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PubMed2002

An evaluation of patient satisfaction with an information leaflet for trauma survivors.

A new leaflet that provided information about posttraumatic reactions and how to deal with them was distributed within 14 days of attendance at the Accident and Emergency Department (ED), Aberdeen Royal Infirmary, to a heterogeneous sample of trauma patients (N = 222). An evaluation form to assess satisfaction with the leaflet was also mailed with the leaflet. A sample of 98 (44%) of the initial patient group responded, and 96% of them reported the leaflet as either very helpful or helpful. Satisfaction with the leaflet was not affected by age, by gender, or by the type of trauma encountered. Overall, the findings confirmed that such a leaflet is well received by trauma patients attending an ED.

Adolescent↗
PubMedDate not supplied

Delivery outcome among physiotherapists in Sweden: is non-ionizing radiation a fetal hazard?

A cohort study was made on 2,043 infants born to 2,018 females registered as physiotherapists at the time of pregnancy during 1973 to 1978. The incidence of perinatal death, serious malformation, short gestational duration, and low birth weight was slightly below the expected with consideration given to maternal age and parity distribution. Information on occupational exposure (use of shortwave, microwave, and ultrasonic equipment, X-ray exposure, use of electrostimulator or hexachlorophene-containing soaps) was obtained in a case-control study within the cohort from mail questionnaires with a 93% response rate. The only positive finding was a higher incidence of shortwave equipment use among the females with a dead or malformed infant than among controls. Various explanations for this finding are discussed.

Abnormalities, Radiation-Induced↗
PubMed1980

Dosimetry intercomparison for partial body x-irradiation of rats.

An X-ray dosimetry intercomparison for partial body irradiations has been performed among a number of laboratories cooperating within EULEP (European Late Effects Project Group) using mailed acrylic plastic rat phantoms. The main objective of this study was to assess the adequacy of exposure arrangements and dosimetry procedures applied to rat partial body irradiations at the participating institutes. The dose and dose distribution in lung and liver substitute material have been measured with dual thermoluminescent (TL) dosemeters LiF and CaF2:Mn. The doses from scattered radiation in the shielded parts of the phantom have also been assessed. The results of the dose intercomparison show that in the first instance six out of the eight participating institutes obtain dose values which differ by more than 5% from the standard dose. Inconsistencies are observed between the lung and liver doses administered at the same institute. After consultation, four institutes indicated the cause for their deviating dose values and quoted revised results which are closer to the standard value. Large dose gradients are measured, since six out of the eight participants applied unilateral exposures. This project has indicated the need for repeated intercomparisons and for improvements in dosimetry and irradiation procedures for partial body irradiations.

Animals↗
PubMed2004

Pain at the vulvar vestibule: a web-based survey.

OBJECTIVE: To assess the prevalence, characteristics, and ethnic distribution of pain in the vulvar vestibule among a national sample of women completing a web-based survey. METHODS: Female participants of the SurveySpot Internet research panel (Survey Sampling International) were invited via e-mail to respond to a web-based questionnaire on women's health issues. The frequency and characteristics of reported pain of the vulvar vestibule were assessed among 994 respondents, using univariate and multivariate analyses. RESULTS: Between May 24, 2002, and June 6, 2002, 730 non-African American women and 364 African American women responded to the invitation to participate, and 94.5% completed the survey. A history of pain at the vulvar vestibule was reported by 288 women (27.9%), with 80 (7.8% of the initial 1032) reporting pain within the past 6 months, 31 (3.0%) reporting pain that lasted 3 or more months, and 18 (1.7%) reporting vestibular pain lasting 3 or more months that occurred within the past 6 months. The prevalence of pain was similar in African American and non-African American women. CONCLUSIONS: The prevalence of pain at the vulvar vestibule is more common than previously estimated. The perception that vulvar pain is rare among African American women was not supported in this survey.

Journal Article↗
PubMedDate not supplied

Over-the-counter drug use in gymnasiums: an underrecognized substance abuse problem?

OBJECTIVE: Many individuals, attempting to gain muscle or lose fat, use 'dietary supplements'. Though widely available over the counter or by mail order in America and Europe, some of these 'supplements' are actually potent drugs such as androstenedione and ephedrine. We sought to estimate the prevalence of these forms of drug use in American gymnasiums. METHODS: We distributed anonymous questionnaires to 511 clients entering five gymnasiums, asking about use of both supplements and anabolic steroids. RESULTS: Among men, 18% reported use of androstenedione and/or other adrenal hormones, 25% reported ephedrine use, and 5% reported anabolic steroid use within the last 3 years; among women these rates were 3, 13 and 0%. Extrapolating from these figures to the United States as a whole, we estimated that possibly 1.5 million American gymnasium clients have used adrenal hormones and 2.8 million have used ephedrine within the last 3 years. CONCLUSIONS: Millions of men and women are currently using potent drugs, widely sold over the counter as 'supplements', despite their known adverse effects, unknown long-term risks, and possible potential for causing abuse or dependence.

