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Selection of neighborhood controls: logistics and fieldwork.

This paper describes the logistics and fieldwork involved in assembling 123 neighborhood controls for a case-control study investigating the relationship between cholecystectomy and right-side colon cancer. All neighborhood controls were matched pairwise to cases on sex, age at diagnosis (+/- years), and race. Eighty-six percent of the neighborhood controls were also matched on street of residence and the remaining 14% on census tract. Study subjects were contacted by mail and then interviewed by telephone with regard to their gastrointestinal surgical history. The mean number of necessary households contacted to obtain each control was nine. When data were stratified by age, the mean number of necessary households contacted increased with increasing age of the cases. Only 3.3% (35/1065) of the residents from these households refused complete participation in the telephone interview. The distribution of fieldwork activities by hours worked is also reported. Similar findings were observed for males and females. Neighborhood controls are a commonly used comparison series. Data from this report may be used to modify the general impression that assembling neighborhood controls can be a difficult task. We urge other investigators to report fieldwork activities used in identifying their control series. These data will be valuable in planning and budgeting case-control studies.

Aged↗

Turnover factors revisited: a longitudinal study of Taiwan-based staff nurses.

BACKGROUND: The relationship between employees' intent to stay/leave a position and the actual turnover of employees merits further investigation. Most previous studies of this relationship have utilized cross-sectional designs to examine nurse turnover from a fixed point in time. Research using a longitudinal design could increase the ability to predict who will leave, and to identify factors that cause turnover behavior. OBJECTIVES: To investigate whether the same mechanisms and factors that affect employee's turnover intentions can be applied to actual turnover in a longitudinal way in an effort to expose causal relationships. DESIGN: After a review of existing literature, we collected baseline data on turnover determinants as well as two intervening variables: job satisfaction and intent to stay. Three years later, hospital personnel records were used to identify the actual turnover of nurses who responded in the first wave. SETTINGS: With its 600 beds and metropolitan site, the target hospital located in Taichung, Taiwan is representative of Taiwan's general hospitals. METHODS: The 412 registered staff nurses (managers excluded) at work in this hospital were reached by a mail questionnaire in the first wave. Three years later, the turnover data collected in wave two had divided the wave one's 308 respondents (74.8%) into 132 leavers (42.9%, coded as "1") and 176 stayers (57.1%, coded as "0"). The data were then processed by descriptive statistics, exploratory factor analysis, multiple regression, and logistic regression. RESULTS: As in previous studies of this type, distributive justice, workload, resource inadequacy, supervisory support, kinship support, and job satisfaction were again proven to be highly associated with intent to stay/leave. Nevertheless, with the exception of workload, these indicators worked poorly when predicting the actual turnover. CONCLUSIONS: The study confirms earlier findings on the relationships among turnover determinants, job satisfaction, and intent to stay, and suggests a more comprehensive selection of turnover factors must be taken into account when attempting to explain variations in actual turnover.

Humans↗

Survey of SLP caseloads in Washington State schools: implications and strategies for action.

PURPOSE: To document statewide and regional caseloads and to examine workload management strategies by surveying speech-language pathologists (SLPs) in Washington State public schools. METHOD: All school SLPs who were registered with the Office of the Superintendent of Public Instruction were mailed a detailed survey in May, 2001 and a brief follow-up survey 1 year later. RESULTS: Response rates were 43% (N=431) and 47% (N=464), respectively. Caseload findings showed a statewide mean of 59 students, with regional variation as high as 30%. IMPLICATIONS: There was no systematic evidence that caseloads were managed through state, district, or local limits or by distributing clients on the basis of the severity of impairment or SLP experience ortraining. There was significant evidence, however, that clinicians with larger caseloads were more likely to have assistants and to conduct a higher proportion of group sessions than were clinicians with smaller caseloads. The authors discuss the implication of these findings for and other states with no caseload limits and a shortage of SLPs. There is an appeal for more research using newly established measures of workload as well as a call to action to address the challenges that these findings represent.

