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Atypical epithelial cells and specimen adequacy: current laboratory practices of participants in the college of American pathologists interlaboratory comparison program in cervicovaginal cytology.

CONTEXT: The Bethesda System for reporting cervical/vaginal cytologic diagnoses introduced terminology for atypical squamous and glandular cells and categories for specimen adequacy. OBJECTIVES: To analyze current laboratory reporting practices and compare trends to previous surveys. DESIGN: Questionnaire surveys were mailed to 2000 laboratories in 1996 and 1997. PARTICIPANTS: Laboratories enrolled in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. MAIN OUTCOME MEASURES: Laboratory policies, criteria, and reporting rates for Bethesda System categories. RESULTS: The 1996 specimen adequacy survey had 1166 respondents, and 768 laboratories returned the 1997 questionnaire focusing on atypical squamous cells of undetermined significance (ASCUS) and glandular cells of undetermined significance (AGUS). Nearly all laboratories (92%) routinely reported specimen adequacy, an increase from the 66% rate in 1991. The median rate for unsatisfactory specimens was 0.5% (mean 0.95%), and the median rate for the satisfactory but limited category was 5.8% (mean 9.3%). The Bethesda criteria for designating a specimen unsatisfactory were used by more than 90% of laboratories. Nearly all laboratories (97%) used the term ASCUS in 1997, and more than 80% of laboratories used the Bethesda criteria for this category. Median reporting rates for epithelial abnormalities were as follows: ASCUS, 4.5%; AGUS, 0.3%; low-grade squamous intraepithelial lesion (SIL), 1.6%; and high-grade SIL, 0.5%. The median ASCUS/SIL ratio was 2.0, with 80% of laboratories reporting ratios between 0.64 and 4.23. The median ASCUS rate and ASCUS/SIL ratio were higher than 1993 survey results. Nearly all laboratories attempted follow-up studies on patients with abnormal cytology results, and midsized laboratories achieved the highest rates of follow-up. Median rates of abnormalities following an ASCUS or AGUS diagnosis were 20% and 15%, respectively. Laboratory respondents commonly used written recommendations in ASCUS/AGUS reports. CONCLUSIONS: Most laboratories that responded to the surveys had adopted Bethesda terminology and criteria for specimen adequacy and ASCUS/AGUS. Reporting rates for SIL and adequacy categories have remained stable, but median ASCUS rates and ASCUS/SIL ratios are higher than in 1993. The AGUS category is reported infrequently, but can be associated with significant pathology.

Clinical Laboratory Techniques↗

Issues in reproducibility and validity of dietary studies.

Numerous factors affect the reproducibility and validity of dietary assessment questionnaires. Although the respondents' abilities to respond accurately are most frequently discussed as the cause of apparently poor reproducibility and validity, many other factors are as important and perhaps more important. Most of these other factors are under the control of the investigator, and thus are amenable to improvement. Factors which may affect reproducibility included the degree of variability permitted by the instrument, the error-proneness of the response format, quality control of coding and keying and real dietary change in the time between the two administrations of the questionnaire. Factors affecting real or apparent validity include respondent characteristics, questionnaire design and quantification, quality control, and the adequacy of the reference data. The implications of inadequate reference data are illustrated and discussed.

Humans↗

The reliability of personal alcohol consumption estimates in a working population.

Health and safety problems related to alcohol consumption represent a major concern in many businesses and consequently pre-employment questionnaires and workplace health promotion packages frequently contain questions seeking basic estimates of alcohol consumption. Although individuals with very heavy drinking patterns often attract much attention, on a population basis most morbidity is likely to arise from drinkers consuming above the recommended limits but not sufficient to result in gross occupational or social effects. This study reviews the research on the reliability of questionnaire techniques used to quantify alcohol consumption and compares the most valid retrospective interview based estimate of consumption, the time line follow-back (TLFB), with a prospective daily diary (DD) method in a working population. The DD method was acceptable and produced significantly higher estimates of consumption and for 'normal' subjects gave consistent estimates of +/- 10 units/week over several weeks. Appropriate questionnaire design is discussed and the use of a DD method in health promotion activities recommended.

Adult↗

Does questionnaire format impact reported partner violence rates?: An experimental study.

