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PubMed1993

Vasectomy and prostate cancer in US blacks and whites.

A large population-based case-control study was carried out to investigate the association between vasectomy and prostate cancer risk in black and in white men in the United States. Study subjects resided in the geographic areas covered by the population-based cancer registries of the Georgia Center for Cancer Statistics, or the Metropolitan Detroit Cancer Surveillance System, or in 10 counties included in the cancer registry of the New Jersey State Health Department. Cases for this study were men aged 40-79 years identified from pathology and outpatient records at hospitals covered by these registries, newly diagnosed with pathologically confirmed prostate cancer between August 1, 1986, and April 30, 1989. Population controls less than age 65 years were selected at periodic intervals by random digit dialing. Older controls were systematically selected (after a random start) from computerized records of the Health Care Finance Administration. A statistically nonsignificant excess risk (odds ratio (OR) = 1.6, 95% confidence interval (CI) 0.5-4.8) for prostate cancer associated with vasectomy was noted in blacks. Overall, the risk for prostate cancer associated with vasectomy in whites was not elevated (OR = 1.1, 95% CI 0.8-1.7). An increase in risk was found, however, for white men who had had a vasectomy 20 years or more prior to study (OR = 1.7, 95% CI 0.9-3.3) or who had had a vasectomy at less than age 35 years (OR = 2.2, 95% CI 1.0-4.4). For the total study group, the odds ratio associated with men who had a vasectomy 20 or more years prior to study was 1.5 (95% CI 0.8-2.7), and the odds ratio associated with men who had had a vasectomy at less than age 35 years was 2.0 (95% CI 1.0-4.0). Further detailed analysis showed that young age at vasectomy (less than age 35 years) was a more important risk factor than was years since vasectomy.

Adult↗
PubMed2000

Access to innovative treatment of erectile dysfunction: clinical, economic, and quality-of-life considerations.

While effective therapies exist for health conditions that diminish the quality of life, there remain hurdles in healthcare delivery that may limit access to such therapies for individuals who would benefit from them. Limited company resources coupled with double-digit increases in pharmaceutical costs--frequently designated as the "culprit" behind recent increases in medical expenditures--may not allow health plans to cover every effective drug in every clinical circumstance for every affected individual. Managed care companies currently employ several mechanisms to counter runaway pharmaceutical costs, such as excluding some drugs from coverage, imposing significant limitations, or requiring higher copayments through tiered pharmaceutical coverage structures. The trend toward greater patient contribution for indicated agents could well invoke cries of bias, in that a tiered copayment system may discriminate based on income and ability to pay. The practical inability within the healthcare community to compare healthcare interventions such as treatments for erectile dysfunction with those for asthma, hypertension, or other conditions prevents the optimal allocation of healthcare services.

Adult↗
PubMed1998

Adolescents' access to care: teenagers' self-reported use of services and perceived access to confidential care.

BACKGROUND: Most surveys on adolescents' use of health services rely on parental report, and this may underestimate adolescents' use of confidential services. OBJECTIVE: To investigate adolescents' report of their own use of health services, access to care, and knowledge and use of confidential services. METHOD: A random digit-dialed survey of 14- to 19-year-old adolescents was conducted in Monroe County, New York. We screened 11 800 numbers and identified 4449 households (40%) of which 393 families (8.8%) had eligible adolescents. Of these, 259 (66%) consented and completed an interviewer-administered survey. RESULTS: Almost all adolescents (92%) rated their health as excellent or good and 90% had visited a health care provider within the year. Most (88%) identified a source of primary care. As many as 27% of adolescents had used more than one source of care. Many youth identify school personnel as important resources for health and counseling needs. Only 8.4% of respondents have used services confidentially, but nearly half of all youth did not know where they could obtain confidential care if they needed to. Adolescents were least likely to know where to obtain mental health or substance abuse and reproductive services. CONCLUSIONS: While most youth have used primary care, a substantial minority have not. Many teenagers depend on multiple sources of care, and they rely on school personnel as important sources of health information. Many do not know where they could go to review confidential services or for other services that they may need. Managed care insurance and public health policies should recognize adolescents' access needs to meet them appropriately.

