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PubMed2000

A survey of physicians' vaccine risk perception and immunization practices for subjects with immunological diseases.

Various publications have caused concern by implying that immunization may be linked to new cases or flare-ups of immunological diseases (IDs). In view of the resulting uncertainty, we studied physicians' vaccine risk perception and immunization practices for adults with IDs. A questionnaire was mailed to three groups of physicians in France: internal medicine specialists, general practitioners, and travel clinic physicians. Thirteen vaccines currently used for adults in France were studied. Risk perception was rated on a 10 cm visual analog scale (VAS). The distribution of the answers was compared between and within groups of physicians. Potential associations between risk perception and reported practices were investigated by multivariate analysis. In the three groups of physicians (n=762), the tetanus and Salk poliomyelitis vaccines had the lowest risk perception. The yellow fever, BCG and Sabin poliomyelitis vaccines were the least well perceived. The distribution of risk perception for these three live vaccines and the hepatitis B vaccine was uniform according to VAS grading. For the other vaccines studied, the distribution was skewed to the low-risk perception side of the VAS. Risk perception was greater for physicians who stated: (1) that certain IDs carried a high risk of adverse events following immunization; (2) that they sought the advice of the referent physician before immunization; (3) warned their patients of the risk of an ID flare-up after vaccination; (4) sought information about recent immunization in patients with a flare-up; and (5) had experience of the side effects of immunization in adults with ID. Risk perception was lower for physicians who said they updated immunizations, and for the internists. The worse the vaccine risk perception by physicians, the more uniform the distribution of perception, thus reflecting the disagreement of the scientific community about the risk of using such vaccines for adults with an ID. Risk perception and immunization practices were related in adults with ID. Understanding of decisions concerning immunization may help to improve immunization updating and prevent risk amplification when evidence is lacking.

Adult↗
PubMed2004

Tracker: continuous HMMER and BLAST searching.

SUMMARY: Tracker is a web-based email alert system for monitoring protein database searches using HMMER and Blast-P, nucleotide searches using Blast-N and literature searches of the PubMed database. Users submit searches via a web-based interface. Searches are saved and run against updated databases to alert users about new information. If there are new results from the saved searches, users will be notified by email and will then be able to access results and link to additional information on the NCBI website. Tracker supports Boolean AND/OR operations on HMMER and BLASTP result sets to allow users to broaden or narrow protein searches. AVAILABILITY: The server is located at http://jay.bioinformatics.ku.edu/tracker/index.html. A distribution package including detailed installation procedure is freely available from http://jay.bioinformatics.ku.edu/download/tracker/.

Database Management Systems↗
PubMed1996

Direct mailing of consensus recommendations did not alter GPs' knowledge and prescription of oestrogen in the menopause.

OBJECTIVE: To investigate the impact of an information-package (direct mailing) concerning oestrogen therapy, deriving from a consensus conference in 1990, on general practitioners' (GPs') attitudes and knowledge. DESIGN AND SUBJECTS: Controlled randomised study. Two groups of Norwegian GPs. The Intervention group received an information-package consisting of the recommendations from the consensus conference, some headline questions with answers, and a classification of the oestrogens available in Norway, including a table and a graphical presentation of the costs of the different treatments. GPs stated their views on prescribing oestrogen on a five step scale, related to nine short case histories, each containing cues on complaints, smoking, family history suggesting risk for cardiovascular disease, and osteoporosis. MAIN OUTCOME MEASURES: GPs' views on prescribing oestrogen, relation to age, sex, practice type (solo/group) and practice location. RESULTS: The differences in answer distributions between the Intervention (n = 193) and Control (n = 181) groups did not reach statistical significance for any of the nine case histories. The answers indicate a more liberal attitude towards replacement therapy in 1992 compared to a study performed in 1990. The views on contraindications was fundamentally unaltered. CONCLUSION: The study did not reveal any significant effect of direct mailing as means of disseminating consensus conference recommendations to GPs.

Adult↗
PubMed1993

Colon and rectal cancer in pregnancy.