Researchers assess partner violence using numerous formats, but whether questionnaire format affects obtained rates has rarely been examined. We compared paper-and-pencil versus computer administrations, and standard Revised Conflict Tactics Scales (CTS2) categories versus dichotomous (yes/no) response categories, in a 2 x 2 experiment with 160 undergraduate students. Differential validity was also examined for gender. Results provide some support for the use of all formats, although sexual coercion rates showed more measurement variability than reports of psychological aggression, physical assault, or injury. Sexual coercion effects also differed by gender. The standard CTS2 categories resulted in more disclosures than dichotomous categories for some variables. Differences between computer and paper-and-pencil formats were generally minimal. More attention to the effects of questionnaire design on disclosures of violence is urgently needed.

Adolescent↗

Acupuncture therapy for the symptoms of Parkinson's disease.

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.

Activities of Daily Living↗

Validation of a patient satisfaction system in the United Kingdom.

This paper describes the results from a study to assess the validity of a patient satisfaction system used extensively in the United Kingdom. The study involved over 700 interviews with patients. The face, content, discriminant and construct validity have been tested. The discriminant and construct validity were judged to be satisfactory and there was some evidence of face validity. The results suggest that this system has the ability to reveal differences in satisfaction between hospitals. The findings from the study are being used to modify the questionnaire design in order to improve the system's ability to indicate which aspects of the service require improvement.

Adolescent↗

Comparison of diets of diabetic and nondiabetic women.

OBJECTIVE: To assess the dietary habits of diabetic women. RESEARCH DESIGN AND METHODS: Participants in the Nurses Health Study, a cohort of 121,700 registered female nurses, were followed since 1976. We compared the usual dietary intakes of women who had been diagnosed with diabetes mellitus by 1980 and age-matched nondiabetic control women; diets of these women were assessed in 1980 and 1984 by a semiquantitative food frequency questionnaire. The study examined 162 IDDM women and 738 NIDDM women. Similar comparisons were made for 429 women who developed NIDDM between 1980 and 1984. RESULTS: Although differences were small, women with IDDM in 1984 and women with NIDDM in 1980 and 1984 consumed less energy from carbohydrates, especially from sucrose, and more energy from protein and fat than did control women. Similar results were also found in 1984 for the 429 women who developed NIDDM between 1980 and 1984. In 1980, energy from nonsucrose carbohydrate was slightly higher in both IDDM and NIDDM women than in the control women. However, in 1984, using a dietary questionnaire designed to assess more complete dietary intake, less consistent results were obtained. Diabetic women tended to avoid desserts and sweets, sugar-containing beverages, and alcoholic beverages but consumed more meat and meat products. Intakes of foods high in complex carbohydrates (e.g., bread, rice, pasta, and potatoes) were similar between diabetic and control women. CONCLUSIONS: The results suggest that these diabetic women did not consume the high-carbohydrate, low-fat diets that the American Diabetes Association has been recommending over the past decade.

Adult↗

The role of play in pediatric occupational therapy.

OBJECTIVE: This study examined the roles that play occupies within current occupational therapy practice with preschoolers. METHOD: Two hundred twenty-four pediatric occupational therapists completed mail questionnaires designed to ascertain how they use play in their practice, their knowledge and use of play assessments, and potential constraints on their use of play. RESULTS: Although respondents indicated that play was important in motivating children and frequently used play as a treatment modality or reinforcer, they less frequently assessed play behaviors or wrote treatment goals and objectives related to play. Differences were found between school-based and non-school-based respondents regarding the discipline or model that addresses play in the work setting, the use of play assessments, and constraints that limit the use of play in the work setting. CONCLUSION: The results suggest a need for increasing the emphasis on play in entry-level curricula and continuing education, improving clinician access to valid and reliable play assessments, and completing studies designed to examine the use and efficacy of play in occupational therapy intervention.

Child Behavior↗

Needs: importance and satisfaction in respiratory therapy personnel.

Using Maslow's hierarchy of needs as a base, this article attempts to determine the motivational level of respiratory therapy personnel. Also analyzed was the importance of these needs to the individuals studied. The instrument used to obtain the necessary data was a questionnaire designed to indicate a mathematical score relevant to a person's position in the hierarchy. This instrument was designed by Lyman Porter and is called the Porter needs-satisfaction index (PNSI). The respondents, who were representatives of all classes of respiratory therapy personnel, showed high levels of satisfaction in areas concerned with helping others, autonomy, and prestige. They ranked ability to help others, self-fulfillment, and feelings of accomplishment as highly important. Further analysis of the questionnaires is presently under way. It is hoped that data relative to position in the hierarchy based on demographic data will soon be available.