Humans↗

Age, specialty, and practice setting predict gastroesophageal reflux disease prescribing behavior.

BACKGROUND: Gastroesophageal reflux disease (GERD) affects more than 40% of adults in the United States each month. Although the economic costs of treating this disorder are enormous, the attitudes and prescribing preferences of physicians who treat patients with GERD are not well known. This study was undertaken to determine physician prescribing practices in the treatment of GERD. METHODS: A questionnaire was mailed to 687 randomly selected, practicing gastroenterologists, internists, and family physicians in the State of Maryland. Each questionnaire was identical and contained 7 questions designed to elicit demographic data (age, sex, degree, specialty, practice setting, years in practice, community served), and 16 questions related to the evaluation and treatment of GERD. RESULTS: A total of 214 completed questionnaires were returned (31.1%), nearly equally distributed among the three different specialty groups. A total of 82% of the respondents were male; 60% of the respondents had practiced more than 15 years, and 6% had practiced 4 years or less. Older physicians prescribed proton pump inhibitors more often than younger physicians for mild or intermittent GERD symptoms. Physicians in an academic setting were more likely to use step-down therapy in patients with well-controlled GERD symptoms than were HMO-employed physicians. Family physicians requested a barium swallow in the evaluation of uncomplicated GERD more frequently than did gastroenterologists or internists. Gastroenterologists were more likely than family physicians and internists to recommend upper endoscopy for GERD patients with warning symptoms and for patients with long-standing reflux disease. CONCLUSIONS: Age, specialty, number of years in practice, and practice setting significantly influence how physicians evaluate and treat patients with GERD. Educational efforts to improve the evaluation and treatment of patients with GERD may require different strategies for different types of healthcare providers.

Adult↗

Gynecologic symptoms and sexual function before and after liver transplantation.

OBJECTIVE: To determine gynecologic symptoms and sexual function in a group of patients awaiting liver transplantation and a second group after liver transplantation. STUDY DESIGN: A questionnaire was mailed to 524 women. Of these, 233 had had transplants, and 291 were on a waiting list. The Transplant Database was used to obtain demographic information regarding these patients, and data were analyzed based on population age, Child's classification, type of liver disease, and pretransplant or posttransplant status. RESULTS: The response rate was 53%. There was no difference in ethnic or age distribution between pretransplant and posttransplant patients. There were no significant differences in rates of amenorrhea, but there was a greater prevalence of amenorrhea in patients with hepatocellular vs. cholestatic diseases (60% vs. 19%, p = 0.009). There was a higher incidence of pad use for urinary incontinence in pretransplant vs. posttransplant patients (14% vs. 7%, p = 0.04). There was no difference in availability of a sexual partner, sexual activity, orgasm experience, dyspareunia, satisfaction with sex life, symptoms of organ prolapse or dysmenorrhea based on transplant status, disease etiology or Child's classification. CONCLUSION: Liver failure patients differed in some of their gynecologic symptoms depending on their disease etiology and transplant status, but sexuality remained unchanged.

Amenorrhea↗

The hepatitis B vaccine: utilization decision process and outcomes in community hospitals.

The process by which administrators, physicians, and other health professionals develop decisions on the adoption of innovations was examined through a study of the decision process relating to the institutional use of a vaccine to prevent hepatitis B. Mail questionnaires and telephone follow-up interviews were used to collect data on the decision process in 56 Arizona hospitals in 1983 and 1984. A five-stage decision process was employed by the institutions. Critical stages in the process involved defining who would make the adoption decision and the collection of information related to the innovation. The institutional plans for vaccine distribution did not exhibit a clear consensus regarding the identification of high-risk employee groups. Employee acceptance of the vaccine, even with the cost paid by the hospital, was limited.

Arizona↗

Survey of maternal-fetal medicine subspecialists: professional activities, job setting, satisfaction, and trends over time.