Adolescent↗
PubMed2000

The subjective image quality of direct digital and conventional panoramic radiography.

One of the main advantages of digital imaging is the possibility of altering display options for improved image interpretation. The aim of the present study was to evaluate the subjective image quality of direct digital panoramic images and compare the results with those obtained from conventional images. Furthermore, the effect of various filter settings on image interpretation was assessed. Panoramic images were obtained with three different types of panoramic equipment (one direct digital and two conventional units) from three groups of 54 patients with a natural dentition in all quadrants. The first series of panoramic images consisted of 54 unprocessed digital images; conventional film images (n = 108) comprised the second and third series. A final series consisted of the digital images treated with three different filters ("smoothening," "sharpening," and "contrast enhancement"). All images were scored randomly by four experts in oral radiology on a 4-point rating scale. The results showed a statistically significant difference in scorings between the conventional and digital panoramic units. The main reason for poor image quality appeared to be a combination of blurring and overlapping in the panoramic image. The premolar region in the upper jaw was the region where most additional radiographs were needed.

Adolescent↗
PubMed2004

The digital revolution.

Digital image technology has advanced considerably in recent years and it has never been simpler to capture digital images or send them around the world. This new technology can bring tremendous benefits to healthcare but, if used inappropriately, will compromise patient confidentiality and increase the risk of litigation to the health providers. It is now time to assess the risks and agree safeguards which will promote the safe use of digital technology in the healthcare environment.

Computer Security↗
PubMedDate not supplied

Cold/flu knowledge, attitudes and health care practices: results of a two-city telephone survey.

The purpose of this paper is to describe knowledge, attitudes and practices of cold and flu self-care and health care utilization, and to identify the predictors of health care utilization for the cold and flu among residents of London and Windsor. Using a random digit dialing survey method, 417 residents were interviewed between November-December, 1993 and February-March, 1994. This survey revealed good knowledge about colds and flu and understanding of appropriate physician visits. Only seven percent reported a doctor visit for their last cold. Socio-demographic, health status, attitude and knowledge level variables were subjected to a logistic regression analysis to identify which variables predicted self-reported physician visits. Only attitudes and health status showed statistically significant log odds (3.6 and 1.5, respectively). In summary, consistent with other studies, attitude and health status, not knowledge, appear to be significant predictors of physician visits for colds/flu.

Adolescent↗
PubMed1999

Digital radiography and California third parties.

Acceptance of digital radiography is increasing but has not yet progressed to the mainstream. A key factor in widespread use of this advancement is acceptance--both theoretical and technological--by dental health plans for claim submissions. This article details a survey of California third parties to examine their practices, concerns, and plans regarding digital dental radiography.

Humans↗
PubMed2004

Mental health service and medication use in New York City after the September 11, 2001, terrorist attack.

OBJECTIVE: A survey assessed use of mental health services and psychiatric medications in New York City four to five months after the September 11, 2001, attack on the World Trade Center. METHODS: A telephone survey using random-digit dialing was conducted among 2,001 adult householders. RESULTS: During the interviews, 7.6 percent of respondents reported use of mental health services in the past 30 days and 7.7 percent reported use of psychiatric medications. Factors associated with service use included experiencing four or more lifetime traumatic events, experiencing two or more stressful life events in the past 12 months, having posttraumatic stress disorder (PTSD), and having depression. African-American and Hispanic respondents were less likely than white respondents to use services. Greater service use after the attack was associated with a graduate education, increased alcohol use after the attack, and depression. Factors associated with medication use included being in either of two age groups (25 to 44 years and 45 to 64 years), having a primary care physician, experiencing two or more stressful life events in the past 12 months, and having depression. African-American and Hispanic respondents were less likely than white respondents to be taking medications. Greater use after the attack was associated with having depression. Mental health visits in Manhattan appeared to decrease compared with the first two months after the attack. However, among respondents with PTSD or depression, those who were nonwhite, younger, without a primary care physician, or without health insurance were less likely to use postdisaster services. CONCLUSIONS: Service use after the terrorist attack was related to mental status and to the amount of trauma and stress experienced. Overall, white respondents, those aged 25 to 64 years, and those with a primary care physician were more likely to use services.