Adult↗
PubMed2006

Private provider participation in statewide immunization registries.

BACKGROUND: Population-based registries have been promoted as an effective method to improve childhood immunization rates, yet rates of registry participation in the private sector are low. We sought to describe, through a national overview, the perspectives of childhood immunization providers in private practice regarding factors associated with participation or non-participation in immunization registries. METHODS: Two mailed surveys, one for 264 private practices identified as registry non-participants and the other for 971 identified as registry participants, from 15 of the 31 states with population-based statewide immunization registries. Frequency distributions were calculated separately for non-participants and participants regarding the physician-reported factors that influenced decisions related to registry participation. Pearson chi-square tests of independence were used to assess associations among categorical variables. RESULTS: Overall response rate was 62% (N = 756). Among non-participants, easy access to records of vaccines provided at other sites (N = 101, 68%) and printable immunization records (N = 82, 55%) were most often cited as "very important" potential benefits of a registry, while the most commonly cited barriers to participation were too much cost/staff time (N = 36, 38%) and that the practice has its own system for recording and monitoring immunizations (N = 35, 37%). Among registry participants, most reported using the registry to input data on vaccines administered (N = 326, 87%) and to review immunization records of individual patients (N = 302, 81%). A minority reported using it to assess their practice's immunization coverage (N = 110, 29%) or generate reminder/recall notices (N = 54, 14%). Few participants reported experiencing "significant" problems with the registry; the most often cited was cost/staff time to use the registry (N = 71, 20%). CONCLUSION: Most registry participants report active participation with few problems. The problems they report are generally consistent with the barriers anticipated by non-participants, but did not impede participation. Recruitment efforts should focus on demonstrating the benefits of the registry to providers. In addition, many participants are not utilizing the full range of registry features; further study is needed to determine how best to increase use of these features.

Attitude of Health Personnel↗
PubMed1990

Physician breach of patient confidentiality among individuals with human immunodeficiency virus (HIV) infection: patterns of decision.

To determine whether the sex, race, or sexual preference of a patient infected with immunodeficiency virus (HIV) influences a physician's decision to breach patient confidentiality, Tennessee primary care physicians were mailed a questionnaire containing a case study in which an HIV-infected patient presented a risk to a third party. Eight different descriptions of the sex, race, and sexual preference of the hypothetical patient were distributed randomly among the physicians, one description to each physician. The physicians were asked to decide whether to maintain confidentiality, notify the health department, or inform the patient's partner. Responses of 199 White male physicians were analyzed using an unconditional saturated logistic regression model. The odds ratios for these physicians saying they would send the patient's antibody status to the health department extend from 18.4 (95 percent confidence interval: 1.3, 260.1) for Black homosexual males to .5 (95 percent CI: 0, 11.5) for White homosexual females. The odds ratios for White male physicians saying they would inform the patient's partner range from 7.5 (95 percent CI: .8, 69.2) for Black heterosexual males to 1.0 (reference category) for Black homosexual females. The results suggest that when physicians decide to protect a third party by breaching an HIV-infected patient's confidentiality, their decision may be influenced in some cases by the race, sex, and sexual preference of the patient.

Adult↗
PubMed2005

Laboratory managers' views on attrition and retention of laboratory personnel.

OBJECTIVE: This study was undertaken to provide information on the current shortage of clinical laboratory employees and to identify strategies for retaining laboratory employees. DESIGN: A paper survey was distributed to 800 clinical laboratory managers. SETTING: The survey was sent to laboratory managers at their work sites. PATIENTS OR OTHER PARTICIPANTS: 190 usable surveys were returned for a response rate of 24%. INTERVENTIONS: Surveys were mailed in March 2003. MAIN OUTCOME MEASURES: The number of CLTs and CLSs considered fully staffed at the laboratory managers' institutions, the numbers of CLTs and CLSs who left the institutions in a five-year period, and the reasons employees left were tabulated. The managers' responses to questions on the factors that they considered most important in retaining laboratory employees were tabulated and categorized. RESULTS: In this five-year period (1998-2002), 5% of employees left their jobs annually. Over 60% of laboratory employees who left did so in the first five years of practice. The top five reasons that employees left their jobs were: (1) new laboratory job, (2) moved/family obligations, (3) retirement, (4) left the field entirely, and (5) employee was fired. In the first year of practice, 15% of the employees who left were fired. Between one and five years of practice, 7.3% left because of the hours or shift, 6.7% left to pursue further education for a non-laboratory career, and 6.7% left the field entirely. In the group of employees who left between five and ten years, 13.5% left the field entirely and 5.2% left for sales or clinical trials positions. Over 40% of the employees with more than ten years of experience who left did so because of retirement. CONCLUSION: Most laboratory employees who left did so to take another laboratory position; however, reasons for leaving vary with years of experience. The number of laboratory employees leaving the profession exceeds the number of new graduates entering the profession making the retention of employees essential. Laboratory managers identified salary as the most important retention factor.