The purpose of this survey was to describe the job setting, professional activities, and satisfaction of maternal-fetal medicine (MFM) subspecialists and to compare these with previous surveys. A questionnaire was mailed to members of the Society of Perinatal Obstetricians (SPO). The results were compared to a similar survey in 1986. Of 1,352 members, 58% responded. In comparison to 1986, there was an increase in percentage of women (25%); a decrease in university hospital-based faculty (55%); and an increase in community hospital-based salaried physicians (23%) and private practice (15%). The distribution of professional time changes with an increase in clinical care, a decrease in teaching and research. The annual number of procedures increased for ultrasound and genetics and decreased for gynecologic procedures. Since 1986, there have been significant changes among MFM subspecialists in job setting, allocation of professional time, and number and types of procedures. Job satisfaction remains high.

Adult↗

Nurses' attitudes toward caring for patients with acquired immunodeficiency syndrome.

The purpose of this study was to examine nurses' attitudes toward caring for patients with acquired immunodeficiency syndrome (AIDS) and factors that might be related to these attitudes. One hundred thirty-eight (138) registered nurses responded to an anonymous mail survey. The survey instrument assessed the subjects' attitudes toward caring for AIDS patients along five dimensions: (1) fears and concerns relating to caring for AIDS patients, (2) attitudes toward health care utilization by AIDS patients, (3) attitudes toward caring for terminally ill patients, (4) attitudes toward homosexuality, and (5) attitudes of significant others toward AIDS patients. The data obtained were analyzed using frequency distributions, independent t tests, and analysis of variance. Results of this study indicated that educational background is not related to nurses' attitudes toward caring for patients with AIDS; however, nurses who have had experience caring for patients with AIDS have more positive attitudes towards health care utilization by AIDS patients (P < .05) and more positive attitudes toward homosexuality (P < .04) than nurses who have not cared for AIDS patients.

Acquired Immunodeficiency Syndrome↗

[The need for bioethics training in the Community of Madrid].

OBJECTIVES MAIN OBJECTIVE: to understand the significance and sense of bioethics for social work/health professionals; the secondary objective is to quantify the bioethics training given in IMSALUD primary care. DESIGN: Interviews with key reporters. Face-to-face interviews with people in charge of the training and research departments. SETTING: The 11 primary health care areas of IMSALUD. PARTICIPANTS AND/OR CONTEXTS: Key reporters (1 for each health area) chosen by heads of teaching: people working in the area with a specific weight or personal interest in bioethics. METHOD: 11 key reporters (1 for each health area); telephone contact and mailing of open-question questionnaire. RESULTS: Bioethics is implicit in daily activity, but unconsciously. General rejection due to its themes, which involve self-criticism. Ethical conflicts basically arising from the relationship of health workers with patients and the family, especially concerning information-giving, were pointed to. Themes considered very important were informed consent and confidentiality. Other ethical problems were allocation and distribution of limited resources, responsibility for taking up situations that worsen health care (lists too long, burnt-out companions, malpractice...). More training, both practical and theoretical, and more time to perform tasks were called for. CONCLUSIONS: The strategy to improve health professionals' ethical approach is to increase their Bioethics training. Very little bioethics training is provided for social work/health professionals by primary care management in the Community of Madrid.

Bioethics↗

Prevalence of snoring and sleep-disordered breathing in a student population.