Adolescent↗
PubMed2003

Using a personal digital assistant enhances gathering of patient data on an acute pain management service: a pilot study.

PURPOSE: Handheld computer technology provides a unique opportunity for health care professionals to access real time or near real time patient information and evidence-based resources at the point-of-care. The purpose of this study was to assess one physician's experience using acute pain assessment software on a personal digital assistant (PDA) to assess patients on an acute pain management service (APMS). METHODS: Using a historical control and a "time and motion" study design, comparisons were made on acute pain assessment time and comprehensiveness when patient assessments are documented on a PDA vs the current paper-based method. RESULTS: The study physician (a PDA-user) reported feeling comfortable with the assessment software after five patient assessments. PDA assessments were more likely to contain documentation regarding pain and side effects (e.g., nausea, pruritus, hypotension) than the paper assessments. The median time of the "assessment only" component of the patient encounter was 53 sec longer using the PDA compared to paper (P < 0.00), however, the median "total encounter" (chart review, assessment, documentation) time was 74 sec shorter using the PDA vs paper (P < 0.00). DISCUSSION: The findings of this preliminary study suggest that the PDA is a reliable tool that meets the data management requirements within an APMS setting. This study found that patient assessments documented using acute pain software developed for use on a PDA were as efficient and content-rich as paper assessments. The PDA may even enhance the efficiency of the patient assessment process through the provision of more comprehensive digital data for research, clinical, and administrative needs.

Computers, Handheld↗
PubMed2005

Emergency eye care in rural Australia: role of internet.

PURPOSE: Significant differences exist in the utilization of emergency eye care services in rural and urban Australia. Meanwhile, influence of internet-based technology in emergency eye care service utilization has not been established. This study aims to demonstrate, from a health provider perspective, an internet-based service's impact on emergency eye care in rural Australia. METHODS: The teleophthalmology service was initiated in the Carnarvon Regional Hospital (CRH) of the Gascoyne region in Western Australia. A digital, slit lamp and fundus camera were used for the service. Economic data was gathered from the Department of Health of Western Australia (DOHWA), the CRH and the Lions Eye Institute. RESULTS: During the study period (January-December, 2003) 118 persons took part in teleophthalmology consultations. Emergency cases constituted 3% of these consultations. Previous year, there were seven eye-related emergency evacuations (inter-hospital air transfers) from the Gascoyne region to City of Perth. CONCLUSIONS: Analysis demonstrates implementation of internet-based health services has a marked impact on rural emergency eye care delivery. Internet is well suited to ophthalmology for the diagnosis and management of acute conditions in remote areas. Integration of such services to mainstream health care is recommended.

Adolescent↗
PubMed2006

Use of information and communication technology (ICT) and perceived health in adolescence: the role of sleeping habits and waking-time tiredness.

The first aim for this paper was to examine gender and age differences in the intensity of usage of information and communication technology (ICT: computer for digital playing, writing and e-mailing and communication, and Internet surfing, and mobile phone). Second, we modelled the possible mediating role of sleeping habits and waking-time tiredness in the association between ICT usage and perceived health (health complaints, musculoskeletal symptoms, health status). The participants were 7292 Finns aged 12, 14, 16 and 18 years responding to a postal enquiry (response rate 70%). The results showed that boys played digital games and used Internet more often than girls, whose mobile phone usage was more intensive. Structural equation model analyses substantiated the mediating hypothesis: intensive ICT-usage was associated with poor perceived health particularly or only when it negatively affected sleeping habits, which in turn was associated with increased waking-time tiredness. The associations were gender-specific especially among older adolescents (16- and 18-year olds). Intensive computer usage forms a risk for boys', and intensive mobile phone usage for girls' perceived health through the mediating links. Girls were vulnerable to the negative consequences of intensive mobile phone usage, as it associated with perceived health complaints and musculoskeletal symptoms both directly and through deteriorated sleep and increased waking-time tiredness. The results of gender-specific ICT usage and vulnerability are discussed as reflecting gendered psychophysiological, psychological and social developmental demands.

