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PubMed1999

A comparison of two measures of stage of change for smoking cessation.

AIMS: To compare two questionnaires used to identify the stages of change of current and former smokers: a conventional five-item questionnaire and an alternative one-item questionnaire. DESIGN AND SETTING: Mail surveys of 1167 ever smokers in Geneva (Switzerland), conducted in 1997. Participants were classified into five stages: precontemplation, contemplation, preparation, action and maintenance. Other questions covered smoking-related behaviours, attitudes and self-efficacy. FINDINGS: Only 62% of participants were classified as being in the same stage by the two questionnaires (weighted kappa = 0.69). The five-item questionnaire produced more missing data (8%) than the one-item questionnaire (2%, p < 0.001). Using the conventional questionnaire, the precontemplation stage included a group of smokers who had absolutely no intention of stopping smoking and a group more prone to change, and the preparation stage included only 43% of people who had made a "firm decision" to quit smoking in the next 30 days. Using the alternative questionnaire, the contemplation stage was also quite heterogeneous. The action stage included over 35% of people who were still smoking occasionally, whichever questionnaire was used. CONCLUSIONS: The single-item questionnaire was better at avoiding missing responses. However, both staging questionnaires classified smokers in heterogeneous groups, and both misclassified many occasional smokers and ex-smokers, which suggests that a discrete five-stage model does not fit reality well. This may reflect underlying conceptual issues, notably that the classic definition of stages incorporates separate dimensions, albeit incompletely (current behaviour, quit attempts, intention to change, time). Both theoretical and methodological developments are needed to overcome these problems.

Adaptation, Psychological↗
PubMed2003

Late outcome of nonoperative management of thoracolumbar vertebral wedge fractures.

OBJECTIVES: To study the medical and social outcome of nonoperative management of traumatic thoracolumbar vertebral wedge fractures in the absence of neurologic damage. DESIGN: Retrospective review of data, as elicited from records and from patients. SUBJECTS AND METHODS: We retrieved the hospital records of 85 consecutive patients who conformed to the foregoing definition and whose admission for fracture had taken place at least 3 years earlier. The current status of each patient was inquired into by a mailed questionnaire designed to determine: 1) presence and severity of back pain; 2) presence and magnitude of overall disability; and 3) current work capacity, postinjury employment history, and history of litigation concerning the injury. Using the last radiographs of the spine, measurements were taken of anterior column deformity (Willen formula) and degree of local, fracture-related kyphosis (lateral angle of Cobb). Correlations between paired variables and group comparisons with respect to means of pain indices were analyzed statistically by analysis of variance (chi 2) and regression analysis. RESULTS: Chronic pain predominant in the lower lumbar area was reported in 69.4% of subjects. Mean pain index was 2.94 +/- 2.67 on a scale of 1 to 10. The mean overall disability score was 56.3 +/- 14.2 on a scale of 1 to 100. Pain intensity was correlated with angle of local kyphosis (p = 0.04) but not with magnitude of anterior column deformity. Twenty-five percent of the subjects had changed jobs, mostly from full- to part-time employment. Forty-eight percent of patients who filed lawsuits concerning their injury versus 11% of those who did not (p = 0.04) were absent from work for > or = 6 months. CONCLUSIONS: Traumatic, uncomplicated thoracolumbar wedge fractures of the vertebral body, below given limits of local kyphosis and anterior column deformity, are adequately managed by a limited period of bed rest alone. Surgery, bracing, and intensive physiotherapy are not indicated.

Adolescent↗
PubMed1999

The Florida School Violence Policies and Programs Study.

The Florida School Violence Policies and Programs Study (FSVPPS) assessed characteristics of violence prevention and control policies and education programs in Florida's 67 public school districts. Data were collected using the Florida School Violence Policies and Programs Questionnaire (FSVPPQ). Instruments used in the national School Health Policies and Programs Study (SHPPS) served as the framework for item development. A questionnaire designed to solicit information about violence policies and education programs was mailed to all 67 school districts in Florida during spring 1996. Sixty-seven key informants were selected by asking district office personnel to identify the person with primary responsibility for violence prevention activities in their district. Fifty-five school districts returned completed questionnaires, yielding a usable response rate of 82%. Respondents included personnel of superintendent rank, district administrators and directors, instructional specialists, principals, and "Safe & Drug Free Schools" coordinators. Participating school districts were evenly distributed geographically across Florida. The FSVPPS data reported in this paper include administrative and programmatic information about violence prevention education.

Adolescent↗
PubMed1995

Escherichia coli O157 infection associated with a farm visitor centre.

