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PubMed2002

Using telephone interviews to reduce nonresponse bias to mail surveys of health plan members.

OBJECTIVE: To assess the nonresponse bias associated with mail-survey returns and the potential for telephone interviews with nonrespondents to reduce that bias. METHODS: A mail survey about health care experiences was conducted with samples of 800 members in each of four health plans. Subsequent attempts were made to interview nonrespondents by telephone. RESULTS: Response rates for the mail surveys averaged 46%; the telephone effort raised the average to 66%. On 17 of 19 measures of health status or need and use of health services, mail respondents were in poorer health and needed more services than interviewed nonrespondents. Thirteen of 36 reports and ratings of health care also differed significantly between the two groups. Based on administrative data, telephone interviews of mail nonrespondents improved the demographic representativeness of the responding samples. Adjusting mail returns to sample population characteristics could not replicate the dual-mode results. CONCLUSIONS: Returns to mail surveys are likely to be related to survey content and hence are potentially biased. Nonresponse to phone surveys is less directly related to survey content. Telephone interviews with mail nonrespondents not only increase response rates but also can produce less biased samples than mail-only protocols.

Adult↗
PubMed2004

Design and evaluation of a personal digital assistant- based alerting service for clinicians.

PURPOSE: This study describes the system architecture and user acceptance of a suite of programs that deliver information about newly updated library resources to clinicians' personal digital assistants (PDAs). DESCRIPTION: Participants received headlines delivered to their PDAs alerting them to new books, National Guideline Clearinghouse guidelines, Cochrane Reviews, and National Institutes of Health (NIH) Clinical Alerts, as well as updated content in UpToDate, Harrison's Online, Scientific American Medicine, and Clinical Evidence. Participants could request additional information for any of the headlines, and the information was delivered via e-mail during their next synchronization. Participants completed a survey at the conclusion of the study to gauge their opinions about the service. RESULTS/OUTCOME: Of the 816 headlines delivered to the 16 study participants' PDAs during the project, Scientific American Medicine generated the highest proportion of headline requests at 35%. Most users of the PDA Alerts software reported that they learned about new medical developments sooner than they otherwise would have, and half reported that they learned about developments that they would not have heard about at all. While some users liked the PDA platform for receiving headlines, it seemed that a Web database that allowed tailored searches and alerts could be configured to satisfy both PDA-oriented and e-mail-oriented users.

Attitude to Computers↗
PubMed1998

Academic dental public health diplomates: their distribution and recommendations concerning the predoctoral dental public health faculty.

OBJECTIVE: The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. METHODS: Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. RESULTS: Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. CONCLUSIONS: Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.

Attitude of Health Personnel↗
PubMed1989

Association of incident carcinoma of the endometrium with body weight and fat distribution in older women: early findings of the Iowa Women's Health Study.

Previous epidemiological studies have demonstrated that obesity increases endometrial cancer risk two- to 10-fold. To test the hypothesis that abdominal adiposity further increases this relative risk, we conducted a nested case-control study of endometrial cancer incidence in a cohort of 41,873 women ages 55-69 years. Women were recruited by mail and asked to have a friend measure circumferences of several body parts using a tape measure and written instructions. Two-year follow-up for cancer incidence was conducted using a state-wide cancer registry. Compared to random controls (n = 1,274), cases (n = 63) had higher age-adjusted mean values of waist-to-hip circumference ratio (P = 0.10) and trunk-to-limb circumference ratio (waist plus hip circumferences divided by arm plus calf circumferences, P = 0.008). Other anthropometric variables, including current body mass index and current weight, were also greater (P less than 0.001) in cases than controls. After accounting for the association with body mass index, neither the waist-to-hip ratio nor the trunk-to-limb ratio remained associated with endometrial cancer incidence (P greater than 0.40). A 5 kg/m2 increase in body mass index was associated with an adjusted relative risk of endometrial cancer of 1.80 [95% CI = 1.46, 2.22] when other significant risk factors, namely age, education level, extended use of exogenous estrogens, and age at menopause, were taken into account. We conclude that endometrial cancer risk is increased in relation to the amount but not the distribution of adiposity. This is in contrast with several other diseases in which, in addition to overall body mass, the distribution of adiposity is also important.

Abdomen↗
PubMed2004

Comparison of EPs' and psychiatrists' laboratory assessment of psychiatric patients.