Adolescent↗
PubMed2003

Sexual behavior of older women: results of a random-digit-dialing survey of 2,000 women in the United States.

BACKGROUND: There are few reports describing sexual activity among women older than 50 years of age. GOAL: The goal of the study was to describe sexual practices and health behaviors of women aged 18-94 years, highlighting characteristics of older women (aged 60-94 years). STUDY DESIGN: The study involved a random-digit-dialing survey (N = 2,000) of women aged 18-94 years living in the continental United States. RESULTS: Frequency and occurrence of sexual activity decreased with age. Married women in every age group were more likely to have engaged in recent sexual activity. Condom use decreased with age and lubricant use increased with age. Over one-third of all women reported douching in a typical month, and there was no trend with age. CONCLUSION: Women in older age groups vary greatly in terms of sexual practices and health behaviors.

Adult↗
PubMedDate not supplied

Incentivized digital outcomes collection.

The objective of this study was to assess the feasibility of digital patient satisfaction outcomes collection using the Internet and interactive voice response technology. Patients, health care providers, and industry sponsors were provided with incentives to participate. The participants included the practitioners and patients in medical and surgical practices who used Project Quality Card (patent pending) and the Practice Improvement Program. The study subjects were convenience samples of new and established patients seen between September 1999 and December 2000. There were 3 different pilot projects: QC1, QC2, and QC3. Patients were provided with a 20-minute prepaid phone card as an incentive for completing an interactive voice response call. Patients answered the 9-item visit rating questionnaire used to measure patient satisfaction. Patients responded on a 5-point scale, with 5 being excellent, and responses were totaled in the categories of patient access and physician attributes and in an overall score for the visit. A total of 998 patients from 77 physician offices participated. The activation responses, or percentage of patients using the Quality Cards, ranged from 12.8% in group 2 (QC2) to 26.6% in group 1 (QC1) to 34.8% in group 3 (QC3). This study demonstrates that incentivized digital outcomes collection can be successfully implemented in multisite community-based medical and surgical offices. The use of Project Quality Card (interactive voice response technology) and the Practice Improvement Program provides opportunities for user-friendly, benchmarked, real-time data collection. The percentage of patient activations is linked to provider participation in quality improvement programs. Patient participation is improved as the frequency of contact with a peer-directed database increases.

Data Collection↗
PubMed1992

Information technology and today's health care management.

With the move to CPR, health information managers will be challenged to reengineer the ways they manage processes within the medical record department. A lot of age-old health information problems (i.e., missing documents, lost test results, and missing records) can be solved and productivity improved with imaging. The digitized records will allow simultaneous access to readily available, legible, and usable information for patient care, research, audits, and correspondence. However, the transition from a manual to computerized record presents many challenges. Health information managers will have to monitor the changeover carefully, anticipating the needs for new information and developing the necessary mechanisms to produce it, as well as implementing new technologies as they emerge. Conditions are right for an advance in health care information systems. Pressures and changes in structure in the health care industry require better management tools. Acceptance of HIS as a management tool is growing rapidly among the health care provider community. The technology to realize the CPR and advanced decision support systems is available. All the pieces are there--they just need to come together. As the health care organization's view of and need for information systems change, medical record professionals must draw on their knowledge and experience and make the transition from managers of record systems to managers of health care information systems.

Decision Support Systems, Management↗
PubMed2003

Do alterations in vertebral and disc dimensions affect an elliptical model of thoracic kyphosis?