During the summer of 1994, four cases of bloody diarrhoea and/or haemolytic uraemic syndrome were reported to the consultants in communicable disease control in Nottingham and Leicester. One case was an adult, and there were three children aged 2 to 4 years. The initial investigation failed to reveal any common foodstuff as the cause of the outbreak, but all four cases had attended a farm visitor centre in Leicestershire in the three weeks before they became ill. A further three cases were found who had visited the same farm. A joint investigation took place with environmental health officers and the local veterinary investigation centre of the Ministry of Agriculture, Fisheries and Food. A questionnaire designed to ascertain possible sources of infection was sent to all cases. Several of the animals on the farm were sampled for Escherichia coli O157 and the farm's facilities for food preparation and hygiene were assessed. The pattern of infection did not suggest a point source for the outbreak. Analysis of responses to the questionnaires failed to reveal any common factor other than the visit to the farm, and all but one case remembered stroking and feeding the animals. Food preparation in the farm restaurant appeared to be satisfactory and there was no evidence of contamination of food with pathogenic bacteria. E. coli O157: H7, PT2, VT2 was isolated from four of the seven human cases and also from four cattle and six goats. Further analysis using restriction fragment length polymorphism (RFLP) showed that the four human strains were indistinguishable from nine of the 10 animal strains. It was concluded that the most likely cause of this outbreak was direct contact with the animals. This was further supported by poor handwashing facilities and lack of information for the visitors on the importance of personal hygiene.

Adolescent↗
PubMed2001

Ascertainment of pesticide exposures of migrant and seasonal farmworker children: findings from focus groups.

BACKGROUND: To design questionnaires for epidemiologic research among children of migrant farmworkers, researchers need to consider ways to best solicit information about pesticide exposures. METHODS: Bilingual facilitators conducted five focus groups with either migrant farmworker mothers or their children (age range 8-16 years) in southern Texas and northeastern Colorado. Guided questions were used to assess activities of migrant farmworker children and the ways to best elicit information about exposure to pesticides. RESULTS: Participants reported a large number of activities that may potentially expose children to pesticides through both direct and indirect routes. Prompting, indirect questions about chemical use, and use of local and trusted facilitators increased information elicited from focus group participants. CONCLUSIONS: These focus groups helped to provide information for developing questionnaire items related to pesticide exposure among migrant farmworker children, and highlighted the importance of using bilingual community interviewers and including children as respondents.

Activities of Daily Living↗
PubMed1992

Self-administered patient questionnaire for assessing knowledge about joint arthroplasty prior to surgery.

This article assesses the discriminant validity of a questionnaire designed to test patients' knowledge about total joint arthroplasty prior to preoperative educational intervention. The method employed was to compare responses on the test by surgeons, health care workers, and patients and to evaluate whether the test could discriminate among groups. A total of 148 patients, 59 health care workers and 28 orthopedic surgeons completed the questionnaire. The results show that patients are knowledgeable about the benefits of surgery, but are in need of information about surgical risks and complications. The test was able to discriminate between surgeons and the other two groups, but there were few differences between health care workers and patients. Item analysis also demonstrates that the test is reliable. Although the test exhibits acceptable psychometric properties, a major problem in using this test in evaluating educational interventions is the relatively high average score and the potential ceiling effect that prevents measurement of further gains in knowledge. More work is needed on expanding the test to include more items where knowledge of total joint arthroplasty is limited.

Discriminant Analysis↗
PubMed1993

Caregivers of persons with stroke: their physical and emotional wellbeing.

This descriptive study was undertaken as a pilot test for several questionnaires designed to examine the well-being of caregivers of persons with stroke. This predominantly female sample was found to have moderately few physical symptoms, but to be in considerable emotional distress. Nearly half the sample had anxiety and depression scores above the level identified as suspicious for clinically relevant distress as indexed by the Symptom Questionnaire. Anger was also a salient finding: 40% of those questioned scored above the cutoff level for hostility and several caregivers expressed anger verbally during data collection. The degree of psychological distress in these individuals is of importance to all health care professionals and deserves increased attention, both from the perspective of the researcher and from the perspective of the clinician.

Adult↗
PubMed2004

Prevalence of female genital mutilation among African women resident in the Swedish county of Ostergötland.