Data Collection↗
PubMed1991

Time spent in state-recommended functions by consultant dietitians in Wisconsin skilled nursing facilities.

In this study we determined how consultant dietitians working in Wisconsin skilled nursing facilities distributed their time among contracted duties. At the time of the study, the 400 skilled nursing facilities in Wisconsin employed 160 consultant dietitians. Of these, 135 consultant dietitians were eligible to participate in the study. A mailed questionnaire was used to collect data on educational background, experience, and actual time spent in state-recommended functions, additional resident-care functions, and additional non-resident-care functions. Completed, usable questionnaires were returned by 65 (48%) of the 135 consultant dietitians. Data were analyzed statistically and presented as medians, means, and standard deviations. Mean time (minutes) consultant dietitians spent per resident admission activity was as follows: data collection, 31.3; care planning, 28.9; resident counseling, 18.5; medical record review, 17.7; discharge referral, 15.4. Mean time (minutes) consultant dietitians spent per month in other activities was as follows: facility evaluation, 75.3; student training, 120; allied staff training, 38.7; foodservice staff training, 46.8; technician training, 128; menu planning, 76.9; diet manual review, 21.6; quality assurance programs, 31.8; quality assurance audits, 34; report preparation for facility administrator, 33.4; and policy development, 32.8. Mean times reported in this study may be used as time guidelines by the state of Wisconsin for evaluating how skilled nursing facilities contract for services of consultant dietitians. Other state and federal regulatory agencies could use the time guidelines for comparison and verification until future studies provide more data on time standards for state-recommended functions, additional resident-care functions, and additional non-resident-care functions.

Consultants↗
PubMed2005

From a paper-based transmission of discharge summaries to electronic communication in health care regions.

OBJECTIVES: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person's medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. METHODS: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. RESULTS: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. DISCUSSION: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established.

Austria↗
PubMed1995

Task force on recurrent respiratory papillomas. A preliminary report.

OBJECTIVE: To obtain pilot data about the incidence, need for surgical intervention, and demographics of recurrent respiratory papillomas in the United States. DESIGN: Otolaryngologists were surveyed using a questionnaire with structured and open-ended questions. PARTICIPANTS: One thousand board-certified otolaryngologists practicing in the United States as of January 1, 1993, through a random mailing list provided by the American Academy of Otolaryngology-Head and Neck Surgery and all active US members of the American Society of Pediatric Otolaryngology and the American Bronchoesophagological Association. A total of 1346 questionnaires were distributed. MAIN OUTCOME MEASURES: Physician's responses to questions about their current patient load of children and adults with recurrent respiratory papillomas, their surgical and anesthetic management of the disease, and their clinical experiences with risk factors for developing recurrent respiratory papillomas. RESULTS: Projected totals for recurrent respiratory papillomas among children were 2354 new cases (95% confidence interval [CI], 1448 to 3260) and 5970 active cases (95% CI, 3465 to 8474), requiring 16,597 surgical procedures (95% CI, 6938 to 26,255) at a cost of $109 million (95% CI, $45 to 172 million) for March 1, 1993 to March 31, 1994. Projected totals for adult recurrent respiratory papillomas were 3623 new cases (95% CI, 2359 to 4887) and 9015 active cases (95% CI, 6435 to 11,591) requiring 9284 surgical procedures (95% CI, 6003 to 12,565) at a cost of $42 million (95% CI, $27 to $59 million) for March 1, 1993 to March 31, 1994. The incidence of recurrent respiratory papillomas among children is estimated at 4.3 per 100,000; among adults, 1.8 per 100,000. The carbon dioxide laser was favored by 92% of respondents. No consensus was reached on the role for cesarean section. Forty-six percent of respondents favored the use of a laser-safe endotracheal tube for anesthetic management. CONCLUSION: A registry of patients with recurrent respiratory papillomas would benefit future research protocols and provide long-term follow-up of patients.