INTRODUCTION: The prevalence of snoring and sleep-disordered breathing (SDB) in young adults in Southeast Asian countries is unknown. We aim to determine the symptoms and prevalence of SDB in a university student population using a questionnaire survey followed by home sleep monitoring. METHODS: The Sleep and Health Questionnaire (a modified version of the Specialized Centers of Research Sleep Questionnaire, translated into Chinese) was distributed to all first-year students (1,306 male and 1,757 female) enrolled in the Chinese University of Hong Kong. Subsequently, those students who returned the questionnaires were randomly chosen to undergo portable home sleep monitoring using the MESAM IV device (Madaus Medizin-Elektronik; Freiburg, Germany). RESULTS: A total of 1,910 replies were obtained from 3,063 questionnaires sent by mail (response rate, 62.4%). The female to male ratio was 1.8:1, with mean age of 19.4 years (SD, 1.3 years) and mean body mass index (BMI) of 20.0 (SD, 2.5). Overall, 25.7% of subjects reported snoring; 10.7% and 42.1% reported impaired performance ability and daytime sleepiness, respectively. Of the 88 subjects who underwent overnight sleep monitoring, 66 subjects (75%) were snorers and 8 subjects (9%) snored > 10% of the night. Male subjects had a higher BMI (p < 0.001) and tended to snore more often than female subjects (p = 0.06). Subjects with an oxygen desaturation index (ODI) > or = 3 had a BMI > 22 (p < 0.05). On sleep study, nine subjects (10.2%) and two subjects (2.3%) had a respiratory disturbance index (RDI) > or = 3 and an RDI > or = 5, respectively, associated with self-reported sleepiness, giving a minimum estimated prevalence of SDB as 0.1% (RDI > or = 5) in the study population. There was no correlation between recorded snoring with either RDI or self-reported sleepiness. Questionnaire responses, neck circumference, and alcohol consumption did not predict the occurrence of SDB. CONCLUSION: Snoring was prevalent, while SDB was uncommon in this student population. However, snoring and self-reported symptoms by questionnaire were poor predictors for SDB. Male gender showed a trend as an independent predictor for snoring, but not for SDB.

Adult↗

US neurologists: attitudes on the US health care system.

Because the American Academy of Neurology (AAN) exists to represent the views and needs of neurologists, a mailed survey to a randomly selected sample of 520 US-based, board-certified or board-eligible neurologist members was conducted in early 1995 to determine their attitudes in four key changing areas of the US health care system: (1) provision of neurologic care, (2) neurology workforce, (3) academic research, industry sponsorship, and pharmaceutical issues, and (4) health care delivery systems issues. Frequency distributions of degree of agreement and disagreement with 40 statements regarding issues in these four areas were tabulated for the entire group of 430 respondents (response rate = 83%). Associations between these attitudes and six demographic and practice variables (age, gender, board certification, practice type, degree of managed care, and geographical region) were evaluated in an exploratory analysis. The high response rate to the survey and the similarity in demographic and practice characteristics of respondents to the entire US-based, board-certified or -eligible AAN membership support that the attitudes that were measured are likely to be representative of US neurologists, excluding resident trainees. The survey results show that neurologists are deeply concerned that patients with chronic neurologic disorders are not receiving all the neurologic services they need. Respondent show uncertainty about whether there is a current oversupply of neurologists but generally agree that there are too many neurology residency positions. Neurologists support industry sponsorship of academic medical center research and new drug development. With respect to many of the current mechanisms for health care cost containment, respondents indicate they have little confidence that these strategies are in the best interests of patients or physicians. The survey results confirm that there is no consensus among US neurologists on how to improve today's health care delivery system, and the results suggest that certain attitudes are related to neurologists' demographic and practice characteristics. Since today's health care market is volatile, regular assessments of neurologists' attitudes will be needed to assure that their views are understood and clearly represented by the AAN.

Adult↗

Oral syringe use survey.

Use of oral syringes at children's and ASHP-accredited residency hospitals in the United States was surveyed. Questionnaires were mailed to 131 hospitals; 117 (89.3%) were returned. Of the responding hospitals, 54.5% of children's hospitals and 67.1% of residency hospitals used oral syringes. There was no definite preference for a particular brand or type (glass vs. plastic) of syringe. Patients who often required liquid dosage forms, including pediatric and geriatric patients and patients with nasogastric tubes, were most frequently included in oral syringe distribution systems. Twenty-six of the 73 hospitals utilizing oral syringes used them for most unit dose liquids in all drug distribution systems. The remainder reported use for specific medications or circumstances. Expiration dating policies varied from 24 hours to one year to the manufacturer's expiration dating. The survey indicates widespread use of oral syringes and identifies a need for evaluation of medication stability in these devices.