Attitude of Health Personnel↗

Psychiatric morbidity in long-term renal transplant recipients and patients undergoing hemodialysis. A comparative study.

This study assessed and compared psychiatric morbidity in long-term (five years or longer) renal transplant recipients and patients undergoing hemodialysis. Fifty-seven of 98 transplant recipients and 44 of 89 patients undergoing dialysis returned questionnaires designed to collect demographic information and to detect psychiatric morbidity. The two groups differed significantly only in that the patients undergoing dialysis were both older and medically sicker than the transplant recipients. Forty-six percent of the transplant group and 48% of the dialysis group could be identified as psychiatrically impaired either by their scores on the General Health Questionnaire or by a history of prior psychiatric treatment. The finding of nearly equivalent psychiatric morbidity in these two groups does not support the often-held notions about psychological advantages of transplantation over dialysis. We conclude that psychiatric morbidity in patients with chronic renal failure is high and appears not to be related to the choice of treatment.

Adjustment Disorders↗

[Characteristics of psychiatric day hospitals in Poland--results of a questionnaire survey].

AIM: The survey was aimed at describing the characteristics and therapeutic means offered and the organizational structure of Polish day hospitals for adults as well the as characteristics of patients treated there. It was part of a wider international project carried out within a 5 EC Framework Program and focused on evaluation of costs and effectiveness of day hospital treatment when set against conventional stationary treatment in different European health care systems. METHOD: Data concerning the year 2000 were gathered using a self-designed questionnaire sent to respondents by post. The response ratio reached 65.2%. RESULTS: Based on the cluster analysis, three main types of day hospitals were recognized: 1. day hospitals focused on rehabilitation of chronic mental disturbances, improvement of social functioning and support, 2. day hospitals being alternative to stationary inpatient treatment, 3. day hospitals intended to continue out-patient treatment and psychotherapy. The number of treatment places, working hours and work-days in a week in polled institutions was constant. Most frequent reasons for not admitting a patient to a day hospital were: intensive suicidal tendencies and acute psychotic decompensation. The most numerous diagnostic groups of patients treated there were schizophrenia (32.2%) and affective disorder (17.4%). Only 18.6% of day hospitals employed a qualified psychotherapist, and 32.6% had a social worker. On the average, one treatment place was offered to 5 patients during a year. CONCLUSIONS: The profile of patients admitted to Polish day hospitals for adults is not arbitrarily defined with respect to diagnosis and severity of disorder. However, it is possible to distinguish day hospitals, which have their preferences: more to rehabilitate or more to treat patients. In the last 16 years there was a threefold increase of the number of patients treated in day hospitals due to affective disturbances.

Adult↗

Young people and the structure of sexual risks in Lima.

