obesity is an independent risk factor for these events. DESIGN: Prospective cohort study. SETTING: United States. PATIENTS: 47,723 male health professionals, 40 to 75 years of age, who responded to a questionnaire mailed in 1986. MEASUREMENTS: Questionnaires in 1986 about physical activity level and body mass index, and questionnaires in 1987 (31,055 respondents) about waist and hip circumferences. Between 1986 and 1992, 203 new patients were diagnosed with colon cancer and 586 were diagnosed with adenomas. RESULTS: Physical activity was inversely associated with risk for colon cancer (high compared with low quintiles of average energy expenditure from leisure-time activities: relative risk, 0.53 [95% CI, 0.32 to 0.88], P for trend = 0.03) after adjustment for age; history of colorectal polyp; previous endoscopy; parental history of colorectal cancer; smoking; body mass; use of aspirin; and intake of red meat, dietary fiber, folate, and alcohol. Body mass index was directly associated with risk for colon cancer independently of physical activity level. Waist circumference and waist-to-hip ratio were strong risk factors for colon cancer (waist-to-hip ratio > or = 0.99 compared with waist-to-hip ratio < 0.90: multivariate relative risk, 3.41 [CI, 1.52 to 7.66], P for trend = 0.01; waist circumference > or = 43 inches compared with waist circumference < 35 inches: relative risk, 2.56 [CI, 1.33 to 4.96], P for trend < 0.001). These associations persisted even after adjustment for body mass and physical activity. Similar associations were seen between obesity and physical inactivity and adenomas of 1 cm or more, but no association was observed for smaller adenomas. Height was also associated with a higher risk for colon cancer (height > or = 73 inches compared with height < or = 68 inches: multivariate relative risk, 1.76 [CI, 1.13 to 2.74], P for trend = 0.02). CONCLUSIONS: The results support an inverse association between physical activity and risk for colon cancer, whereas height and obesity, particularly abdominal adiposity, are associated with an elevated risk.

Adenoma↗
PubMed1999

Use of a mail-out continuing education article to teach health professionals about drug-induced disease.

A U.S. Food and Drug Administration (FDA)/Georgetown University Medical Center conference was the basis for "Clinical Therapeutics and the Recognition of Drug-Induced Disease," the first MEDWATCH continuing education (CE) mail-out article. Developed as a major component of FDA MEDWATCH post-marketing surveillance outreach, the article used a clinical therapeutic approach to discuss topics including adverse drug events (ADEs) pharmacology and ADE reporting. Distributed nationwide through the MEDWATCH Partners, health professionals applied for CE credit by completing a self-assessment examination. With the overall response rate slightly more than 2%, 15,260 health professionals (55% physicians and 37% pharmacists) received CE credit. Evaluation of the initial approximately two-thirds (N = 10,021) of successfully completed exams found 99% agreement that stated learning objectives were met, and the article relevant to their clinical practice; spontaneous comments/letters were also very positive. The highest percentage responding specialists were internists (28%) and psychiatrists (17%), with notable differences found among specialties for response rate versus relative article distribution (such as relatively low response rates among surgeons and radiology/radiation physics specialists). The number of health professionals receiving CE credit, coupled with examination performance and overall response, indicates that "Clinical Therapeutics and the Recognition of Drug-Induced Disease" was well received and fulfilled learning objectives. The results provide encouragement for this continuing educational approach.

Adverse Drug Reaction Reporting Systems↗
PubMed1996

Mass mailing campaigns to promote screening for cervical cancer: do they work, and do they continue to work?

Campaigns involving sending personally addressed letters to encourage women to have Pap smears increase Pap smear rates. The aim of this study was to assess whether this effect is maintained when campaigns are repeated regularly. In October 1992, a letter reminding women of the importance of screening was mailed to all women in three New South Wales postcode regions where a similar letter had been sent three years previously. The response was compared to the response in three regions receiving no earlier letter. The number of women attending for cervical screening during the three months after distribution of the letters was assessed from Health Insurance Commission claims for cervical cytology. These attendances were compared with expected attendances based on the attendance patterns over 28 pre-intervention quarters. Significant postintervention increases in attendance were observed in all three regions receiving an initial letter. However, in one region, the increase in attendances, around 1 per cent of eligible women, was not significantly greater than the increase in the control region (z = 0.15, P = 0.88). The second letter campaign had no measurable effect on attendances. No significant increase in screenings was observed in two of the towns. A significant increase was observed in one region, but this was not significantly greater than the increase in the control region (z = -0.05, P = 0.96). These results suggest that repeated direct-mail campaigns to promote screening for cervical cancer may be of no benefit. A one-off campaign may result in an increase in screenings in the short term.