Aged↗

Feasibility and reliability of a mailed questionnaire to obtain visual analogue scale valuations for health states defined by the Health Utilities Index Mark 3.

To establish the generalizability (external validity) of the Health Utilities Index Mark 3 (HUI3) as a single-summary score generic outcome measure in numerous countries/subgroups (including children), repeated studies of community preferences should be performed in various settings. In performing multiple HUI3 studies, a mailed questionnaire approach, if feasible and reliable, might be substituted for oral interviews. In the present study, we assessed the feasibility and reliability of a mailed questionnaire approach originally developed for the EQ-5D, for the purpose of collecting Visual Analogue Scale (VAS) valuations from parents as surrogate responders for 65 pediatric HUI3 health states and for the state of being dead. Untransformed mean VAS scores of the health states and scores converted into preliminary Standard Gamble (SG)-utilities were compared with Canadian and French multiattribute utility estimates. A random sample of 1920 parents of schoolchildren (aged 4 to 13) received a mailed questionnaire. Each parent was asked to rate 6 HUI3 health states on a 0 to 100 VAS. Response was 70%. Mean completion time was 20 minutes (SD 9). The questionnaire was rated difficult by only 9%. The current format was, however, inappropriate for valuing the state of being dead. Interrater reliability of health state valuations was.87. Spearman's rank correlations, Pearson-R correlations and intra class correlation coefficients (ICCs) between untransformed VAS valuations and Canadian/French utility estimates were > or =.87. However, preliminary SG-utilities showed diminished ICCs (.71 to.72). The data support the feasibility and reliability of mailed HUI3 valuation questionnaires to a considerable extent, but further methodological studies regarding other formats and different populations are recommended.

Activities of Daily Living↗

Improving the treatment of nocturnal asthma: use of an office questionnaire to identify nocturnal asthma symptoms.

Nocturnal asthma is a major problem in many asthma patients and it is important to recognize and treat it. We previously reported the incidence of nocturnal asthma in our practice (1); the current study was done to try to improve upon the incidence of nocturnal asthma in our patients. After our previous survey, which indicated a 67% incidence of nocturnal asthma in our practice, we instituted a previsit questionnaire regarding nocturnal asthma to be filled out by all follow-up asthma patients in our office. After a period of time, we mailed a nocturnal asthma questionnaire to all asthma patients to see if the intervention had improved our incidence of nocturnal asthma. This questionnaire was identical to the one used in our prior study and was mailed to 2019 patients. We had 602 responders, 560 of whom had asthma. A total of 328 of these patients (59%) had nocturnal asthma. This was similar to the results of our previous survey, and our initial conclusion was that the new in-office questionnaire that we instituted had not improved the situation. Then we discovered that the in-office questionnaire had inadvertently been distributed only to the patients of one or our physicians (Dr. A). His patients were then compared with those of the other two doctors (Drs. B and C), and it was found that Dr. A's patients had fewer nocturnal symptoms than did the patients of the other doctors. The percent of asthmatics with nocturnal asthma 4-7 nights per week (more than half the nights in a week) for Dr. A was 16%, for Dr. B 47%, and for Dr. C 39%. The use of a short office questinnaire for asthma patients before they see the doctor for follow-up visits leads to greater recognition and better treatment of nocturnal asthma.

Asthma↗

Matrix management in hospital pharmacy departments.

The results of a nationwide survey to determine the managerial structures of selected hospital departments are reported. A questionnaire was mailed in August 1990 to a random sample of 1792 hospital pharmacy directors. The survey included questions on hospital bed capacity and ownership and on the managerial structures used for several departments and services, including pharmacy, satellite pharmacy, home health care, and hospice care. Recipients were asked to indicate a centralized management structure if decisions were made by a single individual; decentralized if the responsibility was distributed down the hierarchy; functional if departments were grouped according to specialties, skills, and knowledge; and matrix if the vertical hierarchy was overlaid by lateral mechanisms of authority. A total of 567 usable responses were received, for a response rate of 31.6%. Across departments, the most frequently reported type of management was centralized. Functional systems and systems that included a combination of features were cited least often. Of the pharmacy departments, 24.5% had decentralized management. Matrix management was used for 11.8%, 9.7%, 7.0%, and 4.7% of the pharmacy, home health-care, hospice-care, and satellite pharmacy departments, respectively, and was used more often in large hospitals than small hospitals. Pharmacy departments in nonprofit hospitals tended to use decentralized management more often than those in for-profit institutions. Centralized management was used most frequently by pharmacy departments, followed by decentralized and matrix management structures. Few pharmacy directors reported plans to implement matrix management.