OBJECTIVES: (1) To describe psychosocial variables related to sexual activity and the prevalence of contextual factors (e.g. coercion, paid sex and drug/alcohol use) and various sexual experiences among young men and women in Lima; and (2) to assess the relationship between psychosocial, contextual and behavioral factors on one hand and negative sexual health events such as unplanned pregnancies and sexually transmitted diseases (STDs) on the other hand. DESIGN: A cross-sectional serosurvey complemented with focus groups and in-depth interviews. SUBJECTS AND METHODS: A total of 611 adolescents (16-17 years old) and 607 young adults (19-30 years old) were recruited randomly from among those registering for military service (adolescents) or seeking work/study permits (young adults). These subjects were asked to fill out a self-administered questionnaire with detailed information on sexual experiences and psychosocial variables. The response rates were 98% (adolescents) and 82% (young adults). A subsample of 858 subjects provided blood specimens, which were analyzed for antibodies to HIV-1, the hepatitis B virus and syphilis. The relationship between the main study variables and sociodemographic indicators was also assessed, and multivariate analysis was used to identify those variables associated with sexual health problems. A preliminary qualitative phase helped in the questionnaire design and in interpreting survey findings. RESULTS: Thirty-four percent of adolescents and 75% of young adults were sexually experienced. The prevalence of bisexual behavior was high, particularly among males (12%). The males often reported paid sex (47%) and the females often reported sexual coercion (47%). Among the heterosexually active, only 11% reported consistent use of condoms. While 22% of the heterosexually active reported an unplanned pregnancy in self (females) or partner (males), 18% of the sexually active reported a history of STD symptoms or diagnoses. Among the sexually active who gave a blood sample, 0.2% were positive for HIV, 6.7% for hepatitis B and 1.5% for syphilis. Those who experienced an unplanned pregnancy or STD symptoms or, for the subsample, were seropositive for HIV or other STDs, were more likely to perceive social norms as restricting condom use to casual sex, to be older, to combine sex with alcohol or drugs and to report a history of sexual coercion or of having paid or been paid for sex. For females only, engaging in sex at a younger age was a risk marker, while engaging in any homosexual activity was protective. CONCLUSIONS: Cultural norms that restrict condoms to casual sex may place many young people in Lima at risk of an unplanned pregnancy or STDs. Sexual behavior may be especially risky in a context of sexual coercion and paid sex, when sex is combined with drugs and alcohol, and when engaged in by younger females. Sexual health education should work to change such cultural norms and these risky contexts.

Adolescent↗

Functional status and quality of life measurement among ophthalmic patients.

OBJECTIVES: Assessment of the relationship between visual function and functional status/quality of life in clinical research involving patients with eye disease by investigating whether the scores of four existing functional status/quality of life patient questionnaires are sensitive to differences in visual acuity and studying whether selected subscales of the questionnaires provide similar information concerning the relationship between functional status/quality of life and visual acuity as do the respective full-length questionnaires. DESIGN, SETTING, PARTICIPANTS: Case patients consisted of 86 consecutive patients seen at The Wilmer Ophthalmological Institute Retinal Vascular Center, Baltimore, Md. Controls consisted of 51 individuals with normal visual acuity and no known ocular disease and were frequency-matched to the case patients by age (+/- 5 years), sex, and race. Subjects were interviewed in person using each of the following questionnaires: the Sickness Impact Profile, the vision-specific Sickness Impact Profile, the Community Disability Scale, and the General Health Questionnaire. RESULTS: Scores of all four questionnaires and their subscales were significantly associated with visual acuity. The vision-specific Sickness Impact Profile and the Community Disability Scale were independently significant predictors of visual acuity. Regression analysis revealed that in our study, selected subscales of the respective full-length questionnaires were able to demonstrate the association between vision and functional status/quality of life. CONCLUSIONS: Ophthalmic patients are at high risk for decreased functional status/quality of life. Subscales of existing questionnaires potentially may be substituted for the full-length questionnaires, thereby increasing the efficiency of functional status/quality of life measurement in such patients.

Aged↗

Factor analytic study of two questionnaires measuring oral health-related quality of life among children and adults in New Zealand, Germany and Poland.

A questionnaire designed to measure oral health-related quality of life (OHRQOL) in adults and children was assessed for its factorial structure and reliability using data from the Second International Collaborative Study on Oral Health Outcomes in New Zealand, Poland and Germany. Principal component analysis with orthogonal and oblique rotation was applied. The three-factor structure hypothesized for the children's questionnaire (self-reported oral disease symptoms, perceived oral well-being, social and physical functioning) was confirmed in New Zealand and Poland, and two self-reported oral disease symptom dimensions emerged in Germany. Five factors instead of the three hypothesized were identified for adults: two dimensions of symptoms were identified, and social and physical functioning appeared to be independent dimensions of OHRQOL. Similarity between the factors was demonstrated in all three countries. The reliability of the questionnaire ranged from moderate to excellent depending on the dimension and the country. These findings provide preliminary evidence of the cross-cultural stability of the OHRQOL questionnaire in New Zealand, Poland and Germany, for both children and adults. Further investigations by the present authors of the properties of the instrument in other samples will focus on demonstrating the stability and replicability of the factor structure identified here.

Adolescent↗

[Respiratory system function in workers from the Mechanical Petrochemical Plant in Płock--influence of the workplace environment].

