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PubMed1998

Bayesian estimation of asthma prevalence, and comparison of exercise and questionnaire diagnostics in the absence of a gold standard.

PURPOSE: To estimate the sensitivities, specificities, and predictive values of exercise challenge and questionnaire, when these tests are used to diagnose asthma in children. METHODS: Participants were children, predominantly aged 6 to 12 years, selected from three primary school grades among 18 different schools in Montreal. Of 1111 participants, 989 successfully completed a six-minute free running test at school and returned a respiratory questionnaire. A total of 952 children had complete information that could be used for analysis. A history of wheezing in the past year in conjunction with a past diagnosis of asthma defined current asthma by questionnaire. Exercise responsiveness was defined as a > or = 10% fall in FEV1 after a six-minute free run. As there is no perfectly accurate diagnostic test for asthma, we analyzed the data using a previously published Bayesian method that allows for the estimation of test properties when no gold standard test is available. RESULTS: Current asthma by questionnaire was found to have significantly higher specificity (94.9%, 95% credible interval (CI): 93.2-96.5 versus 82.6%, 95% CI: 79.9-85.1) and positive predictive value (53.8%, 95% CI: 41.0-66.7 versus 19.2%, 95% CI: 12.3-27.8) in comparison to exercise challenge. While there was no statistically significant difference between the two tests with respect to sensitivity and negative predictive values, the estimates were higher for current asthma (64.4%, 95% CI: 50.9-76.6 and 96.7%, 95% CI: 94.6-98.1, respectively) in comparison to exercise challenge (51.3%, 95% CI: 37.8-64.5 and 95.4%, 95% CI: 93.2-97.1, respectively). Agreement between the two diagnostic methods was poor and the combined use of the two tests did not significantly improve the likelihood of correctly identifying children with asthma. CONCLUSIONS: Our findings support the view that exercise testing adds little to a well designed questionnaire in identifying subjects with asthma in community based studies.

Asthma↗
PubMed1998

One-year follow-up of quality of life in adults with untreated growth hormone deficiency.

OBJECTIVE: The aim of the study was to evaluate the impact on health-related quality of life (HRQoL) in untreated GHD patients using the disease-specific Assessment of Growth Hormone Deficiency in Adults (AGHDA) questionnaire. DESIGN AND PATIENTS: A cohort of 356 consecutive adult GHD patients, diagnosed after the age of 18 years, from the endocrinology units of 37 Spanish hospitals were included over a 6-month period in a longitudinal observational quality-of-life study. In addition, patients' HRQoL scores were compared to those obtained from a random sample of 963 subjects from the general population recruited by trained interviewers in a 6-month period and matched by age and sex to figures of the 1991 Spanish census. MEASUREMENTS: Patients were evaluated at baseline and after 12-months. Socio-demographic and health variables such as age, sex, level of education, income level, number of chronic diseases and self-reported health status were recorded at baseline and follow-up visits. Patients underwent physical and analytical examination and completed the AGHDA questionnaire. A survey including socio-demographic, self-reported health status and the AGHDA questionnaire was administered at the individuals' homes. RESULTS: Mean score for patients at baseline was 9.4 (CI = 8.4-10.4) and at 12 months 10 (CI = 8.8-11). HRQoL was worse in the case of older patients with a low level of education, lower income levels, reporting having an associated chronic disease and poor self-reported health status (P < 0.01). Untreated GHD patients maintain or slightly worsen their HRQoL after 12 months of follow-up, with high individual variability. Although AGHDA scores worsened during the observation period, differences were not statistically significant. AGHDA mean score in controls was 5.49 (CI = 5.27-5.71). Comparison of the mean AGHDA scores between patients and controls previously standardized by level of education and age were statistically different (P < 0.01), indicating that patients declared a worse HRQoL than the general population except for those aged 60-69 years. GHD patients presented a deterioration in HRQoL almost double that of the general population. CONCLUSIONS: These results permit comparison of patients' scores against reference scores with regard to the desirable effect of treatment. Future use of the AGHDA questionnaire in clinical trials should try to establish a relationship between biological and HRQoL changes.

Adolescent↗
PubMedDate not supplied

Psychiatric-mental health nursing: career characteristics, professional activities, and client attributes of members of the American Nurses Association Council of Psychiatric Nurses.

As the twenty-first century approaches, psychiatric nursing is reviewing its past and speculating about its future. This article reports on the current status of 525 psychiatric-mental health nurses. The nurses responded to a questionnaire designed to elicit information on career characteristics, professional activities, and client attributes. The nurses work primarily in acute care institutions or hospitals. The typical client is white, middle class, and adult. The focus of care in mental health is moving to the community. If psychiatric nurses want a viable role in the mental health system of the future, they must begin to develop a system of care for at-risk populations in the community now.

Career Mobility↗
PubMed2003

Regulatory disorders in Israeli infants: epidemiologic perspective.