Colorectal carcinoma presenting in pregnancy is an uncommon disease that is reported to be associated with an extremely poor prognosis. To better characterize this disease, we surveyed the membership of the American Society of Colon and Rectal Surgeons by mailed questionnaire and reviewed the literature. Forty-one new cases of women with large bowel cancer who presented during pregnancy or the immediate postpartum period were identified. The mean age at presentation was 31 years (range, 16-41 years). Tumor distribution was as follows: right colon-3, transverse colon-2, left colon-2, sigmoid colon-8, and rectum-26. Dukes stage at presentation was A = 0, B = 16, C = 17, and D = 6 (two patients were unstaged). Average follow-up was 41 months. Stage for stage, survival was found to be similar to patients with colorectal tumors in the general population. Large bowel cancer coexistent with pregnancy presents in a distal distribution (64 percent of tumors in the current series and 86 percent of those reported in the literature were located in the rectum) and presents at an advanced stage (60 percent were Stage C or more advanced at the time of diagnosis). While patient survival is poor, it is no different stage for stage from the general population with colorectal tumors.

Adolescent↗
PubMed2004

[Smoking habits among sixth-year medical students in Spain].

OBJECTIVE: To describe and analyze the smoking habits of sixth-year Spanish medical students. MATERIAL AND METHODS: The target population of this descriptive cross-sectional study was students completing their sixth year in Spanish medical schools. An anonymous, self-administered questionnaire was sent to the students' homes by ordinary mail. The relationships between the variables were analyzed using contingency tables, the chi2 test, the Student t test, and analysis of variance with a significance level of P< .05. The software package was SPSS. RESULTS: A total of 3840 questionnaires were distributed to students, and 1340 were returned completed (34.9%). Of the respondents, 27% were smokers (8.7% smoked only on weekends, and 18.3% were daily smokers). The mean (SD) number of cigarettes smoked per day was 10.54 (7.89). Consumption was significantly higher among men than among women. The mean age of initiation was 17.20 years. Of the students who were smokers, 32.54% stated that they had started smoking during their medical studies. The percentage of smokers who stated that they wanted to quit was 76.3%, and 56.6% said that they had already made at least one quit attempt. CONCLUSIONS: It is cause for concern that a large number of students start smoking after they enter medical school. One of the reasons for this is the lack of concern about smoking as a health problem within medical schools. The smoking habits of medical students are affected by the same phenomena that affect those of the general public, such as the increase in the number of women smokers, the influence of sociocultural factors, and the increasingly broader age range of initiation. The lower prevalence of smoking among medical students with respect to other populations is probably due to the fact that, in general, these students have better health habits than the general public, and/or the reasons that led them to study medicine also make them disinclined to smoke.

Adolescent↗
PubMed2002

Patient web-resource interest and internet readiness in pediatric inflammatory bowel disease.

OBJECTIVE: The internet has been touted as a cost-effective method of providing valuable patient education and support resources. However, little is known of the level of internet interest in or access to web-based resources of most chronically ill populations generally, and pediatric populations in particular. Web-based patient resources could be especially applicable to the pediatric inflammatory bowel disease (IBD) population given the potential appeal of an anonymous forum for this group. METHODS: Tertiary-care clinic patients aged 8-18 years and diagnosed with IBD were surveyed by mail. chi and/or analysis of variance were used to compare demographic data from nonresponders and responders and for subgroup analyses. RESULTS: Of 162 eligible patients, 63 (38.9%) completed the survey. Responders did not differ significantly from nonresponders by age, sex, or distribution of disease. Overall, 98.4% of those surveyed had internet access, with 61.9% having access at school. Ninety-five percent had used the internet, while 91% expressed interest in visiting a pediatric IBD website for general IBD information (83%), for support (73%), to pose questions (78%) or read (73%) or respond (60%) to questions, or to chat with others (46%). Despite expressed interest, far fewer had ever used the internet as an IBD information (52.4%) or support (9.5%) resource. Similarly, although 15.8% anticipated visiting a pediatric IBD site weekly, only 1.5% had done so in the week of the survey. CONCLUSIONS: Reported levels of interest in web-based patient resources are high among pediatric IBD patients, yet use may be infrequent.

Adolescent↗
PubMedDate not supplied

Perceptions of the limit of viability: neonatologists' attitudes toward extremely preterm infants.

