Drug products not to be exposed to postal irradiation.
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Disinfection↗
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Comparison between a cognitive behavioural alcohol programme and post-mailed minimal intervention in high-risk drinking university freshmen: results from a randomized controlled trial.
AIM: Examine the effect of a 10 h intervention programme compared with post-mailed minimal intervention (PMMI) given to high-risk alcohol-drinking university freshmen in a random design. METHOD: In total 693 freshmen at the Lund Institute of Technology, Lund University, Sweden were included in the study. A cognitive behavioural alcohol program (CBAP) or PMMI was given to high-risk drinking freshmen (n = 177) in a randomized design. A 10-item screening instrument, Alcohol Use Disorder Identification Test (AUDIT), was used before and 1 year after the intervention programmes were given. RESULTS: There were no significant differences between the CBAP and the PMMI groups. Both groups declined their AUDIT scores with -1.7 [CI 95% -2.6, -0.7] and -2.7 [CI 95% -3.6, -1.7], respectively which could be explained by effects of regression to the mean. CONCLUSION: No significant differences between the groups were found.
Adolescent↗
Regression to the mean: what does it mean?
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Adolescent↗
Effect of timing on the response to postal questionnaires concerning satisfaction with anaesthesia care.
BACKGROUND: There is little information on the effect of time on the assessment by the patient of quality of anaesthesia care. This study compared the patient's assessment of anaesthesia care after three different periods of time following discharge from hospital. Materials. Three groups of patients were assigned to receive a standardized, validated psychometric questionnaire either 1, 5, or 9 weeks after discharge from hospital. We measured response rate and the total mean problem score of six dimensions. RESULTS: Groups 1, 2, and 3 received 748, 743, and 723 questionnaires, respectively. The response rates including one reminder were 67.3 (95% confidence interval [CI] 63.9-70.6%), 64.5% (CI 61.1-67.9%), and 58.9% (CI 55.5-62.4%), respectively (Group 1 vs Group 3, P<0.001, and Group 2 vs Group 3, P<0.05). The total mean problem scores were not significantly different with 17 (CI 1.4%), 17 (CI 1.4%), and 15% (CI 1.3%), respectively. In two out of six dimensions ('Continuity of personal care by anaesthetist' and 'Nursing care in recovery room') significantly less problems were reported after 9 weeks. The other dimensions of the questionnaire showed no consistent differences between groups. CONCLUSIONS: The response rate is significantly lower at 9 weeks compared with 1 and 5 weeks after discharge. The total mean problem score remains unchanged but certain fields show fewer problems after 9 weeks compared with 1 and 5 weeks. Questionnaires on patient satisfaction with anaesthesia care should be sent within 5 weeks of discharge.
Adolescent↗
Postal survey on asthma, chronic bronchitis and respiratory symptoms among adult Estonians and non-Estonians (FinEsS-study).
BACKGROUND: According to the data of the population census held in Estonia in 1989, the resident population consisted of 61.5% Estonians and 38.5% non-Estonians, the majority of them being Russians--30.3%. The aim of this study was to investigate the prevalence of asthma, chronic bronchitis and respiratory symptoms among the adults in these ethnic groups. METHODS: The study was a postal survey, similar in design to parallel studies currently in progress in Finland, Estonia and Sweden (FinEsS). RESULTS: The prevalence of physician-diagnosed asthma was 2.0%, being similar in men and women and in both Estonians and non-Estonians. The prevalence of physician-diagnosed chronic bronchitis was 10.5%. Compared with the non-Estonian population, the prevalence was much lower among Estonians (7.9% vs. 13.5%, p<0.001). Such a difference in prevalence was observed in all age groups. The high prevalence of chronic bronchitis in non-Estonians could be related to more extensive smoking habits, smoking indoors and probably ETS exposure. The defined OR between non-Estonians vs. Estonians after correcting for the influence of smoking habits, area of domicile, age, gender, and socioeconomic group was 1.30. A similar pattern of differences between Estonians and non-Estonians was observed in respiratory symptoms. CONCLUSION: This study revealed that the prevalence of physician-diagnosed asthma in Estonians and non-Estonians was the same. Physician-diagnosed chronic bronchitis was more frequent in non-Estonians than in Estonians. A significant difference was determined in the prevalence of respiratory symptoms, especially among those common to chronic bronchitis. The differences remained significant after correction for possible confounders.
Asthma↗
Factors associated with self-rated health in Greece: a population-based postal survey.
