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At least 811 records · Page 45Linked to original sources
PubMed1995

Computer-aided learning validation: a CAI-critical mission.

Despite a marked increase in computer-assisted instructional applications (CAI) over the past few years, little attention has been paid to revising traditional approaches toward educational testing. This paper reports a CAI project that emphasizes integrating the testing and training of visual judgmental capacities of health care professionals. It takes advantage of the computer's ability to display digital video segments and to record and compare user learning accomplishment and at the same time a normative performance scale can be developed. The program uses a method which, in addition to validating the efficacy of the project itself, collects data and stratifies users' level of proficiency by integrating pre-test and post-test modules. Routine incorporation of these principles in CAI may provide a more effective means of correctly evaluating the individual's mastery of a topic.

Cardiology↗
PubMed1996

New adjunctive methods for cervical cancer screening.

The sensitivity of cytology for detection of cervical intraepithelial neoplasia (CIN) is effectively augmented by cervicography with the disadvantage of lower specificity. However, the combination of cytology and cervicography can decrease the number of recalls, biopsies, and unnecessary treatments, which reduces cost. Down-staging of invasive cancer by visual inspection seems a cost-effective alternative to the introduction of cytology in countries with limited health facilities. Other methods such as speculoscopy, polarprobe, laser-induced fluorescence, computerized digital imaging colposcopy, or computer imaging have a potential to be used for future screening or triaging; however, so far, insufficient data are available to evaluate the validity of these techniques.

Colposcopy↗
PubMed2000

Evaluation of a digital camera for acquiring radiographic images for telemedicine applications.

Many rural sites cannot afford a digitizer to digitize radiographic films and transmit them via a telemedicine network for review by a radiology specialist. This project tested the feasibility of using a consumer digital still camera to photograph radiographic images and transmit them via a telemedicine network to a consulting hub site. In this study, the feasibility of using a digital camera to photograph plain film radiographs of 40 bone trauma cases from a rural health center in Arizona was tested. The cases were transmitted to the Arizona Telemedicine Program hub site using a private asynchronous transfer mode network based on T1 carriers. Two orthopedic surgeons and two radiologists reviewed the cases on a color monitor and the original film images. The readers also rated image quality. There were no significant differences in diagnostic accuracy between conventional film and telemedicine reading. Diagnostic agreement between film and monitor viewing was quite high, as was agreement in confidence ratings. Image quality was generally rated as excellent to good in both viewing conditions. Cases that did not correlate well were judged to have poor image quality, or diagnoses were based on photographs that had part of the diagnostic region of interest cropped off. It was determined that a digital still camera can be used effectively in many cases to photograph radiographic images for transmission and viewing via a telemedicine network, as long as adequate views, zoomed in regions of interest, and good quality original films are used in the acquisition process.

Arizona↗
PubMed2003

The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and blacks in four low-income New York City neighborhoods.

OBJECTIVE: This study examines the association between discrimination due to race and other attributes (e.g., sex, age) and self-assessed mental and physical health among Latinos and blacks. DATA SOURCE: Latino and black adult participants (n = 873) identified by random digit dialing were interviewed by telephone in four low-income neighborhoods in New York City: the South Bronx, East Harlem, Central Harlem, and Bedford-Stuyvesant. STUDY DESIGN: In this cross-sectional study, generalized estimating equations were used to fit multilevel multivariable models to test the association between discrimination and poor mental and physical health while controlling for socioeconomic status, access to health care, social support, smoking, and the racial and ethnic composition of each neighborhood. PRINCIPAL FINDINGS: Discrimination due to race and discrimination due to other attributes were associated with poor self-assessed mental but not physical health in separate multivariable models. Persons who experienced multiple domains of discrimination had a greater probability of reporting poor mental health than persons who experienced no discrimination. CONCLUSIONS: Discrimination due to race and other attributes was a significant correlate of mental health among Latinos and blacks independent of other accepted determinants of health.

Adolescent↗
PubMed1999

An electronic survey of opinions on the compatibility of current X-ray generators with intra-oral digital X-ray systems.

