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PubMed2005

Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women.

BACKGROUND: Uterine leiomyomata are a major source of morbidity in black women. We prospectively investigated the risk of self-reported uterine leiomyomata in relation to body mass index (BMI), weight change, height, waist and hip circumferences, and waist-to-hip ratio in a large cohort of U.S black women. METHODS: Data were derived from the Black Women's Health Study, a U.S. prospective cohort study of black women who complete biannual mailed health questionnaires. From 1997 through 2001, we followed 21,506 premenopausal women with intact uteri and no prior diagnosis of uterine leiomyomata. Cox regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: After 70,345 person-years of follow up, 2146 new cases of uterine leiomyomata confirmed by ultrasound (n = 1885) or hysterectomy (n = 261) were self-reported. Compared with the thinnest women (BMI <20.0 kg/m), the multivariate IRRs for women with BMIs of 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-32.4, and 32.5+ kg/m were 1.34 (95% CI = 1.02-1.75), 1.39 (1.07-1.81), 1.45 (1.12-1.89), 1.47 (1.11-1.93), 1.36 (1.02-1.80), and 1.21 (0.93-1.58), respectively. IRRs were larger among parous women. Weight gain since age 18 was positively associated with risk, but only among parous women. No other anthropometric measures were associated with risk. CONCLUSIONS: BMI and weight gain exhibited a complex relation with risk of uterine leiomyomata in the Black Women's Health Study. The BMI association was inverse J-shaped and findings were stronger in parous women. Weight gain was positively associated with risk among parous women only.

Adipose Tissue↗
PubMed2002

Using a telephone survey to acquire genetic and behavioral data related to cigarette smoking in "made-anonymous" and "registry" samples.

In the Smokers and Nonsmokers Study, the authors investigated the feasibility of using random digit dialing telephone interviews to locate adults in the continental United States who were willing to provide DNA from buccal swabs through the mail. Interviews with 3,383 adults regarding their smoking-related behaviors (response rate = 70%) were conducted in 1999-2000; swab returns continued into early 2001. Overall, 57% of interviewees agreed to receive mailed information explaining the study. Better-educated persons (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.1, 1.6), younger persons (OR = 0.988, 95% CI: 0.983, 0.992), persons with symptoms of depression (OR = 1.8, 95% CI: 1.4, 2.4), and current smokers (OR = 2.25, 95% CI: 1.8, 2.8) were likelier to agree to receive a mailing. Approximately 26% of interviewees (45% of those receiving kits) returned buccal swabs, and 18% were successfully genotyped. Older (OR = 1.02, 95% CI: 1.01, 1.03), better-educated (OR = 1.4, 95% CI: 1.1, 1.7), and White (OR = 1.8, 95% CI: 1.4, 2.5) participants were more likely to return DNA samples, but current smokers (OR = 0.6, 95% CI: 0.5, 0.8) were less likely to do so. Participants were randomly assigned to one of two forms of participation: the "registry" group (names were kept on file) or the "made-anonymous" group (names were unassociated with samples). The two groups were equally likely to return kits, but registry respondents were more likely to nominate siblings for participation in the study (OR = 1.6, 95% CI: 1.2, 2.1). The participants in this study were similar demographically to the national population. The authors conclude that random digit dialing surveys coupled with mail collection of DNA may constitute a practical method of obtaining DNA samples for biobehavioral research.

Adult↗
PubMed2005

The prevalence of bother, acceptance, and need for help in men with erectile dysfunction.