BACKGROUND: Self-rated health (SRH), as an indicator of population health, is a concept useful both for research and planning. This study reports SRH, and factors related to it, in Greece. METHODS: Population-based postal survey, using World Health Organisation (WHO) questionnaires with a sample of randomly selected geographically stratified individuals. Response rate reached 41%. RESULTS: As expected, age, income and education were related to SRH, but accounted for only 20% of the variance. CONCLUSIONS: SRH in Greece is related to sociodemographic factors, but perhaps not as strongly as in other populations. Other explanatory variables will require further research.
Adolescent↗
Is the occurrence of back pain in Germany decreasing? Two regional postal surveys a decade apart.
BACKGROUND: Back pain is often perceived as an epidemic disorder with an ever-increasing prevalence. The objective of this paper is to estimate and compare point and period prevalence rates of back pain from two highly comparable postal surveys, a decade apart within a single regional population in the north of Germany. METHODS: In 1991/1992 and 2003 two systematic random samples of German residents of Lübeck aged 25-74 years were independently drawn from the municipal population registry. They received a short postal questionnaire with maximally two reminders. All data were directly standardised on the age, sex, and educational distribution of the merged samples. A sharp decrease in response rates from 81% in the early 1990s to 60% in 2003 required complex considerations of non-response bias. RESULTS: Both the overall and gender-specific point and 1 year prevalence rates of back pain remained fairly stable as well as the rate of severe disabling back pain. The overall prevalence (adjusted for age, sex, and education) of 'back pain today' was 39.2% (1991/92) and 38.2% (2003), the 1 year prevalence was 75.3% (1991/92) and 73.8% (2003), and the prevalence of severe pain was 9.9% (1991/92) and 10.2% (2003). CONCLUSIONS: The data do not support the widespread public notion of a growing epidemic of back pain in Germany.
Adult↗
Morbidity in responders and non-responders in a register-based population survey.
BACKGROUND: Non-response analysis is often restricted to the influence of age, sex and socio-economic status on response status. In this study the health status of responders and non-responders was also compared. RESULTS: Responders were comparable to non-responders with regard to the number of diagnosed disorders as well as to the prevalences of disorders within body systems. Non-responders only showed psychological disorders more often. CONCLUSION: It is useful to assess the relation between non-response and morbidity patterns in other studies as well, in order to detect selective non-response and bias.
Adult↗
Influence of postal distribution of the Royal College of Radiologists' guidelines, together with feedback on radiological referral rates, on X-ray referrals from general practice: a randomized controlled trial.
BACKGROUND: The Royal College of Radiologists (RCR) have produced regularly updated guidelines on radiological referrals since 1990. A small study in 1992 showed postal distribution of guidelines reduced general practitioners' referrals over the subsequent 9 weeks. However there have been no randomized trials of the longer term effects of radiological guidelines and feedback on referral rates on X-ray requests from primary care. OBJECTIVES: To see if the introduction of radiological guidelines into general practices together with feedback on referral rates reduces the number of GP radiological requests over one year; and to explore GPs'attitudes to the guidelines. METHODS: Sixty-nine practices referring patients to St George's Healthcare Trust were randomly allocated to intervention or control groups. In February 1995 a GP version of the RCR guidelines was sent to each GP in the 33 practices in the intervention group. After 9 months intervention, practices were sent revised guidelines with individual feedback on the number of examinations requested in the past 6 months. The total number of requests per practice was compared for the year before and the year after the introduction of the guidelines. Control practices were sent the guidelines at the end of the study. All doctors were sent a questionnaire about the guidelines. RESULTS: A total of 43 778 radiological requests were made during the two years 1994-1996. In practices receiving the guidelines there was a 20% reduction in requests for spinal examinations compared with control practices (P < 0.05). This corresponded to the effect reported by GPs. There was also a 10% difference between the groups in the total number of requests made, but due to wide interpractice variation in referral rates this failed to reach statistical significance. CONCLUSIONS: Introduction of radiological guidelines together with feedback on referral rates was effective in reducing the number of requests for spinal examinations over one year. Wider use of GP-orientated guidelines with regular updating and feedback might save costs and reduce unnecessary irradiation of patients.
Attitude of Health Personnel↗
Third mailings in epidemiological studies: are they really necessary?