OBJECTIVES: To assess opinions on the compatibility of current X-ray generators with intra-oral digital X-ray systems. METHODS: A questionnaire was posted in both English and in Japanese on oral and maxillofacial radiology electronic bulletin boards. The questionnaire was also mailed to selected researchers and manufacturers in oral and maxillofacial radiology. The replies were evaluated to determine opinion on the current and future status of digital intra-oral imaging with special reference to their compatibility with current X-ray generators. RESULTS: Seventy-one replies were received from 19 countries: 39% from Japan and Korea, 27% from North America, 25% from Europe and 8% from the rest of the world. Eighty per cent of respondents were from academia, 15% from industry and the remainder largely in private practice. Respondents' experience was equally divided between solid state, mainly charge-coupled devices (CCDs) and photostimulable phosphor (IP) technologies. Sixty-eight per cent considered that current X-ray generators are compatible with intra-oral digital systems and many believed this was due to their gray scale flexibility. Twenty-eight per cent believed that existing X-ray generators are inconsistent with low exposure times. Many of the replies suggested that in future pixel size would decrease and bit depth and receptor sensitivity increase. CONCLUSIONS: Most respondents are happy to use existing X-ray generators with digital X-ray systems. However, they also believe that increased sensitivity of receptors could lead to more stringent designs of X-ray generators to ensure more reliable outputs in the low exposure range.

Attitude of Health Personnel↗
PubMed2006

Was there unmet mental health need after the September 11, 2001 terrorist attacks?

BACKGROUND: This study examined the use of professionals for mental health problems among New York City residents who were directly affected by the September 11, 2001 terrorist attacks on the World Trade Center (WTC) or had a probable diagnosis of post-traumatic stress disorder (PTSD) or depression in its aftermath. Correlates of help seeking from professionals for mental health problems after the attacks and barriers to care were also assessed. METHOD: Data were from a random digit dial telephone survey of 2,752 adults representative of the Greater New York Metropolitan area conducted 6 months after the September 11 terrorist attacks. RESULTS: Fifteen percent of those directly affected and 36% of those with probable PTSD or depression sought help from a professional for a mental health problem after the attacks. There was little new utilization of professionals for mental health problems after the attacks among persons who were not already receiving care prior to September 11. Barriers that prevented people from seeking help for mental health problems 6 months after the September 11 attacks included traditional barriers to care (e.g., cost) and barriers that are unique to the post-disaster context (e.g., the belief that others need the services more than oneself). CONCLUSIONS: This study suggests that there was potential unmet mental health need in New York City 6 months after the September 11 attacks on the WTC, but these findings should be tempered by research showing an apparent decrease in population-rates of PTSD. In the aftermath of a disaster, interventions should target persons with mental health needs who were not previously seeking help from a professional for a mental health problem.

Adolescent↗
PubMed2005

Practice of habitual and volitional health behaviors to prevent severe acute respiratory syndrome among Chinese adolescents in Hong Kong.

PURPOSE: To explore factors relating to the practice of habitual and volitional health behaviors against the severe acute respiratory syndrome (SARS) among Chinese adolescents in Hong Kong. METHODS: A community telephone survey was conducted with 230 Chinese adolescents. Random-digit dialing of the local residential telephone directory was used to select respondents, who were asked to provide information on their practice of SARS preventive health behaviors and associated factors as specified by the Health Belief Model. These factors included perceived threat of SARS, perceived benefits and barriers in practicing SARS preventive health behaviors, cues to action, knowledge of SARS, and self-efficacy. Hierarchical regression analyses were conducted to determine salient correlates of habitual and volitional health behaviors against SARS. RESULTS: About 54.8% of respondents reported practicing all three recommended habitual health behaviors. Another 47.8% indicated consistent practice of volitional health behavior of facemask-wearing to prevent SARS. Results of hierarchical regression analyses showed that habitual health behaviors against SARS were related to perceived health threat and environmental cues. For facemask-wearing, salient correlates were environmental cues, rates of SARS habitual health behaviors, younger age, and perceived health threat. CONCLUSIONS: The Health Belief Model is useful in understanding Chinese adolescents' practice of health behaviors, especially volitional health behaviors.