Ownership↗

The Epidemiologic Surveillance Project: a computer-based system for disease surveillance.

The Epidemiologic Surveillance Project (ESP) is a computer-based surveillance system for the rapid transmission and analysis of national morbidity data. These data are transmitted weekly by state health department computers to the Centers for Disease Control (CDC), using a commercial electronic mail facility (MINET). Participating state health departments transmit data through existing computer systems using a standard record and data transmission protocol. State and national data are rapidly analyzed at the CDC, and reports of these analyses are transmitted through MINET to the states. Maps based on these data and other tabular displays of demographic and epidemiologic characteristics of the diseases being tracked are periodically prepared and distributed. Because the efficiency, speed, and uniformity of tabulation of this system are greater than those of systems that use protocol and telephonic reports of case totals, the ESP may be a model for future surveillance systems.

Centers for Disease Control and Prevention, U.S.↗

Mailed personalized normative feedback as a brief intervention for at-risk college drinkers.

OBJECTIVE: The current study examined the efficacy of mailed personalized normative feedback (PNF) as a brief alcohol intervention for at-risk college drinkers, and investigated discrepancy as a possible mediator of the intervention effect. METHOD: Participants consisted of 100 at-risk college drinkers who completed an alcohol-use assessment at baseline, 6-week posttest and 6-month follow-up. Measures included number of drinks consumed per heaviest drinking week, frequency of heavy-drinking episodes, peak blood alcohol concentration and number of alcohol-related problems, all for the last month. Participants were randomly assigned to either a mailed brief intervention (MBI; n = 49) or attention-control (C; n = 51) group. The MBI group received mailed PNF that was based on baseline responses to the drinking measures; the C group received a psychoeducational brochure about alcohol. RESULTS: Mixed-model, repeated measures ANOVAs were used to examine the effects of time, group and gender on discrepancy and the drinking variables. Following the intervention, the MBI group reported significantly higher perceived discrepancy between self and others' drinking than the C group. The MBI group reported consuming significantly fewer drinks per heaviest drinking week and engaging in heavy episodic drinking less frequently than the C group at the 6-week posttest; however, these differences were no longer evident at the 6-month follow-up. Hierarchical regression analyses did not provide evidence for the hypothesized mediating effect of discrepancy. CONCLUSIONS: Mailed PNF may be a cost- and time-efficient means of developing discrepancy and temporarily reducing heavy alcohol consumption among at-risk college drinkers.

Adolescent↗

Validating the Functional Capacity Index as a measure of outcome following blunt multiple trauma.

BACKGROUND: The validity of the Functional Capacity Index (FCI) is evaluated by examining its distributional characteristics, its correlation with other well-known measures of outcome and its ability to discriminate among persons with injuries of varying type and severity. METHODS: A telephone survey which included the FCI and the SF-36 was administered 1 year post-injury to 1240 blunt trauma patients discharged from 12 trauma centers. A subsample of 656 patients also completed the Sickness Impact Profile (SIP) by mail. RESULTS: FCI scores correlated well with the physical health subscores of the SIP and SF-36. They also correlated well with self-reported change in health status and return to work. The FCI, when compared to either the SF-36 or the SIP, however, appears to discriminate better among patients according to the presence and severity of head trauma. CONCLUSIONS: While further testing of the FCI is needed, it holds promise as a preference based measure for assessing the physical impact of trauma.

Activities of Daily Living↗