INTRODUCTION: Apart from knowledge on the prevalence of erectile dysfunction (ED), for clinical reasons it is important to obtain information on concern or bother and need for help. However, information is lacking on men with ED who need help but do not seek medical attention. Thus, this study aimed to assess the distribution of bother, acceptance, and need for help in men with ED, and assess characteristics of patients with ED in need for help but not receiving medical attention for ED. METHODS: A total of 5,721 men aged 18 years and older and registered in 12 general practices in the middle of the Netherlands were sent a questionnaire by mail about sexual problems, ED, need for help, and medical attention. Out of 2,117 questionnaires that were returned, 1,481 were completed on ED, bother, and need for help. RESULTS: The prevalence of ED (according to World Health Organization definition) in the 1,481 men was 14.2%. Of these men 67.3% were bothered, 68.7% did not accept ED, and 85.3% wanted help. Surprisingly, 41.9% of men who denied a need for help were bothered and 19.4% did not accept ED. Only 10.4% of men with ED received any medical care. Bother in men with ED was related to increasing age (decreasing above 60 years). Compared with men who already received help for ED, men who wanted help but did not receive it more often suffered from diabetes, neurological problems, and various cardiovascular problems. On the other hand, history of myocardial infarction increased the chance of getting adequate medical attention for ED. CONCLUSIONS: The majority of men with ED are concerned or bothered and perceive a need for help. Most of them do not receive any medical attention. These men are characterized by chronic medical conditions, visiting the physician's office regularly for their medical condition.

Adolescent↗
PubMed1990

Improving access to computer-based library and drug information services in patient-care areas.

A project to increase access to drug and biomedical information through electronic linkage of drug information and library services to three patient-care areas is described. In February 1987, microcomputer work stations were installed in the Bexar County Hospital District's hospital emergency department, medical residents' office, and ambulatory-care clinic, as well as in The University of Texas Health Science Center's library reference area and drug information service office. Drug information was available on compact disk through the Micromedex Computerized Clinical Information System (CCIS) database, which includes DRUGDEX, POISINDEX, EMERGINDEX, and IDENTIDEX. Each work station was also connected to the library's computer via modem, allowing access to the Library Information System, books, journals, audiovisual materials, miniMEDLINE, and an electronic mail system. During the six-month project, the system was used 5487 times by 702 people. The system was successful in providing drug and other information in clinical settings and in introducing clinical staff members to new information technology. To increase access to the system after the project ended, the CD-ROM version was discontinued, and the distributed tape version of CCIS for VAX computers was added to the library's online information system, making drug information more available throughout the campus and teaching hospitals. In 1988-89 an average of 200 people accessed the tape version of CCIS each month. Although it is difficult to replace the convenience of an onsite library, at least some drug and biomedical information needs in the clinical setting can be met through computer networking.

Computer Communication Networks↗
PubMed1994

Familial aggregation and heritability of waist-to-hip ratio in adult women: the Iowa Women's Health Study.

The aim of this study was to assess evidence that genetic factors influence body fat distribution. First-degree relatives of 324 cancer-free females in a population-based prospective study of 41,837 women (99% white) between the ages of 55 and 69 at baseline in 1986 were studied. A total of 396 living sisters (mean age 65.7 years) and 446 living daughters (mean age 41.2 years) were identified through a mailed 'family tree' questionnaire sent to each participant. Family members were mailed a questionnaire to obtain self-reported measures of current height and weight. A paper tape measure and written instructions were enclosed to obtain waist and hip circumferences. The age-adjusted mother-daughters correlations for waist-to-hip ratio and body mass index (kg/m2) were 0.19 and 0.23, respectively (P < 0.05 using Fisher's z-transformation). The corresponding sister-sister correlations were 0.23 and 0.19, respectively (P < 0.05). The sister-sister correlations were not significantly different from the mother-daughter correlations. After adjustment for body mass index the mother-daughter correlation for waist-to-hip ratio increased to 0.20 and the sister-sister correlation increased to 0.26. These familial correlations suggest that genes and common environment may contribute 40 to 50% of the total variance of waist-to-hip ratio in white women in the Midwest.

Aged↗
PubMed2001

[Prevalence and factors associated with burnout in a health area].