Adolescent↗
PubMed2004

Cost-effectiveness of digital photographic screening for retinopathy of prematurity in the United Kingdom.

OBJECTIVES: To compare the cost-effectiveness of alternative methods of screening for retinopathy of prematurity (ROP) in the United Kingdom, including the existing method of indirect ophthalmoscopy by ophthalmologists and digital photographic screening by nurses. METHODS: A decision tree model was used to compare five screening modalities for the UK population of preterm babies, using a health service perspective. Data were taken from published sources, observation at a neonatal intensive care unit (NICU), and expert judgment. RESULTS: We estimated that use of standard digital cameras by nurses in NICUs would cost more than current methods (pound 371 compared with pound 321 per baby screened). However, a specialist nurse visiting units with a portable camera would be cheaper (pound 172 per baby). These estimates rely on nurses capturing and interpreting the images, with suitable training and supervision. Alternatively, nurses could capture the images then transmit them to a central unit for interpretation by ophthalmologists, although we estimate that this would be rather more expensive (pound 390 and pound 201, respectively, for NICU and visiting nurses). Sensitivity analysis was used to examine the robustness of estimates. CONCLUSIONS: It is likely that there is an opportunity to improve the efficiency of the ROP screening program. We estimate that screening by specialist nurses trained in image capture and interpretation using portable digital cameras is a cost-effective alternative to the current program of direct visualization by ophthalmologists. This option would require the development of a suitable portable machine. Direct comparative research is strongly needed to establish the accuracy of the various screening options.

Cohort Studies↗
PubMed1996

Experiences of battered women in health care settings: a qualitative study.

Interventions to help battered women seek and receive optimal health care must be informed by battered women's experiences in health care settings. In this study, we used a Systems Model to categorize the barriers battered women encounter in health care settings into patient, provider, and organizational levels. We conducted in-depth, face-to-face interviews with 31 battered women recruited by random digit dialing of households and by a publicity recruitment campaign. The data revealed that at the patient level, many women chose to conceal their abuse from their health care professionals, some fearing retaliation from their partners if they revealed the source of their injuries. At the provider level, the women perceived health care professionals to be disinterested or unsympathetic toward the needs of battered women, causing the women to feel ignored or trivialized. And at an organizational level, battered women believed that the structure of the health care system did not allow health care professionals enough time to deal with issues beyond treating their immediate presenting injuries. To ensure that battered women seek and receive optimal health care, multicomponent interventions should be designed to address the complex barriers at the three levels. We conclude by suggesting possible ways to help battered women get the tools they need to raise the issue of domestic violence with their health care professional. We also suggest ways to enable these professionals to identify battered women, validate their experiences, and provide appropriate referrals.

Adult↗
PubMed2003

Comparison of the diagnostic potential of direct digital and conventional intraoral radiography in the evaluation of peri-implant conditions.

The aims of this study were to examine whether viewers agreed on details seen in direct (real time) digital and conventional film radiographs of implants, and whether there were differences in agreement between the systems. Intra-oral radiographs of implants were exposed both as direct digital and conventional film radiographs. Fifty pairs of radiographs with similar projection and exposure were selected, showing 59 implants. Ten viewers assessed the radiographs separately and noted eight different details. The viewers showed very high agreement in their assessments of radiographs of each technique separately, and there were no statistically significant differences. However, there was a tendency to stronger agreement in the direct digital radiographs in four assessed points out of eight. The patients' experience of having radiographs exposed with the two methods was also studied by questionnaire. The patients' opinions on the two techniques did not differ statistically. This study shows that digital radiography has at least equal diagnostic yield compared to film radiography.

Adolescent↗
PubMed2001

The impact of managed care and current governmental policies on an urban academic health care center.

BACKGROUND: Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. METHODS: Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. RESULTS: Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). CONCLUSIONS: Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

Academic Medical Centers↗
PubMed2002

Clinical evaluation of patients with diabetic retinopathy: accuracy of the Inoveon diabetic retinopathy-3DT system.