EPs frequently transfer psychiatric patients to psychiatric hospitals with the approval and acceptance of a psychiatrist. EPs and psychiatrists have an unknown set of testing routines and requirements that are used to determine medical clearance of the psychiatric patient. The purpose of this study was to compare the routine and required testing performed by EPs as compared with psychiatrists. A survey of routine and required test ordering for the medical clearance of patients presenting with psychiatric complaints by EPs and psychiatrists was developed. The survey contained information on the physician and hospital demographics, tests routinely performed, required tests, and estimated cost of testing. The survey was distributed to all of the 1,055 EPs in Illinois using the American College of Emergency Physicians database and all of the 117 psychiatrists at state-operated psychiatric facilities in the state of Illinois. The surveys were mailed and remailed to the nonresponders in both groups. The results were inputted into an SPSS (Chicago, IL) program to determine frequencies, descriptives, and correlations. The study results comparing the EPs with the psychiatrists were performed using Fisher exact testing. The survey was returned by 507 (48.1%) of the EPs and 65 (56.4%) of the psychiatrists. A total of 37.0% of EPs responded who were mostly 31 to 40 years old (187 of 506), male (347 of 469), and board-certified (348 of 477). The psychiatrists were mostly 51 to 60 years old (36 of 56), male (34 of 57), and board-certified (42 of 59). The most frequent routine and required tests ordered by EPs and psychiatrists were a urine drug screen (routine 378 of 507, 45 of 66 and required 381 of 507, 31 of 66), alcohol (348 of 507, 33 of 66 and 348 of 507, 33 of 66), and complete blood count (270 of 507, 53 of 66 and 334 of 507, 34 of 66) and least frequently electroencephalogram (0 of 507, 2 of 66 and 1 of 507, 0 of 66), computed tomography scan (6 of 507, 3 of 66 and 2 of 507, 0 of 66), and lumbar puncture (1 of 507, 2 of 66 and 0 of 507, 0 of 66) respectively, at a most frequent estimated cost of required testing of $101 to $200 for EPs (102 of 507) and $201 to $300 for psychiatrists (13 of 66). There were 10 of 16 differences in routine test ordering and three of 16 required tests performed by EPs compared with psychiatrists. Although the number of sets required by both groups were different, the tests required by psychiatrists and EPs for medical clearance of the psychiatric patients were found to be similar. It is unknown if the psychiatrists influenced the ordering behavior of the EPs. However, this study does demonstrate a difference in the routine test ordering, implying that these is a difference in the approach to the patient in the ED. Further means to obtain congruence in the testing protocol of psychiatric patients would be a valuable endeavor.

Adult↗
PubMed1999

Primary care providers need a variety of nutrition and wellness patient education materials.

OBJECTIVE: To assess and document the need for nutrition and wellness patient education materials. DESIGN: The results of open-ended interviews and focus groups were used to develop a mail-type survey. The 46-item survey addressed barriers to using nutrition and wellness education materials as well as format, education/reading level, foreign languages, and topics needed. North Carolina Cooperative Extension Service (NCCES) family and consumer education agents distributed surveys to family and general practices throughout North Carolina. SUBJECTS: Of the 721 primary care providers surveyed, 303 (42%) returned usable surveys. Respondents practiced in 89 of the 100 counties of the state served by NCCES family and consumer education agents. STATISTICAL ANALYSIS PERFORMED: Descriptive statistics and independent sample t tests were used to analyze survey results. RESULTS: Limited time with patients and inability to obtain materials because of cost or being unsure of sources were most often identified as barriers to using nutrition and wellness materials. Of the 26 topics surveyed, 6 had mean levels of need greater than or equal to high need (mean score > or = 4): weight control for adults, smoking cessation, changing dietary fat intake, exercise guidelines for healthy adults, general stress management guidelines, and healthful eating for older adults. Twenty-four of the 26 topics had mean levels of need greater than or equal to moderate need (mean score > or = 3). Topics with moderate need included guidelines for overweight children and adolescents, nutrition for chronic disease prevention, and healthful eating for various stages of the life cycle. The combined mean score for topics dealing with weight control and exercise for adults, adolescents, and children was greater than the score for high need (mean score > 4). Eighty-three percent of respondents preferred 1-page, printed handouts. Forty-five percent requested materials in Spanish. APPLICATIONS: Dietitians who work in a variety of settings can use techniques similar to those described here to determine the patient education materials practitioners need for the populations they serve. The information obtained from this study will be used to develop 1-page, printed handouts. A registered dietitian and a food and nutrition specialist with NCCES will develop and pilot-test the handouts. These materials will be made available to primary care providers in North Carolina via local NCCES family and consumer education agents, many of whom are registered dietitians.