Adult↗
PubMed2005

[Health campaign for atherosclerosis prevention].

The goal of the campaign "plus leben", a project designed to run for at least 5 years, is to heighten the awareness of patients at risk of heart disease and to provide them with an appropriate prevention program. During the first two years of the campaign 20,000 visitors were registered on the homepage, 400,000 tests for risk of heart disease were distributed, and more than 3,000 health information brochures were requested. Thus, a survey of patients was designed to provide information on the extent to which preventive measures are effective. The survey, which was carried out by mail, had a response rate of 28%, or 230 participants. In the random sample, consisting of about 60% men and 40% women, only 16% are younger than 50 years of age. Thus the survey provides a representative picture of the affected target group. The test for risk of cardiac disease provided by "plus leben" led to an increase in awareness of preventive measures in more than two thirds of the respondents, and 60% also completed the test. Although only a fourth of the patients are regularly informed by their physician about preventive measures, the campaign has led about 90% of the respondents to make fundamental or at least partial changes in their lifestyle. In connection with the study it was shown that the media play an important role in providing information on preventive measures. Communication in the doctor's office as an important building block in raising consciousness about atherosclerosis prevention could be further improved.

Adult↗
PubMed2006

U.S. board-certified pain physician practices: uniformity and census data of their locations.

UNLABELLED: We determined the profiles of the board-certified pain physician workforce and the profiles of those residing near medical pain practices. Data from a mail survey of U.S. pain specialists were compared with U.S. Census data, and different settings and types of practices were contrasted. The 750 respondents (32.1%) were similar to the entire board-certified group in age, geographic distribution, and primary specialty. Although pain practices were underrepresented in rural areas, their prevalence was unrelated to other demographic data. Ninety-six percent of pain physicians treated chronic pain; 84% followed patients longitudinally; 31% worked in an academic environment; 50% had an interdisciplinary practice; and 29% focused on a single modality. Academics were more likely to be neurologists (P < .05) and to have had a pain fellowship (P < or = .0001). Modality-oriented practitioners were more likely to be anesthesiologists (P < or = .0001) and were less likely to follow patients with chronic pain longitudinally (P < or = .0001), provide training to fellows, prescribe controlled substances (P < or = .0001, respectively), or require an opioid contract (P < or = .01). Although boarded specialists learn from similar curricula and must pass a certifying examination, their practices vary considerably. Data are needed to further clarify the nature of workforce variation, its impact on patient care, and the role of other pain management clinicians. PERSPECTIVE: A survey of board-certified pain specialists reveals considerable variation in practice and a total number of specialists that is probably insufficient to meet the needs of the population with chronic pain. The location of pain management practices largely corresponds to census data, with the exception of underrepresentation in rural areas.

Adult↗
PubMed2003

Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation.

A randomized trial was conducted of two different self-help programs for panic disorder (PD) on the Internet. After confirming the PD-diagnosis with an in-person structured clinical interview for DSM-IV (SCID) interview 22 participants were randomized to either applied relaxation (AR) or a multimodal treatment package based on cognitive behavioral therapy (CBT). Overall, the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail has a significant medium to large effect (Cohen's d=0.71 for AR and d=0.42 for CBT). The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs.

Adult↗
PubMed1997

Urea breath tests for the detection of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori is recognized as an important human pathogen. The urea breath test, using either 13C or 14C, provides a noninvasive diagnostic method for the detection of active H. pylori infection. METHODS: We review the data regarding the utility of the urea breath test in the diagnosis and follow-up of patients with suspected H. pylori infection. RESULTS: Following its ingestion, labeled urea is hydrolyzed by H. pylori urease, producing ammonia and labeled CO2, which is absorbed and can be detected in expired breath. The urea breath test provides a semiquantitative assessment of the load of H. pylori and overcomes the problem of the sampling error due to the patchy distribution of the infection. 13C-urea breath test has an advantage over the 14C version, because the 13C isotope is a nonradioactive natural isotope; therefore, a user's license is unnecessary, making simple the handling and mailing of samples. The 13C-urea breath test is preferred in children and expectant mothers. CONCLUSION: The high sensitivity, and specificity of the 13C-urea breath test are such that it can be considered a clinical gold standard against which other diagnostic methods can be validated. This test can be used as the sole method for evaluating the effectiveness of treatment of H. pylori infection.

Helicobacter Infections↗
PubMed2002

[Survey of physicians working for AIDS core hospitals on foodborne disease reporting].