Although recent technologic advances have dramatically improved the survival of preterm infants, little information exists regarding the attitudes of neonatologists toward their smallest patients, infants born at the "limit of viability." In this pilot study we sent a single mailing of a 25-question survey designed to provide information about the medical treatment of extremely preterm infants (< 22 to 27 weeks' gestational age) to 3056 neonatologists practicing in the United States in September 1992. The 1131 (37%) respondents were well distributed geographically and by nature of practice (i.e., academic, academic affiliate, and community hospitals). Most of the respondents counseled parents that all infants < or = 22 weeks' gestational age die and that at least 75% of infants born at 23 weeks' gestation die. Only for infants born at > or = 26 weeks' gestational age did most of the neonatologists counsel parents that mortality is < or = 50%. Nonintervention or compassionate care in the delivery room was believed to be appropriate for infants less than 23 weeks' gestational age by virtually all neonatologists, by 52% of respondents for infants 23 weeks' gestational age, and by only 1% of respondents for infants 25 weeks' gestational age. Approximately two thirds of neonatologists considered parental wishes regarding resuscitation, and one quarter considered parental parity/fertility history in their medical decision making for infants born at 23 to 24 weeks' gestation. If an infant who had been previously resuscitated decompensated in spite of maximal medical treatment, most of the neonatologists were not willing to provide full resuscitation for infants born at any gestation less than 27 weeks. However, the number of neonatologists who would actively encourage withdrawal of support in a decompensating infant decreased markedly for infants born at > or equal 25 weeks' gestation. Neonatologists who responded to this survey in 1992 considered 23 to 24 weeks of gestation the limit of viability and had great concerns regarding medical decision making for these infants.

Data Collection↗
PubMed2004

Substance use by pharmacy and nursing practitioners and students in a northeastern state.

PURPOSE: The prevalence and predictors of substance use among pharmacists and nurses and pharmacy and nursing students were studied. METHODS: During summer 2002, pharmacists and nurses in a northeastern state were mailed an anonymous survey to determine their use of alcohol, tobacco, and commonly abused drugs; to determine their ease of access to controlled substances; and to measure their family history of alcohol and drug problems. A similar but not identical survey was distributed to pharmacy and nursing students during spring 2000. RESULTS: A total of 262 usable questionnaires were received from pharmacists and nurses (response rate, 72.8%), and 138 usable questionnaires were received from students (35.3%). Large majorities of nursing students, pharmacy students, and nurses were women. A higher percentage of pharmacists reported having used an opioid or an anxiolytic at least once in their lives (24.8% and 14.3%, respectively) than nurses (14.5% and 7.8%). Higher percentages of nursing students and nurses reported having ever used an unprescribed drug (74.5% of nursing students and 63.6% of nurses). CONCLUSION: A survey of pharmacy and nursing practitioners and students in a northeastern state provided important information on alcohol, tobacco, and illicit drug use among these groups and highlighted the need for prevention and intervention.

Humans↗
PubMed1990

Validity of self-reported waist and hip circumferences in men and women.

Recent epidemiologic evidence indicates an association between fat distribution and many diseases. To assess the validity of circumference measurements obtained by self-report, the authors analyzed data from 123 men aged 40-75 years and 140 women aged 41-65 years, drawn from two large ongoing prospective studies. On mailed questionnaires, subjects were asked to measure and record their weight and waist and hip circumferences. These data were compared with standardized measurements taken approximately six months apart by technicians who visited participants at their homes. Crude Pearson correlations between self-reported waist circumferences and the average of two technician-measured waist circumferences were 0.95 for men and 0.89 for women. Similar correlations for hip measurements were 0.88 for men and 0.84 for women, and for waist-to-hip ratios, 0.69 for men and 0.70 for women. After adjusting for age and body mass index (kg/m2), correlations for waist-to-hip ratios were 0.55 for men and 0.58 for women. Correlations became stronger after correcting for random within-person variability from daily or seasonal fluctuations. Self-reported and measured weights were highly correlated: 0.97 for men and 0.97 for women. Self-reported waist, hip, and weight measurements appear reasonably valid. The moderate degree of measurement error for the ratio of self-reported waist and hip circumferences, however, implies that previously reported associations based on self-report of these measures may have been appreciably underestimated.

Adult↗
PubMed1999

Telemedicine in neurosurgery using international digital telephone services between Japan and Malaysia--technical note.

A new image transmission and teleconference system using international digital telephone services was established between Japan and Malaysia. This new system consists of an ordinary personal computer, image scanner, and terminal adapter for digital telephone lines. The quality of images transferred using this system was high enough for diagnosis and discussion except for images such as radiographs requiring huge data transfer. Transmission of one image took approximately 20 seconds. The cost performance was almost equal to the conventional mailing system. The most remarkable advantage of this new system is the high quality of transferred images, the cost and time performance, and security of the medical information. New communication systems using international digital networks including the internet may allow re-distribution of medical resources between advanced countries and developing countries in neurosurgery.

Academic Medical Centers↗
PubMed1992

[Assessment of health status of the elderly. Application of a Dutch version of the MOS scale].