UNLABELLED: The aim of this study was to evaluate the influence of the work place environment on the function of the respiratory system. MATERIAL: Study covered 211 male from Mechanical Plant of Plock Refinery (M.P. group 1) and the control group consisted of 53 male employed in Design Office (D.O. Group II). Group I was exposed to toxic substances (NO2, SO2, dust, manganese and iron oxides). METHODS: Lung function tests were performed using laboratory "Compact-Lab" (JAEGER). The FVC, FEV1, FEV1%FVC, PEF, FEF50 were obtained from flow-volume curve and TGV, Rt measured using plethysmography method. Information concerning symptoms and cigarette smoking were obtained from questionnaire designed for this study. RESULTS: Mean values of respiratory indices were within normal range and did not differ between groups. The percentage of abnormal results was similar in groups. Air flow limitation (FEV1%FVC < 70%) was observed in 15.2% of total. Smokers have had significantly lower indies of air flow limitation but still within normal range. Symptoms (cough, expectoration, dyspnea) were equally frequent in M.P. and D.O. and significantly more frequent in smokers. CONCLUSION: In our study we did not find the influence of work place environment on the function of the respiratory system.

Adult↗

An 8-year comparison of hospitalized veterans' attitudes toward smoking and smoking cessation.

A 48-item questionnaire designed to measure attitudes toward smoking and interest in smoking cessation treatment was administered to 73 male hospitalized veterans and compared with previous administrations of the same instrument 4 and 8 years earlier. A surprising degree of stability of responses over time was evident. The alarmingly high rate of smoking among hospitalized veterans was again confirmed by this survey. The present survey showed that 60% of the sample smoked, compared with 68% and 69% found in the previous surveys. Forty-five percent of the smokers surveyed reported that they would be willing to participate in a program designed to help them stop smoking. It was pointed out that the Veterans Administration has failed to adequately address the problem behavior of smoking.

Aged↗

The reliability and validity of a Dutch questionnaire on fat consumption as a means to rank subjects according to individual fat intake.

In this paper a short, 25-item, telephone-administered questionnaire, designed to rank individuals according to their dietary intake of fat, is presented. Based on two studies of 52 and 639 men and women, respectively, its relative validity regarding a 7-day diet record and its reproducibility are discussed. A Pearson correlation of 0.59 was observed between fat intake estimated by 7-day diet records and fat score derived from the short questionnaire. Gross misclassification, defined as disagreement between the two fat consumption assessments beyond an adjacent tertile, was 15.4%. A Pearson correlation of 0.71 was calculated by a test-retest procedure. It is concluded that the Dutch short questionnaire on fat consumption is a rapid, simple and inexpensive method that can very well be used in nutrition education research to rank individuals according to their dietary fat intake.

Adolescent↗

Educational needs and altered eating habits following a total laryngectomy.

PURPOSE/OBJECTIVES: To describe eating-related experiences and informational needs of people following total laryngectomies. DESIGN: Descriptive study. SETTING: Internet-based laryngectomy support group in the United States. SAMPLE: 34 people with a laryngectomy (68% total laryngectomy, 29% with total plus radical neck dissection, and 3% with partial laryngectomy with radical neck dissection): 29 males, 5 females; mean age of 62 years. METHODS: Members of a laryngectomy support group completed a Food Eating Experiences and Diet Questionnaire designed by the investigators. Both quantitative and qualitative data were collected. MAIN RESEARCH VARIABLES: Effect of laryngectomy on food choice, eating habits, and overall enjoyment of eating: perceptions of teaching received from healthcare professionals regarding potential eating difficulties as a result of laryngectomy. FINDINGS: 90% of the participants experienced a change in one or more aspects of eating. The most prominent changes were decreased sense of smell, decreased taste, decreased enjoyment of eating, and an increase in the length of time required to eat meals. Most participants were not satisfied with the information they received from healthcare professionals. Topics requiring emphasis during patient teaching were identified from participants' comments. CONCLUSIONS: Total laryngectomy produced significant changes in factors related to eating that can affect nutritional intake and quality of life. Participants reported that most healthcare providers did not adequately prepare them for potential alterations in eating that can occur following a total laryngectomy. IMPLICATIONS FOR NURSING PRACTICE: Data from this study can be used to raise awareness of incidence and severity of changes in eating that occur after total laryngectomy and to improve patient preparation to cope with these changes.

Adult↗