OBJECTIVES: To clarify the attitude of physicians toward the diagnosis and reporting on patients with foodborne disease after implementation of infectious disease prevention and medical treatment to patients as per the Infectious Diseases Act of 1999. METHODS: A questionnaire, including experience of diagnosis and reporting on patients with foodborne disease, was mailed to all physicians in charge of AIDS treatment in medical facilities established as AIDS core hospitals. RESULTS: Out of the 391 AIDS core hospitals, 224 (57%) cooperated with the survey. Seven hundred and four questionnaires were distributed to physicians and 681 (97%) were returned. The number of physicians with experience of diagnosing patients with foodborne disease was 391 (57%). One hundred and sixty-six physicians (57%) answered "Reported occasionally" and fifty-five (14%) answered "Never reported". The two main reasons for not reporting were "Did not report because I thought there were no other cases" and "Did not report because the case was not so severe". CONCLUSIONS: A single or sporadic case must be reported by physicians to health authorities to ensure an early alert of illness or potential illness that could affect communities.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Using willingness to pay to measure family members' preferences in mental health.

BACKGROUND: Willingness to pay is a valuation technique that has rarely been applied in mental health economics. First used in environmental economics to measure the intangible value of environmental improvements, WTP has increasingly been used in health care economics. The technique may be useful in mental health policy research where it can be critical to include the intangible impact of mental health treatment on individuals other than the person with illness, such as family members, in cost-benefit analyses. AIMS OF THE STUDY: The goal of the study was to test the application of WTP in a sample of individuals who have family members with serious mental illness. This paper describes the survey development process and the feasibility analysis that was conducted as part of the study. METHODS: A mail survey was designed by the author in two phases and utilized cognitive pretests and focus group pretests in the process of development. Qualitative analysis of this process resulted in a revised survey instrument that was then distributed to a random sample of 2000 individuals who have family members with mental illness. Feasibility was evaluated based upon the study response rate, the willingness to pay item response rate and an outlier response analysis. RESULTS: Qualitative analysis during the survey development process found that it was critical to consider two areas of concern in the application of WTP with this population in the mental health field. Some respondents experienced a highly emotional response to the initial versions of the survey, and complex probabilities were difficult for the respondents to answer. These findings resulted in significant modifications in the survey design. The analysis of response rate, WTP item non-response rate, and outlier responses found no significant concerns regarding overall feasibility of WTP with this population. DISCUSSION: Based upon the results from this study, WTP is a potentially useful tool for further research in the mental health policy and economics field. However, significant accommodations must be made in survey design to account for a possibility of a high level of emotional distress for those dealing with the illness of a family member. Some of these modifications may be in contrast to the recommendations currently being followed in health care economics. Face-to-face surveys may be preferred in some cases, such as with elderly respondents. Limitations of this study include the lack of targeted follow-up due to the anonymous study design and the fact that there are so few models for WTP studies in mental health. IMPLICATIONS FOR MENTAL HEALTH POLICY: Given that effective mental health programs can be matched with additional expenditures, it is important to explore comprehensive measures of value for treatment in cost-benefit analysis. The values of persons whose family members have serious mental illness are important to consider in setting policy. The success of this study suggests that WTP could be used in other settings, e.g., to understand community preferences for mental health treatment programs, to understand differences in preferences across multiple stakeholder groups.

Consumer Behavior↗
PubMed2005

Increasing response to mailed questionnaires by including a pencil/pen.

Nonmonetary incentives lead to small increases in response rates to mailed questionnaires. However, inclusion of a pen or pencil, which may be a facilitating factor as well as a reward, has not been shown to improve response to health surveys in prior trials. In 2001 and 2002, the authors conducted two US trials in which a study-logo pen or pencil was randomly included in a second questionnaire mailed to nonresponders to a first mailing. In the first study, of 10,686 nonresponders to a cohort recruitment mailing, response to the second mailing was 55% with inclusion of a pen versus 40% without one (p < 0.001). In the second study, of 141 nonresponders to a pilot follow-up survey conducted 2 years after entry into a cohort, response was 43% with inclusion of a pencil versus 24% without one (p = 0.02). This 15-19 percentage point increase for mailing 2 translated to a 5-6 percentage point increase after the two mailings combined. In a simulated study of three mailings based on these studies, the overall response rate increased by 4 percentage points at no added cost through inclusion of a pencil in the second mailing. The additional cost of the pencil was compensated for by the reduced number of nonrespondents sent packets at the third mailing. This study supports including a study-logo pen or pencil in a second questionnaire mailing to nonrespondents as a cost-effective method of increasing response rates.

Aged↗