STUDY DESIGN: Mathematical modeling, using least squares method, of thoracic kyphosis was constructed as digitized points from radiographs of 50 healthy patients. OBJECTIVE: To determine a simple geometric model of the thoracic kyphosis. SUMMARY OF BACKGROUND DATA: Thoracic kyphosis is an important parameter of health, but geometric models of kyphosis are rare. Few papers report vertebral body and disc height data. METHODS: Thoracic vertebral bodies were digitized on lateral radiographs of 50 healthy patients. The average path of the posterior vertebral body corners of T1 through T12 was modeled, in the least squares sense, with a portion of an ellipse. The best-fit ellipse was sectioned with different model partitions using four sets of vertebral body heights and disc heights. Segmental and global angles derived from these four models were compared with reported values in the literature. RESULTS: A 72 degrees portion of an ellipse, with a minor-to-major axis ratio of 0.69, can closely approximate the path of the posterior body corners from the inferior of T1 to the superior of T12. The posterior vertebral body heights and disc heights have an average ratio of approximately 5:1. Segmental angles from T3-T4 through T11-T12 for all four models are close to other reported values. The thoracic spine has a height-to-length ratio of approximately 0.96. CONCLUSIONS: Thoracic kyphosis from inferior-posterior T1 to superior-posterior T12 can be closely modeled (least squares error per point < 1 mm) with a 72 degrees piece of an ellipse with a minor-to-major axis ratio of 0.69. The major axis is parallel to the posterior body margin of T12, whereas the minor axis passes through the superior endplate of T12. Segmental angles derived from this elliptical modeling are in the range of values from healthy patients.

Humans↗
PubMed1998

A comprehensive physical image quality evaluation of a selenium based digital x-ray imaging system for thorax radiography.

A selenium based digital x-ray system dedicated to chest radiography has been installed by the UK Department of Health's Medical Devices Agency at Leeds General Infirmary, UK, to undergo a comprehensive evaluation, including the physical image quality. The underlying characteristics which define the overall image quality of a system are the following: sensitometric response, modulation transfer function, and noise power spectrum. These have been measured objectively on preprocessed digital data acquired under relevant radiographic conditions. The image data is further processed prior to hard copy display. The displayed image quality may only be measured subjectively; threshold contrast detail detectability is such a measure which can be related to the objective measures of image quality. The objective imaging characteristics suggest that Thoravision has a significant advantage over conventional radiography imaging systems. However, subjective measures have demonstrated that the image processing can have a significant effect on the perceived image quality. Thoravision has the potential to deliver a significantly improved image quality to clinicians with no increase in radiation exposure to the patient, or image quality may be maintained with a reduction in radiation exposure. Digital image processing is central to the efficiency with which it achieves this.

Biophysical Phenomena↗
PubMed2003

Awareness and perceptions of a communitywide mental health program in New York city after September 11.

The Project Liberty program was established after the terrorist attacks of September 11, 2001, to offer free mental health services to New York City residents. The authors used data from a random-digit-dial telephone survey to assess public awareness of and willingness to make use of Project Liberty's services. They found that 24 percent of the New York City residents surveyed (480 of 2001 respondents) had heard of Project Liberty four months after September 11. Persons with lower socioeconomic status and those who had psychological symptoms consistent with posttraumatic stress disorder were more likely to say that they would contact Project Liberty. The results of the study suggest that although awareness of this public mental health services was low, Project Liberty was well received among the people who may be most likely to need its services.

Adolescent↗
PubMed2003

Improving the self reporting of tobacco use: results of a factorial experiment.

OBJECTIVES: To examine divergent estimates of smoking prevalence in two random digit dial surveys for the same population. Based upon internal and external reviews of survey procedures, differences in survey introductions (general health versus tobacco specific introduction) and/or differences in the use of filter questions were identified as the most likely explanations. This prompted an experiment designed to investigate these potential sources of measurement error. DESIGN: A randomised 2 x 2 factorial experiment. SETTING: A random digit dial telephone survey from July to September 2000. SUBJECTS: 3996 adult Californian respondents. MAIN OUTCOME MEASURES: A series of smoking prevalence questions in the context of a tobacco or general health survey. RESULTS: Logistic regression analyses suggest that, among females, prior knowledge (from the survey introduction) that a survey is concerned with tobacco use may decrease self reported smoking prevalence (approximately 4% absolute prevalence difference). Differences in the use of filter questions resulted in almost no misclassification of respondents. CONCLUSIONS: The tobacco specific survey introduction is causing some smokers to deny their tobacco use. The data suggest that these smokers tend to be women that smoked occasionally. A desire by the participants to minimise their personal time costs or a growing social disapproval of tobacco use in the USA may be contributing to the creation of previously undetected survey artefacts in the measurement of tobacco related behaviours.

Adolescent↗