The 'MOS Shortform General Health Survey', a measure for assessing general health, has been used in an elderly population in the Netherlands (N = 354). The 20-item (mail) questionnaire comprises six dimensions or subscales: physical functioning (6 items), role functioning (2), social functioning (1), mental health (5), health perceptions (5) and body pain (1). Our results show reasonable psychometric properties of the subscales (internal reliability, skewness and kurtosis of distribution, correlation between subscales and correlation with other health measures, 8 weeks test-retest reliability), which are comparable to those in the United States in a general patient population. The six subdimensions of the scale together seem to meet the criteria of the stochastic cumulative measurement model (Mokken-type scale). The results show that this instrument gives an opportunity to assess general health in the elderly within just a couple of minutes.

Activities of Daily Living↗
PubMed1990

ASHP national survey of hospital-based pharmaceutical services--1990.

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during May through July 1990 are reported and compared with the results of earlier ASHP surveys. A sample of community hospitals (short-term, nonfederal) was selected randomly from the population of community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 881. The net response rate was 66% (582 usable replies). The average number of hours of pharmacy operation per week reported by the respondents was 96. Complete unit dose drug distribution was offered by 89% of the respondents (up from 74% in 1987). About 70% offered complete, comprehensive i.v. admixture programs (essentially unchanged from 1987). Most of the hospitals (70%) had centralized pharmaceutical services. A computerized pharmacy system was present in 64% of the departments, and 75% had at least one microcomputer. More than 90% reported participation in adverse drug reaction and drug-use evaluation programs. Some 80% participated in drug therapy monitoring. Almost half of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records. Approximately one third provided patient education or counseling, and one third provided drug management of medical emergencies. A well-controlled formulary system was in place in 58% of the hospitals; therapeutic interchange was practiced by 49%. A total of 98% of the respondents participated in group purchasing, and 96% used a prime vendor. Half of the departments served as training sites for pharmacy students. Less than half had a staff development program, but about two thirds supported continuing-education activities for pharmacists. The 1990 survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys and identified static areas that merit the attention of pharmacy leaders.

Centralized Hospital Services↗
PubMed1984

The distribution of chymotrypsin within the feces and description of a new device for the preparation of stool samples.

We measured the distribution of chymotrypsin within feces by comparing duplicate 100-mg stool aliquots from 48 stool specimens. For practical purposes, the distribution of the enzyme in stool appears sufficiently homogeneous to assure representative results even from 100-mg stool aliquots. Given this likelihood, we have developed a new disposable device that measures 100-mg stool aliquots hygienically, prepares this material for shipping by mail, homogenizes and suspends the stool sample, and facilitates centrifugation of the fecal suspension, all within the same instrument. Performance studies with this new device revealed that stools of different consistency can be measured out precisely and conveniently by volume. The difference in the specific weight of different stools appears to be so low that for practical purposes a 100-mg mass of stool can be weighed out by volume.

Centrifugation↗
PubMed2005

Self-perceived normality in defecation habits.

BACKGROUND: Available information on normal bowel habits was mainly gathered by means of telephone interviews or mailed questionnaires. AIMS: We undertook a prospective study to evaluate the defecatory habits in subjects perceiving themselves as normal concerning this function. SUBJECTS AND METHODS: A questionnaire (4-week diary with "yes-no" daily answers to six questions concerning bowel habits) was distributed to 204 subjects perceiving their defecation behaviour as normal. RESULTS: The completed questionnaire was returned by 140 subjects. No significant differences were found between sexes or age groups for any variable, even though straining at stool and feeling of incomplete and/or difficult evacuation showed a trend to increase with age. No subject had less than three bowel movements per week or more than three per day. The percentage of symptoms linked to an abnormal defecatory behaviour was well below 10%. Fifty-five percent of subjects reported at least one parameter of abnormal functioning; the most frequent was straining at stool and the rarer was the manual manoeuvres to help defecation. CONCLUSIONS: In normal subjects the prevalence of symptoms considered in Rome II criteria as part of an abnormal defecatory behaviour (in more than 25% of defecations) is well below 10%, manual manoeuvres are almost never used to help defecation, and the frequency of defecations is at least three per week.

Adolescent↗
PubMed2002

A cross-sectional analysis of work-related outcomes in adults with asthma.