INTRODUCTION: Whether or not third mailings are appropriate or worthwhile in postal epidemiological studies has not been thoroughly investigated and requires examination. METHODS: A self-completion postal questionnaire of 2184 individuals was conducted in 2000. The socio-demographic and health characteristics of four groups of individuals (first mailing respondents, second mailing respondents, third mailing respondents and non-respondents) were compared. RESULTS: Some significant differences between the groups were found, however, the inclusion of respondents to the third mailing did not significantly change the overall characteristics of respondents compared to non-respondents. DISCUSSION: When differences do exist between respondents and non-respondents, our results suggest that a third mailing is unlikely to remove many of these differences. The study supports our previous suggestion that the effort and resources expended in carrying out a third mailing may not be justified.
Adult↗
Short report: encouraging GPs to complete postal questionnaires--one big prize or many small prizes? A randomized controlled trial.
BACKGROUND: Low response rates to surveys are a problem in general practice. There is evidence that offering GPs incentives improves response rates to postal questionnaires. However, there is less evidence about the most effective form of incentive. OBJECTIVE: Our trial aimed to maximize response to a postal questionnaire and to test the most effective form of incentive. METHODS: The study involved a randomized controlled trial of a postal survey RESULTS: The incentive of a lottery for six bottles of champagne generated a response rate of 79%. Furthermore, one chance of six bottles generated 9% more responses than six chances of one bottle. CONCLUSIONS: This study has established that, among incentives for postal questionnaires, one big prize improves the yield more than many small prizes despite the lower odds of winning. It has also confirmed that offering a modest incentive to GPs generates good response rates for postal questionnaires.
Attitude of Health Personnel↗
Patient satisfaction with large-scale out-of-hours primary health care in The Netherlands: development of a postal questionnaire.
BACKGROUND: Since the turn of the millennium, out-of-hours primary health care in The Netherlands has faced a substantial change from small locum groups towards large GP cooperatives. Improving the quality of care requires evaluation of patient satisfaction. OBJECTIVE: To develop a reliable postal questionnaire for wide-scale use by patients contacting their out-of-hours GP cooperative and to present the results of a national survey. METHODS: Literature review and interviews with both patients and health carers were carried out to identify issues of potential relevance, followed by two postal pilot studies and additional interviews to remove or rephrase items. Finally, postal questionnaires were sent to 14,400 people who contacted one of 24 GP cooperatives in The Netherlands. RESULTS: Overall response was 52.2% for all types of contact. Three scales were identified prior to the field phase and confirmed by principal components analysis: telephone nurse, doctor and organization. Reliability was high, with Cronbach's alphas and intraclass correlation coefficients exceeding 0.70 for all scales. Only items in the organization scale showed clear differences among the participating cooperatives. Respondents receiving telephone advice showed lower levels of satisfaction than respondents with other types of contact (P < 0.001); centre consultation scored lower than home visit (P < 0.030 or less for all differences). CONCLUSION: A reliable measure of patient satisfaction has been developed that can also be used for the comparison of GP cooperatives on an organizational level. Overall satisfaction was high, showing highest levels for home visit and lowest levels for telephone advice.
Adolescent↗
System-wide adoption of health promotion practices by schools: evaluation of a telephone and mail-based dissemination strategy in Australia.
Schools can potentially benefit from system-wide approaches to the dissemination of health promotion practices. This intervention study undertaken in the Hunter Region of NSW, Australia, used a pre-post design to assess whether a phone and mail intervention dissemination strategy was associated with an increase in the proportion of 218 primary schools undertaking eight health promotion practices. Health promotion practices addressed the prevention of harm associated with five agreed health issues-smoking, nutrition, playground safety, asthma and infectious diseases. The study also assessed acceptability of the dissemination strategy to schools, cost and whether intervention schools' characteristics were associated with uptake of health promotion practices. Compared to baseline a significant improvement in prevalence was observed at both 1 and 2 year follow-up for seven of the eight health promotion practices addressed. The greatest improvement occurred in the first year of the project. There was a greater uptake of the practice of providing information regarding passive smoking in urban schools. The dissemination strategy was found to have a cost per adopted practice of 121 Australian dollars and to be acceptable to the large majority (>90%) of schools. The results suggest that the dissemination strategy may represent a relatively low cost method of enhancing health promotion practices in schools and of monitoring such practices. Further research addressing the methodological issues of this study is needed to confirm these findings.
Australia↗
Social surveys in HIV/AIDS: telling or writing? A comparison of interview and postal methods.