OBJECTIVES: To establish the prevalence of female genital mutilation (FGM) among African women resident in the Swedish County of Ostergötland and assess the types of FGM. MATERIAL AND METHODS: Three hundred and four African women aged > or = 18 years were domiciled in Ostergötland by the end of 1998. The women were invited by letter. A socio-cultural questionnaire designed to give an overall picture of FGM within a socio-economic context, and also to invite the women to an interview and examination, was sent to all African women in the county of Ostergötland. Women who gave their consent (n = 63) underwent a gynecologic examination. RESULTS: The response rate was 84%. According to the questionnaire, 68% of all the African women were genitally mutilated. The clinical examination revealed that 39 women (62%) were mutilated, 17 of them (44%) had undergone removal of part or all external genitalia and stitching ('infibulation'), 26% had undergone removal of the prepuce of the clitoris ('prepucectomy'), 23% had undergone various cultural practices on the external genitalia, and 7.7% excision of the clitoris with partial or total removal of labia minora ('clitoridectomy'). CONCLUSION: The influx of immigrants to Sweden and the other Scandinavian countries from cultures where FGM is practiced, requires that physicians and other health professionals familiarize themselves with the practice and the cultural beliefs underlying it. Sensitivity to the needs of these women as well as attention to the potential physical hazards posed by the practice are important factors in care.

Adult↗
PubMed1998

Evaluation of a primary care counselling service in Dorset.

BACKGROUND: Research into the effectiveness of counselling in primary care is rare. This study attempts to provide a thorough evaluation of the effects of a new counselling service introduced throughout Dorset. AIM: To evaluate the impact of counselling on client symptomatology, self-esteem, and quality of life. The effect of counselling on drug prescribing, referrals to other mental health professionals, and client and general practitioner (GP) satisfaction were also assessed. METHOD: All new clients referred for counselling were asked to complete and return questionnaires before and after counselling. A total of 385 clients took part in the study. The first and second assessments were compared statistically. Clients were ascribed a psychiatric diagnosis using a simplified version of DSM-IIIR (Diagnostic and Statistical Manual of the American Psychiatric Association). GPs' views of the service were determined using a specially designed questionnaire. Drug data were obtained from the Prescription Pricing Authority and referral statistics from Dorset HealthCare National Health Service (NHS) Trust. RESULTS: The number of psychiatric symptoms and their severity were significantly reduced by counselling. There were no significant differences in the prescription of anxiolytic/hypnotic and anti-depressant medication between matched practices with and without counsellors. The presence of a counsellor did not affect the rate of referral to other mental health professionals. Clients and GPs valued the service highly. CONCLUSIONS: The Psychology Managed Counselling Service is an effective method of running a counselling service and is well received by both clients and GPs. Counselled clients improved significantly on several measures.

Counseling↗
PubMed2000

A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda.

BACKGROUND: Currently available aqueous purgatives used before colonoscopy are poorly tolerated. We designed a tableted sodium phosphate purge that we believe will yield much greater patient acceptance. METHODS: A total of 305 outpatients undergoing routine diagnostic colonoscopy were randomized to one of three preparation groups: Colyte (100 patients), Fleet Phospho-Soda (106 patients), or sodium phosphate tablets (99 patients). Endoscopists were blinded to the type of preparation administered and answered a questionnaire regarding preparation quality. Patients answered a questionnaire designed to analyze tolerability. Adverse events were closely followed and recorded. RESULTS: There were no significant differences in quality of preparation across the groups (80% excellent or good, 4% repreparation). Although hypocalcemia (4 of 71), hypokalemia (18 of 68), and hyperphosphatemia (39 of 69) were observed in patients receiving the tablets, no adverse events occurred. Patients preferred taking the tablets over Colyte and Fleet Phospho-Soda. CONCLUSION: The evaluation of a novel delivery system of a sodium phosphate purge is described. Intended for use before colonoscopy, it circumvents the poor taste and excessive volume of ingestion that are aversive to patients. The tableted purgative is equally effective, safe, and greatly preferred over the existing aqueous preparations. This may improve patient compliance with recommendations for screening colonoscopy.

Administration, Oral↗
PubMed2005

Sesame allergy in Britain: a questionnaire survey of members of the Anaphylaxis Campaign.

Sesame is a major allergen in countries where it is a common food. It was noted that an increasing number of members of the UK charity, the anaphylaxis campaign, were reporting allergy to sesame. This study, sought to examine features of sesame allergy among members of the Anaphylaxis Campaign (which supports those at potentially life-threatening risk from allergies) focusing on clinical symptoms and features of the foods implicated. A physician-designed questionnaire was sent by post to 400 members of the Anaphylaxis Campaign who reported avoidance of sesame. Two hundred and eighty replies were received (70%). Twenty-three replies (7%) were excluded and 96 replies (24%) came from subjects who avoided sesame but had never reacted to it. One hundred and fifty people (54%) reported 288 reactions to sesame. 89% of reactive subjects reported other atopic diseases and notably 84% were also nut/peanut allergic. One in six (17%) had suffered potentially life-threatening symptoms, with 65% of severe reactions happening on first known exposure. The age of first reaction ranged from 6 months to 65 yr. The majority of reactions reported (91%) involved foods or dishes which had sesame as a deliberate ingredient, rather than sesame as an accidental contaminant. Respondents represented a well-informed and highly selected group of people at risk from potentially life-threatening allergies. Sesame should be identified clearly as an ingredient and separately from nuts and peanuts when it may be an allergen contaminant. People at potential risk need clear allergy diagnosis and informed guidance to enable them to avoid this key allergen more easily.