OBJECTIVES: The main objective was to determine the prevalence of the burnout syndrome among health workers and its distribution by social, demographic and work variables. The secondary aim was to detect potentially modifiable causes. DESIGN: Descriptive cross-sectional study. SETTING: Primary care. PARTICIPANTS: All the 354 doctors, nurses and clinical auxiliaries belonging to the 22 primary care teams of Area VI, Madrid. MEASUREMENTS AND MAIN RESULTS: A self-administered, anonymous questionnaire was sent out by internal mail. This had three instruments: a questionnaire on social and demographic variables, the validated questionnaire known as the Maslach Burnout Inventory and an open opinion section. High levels of burnout were detected: 30.6% in the high range on the emotional tiredness sub-scale, with higher scores among men (p = 0.026). There were also more paediatric staff affected in personal achievements. There was scant relationship of the syndrome to social variables. 43.9% thought they suffered or had suffered from some kind of physical or psychological disorder directly related to exercising their profession. 38.3% associated directly their burnout with the excess demand habitually experienced in clinics. CONCLUSIONS: We detected worryingly high levels of this syndrome among our professionals, similar to other surveys in Spain. The subjects of the survey linked their unease with certain work factors that could easily be modified. The training received in techniques of self-control and stress management is clearly insufficient.

Burnout, Professional↗
PubMed2002

Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys.

INTRODUCTION: Measuring patient-perceived outcomes following orthopaedic procedures have become an important component of clinical research and patient care. General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients' perceived health status. Unfortunately, paper-based, self-administered instruments remain inefficient for collecting data because of: (a) missing data (b) respondent error, and (c) the costs to administer and enter data. OBJECTIVE: To study the comparability of palm-top computer devices and paper-pencil self-administered questionnaires in the collection of health-related quality of life (HRQL) information from patients. METHODS: The comparability of administering HRQL questionnaires using palm-top computer and traditional paper-based forms was tested in a sample of 96 patients with complaints of hip and/or knee pain. Each patient completed mailed versions of the Medical Outcomes Study (MOS), 36-item Health Survey (SF-36), and Western Ontario and McMasters University Arthritis Index (WOMAC) three weeks prior to presenting to clinic. At the clinic they were asked to complete the same outcomes measures using the palm-top computer or a paper-and-pencil version. ANALYSIS: In the analysis, scale distributions, floor and ceiling effects, internal consistency and retest reliability of scales were compared across the two data collection methods. Because the baseline characteristics of the groups were not strictly comparable according to age, the data were analyzed for the entire sample and stratified according to age. RESULTS: Few statistically significant differences were found for the means, variances and intra-class correlation coefficients between the methods of administration. While the scale distribution between the two methods was comparable, the internal consistency of the scales was dissimilar. CONCLUSIONS: Administration of HRQL questionnaires using portable palm-top computer devices has the potential advantage of decreased cost and convenience. These data lend some support for the comparability of palm-top computers and paper surveys for outcomes measures widely used in the field of orthopaedic surgery. The present study identified the lack of reliability across modes of administration that requires further study in a randomized comparability trial. These mode effects are important for orthopaedic surgeons to appreciate before implementing innovative data-capture technologies in their practices.

Aged↗
PubMed1997

BASCD surveys and computer communication. British Association for the Study of Community Dentistry.

The British Association for the Study of Community Dentistry (BASCD) has coordinated National Health Service surveys of the dental health of school children since 1985, when Wales and parts of England were included. Scotland joined in 1987 and Northern Ireland in 1994. This series spans an interesting time in the growth of accessible technology in both statistics and medical research. The purpose of this paper is to chart the development of this data base from pen and paper via microcomputers to the Internet. The annual work now involves calibration of examiners, data collection with portable computers or by manual transcription and subsequent 'punching', paper reports passed to regional coordinators who fill in spread sheets that are passed by e-mail or through posted discs to the data coordinating centre at the Dental Health Services Research Unit at the University of Dundee. The data is checked; statistical analyses are undertaken; a paper is prepared for print and the data is deposited on the BASCD Web Site. Four operating systems and at least eight software packages are used to produce and distribute the survey results.