Data Collection↗
PubMed1992

Methods and algorithms for statistical analysis of protein sequences.

We describe several protein sequence statistics designed to evaluate distinctive attributes of residue content and arrangement in primary structure. Considered are global compositional biases, local clustering of different residue types (e.g., charged residues, hydrophobic residues, Ser/Thr), long runs of charged or uncharged residues, periodic patterns, counts and distribution of homooligopeptides, and unusual spacings between particular residue types. The computer program SAPS (statistical analysis of protein sequences) calculates all the statistics for any individual protein sequence input and is available for the UNIX environment through electronic mail on request to V.B. (volker/genomic@stanford.edu).

Algorithms↗
PubMed1985

Pharmaceutical services in hospitals treating pediatric patients.

A survey was conducted of pharmaceutical services in 120 of the 325 short-term hospitals associated with accredited pediatric residency training programs, 52 pediatric hospitals, and 68 adult hospitals with pediatric units or floors. The mail survey conducted in 1983 had a 70% response. Centralized pharmaceutical services were offered by the majority of the hospitals. Seventy-two percent of the respondents indicated that either a complete or partial unit dose drug-distribution system was used for most of their pediatric patients, while 25% indicated that they used either the traditional individual patient-fill system or some combination of drug-distribution systems. A total of 80% of the hospitals provided either complete or partial i.v. admixture services. The preparation of total parenteral nutrient solutions was the most common admixture service provided. Clinical services were provided, to some extent, by 63% of the respondents. Computers were used for multiple functions, such as generating patient profiles, organizing the formulary, and providing labels for unit dose and i.v. admixture services, by 33% of the respondents. Selection of therapeutic alternates was performed by pharmacists in 51% of the responding hospitals, and the majority of institutions had formulary systems. Modern drug-distribution systems and clinical services have been established in many hospitals treating pediatric patients.

Computers↗
PubMed1993

ASHP national survey of hospital-based pharmaceutical services--1992.

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during summer 1992 are reported and compared with the results of earlier ASHP surveys. A simple random sample of community hospitals (short-term, nonfederal) was selected from community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 889. The net response rate was 58% (518 usable replies). The average number of hours of pharmacy operation per week was 105. Complete unit dose drug distribution was offered by 90% of the respondents, and 67% offered complete, comprehensive i.v. admixture programs. A total of 73% of the hospitals had centralized pharmaceutical services. Some 83% provided services to ambulatory-care patients, including clinic patients, emergency room patients, patients being discharged, employees, home care patients, and the general public. A computerized pharmacy system was present in 75% of the departments, and 86% had at least one microcomputer. More than 90% participated in adverse drug reaction, drug-use evaluation, drug therapy monitoring, and medication error management programs. Two thirds of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records, and the same proportion provided patient education or counseling. One third provided drug management of medical emergencies. One fifth provided drug therapy management planning, and 17% provided written histories. Pharmacokinetic consultations were provided by 57% and nutritional support consultations by 37%; three fourths of pharmacist recommendations were adopted by prescribers. A well-controlled formulary system was in place in 51% of the hospitals; therapeutic interchange was practiced by 69%. A total of 99% participated in group purchasing, and 95% used a prime vendor. The 1992 ASHP survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys (e.g., growth in clinical services, ambulatory-care services, computerization) and identified static areas that merit the attention of pharmacy leaders (e.g., provision of complete, comprehensive i.v. services).

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Behaviors used by men to protect themselves against prostate cancer.

This paper reports on behaviors men use to protect themselves against prostate cancer. Data were collected via a telephone or mailed survey from 353 men enrolled in two studies of prostate cancer screening. Respondents reported behaviors they used to protect themselves against prostate cancer, and responses were coded as conventional care, self-care, or nothing. Men who reported using both conventional care and self-care were categorized as conventional care users. Polytomous logistic regression was conducted to evaluate the association between sociodemographic background, prior prostate screening, and cognitive, affective, and social support and influence factors with protective behavior type. The distribution of protective behaviors was as follows: conventional care, 63%; self-care only, 19%; and nothing, 18%. In multivariable analyses, higher education level was found to be positively associated with conventional care use. Perceived salience and coherence of prostate cancer screening was positively associated with conventional care use among men in one of the two studies. Low concern about screening was positively associated with self-care use, as was mailed survey completion. This study presents self-report data regarding prostate cancer protection behaviors. Most men in the study reported using some type of prostate cancer protective behavior. Decision-making about whether or not to take protective action and what type of behavior to use may be influenced by socioeconomic background, cognitive perceptions related to behavioral options, and concern about risk.