Adolescent↗
PubMed2003

The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis.

STUDY DESIGN: Outcome study to determine response distribution, internal consistency, reproducibility, and concurrent validity of the Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. OBJECTIVES: Further refinement of an HRQL questionnaire specific for idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Previous experience with the original and modified SRS HRQL questionnaires suggested a need for further refinement and more complete validation. METHODS: The SRS-22 and Short Form 36 (SF-36) HRQL questionnaires were mailed to 83 previously surveyed postoperative idiopathic scoliosis patients. RESULTS: Fifty-eight (70%) patients returned the first set of questionnaires. Their average age at surgery was 14.6 years, and their average follow-up interval since surgery was 10.8 years. Fifty-one (88%) of the 58 returned the second set of questionnaires an average of 28 days later. The psychometric attributes of the instruments were comparable: score distribution, SRS-22 56.9% ceiling and 1.7% floor, SF-36 79.3% ceiling and 1.7% floor; internal consistency (Cronbach alpha), SRS-22 0.92 to 0.75, SF-36 0.91 to 0.36; and reproducibility (intraclass correlation coefficient), SRS-22 0.96 to 0.85, SF-36 0.92 to 0.61. Concurrent validity, determined by Pearson Correlation Coefficients between SRS-22 and SF-36 domains, was 0.70 or greater ( < 0.0001) for 17 relevant comparisons. CONCLUSION: The SRS-22 HRQL questionnaire is reliable with internal consistency and reproducibility comparable to SF-36. In addition, it demonstrated concurrent validity when compared to SF-36. It is shorter and more focused on the health issues related to idiopathic scoliosis than SF-36.

Adolescent↗
PubMed2004

Social inequality in perceived oral health among adults in Australia.

OBJECTIVE: To establish population estimates of self-assessed tooth loss and subjective oral health and describe the social distribution of these measures among dentate adults in Australia. METHODS: Self-report data were obtained from a nationally representative sample of 3,678 adults aged 18-91 years who participated in the 1999 National Dental Telephone Interview Survey and completed a subsequent mail survey. Oral health was evaluated using (1) self-assessed tooth loss, (2) the 14-item Oral Health Impact Profile, and (3) a global six-point rating of oral health. RESULTS: While the absolute difference in tooth loss across household income levels increased at each successive age group (18-44 years, 45-64 years, 65+ years) from 0.7 teeth to 6.1 teeth, the magnitude of the difference was approximately twofold at each age group. For subjective oral health measures, the magnitude of difference across income groups was most pronounced in the 18-44 years age group. In multivariate analysis, low household income, blue-collar occupation, and high residential area disadvantage were positively associated with social impact from oral conditions and pathological tooth loss. Speaking other than English at home (relative to English), low household income (relative to high income), and vocational relative to tertiary education were each associated with more than twice the odds of poor self-rated oral health. CONCLUSIONS: Significant social differentials in perceived oral health exist among dentate adults. Inequalities span the socio-economic hierarchy. IMPLICATIONS: In addition to improving overall levels of oral health in the adult community, goals and targets should aim to reduce social inequalities in the distribution of outcomes.

Adolescent↗
PubMed1989

Physician need. An alternative projection from a study of large, prepaid group practices.

To model a base level of physician demand in a managed health care system, we examined in 1983 the ratios by specialty of full-time equivalent physicians to health maintenance organization members in seven large, closed-panel health maintenance organizations, each with more than 100,000 members. The medical director of each plan was surveyed by mailed questionnaire and telephone interview to determine the plan's number of full-time equivalent physicians by specialty and members served. Out-of-plan physicians contracted by the group were included within the specialty distribution wherever possible. We compared our findings (4779.4 full-time equivalent physicians serving 4,297,790 members) with Graduate Medical Education National Advisory Committee and others' projections of physician need and supply. Based on this model and unknowns that might affect utilization, our study suggests that at least 111 physicians per 100,000 population would be necessary in a system that emphasized reduced utilization of services and that more primary care physicians would be needed than the Graduate Medical Education National Advisory Committee predicted would be available.

Forecasting↗