Adolescent↗
PubMed2003

Neuro-oncology research opportunities in North America: results of a survey by the AANS/CNS section on tumors.

OBJECTIVE: A primary goal of the AANS/CNS Section on Tumors is to foster neuro-oncology research. The Research Committee was charged with the responsibility of assessing the neuro-oncology research opportunities currently available within neurosurgery residency programs and proposing strategies to enhance these activities. METHODS: Two separate surveys were mailed to all neurosurgery program directors (112) and neurosurgery residents (872) in North America. The initial mailing was in December 1997 and a follow-up mailing was sent in June 1998 to those who did not respond. RESULTS: Seventy-seven (69%) program directors and 279 (32%) neurosurgery residents responded to the survey. Neuro-oncology research rotations of varying duration (usually <12 months) were available at most residency programs (87%). Research mentors included equal numbers of neurosurgeons and outside faculty. Funding sources were well distributed among departmental (27%), federal (24%), institutional (22%), and private (19%) sources. Common basic science research areas included molecular biology, gene therapy, and pathology, whereas image-guided surgery was the most frequent area of clinical research. Approximately one-third of the responding residents had completed a neuro-oncology research rotation, mainly in an area of basic science, which resulted in an average of two publications and three presentations at national meetings. The most significant challenges for residents pursuing neuro-oncology research were concurrent clinical responsibilities, lack of faculty mentors, and insufficient research funding. CONCLUSIONS: Neuro-oncology research opportunities are available within most neurosurgery residency programs and appear to attract a reasonable number of productive trainees. The results of this survey have identified several important ways in which the AANS/CNS Section on Tumors can enhance neuro-oncology research opportunities and a comprehensive strategy for accomplishing these goals is presented.

Data Collection↗
PubMed1995

Participants' characteristics in a French colorectal cancer mass screening campaign.

BACKGROUND: Participation by the target population is clearly a key element in the success of mass screening programs for colorectal cancer. In France, involvement of general practitioners in test distribution is essential to reach a satisfactory participation rate, but other forms of recruitment also have to be organized. The aim of this study was to determine the influence of demographic characteristics such as sex, age, and place of residence on the participation rate in a French mass screening according to different recruitment methods. METHODS: The Hemoccult IIR test was proposed in three consecutive ways: spontaneously by general practitioners and occupational doctors during appointments (phase 1), by postal invitation (phase 2), and finally by direct mailing of the test (phase 3). The target population consisted of 11,947 people between 45 and 74 years of age, living in a district of the French county of Calvados, between March 1991 and April 1993. RESULTS: The overall participation rate was 51.3%. Forty-nine percent of all the tests were done during phase 1, 31% during phase 2, and 20% during phase 3. The overall participation rate varied essentially according to the place of residence, from 65.5% in urban areas and 48.9% in intermediate areas to 27.7% in rural areas. The overall participation rate was also higher for females (57%) than for males (45%) and for those 60 years and older (53.9%) than for those below this age (49.2%). The proportion of tests done during phase 1 was lowest among the youngest and the oldest age groups (37.5% in the 45- to 49-year class and 45.2% in the 70- to 74-year class) and among people living in the rural environment (respectively 55.3%, 45.5%, and 35.9% in urban, intermediate, and rural areas). CONCLUSIONS: This study shows that place of residence strongly influences the global participation rate in mass screening for colorectal cancer in France, whereas sex and age have little influence. Recruitment methods complementary to distribution by general practitioners must be organized, especially for the youngest and oldest age groups (45-49 years and 70-74 years) and above all for people living in rural areas. The social, cultural, and psychological reasons for these differences remain to be investigated, with the aim of adapting mass screening strategies to the different population groups.

Aged↗
PubMed2004

Preferential exchange: strengthening connections in complex networks.