Adult↗
PubMed1996

Electronically distributed, computer-generated, individualized feedback enhances the use of a computerized practice guideline.

Clinical guidelines have been developed to assist with the management of patient care; however, these guidelines are frequently neglected in clinical practice. Computer-generated reminders enhance guideline use, but these systems often fail to achieve high rates of guideline utilization. This study was designed to test the hypothesis that computer-generated, individualized feedback regarding adherence to care guidelines will significantly improve clinician compliance with guideline recommendations presented through a computer-assisted management protocol. Half of the 45 primary care clinicians employed at a primary care clinic affiliated with an academic medical center, were randomized to receive a biweekly electronic mail message consisting of a computer-generated report summarizing his/her response to care guideline recommendations for the diabetic patients seen during the previous 2 weeks. Clinician compliance with guideline recommendations was the primary outcome measure. This study demonstrated that the intervention significantly increased clinician compliance with the guideline recommendations without incurring high maintenance expenses. Median compliance among the intervention group was 35% versus 6.1% among the control group (p < 0.01). Electronically distributed, computer-generated, individualized feedback regarding clinician use of care guideline recommendations is an effective way to enhance compliance with a care guideline.

Attitude to Computers↗
PubMed1994

[Prevalence of health problems in the Gazel (EDF-GDF) cohort: regional distribution and disparities].

This study deals with regional differences in annual prevalence of 44 declared diseases or clinical disorders in 1989 in GAZEL cohort participants from "Electricité de France-Gaz de France" company. The studied sample consisted of 20,325 people, from 35 to 50 years old, living in France, who answered to a mail questionnaire in 1989. The collected data from one year were analysed. An overall "regional effect" was searched about every listed disease in the questionnaire. For this purpose, a logistic model, controlling for age and sex, was used. For comparing prevalence of a disease in one region with average prevalence, an odds ratio (OR) was calculated: it was defined here as the ratio of disease odd in the region to the average French odd. The regional effect was studied in greater detail for five diseases, making allowance for extra factors of adjustment (tobacco and alcohol consumption, Quetelet index, salary category, number of declared diseases). The regional effect remained significative for four diseases: hypertension with OR from 1.26 to 1.68 in northern regions, and from 0.63 to 0.75 in southeastern ones; osteoarthrosis with OR lower than 1 in western regions (0.60 to 0.79), and larger in the South (1.24 to 1.46); hyperthyroidism, goiter with OR elevated in Midi-Pyrénées (2.91) and Lorraine (1.82) [corrected]; renal stones with OR high in the South (1.85 in Provence Riviera). These results can be compared to known observations about geographical differences in mortality. They also suggest persistence of hazardous areas for some diseases.

Adult↗
PubMed1999

Prevalence of carpal tunnel syndrome in a general population.

CONTEXT: Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. OBJECTIVE: To estimate the prevalence of CTS in a general population. DESIGN: General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). SETTING: A region in southern Sweden with a population of 170000. PARTICIPANTS: A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. MAIN OUTCOME MEASURES: Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. RESULTS: Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). CONCLUSION: Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.

Adult↗
PubMed1999

Diagnostic categories of dental anxiety: a population-based study.

This study aimed to use a population-based sample to assess the psychological validity of the Seattle system for diagnosing dentally anxious individuals. This system consists of four diagnostic types in which such individuals are categorized according to the main source of their fear regarding dental treatment. Subjects were 1420 randomly selected adults aged 18 years and over who took part in a two-stage mail survey. The questionnaires contained measures of dental anxiety and standardized measures of general anxiety and fearfulness. Allocation to the Seattle categories was based on responses to four diagnostic items. Overall, 16.4% of the sample were dentally anxious. Their distribution across the four Seattle types was as follows: type I (simple conditioned phobia)--49.6%; type II (fear of catastrophe)--7.8%; type III (generalized anxiety)--19.4% and type IV (distrust of dentists)--9.9%. The remaining 13.3% could not be categorized. Judging by their scores on measures of dental anxiety, these subjects were borderline cases. Scores on the measures of anxiety and fearfulness indicated that the diagnostic system was valid and identified sub-groups of the dentally anxious population which were internally consistent. However, all subjects indicated extreme fear of dental treatment and were broadly similar in terms of their cognitive and behavioral responses to dental care. Of particular interest was the distribution of diagnoses according to age. Younger subjects were more likely to be categorized as type I, while older subjects were more likely to be categorized as type III. Overall, the results indicate that dental anxiety is a complex fear with a number of components.