We compare a probability sample postal questionnaire survey and a quota controlled interview survey, and review the literature on these subjects. In contrast to other studies, where quota samples were not representative because of biased selection of respondents by interviewers, our quota sample was representative. Response rates were similar in our postal and interview surveys (74 and 77%, respectively), although many previous similar postal surveys had poor response rates. As in other comparison studies, costs were higher in our interview survey, substantive responses and the quality of responses to closed-ended questions were similar, and responses to open-ended questions were better in the interview survey. 'Socially unacceptable' responses on sexual behaviour were less likely in interviews. Quota controlled surveys are appropriate in surveys on HIV/AIDS under certain circumstances, e.g. where the population parameters are well known, and where interviewers can gain access to the entire population. Postal questionnaires are better for obtaining information on sexual behaviour, if adequate steps are taken to improve response rates, and when in-depth answers are not needed. For most surveys in the HIV/AIDS field we recommend the postal method.
Acquired Immunodeficiency Syndrome↗
Introductory postcards: do they increase response rate in a telephone survey of older persons?
The purpose of this study was to assess whether contact by mail via an introductory postcard would increase the response rate to a telephone survey in a selected population of 348 people 60 years and older. Of this group, 208 were sent a postcard introducing the study and informing them that someone would call in the next 1-2 weeks to conduct a telephone interview. The remaining sample of 140 did not receive the introductory postcard. Amongst the potential participants who were contacted and able to participate (n = 240), the response rate for completed interview was 58.0% for those sent a postcard and 42.3% for those who were not. The refusal rate was 25.3% (postcard sent) and 37.2% (not sent a postcard). When the outcome of contact is collapsed to two categories, 'agreed to participate' and 'refusal', the response rate to participate was 73.5% (sent a postcard) and 59.0% (not sent a postcard) (chi(2) 5.14, d.f. 1, sign. 0.023). The response rate amongst those who recall being sent a postcard rose to 86.0%. Whether agreeing to participate or refusing to be involved in the survey was dependent on being sent an introductory postcard. The conclusion is that mailing a postcard prior to the first telephone contact increases the participation rates of older persons in a telephone survey at very little extra cost (A$0.60 per person).
Aged↗
Reducing occupational psychological distress: a randomized controlled trial of a mailed intervention.
There are increasing levels of psychological distress among general practitioners (GPs). The purpose of this study is to evaluate the effectiveness of a mailed intervention to reduce distress among 'at-risk' GPs. A questionnaire was sent to 1356 GPs from eight Divisions of General Practice. Out of 819 (60%) who responded, 233 GPs were recruited with scores indicative of psychological distress. These GPs were randomized to intervention (n = 120) or control (n = 113). The intervention consisted of a simple letter feeding back and interpreting the psychological score together with a self-help sheet. During the study, an educational program was offered to GPs by Divisions of General Practice. The main outcome measure used was changes in psychological distress (General Health Questionnaire 12) score after 3 months. Significance was set at P < 0.05. Initial analysis of the data showed borderline significance (P = 0.05). However, analysis of the data post hoc excluding GPs who participated in the educational program showed a significant reduction in psychological distress (P = 0.03). It appears that there may have been a dilution of the intervention effect. Mailed interventions are a cost-effective way of reaching at-risk GPs and may contribute to a reduction in psychological morbidity.
Australia↗
A postal survey of hydrosalpinx management prior to IVF in the United Kingdom.
BACKGROUND: In the last decade, numerous studies have demonstrated concern about the presence of hydrosalpinx and its management in patients undergoing IVF. We evaluated the current management of hydrosalpinx prior to IVF treatment in the UK. METHODS: A total of 117 postal survey, anonymous, sealed questionnaires were sent to all IVF centres in the UK, to determine the policy for the management of hydrosalpinx in infertile women prior to IVF treatment. RESULTS: There were 88 (75%) responders, of which 80 (91%) indicated that they discussed the effect of hydrosalpinx on IVF outcome. Ten (12%) units did not recommend treatment of hydrosalpinx prior to IVF treatment, while 30 (36%), 27 (33%) and 16 (19%) recommended treatment weakly, strongly and very strongly respectively. The treatment options offered by clinicians were laparoscopic salpingectomy (75%), open salpingectomy (45%), salpingostomy (40%), proximal tubal occlusion (34%), transvaginal songraphic (TVS) aspiration during oocyte collection (23%) and TVS aspiration before oocyte collection (10%). The frequency of use varied from one option of treatment to another. Only 28% of the responders had a protocol or guidelines for the management of hydrosalpinx. CONCLUSIONS: More attention should be given to patients with hydrosalpinx prior to IVF treatment and patients should be counselled about the negative effect of hydrosalpinx on IVF outcome. There is a wide variation in the management of hydrosalpinx prior to IVF treatment in the UK and many treatment options may be questionable, as they are not yet based on evidence.
Ambulatory Care Facilities↗