Many social, technological, and biological interactions involve network relationships whose outcome intimately depends on the structure of the network and on the strengths of the connections. Yet, although much information is now available concerning the structure of many networks, the strengths are more difficult to measure. Here we show that, for one particular social network, notably the e-mail network, a suitable measure of the strength of the connections can be available. We also propose a simple mechanism, based on positive feedback and reciprocity, that can explain the observed behavior and that hints toward specific dynamics of formation and reinforcement of network connections. Network data from contexts different from social sciences indicate that power-law, and generally broad, distributions of the connection strength are ubiquitous, and the proposed mechanism has a wide range of applicability.

Journal Article↗
PubMed1982

Prevalence of affective disorder in a sample of young men.

To evaluate the prevalence of depression among young men and the relationship between affective disturbances and drug- or alcohol-use patterns, the author mailed a questionnaire to male students and nonacademic staff, aged 21-25 years, at the University of California, San Diego. Of the 964 men responding, 173 (18%) reported a history of depression, including 69 (7%) whose depressions were serious enough to result in a major life upset. The 318 respondents with some alcohol- or drug- related life impairment (33%) were unevenly distributed among the three depressive history groups, with 44% to 48% of those with depressions also reporting substance problems while the same was true for only 30% of the depression-free men. The author advises clinicians to consider the possibility that a depressive disturbance in young populations may occur in relation to substance intake.

Adult↗
PubMed2002

Using a decade of data on medical student computer literacy for strategic planning.

PURPOSE: From 1991 through 2000, incoming medical students (M-Is) at the School of Medicine at Virginia Commonwealth University have been surveyed with a written questionnaire on their computer literacy. The survey's purpose is to learn the students' levels of knowledge, skill, and experience with computer technology to guide instructional services and facilities. METHODOLOGY: The questionnaire was administered during M-I orientation or mailed to students' homes after matriculation. It evolved from sixteen questions in 1991 to twenty-three questions in 2000, with fifteen questions common to all. RESULTS: The average survey response rate was 81% from an average of 177 students. Six major changes were introduced based on information collected from the surveys and advances in technology: production of CD-ROMs distributed to students containing required computer-based instructional programs, delivery of evaluation instruments to students via the Internet, modification of the lab to a mostly PC-based environment, development of an electronic curriculum Website, development of computerized examinations for medical students to prepare them for the computerized national board examinations, and initiation of a personal digital assistant (PDA) project for students to evaluate PDAs' usefulness in clinical settings. CONCLUSION: The computer literacy survey provides a snapshot of students' past and present use of technology and guidance for the development of services and facilities.

Computer Literacy↗
PubMed2005

Clustering of risk behaviours for oral and general health.

UNLABELLED: While it is recognised that risk behaviours for general health tend to cluster among individuals, it is less clear whether risk behaviours for oral health co-occur among these same individuals. OBJECTIVES: To describe the distribution of health-relevant behaviours in a population sample, to examine whether oral and general risk behaviours cluster among individuals and to identify population groups with a shared risk profile. METHODS: Self-reported data were obtained from a stratified random sample of adults aged 18+ who participated in the 2002 National Dental Telephone Interview Survey and completed a subsequent mailed questionnaire (n = 3,132). Data were weighted to represent a simple random sample of Australian adults and analysis was limited to dentate adults. RESULTS: Four oral health behaviours (toothbrushing frequency, interdental cleaning, exposure to non-milk extrinsic sugars, usual reason for a dental visit) and four general health behaviours (smoking, alcohol consumption, physical activity, Body Mass Index) were dichotomised. K-means cluster analysis identified two readily interpretable groups that differed significantly on each behaviour apart from alcohol consumption (ANOVA; p = 0.77). A significant relationship emerged between cluster memberships and sociodemographic characteristics. Over-represented in the risk behaviour group (40.7% of the sample) were males, young adults, Australian born, those who did not live in a major city, adults who rented their housing and those adults with lower levels of education and household income (Chi square; p < 0.05). CONCLUSION: The interrelatedness of oral and general risk behaviours and their sociodemographic associations supports the tailoring of integrated oral and general health promotion messages and services to targeted population groups.