Adolescent↗
PubMed1989

Job satisfaction among music therapists.

Job satisfaction surveys were mailed to 2,371 registered and certified members from the National Association for Music Therapy (NAMT) and the American Association for Music Therapy (AAMT). Materials included a 36-item questionnaire and a stamped, return addressed envelope. Of the questionnaires distributed, 1,344 (57%) were returned. Reliability analysis of the job satisfaction scale, performed as a measure of internal consistency on 885 cases, revealed an alpha coefficient of .85. The measure of job satisfaction used in this study is therefore accepted as highly reliable. The present study suggests that music therapists indeed report a pleasurable emotional state as they evaluate their jobs. The nature of music therapists' work and other conditions of their employment contribute to high job satisfaction.

Analysis of Variance↗
PubMedDate not supplied

Career promotional activities of Iowa dental hygienists.

PURPOSE: The purpose of this research was to investigate the relationship between Iowa dental hygienists' career promotional behaviors and (1) attitudes about career satisfaction, (2) beliefs about the job market, (3) membership in the American Dental Hygienists' Association, (4) demographics, and (5) employment characteristics. METHODS: In February 1993, questionnaires were mailed to a stratified random sample of 467 Iowa dental hygienists licensed and residing in the state of Iowa. Participation in four career promotional behaviors was ascertained as well as several independent variables. The data were analyzed with frequency distributions, Pearson's correlation coefficients, and chi-square statistics. RESULTS: An adjusted response rate of 92.3% was achieved (N=423 respondents). The majority of respondents (79.1%) recommended a career in dental hygiene, but fewer than 20% participated in a dental hygiene career day, gave an undesignated monetary gift to a dental hygiene education program, or donated to a dental hygiene scholarship fund. The independent variables were not related consistently to each of the career promotional activities. CONCLUSIONS: It appears that career promotional behaviors are multifaceted and require additional research to elucidate the interrelationships and enhance coordinated approaches to dental hygiene career recruitment.

Adult↗
PubMed1996

[Pharmaco-epidemiologic study of the use of antidepressant drugs in the general population].

The objective of this study was to evaluate the mode of prescription and the users of antidepressant agents. It consisted of an initial phase (survey of the general population), aimed at selecting a representative sample of antidepressants users by a mail questionnaire, without asking prescribers in order to avoid the bias inherent to such an approach. Results showed a current incidence of use of 2.75 % for the 8 main antidepressants, i.e. more than one million adults in France. The distribution of antidepressants showed Prozac in first place, followed by Anafranil, and Laroxyl, then Stablon, Athymil, Survector and Ludiomil. In more than 50 % of cases, antidepressants have been taken for a year or more, continuously of intermittently. They were prescribed by a general practitioner in 60 % of cases and a psychiatrist in 30 %. A second survey phase (telephone) undertaken by psychiatrists and involving a sample of this population enabled determination of the pathophysiological profile of consumers at the time of prescription of antidepressant treatment, using a validated diagnostic tool, the MINI. Taking all drugs together, results showed that prescription was within Marketing Authorization approved indications in about 65 % of cases (existence of depression 61 %, dysthymia 3 %, OCD 1 %). This study shows that, in 23 % of cases, antidepressants are not used in patients with one of the psychiatric diseases identified by the MINI but nevertheless suffering from pathophysiological symptoms (subsyndronic syndrome). It can be concluded that, in some subjects, antidepressants are used in non-identified disorders. It must also be recognized that, with 3 % of users, the population of individuals treated by antidepressants is less than that of patients suffering, in the general population, from depression (5 to 10 % per year, according to studies).

Adult↗
PubMed2006

Effectiveness of mailing "Bathing Without a Battle" to all US nursing homes.

An educational CD-ROM/video program was developed to educate nursing home staff about two research-based techniques for reducing agitation and aggression during bathing of persons with Alzheimer's disease, including person-centered showering and the towel bath. This educational program was distributed free of charge to all 15,453 US nursing homes in the Centers for Medicare and Medicaid Services database. The dissemination, use, and short-term outcomes were evaluated by extrapolating data collected by long-term care surveyors in three states; usage was further assessed by tracking the number of nursing home staff who registered for the continuing education credits associated with the program. The program's quality and content was evaluated by actual program users, who rated the program after completion. Short-term learning outcomes were assessed by examinations built into the CD-ROM. Evaluating a national innovation presented a set of unique challenges; yet, to date, our findings have revealed mostly favorable short-term outcomes in terms of its dissemination, usage, and educational value. The long-term outcomes of this educational program continue to be monitored.

Adult↗