PURPOSE: This study analyzed the accuracy of the Inoveon Diabetic Retinopathy (DR-3DT) system (Inoveon Corp., Oklahoma City, OK), a scalable evaluation method for the management of diabetic retinopathy using high-quality digital retinal imaging. DESIGN: An independent, masked, cross-sectional, clinical validation study. PARTICIPANTS: Two hundred ninety adult patients with diabetes from the Chickasaw Nation's Carl Albert Indian Health Facility in Ada, Oklahoma. METHODS: All participants underwent DRS7 imaging using a Zeiss FF450 fundus camera with images recorded on 35-mm film and a Kodak DCS520 digital camera back. Masked double grading with independent third reader adjudication yielded an Early Treatment Diabetic Retinopathy Study (ETDRS) Final Retinopathy Severity Scale Level (ETDRS Level) and macular edema stage for each eye. The presence of greater-than-or-equal ETDRS Level 53, questionable or definite clinically significant macular edema in either eye, or ungradeable images was defined as a threshold event requiring referral. MAIN OUTCOME MEASURES: Accuracy (sensitivity, specificity, predictive values) of the digital system relative to the film "gold standard" on the threshold referral criteria per patient. RESULTS: All patients with gradeable 35-mm slides from at least one eye were included in this per patient analysis (n = 290). The prevalence of threshold events was 19.3%. The sensitivity of the digital system in detecting threshold events was 98.2% (95% confidence interval [CI], 90.5%-100.0%) and specificity 89.7% (95% CI, 85.1%-93.3%). The positive predictive value was 69.5% and negative predictive value 99.5% for this sample. CONCLUSIONS: When compared with the "gold standard," Inoveon's DR-3DT system provides highly accurate diabetic retinopathy referral decisions. Given their inherent advantages, high-quality digital imaging systems could replace the film "gold standard" as the basis for scalable, accessible, diabetic retinopathy evaluation.

Adult↗
PubMed1999

Self-reported health-promoting behaviors of black and white caregivers.

The purpose of this study was to describe the behaviors that caregivers report carrying out to maintain their own health, and to compare the health-promoting behaviors of Black and White caregivers. Although many studies have examined health-promoting behaviors, few have examined health promotion among caregivers. Reported studies of caregivers' health-promoting behaviors have not compared cultural groups. The sample for this study was selected by random digit dialing, and included 136 Black and 257 White caregivers of frail elders. Content analysis of respondents' answers to the open-ended question, "In general, what do you do to stay healthy?" was used to address the research questions. Most caregivers reported specific behaviors they engaged in for the purpose of staying healthy. Although most of their behaviors addressed physical health, caregivers also mentioned behaviors that contribute to mental and spiritual health. Both differences and similarities were found in Black and White caregivers' self-reported health behaviors, which have important implications for nursing practice and research in the future.

Adult↗
PubMed2004

Spatial pattern of private health care provision in Ujjain, India: a provider survey processed and analysed with a Geographical Information System.

In developing countries like India, official information on private health care providers is scanty. This is an obstacle for effective health care planning and policy development. In this paper, we present a project aimed to enumerate, characterise and digitally map all private providers (PPs) using Geographical Information System (GIS) in a rural district in India. A team of surveyors carried out a census of private providers in the district. This data was combined with official data on geophysical characteristics and infrastructure, demographic situation and location of settlements and public health care providers. This study highlights the need to consider PPs in health policy making in India. The survey identified about 2000 additional PPs over and above those listed with the health authorities. About half practised modern medicine (Allopathy) while the rest practised other types of formal medical systems (Ayurveda or Homeopathy) or informal therapeutic systems. Individuals with no formal health care training constituted the majority of PPs. Formally trained doctors were highly concentrated in urban areas while trained non-doctors and untrained PPs dominated in the rural areas. The study shows how GIS can be used to create an improved basis for health services research. In the future, the digitised map will be used as a sampling frame and point of reference for studies on quality and utilisation of PPs in Ujjain district. However, the utility for health care planning is less clear. GIS has limitations in countries like India due to lack of valid routine data to enter into GIS as well as to competing demand for health care resources.

Data Collection↗
PubMed1997

Life circumstances, lifestyles and oral health among older Canadians.

OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question.

Age Factors↗