Adolescent↗
PubMedDate not supplied

Employment of dental hygienists and registered dental assistants: highlights of the 1996 survey.

PURPOSE: The purpose of this study was to determine various employment characteristics of Minnesota's allied dental health workforce, specifically dental hygienists and registered dental assistants. METHODS: In 1995 and 1996, two questionnaires one-year period apart were mailed to all licensed dentists in the state, accompanied with a request that only one survey form per practice be returned. An estimated 73 percent and 65 percent of all practices reported in the two years respectively. RESULTS: Results suggest few changes over the two-year period. Information is reported on a wide variety of conditions, including practice configurations, workload distributions, turnover, salaries, and relative demand for hygienists and registered assistants. CONCLUSIONS: These studies provide a good baseline for future reports and suggest that, at present, patient demand is stable or strong, and that while an adequate supply of allied dental health workers is available statewide, some local supply problems exist.

Data Collection↗
PubMed2004

Brain region-specific, age-related, alterations in mitochondrial responses to elevated calcium.

An age-related Ca(2+) dysregulation and increased production of reactive oxygen species (ROS) may contribute to late-onset neurodegenerative disorders. These alterations are often attributed to impaired mitochondrial function yet few studies have directly examined mitochondria isolated from various regions of the aged brain. The purpose of this study was to examine Ca(2+)-buffering and ROS production in mitochondria isolated from Fischer 344 rats ranging in age from 4 to 25 months. Mitchondria isolated from the cortex of the 25 month rat brain exhibited greater rates of ROS production and mitochondrial swelling in response to increasing Ca(2+) loads as compared to mitochondria isolated from younger (4, 13 month) animals. The increased swelling is indicative of opening of the mitochondrial permeability transition pore indicating impaired Ca(2+) buffering/cycling in aged animals. These age-related differences were not observed in mitochondria isolated from cerebellum. Together, these results demonstrate region specific, age-related, alterations in mitochondrial responses to Ca(2+).

Adaptation, Physiological↗
PubMed2004

Adoption of information technology by resident physicians.

The Internet represents a technological revolution that is transforming our society. In the healthcare industry, physicians have been typified as slow adopters of information technology. However, young physicians, having been raised in a computer-prevalent society, may be more likely to embrace technology. We attempt to characterize the use and acceptance of the Internet and information technology among resident physicians in a large academic medical center and to assess concerns regarding privacy, security, and credibility of information on the Internet. A 41-question survey was distributed to 150 pediatric, medical, and surgical residents at an urban, academic medical center. One hundred thirty-five residents completed the survey (response rate of 90%). Responses were evaluated and statistical analysis was done. The majority of resident physicians in our survey have adopted the tools of information technology. Ninety-eight percent used the Internet and 96% use e-mail. Two-thirds of the respondents used the Internet for healthcare-related purposes and a similar percentage thought that the Internet has affected their practice of medicine positively. The majority of residents thought that Internet healthcare services such as electronic medical records, peer-support websites, and remote patient monitoring would be beneficial for the healthcare industry. However, they are concerned about the credibility, privacy, and security of health and medical information online. The majority of resident physicians in our institution use Internet and information technology in their practice of medicine. Most think that the Internet will continue to have a beneficial role in the healthcare industry.

Adult↗
PubMed1996

[Internet network and cancer].

Internet is a tool allowing a wide distribution of information. Initially reserved to the field of scientific research, it develops currently in many sectors of the socio-economic life and saved the area of the health. Each day appear new services allowing the access to the information on the diagnostic and treatment of different pathologies. Patients and physicians share their knowledge and their information, through newsgroups and electronic mail. This paper presents the Internet and cancer resources to allow clinicians and researchers a rapid access to the relevant information.

Computer Communication Networks↗