Adolescent↗
PubMed2006

Factors motivating dyspepsia patients to enter clinical research.

One of the most influential factors in science and medicine has been the development of placebo-controlled clinical trials. However, recruitment of patients for clinical trials is sometimes a major problem in clinical research. Successful patient recruitment may be enhanced with a clear understanding of the motivating factors that determine a patient's decision to enter a study. We have developed the Patients' Expectations, Attitudes and Knowledge (PEAK) Program consisting of questionnaires designed to study the factors motivating patients to enter a clinical trial, as well as capturing the experiences of research participants. A total of 247 female patients with dyspepsia (mean age: 43.9; range: 18.0-78.0 years) who entered either of two prospective double-blind, randomized, placebo-controlled multicenter trials in the USA completed PEAK Entry questionnaires during the first study visit. Based on their responses, the top three factors motivating patients to join the clinical trial were: interest in receiving investigational treatment with average score (AS) of 4.33 +/- 0.08 (M +/- SEM) on a 5-point scale, possibility of getting skilled professional care (AS = 4.07 +/- 0.09), and altruism expressed as an intention to help develop a new drug for the sake of other people (AS = 3.89 +/- 0.09). Age, ethnicity, and educational status significantly affected motivational factors of patients. These results indicate that recruitment can be enhanced by targeting these motivations in physician/patient communications, informed consent process and advertising for study participants.

Adolescent↗
PubMed2001

Botulinum A toxin improves life quality in severe primary focal hyperhidrosis.

Focal hyperhidrosis is a condition that may disturb emotional, social and professional life. Treatment options for severe cases are surgical sympathectomy and local chemical sweat gland denervation by intradermal injections of botulinum toxin A (Btx A). The Dermatology Life Quality Index (DLQI) is a simple validated questionnaire designed to measure and compare disability in different skin diseases. The aim of this study was to assess quality of life with the DLQI before and after treatment with botulinum toxin injections in a group of patients with severe hyperhidrosis. DLQI was administered to 58 randomly chosen patients before and after treatment. All patients answered the DLQI questionnaire prior to treatment and 53/58 at mean 5.2 months after treatment. The mean DLQI score in the 58 patients before treatment was 10.3 (2-23). In the group of 16/53 patients who had a relapse of sweating when answering the DLQI a second time, no significant improvement was seen [score 10.6 before and 8.8 after treatment (P = 0.21)]. In patients without relapse, a 76% improvement was obtained (DLQI was reduced from 9.9 to 2.4; P < 0.0001). The study showed that focal hyperhidrosis may considerably reduce life quality and the disability experienced by the patients can be largely reversed by botulinum toxin injections.

Adolescent↗
PubMed1988

Assessment of denture satisfaction.

The aim of this investigation was to evaluate the reliability and validity of a complaints questionnaire, designed to measure different aspects of denture satisfaction. Two groups of patients with full maxillary and mandibular dentures participated in the study. The patients in Group 1 (n = 113) were on a waiting list for new dentures, patients in Group 2 (n = 102) had recently had new dentures fitted. Five denture complaint scales were constructed from the questionnaire. The internal consistency (coefficient alpha) of the scales varied from 0.65 to 0.92. Furthermore, the scales showed a discriminatory ability between the patient groups (P less than or equal to 0.001) and significant Pearson correlation coefficients with satisfaction-related questions (r = 0.25-0.79). The scores on the scales can be considered a quantitative measure of denture satisfaction.

Consumer Behavior↗
PubMed2002

[At-home self-care of patients of long-term survival after renal transplantation: a survey of current status].

OBJECTIVE: To understand the current status of at-home self-care implemented by patients with renal transplantation of long-term survival, so as to provide the patients with adequate professional advice and follow-up care after discharge from hospital. METHOD: A survey was conducted in 248 patients who survived for over 3 years with functioning transplanted kidneys by utilizing a self-designed questionnaire. RESULTS: The at-home self-care was generally not well practiced by the patients with apparent lack of self-care awareness and abilities. Though the current status problematic, the survey showed that 96.32% of the patients wished to be informed about self-care knowledge and skills. CONCLUSION: The patients currently lack at-home self-care abilities and the medical staff should carefully design self-care plans tailored to the needs of individual patient to improve the survival of the patients and the transplanted kidneys as well.