BACKGROUND: Asthma is a disease with physical symptoms that can impair a person's functioning to the point of interfering with school, work, and social activities. OBJECTIVE: Describe how disease (asthma) and patient characteristics affect perceived work performance and absenteeism. METHODS: Using a cross-sectional study design, 369 adults with asthma from a managed care organization responded to a mailed questionnaire which included a perceived work performance scale (WPS) and an item assessing absenteeism. Analysis consisted of psychometric testing of the scale (internal consistency and construct validity); trend observation of influence of perceived and symptom-derived severity on WPS and absenteeism distribution; and regression analysis to examine the relationship between patient/disease characteristics and the work-related outcomes. RESULTS: The mean WPS score was 88.0 +/- 16.2 (of a possible 100), with a Cronbach's alpha of 0.79. Most respondents (84.7%) did not miss any work in the previous 4 weeks. WPS scores declined and the percentage of respondent absenteeism increased as perceived and symptom-derived severity worsened. The regression model for WPS produced an adjusted R2 of 0.32 and included the number of other illnesses, health beliefs, race, income, and perceived and symptom-derived asthma severity. The regression model for absenteeism included number of other illnesses, race, health beliefs, and symptom-derived severity. Perceived work performance and absenteeism are outcomes measures that are distinctive and complementary. CONCLUSIONS: Disease severity, race, income, and health beliefs also contribute and should be considered in health services research related to asthma.

Absenteeism↗
PubMed2004

Survey of United States neurosurgical residency program directors.

OBJECTIVE: The field of neurosurgery in the United States faces many challenges. Neurosurgical program directors in the United States represent a logical source for inquiries about manpower issues, the training process, and Residency Review Committee (RRC) oversight. METHODS: Ninety-one active residency program directors were sent an anonymous 31-question survey. The respondents were given the option of adding additional comments. The questions were designed to address issues related to manpower, the training process, and RRC governance. Sixty-one responses were returned before an email reminder and 11 after the reminder (a total response rate of 79%). The data were entered into a database, and a descriptive analysis, with frequency distribution, was performed. RESULTS: The purpose of this review was to gain a preliminary understanding of the perceptions of program directors regarding the neurosurgical training process, the RRC, the oversight process, and projected manpower needs. A 79% response rate is high for a mail survey and likely reflects heightened concern and interest in such issues. The survey responses indicate general satisfaction with the role and governance of the RRC, significantly divergent perceptions of resident output and available positions, and serious concerns regarding the current training process. CONCLUSION: This survey suggests that a broader discussion of resident training issues would be valuable, perhaps using validated survey instruments.

Advisory Committees↗
PubMed1979

Glucose-6-phosphate dehydrogenase deficiency: biochemical and histochemical studies on hair roots for carrier detection.

Kinetic properties of human hair root glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase were studied in order to optimize the assay of these enzymes in lysates from single hair roots. In contrast to previously reported methods, an excess of purified 6-phosphogluconate dehydrogenase was added to the glucose-6-phosphate dehydrogenase reaction mixtures, thus allowing a more exact quantification of glucose-6-phosphate dehydrogenase activity. Although enzyme histochemical techniques suggest a similar distribution of hair root glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase, enzyme assays on hair root segments after microdissection nevertheless indicate differences in the distribution of these enzymes. Upon storage a gradual drop in the activity of both hair root enzymes was found, but the rate of decrease in enzyme activity was about equal: the enzyme activity ratio was, therefore, not affected. This opens interesting possibilities for mailing hair roots for screening purposes without any special precautions.

Genetic Carrier Screening↗
PubMed1985

Medication carts--are they all the same?

Purchase of unit dose medication carts is one of the major capital expenditures in the development and maintenance of a unit dose distribution system. Critical factors in this selection process are the considerations of product reliability and durability. To develop an assessment of user satisfaction with the various brands of unit dose carts, a national survey of 500 randomly selected hospital pharmacies was developed and mailed. The questionnaire requested information on types of carts used, satisfaction with cart performance, types of repairs needed, frequency of repairs, providers of cart repairs, and frequency of cart maintenance inspections. Two hundred seventy responses (54%) were available for evaluation. Eighty-five percent of cart users have five or more carts. Although 60% of respondents have carts greater than or equal to 4 years old, comparative satisfaction did not decrease as a function of increasing age of carts. There were 11 brands of unit dose carts reported by 214 responders. One hundred and three of these 214 responders (48.1%) used MacBick as compared with 36, 22, 18, and 35 users of Trans Aid, Lionville, Ferno Forge, and seven other brands, respectively. MacBick's users reported less equipment failure rate compared with the other brands, but this difference did not reach statistical significance (p less than 0.2 greater than 0.05). It was also determined that only 29% of hospitals routinely inspect carts to insure proper functioning. Since the most frequent type of equipment failure reported (up to 61% of users) involved cart locking mechanisms, drug security can be compromised without routine inspections.

Attitude of Health Personnel↗