Adolescent↗
PubMedDate not supplied

Handling of the MED-EL TEMPO+ ear-level speech processor by paediatric cochlear implant users and their parents.

MED-EL launched the first ear-level speech processor offering a high-rate CIS+ strategy, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy, when compared to the body-worn processor. In this study we evaluated responses from parents of young children about ease of handling and usage of the TEMPO+, and satisfaction with the TEMPO+ and its performance. Overall, 65 custom-designed questionnaires were analysed. The results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and using the accessories provided. These results confirm the suitability of the TEMPO+ for infants and toddlers.

Adolescent↗
PubMed1995

Feasibility and acceptability of a proposed infant feeding intervention trial for the prevention of type I diabetes.

OBJECTIVE: To determine the feasibility of a randomized double-blind controlled trial of an infant formula without intact cow's-milk protein for preventing type I diabetes in high-risk children. RESEARCH DESIGN AND METHODS: We surveyed 83 people who either were parents of a child with type I diabetes or were pregnant women with type I diabetes in the ambulatory diabetes and obstetrics clinics in a university hospital. After a written and verbal description of the cow's milk-diabetes hypothesis, participants were asked to sign a sham consent form. A questionnaire designed to explore factors affecting their decision to either sign or not sign the consent form, as well as infant-feeding patterns, was subsequently administered. RESULTS: Overall, 69.9% (95% confidence interval, 60.0-79.8%) consented to participation in the proposed randomized trial. The decision to consent was not affected by the degree of belief in the cow's milk-diabetes hypothesis, the child's risk of diabetes, the respondent's demographic data, or infant feeding habits. CONCLUSIONS: A randomized feeding intervention study is an acceptable and feasible way to determine whether avoidance of cow's-milk protein during the first 6 months of life prevents type I diabetes in North American children.

Animals↗
PubMed1992

Methicillin-resistant Staphylococcus aureus: a questionnaire survey of 75 long-term care facilities in western New York.

OBJECTIVES: To determine the frequency of recognition of methicillin-resistant Staphylococcus aureus (MRSA) as an infection control problem and its prevalence among long-term care facilities, and to evaluate whether certain long-term care facility characteristics such as bed size, ownership, level of infection control activity, and frequency of resident transfers to acute care hospitals are related to the recognition or prevalence of MRSA in this setting. DESIGN: Questionnaire survey. SETTING: Seventy-five long-term care facilities in the 8 counties of western New York. RESULTS: Seventy-five of 81 (92.6%) long-term care facilities returned a completed questionnaire. Seventy-nine percent were considered to have a "limited" level of infection control activity (part-time infection control practitioner who spent less than 10 hours a week on infection control activities). The larger the long-term care facility, the more time was spent on infection control activities (p = .01). Seventy-two percent of the long-term care facilities screened new admissions for MRSA by reviewing culture reports; 69% of the long-term care facilities had a specific infection control policy for MRSA. Sixteen of the 75 (21%) facilities felt they had an infection control problem with MRSA. By univariate analysis, the only characteristic significantly associated with this recognition was use of nurse practitioners or physician assistants by a facility (p < .05). Eighty-one percent of the 75 long-term care facilities had identified one or more patients with MRSA in the year prior to the survey. By univariate analysis, the only characteristics that were significantly associated with the number of residents with MRSA were the monthly average number of residents transferred to acute care facilities (p = .034) and facility bed size (p = .022); there was also a trend toward increasing intensity of infection control activities (p = .085). However, facility bed size and the average number of resident transfers per month to acute care facilities were strongly associated (p = .0002). By stepwise logistic regression analysis, only bed size was an independent predictor of the number of residents with MRSA. Many long-term care facilities had tried to eradicate MRSA; ciprofloxacin was most commonly used to eradicate MRSA. CONCLUSIONS: The vast majority of the 75 long-term care facilities in the 8 counties of western New York have identified patients with MRSA, although only a minority (21%) of them actually believed that an infection control problem existed. Facility size (a surrogate for the monthly average number of resident transfers to acute care facilities) seems to be an important factor in determining the number of residents with MRSA in long-term care facilities in our geographic region. The major longitudinal studies of MRSA in such facilities have so far been done only in Veterans Affairs facilities. Further studies are needed in freestanding long-term care facilities, the largest group of long-term care facilities in the United States, to determine the epidemiology of MRSA in this setting and to develop practical and valid infection control methods for residents with MRSA.

Health Facility Size↗