The concept of regulatory disorders has been clinically defined. However, epidemiologic validity has not yet been investigated. Children between the ages of 6 and 36 months (N = 450) were included in the study. Two age groups were analyzed separately: 6 to 17 months (53%) and 18 to 36 months (47%). A specially designed questionnaire in Arabic and Hebrew pertaining to the physiologic and behavioral aspects of regulatory disorders was administered at the mother and child health clinics in northern Israel. It was established in the present study that a minimum of four regulatory items should be reported for the diagnosis of a regulatory disorder, as perceived by parents. Factor analysis revealed 6 and 10 different aggregates of regulatory items in the young and older age groups, respectively. The general prevalence of regulatory disorder as defined in the present study was found to be 18%. Age, maternal education, and sex were found to be significantly related to the prevalence of regulatory disorders. No difference in the prevalence of regulatory disorders between Arab and Jewish infants was found. Further validations of the concept of regulatory disorder as well as devising appropriate measurements in well-designed studies are warranted.

Arabs↗
PubMed1996

Psychosomatic: connotations for people who are neither nurses nor physicians.

Words with ambiguous meanings allow or promote uncaring relationships that are destructive to nurses and patients. The term "psychosomatic" is frequently associated with the connotation that the mind affects the body, but disregards the continuous and joint interaction of mind and body. The purpose of this study was to examine the connotative meanings of the term psychosomatic among people who were neither nurses nor physicians. An open-ended questionnaire designed to solicit information about the connotative meanings attached to the word psychosomatic was used to solicit persons. Findings revealed that the majority of subjects held a unidirectional definition of the term; that is, they believed that the mind influences the body but not vice versa. Negative thoughts and feelings were attached to the term. Nurses need to be aware of the meanings that words evoke when communicating with patients.

Adult↗
PubMed1989

Evaluation of the effectiveness of AIDS training and information courses.

Acquired immunodeficiency syndrome (AIDS) is considered to be the major health threat of the 20th century. The only way to contain the spread of AIDS is by prevention of infection in the first place. This task is essentially one of education. Because the South African Institute for Medical Research is traditionally associated with the prevention of infectious diseases, an AIDS Centre was established to promote education. As part of the launching of the Centre in January 1988, a series of four 1-day courses was held for different target groups. Attendance rates were high and all participants completed a pre- and post-test questionnaire designed to evaluate the effectiveness of the courses and identify existing level of knowledge, present needs and possible future demands. Collected data were examined by correlation analysis, the chi-square test and the t-test. Results generally showed improved changes in knowledge and attitudes about AIDS, and pointed the way forward for future education interventions in the community.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Geriatric medicine in Sweden: a study of the organisation, staffing and care production in 2000-2001.

OBJECTIVE: the organisation of long-term medicine and geriatric medicine has undergone many changes during the last 15 years. The aim of this study is to gain an overall perspective of the present organisation of geriatric medicine in Sweden. DESIGN: questionnaire survey. METHODS: The Swedish Society for Geriatric Medicine and Gerontology, in collaboration with the Federation of County Councils and the Swedish Association of Local Authorities, sent out a survey to people in all county councils in Sweden. The subject of the survey was the speciality of geriatric medicine in the Swedish healthcare system, with regard to healthcare organisation, staffing and care production in 2000/2001. RESULTS: there were 52 separate geriatric units, 41 independent 'clinics' and 11 'sections' within other departments. There were a total of 3,101 geriatric inpatient beds. On average, there was one geriatric bed for every 799 individuals within the local population aged 65 years and over, with a 10-fold variation between counties. Four counties had no geriatric provision. The 'geriatric clinics' were mainly located in university towns and averaged 85 beds per clinic, again with a 10-fold variation. There were 604 established positions for doctors within geriatrics, of which 63% were at geriatric clinics. On average, the clinics had 16 positions each (of which 75% were filled with geriatric specialists) with 7 beds per doctor. The corresponding averages for nurses and paramedics could not be summarised due to organisational differences between the county councils. In general, there were very few nurses with specialist training in geriatric medicine. CONCLUSIONS: the field of geriatric medicine in Sweden is very heterogeneous regarding terminology, designations, structure, staffing and care production. There is no overall structural plan for the role of geriatric medicine in Swedish healthcare, with the desired close connection between content and dimensioning of geriatric specialist training and the practical organisation of the activities. The county councils designate geriatric medicine so differently that it is hardly possible to compare different geriatric facilities today. Considering how many patients at hospitals today are elderly and suffer from multiple illnesses, it is a major quality issue to ensure that these patients have access to geriatric specialists.

Aged↗
PubMed1995

Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women.

OBJECTIVE: To compare nutrient intakes between vegetarians and nonvegetarians with similar health practices, and to assess relationships with eating behavior scores from the Three-Factor Eating Questionnaire. DESIGN: Survey. SETTING: Metropolitan area in western Canada. SUBJECTS: Subjects (n = 45) were participants in a study comparing subclinical menstrual disturbances between vegetarians and nonvegetarians. To be included, women had to be 20 to 40 years old, be weight stable with a body mass index (BMI; kg/m2) of 18 to 25, be a nonsmoker, exercise 7 hours a week or less, consume one alcoholic drink or less a day, and not be using oral contraceptives. Nonvegetarians (n = 22) ate red meat three times a week or more, and vegetarians (n = 23, 8 vegans and 15 lactovegetarians) had excluded all meat, fish, and poultry for 2 years or more. MAIN OUTCOME MEASURES: Nutrient intake assessed by three 3-day diet records; supplement use; body composition; and dietary restraint (conscious limitation of food intake), disinhibition, and hunger assessed by the Three-Factor Eating Questionnaire. STATISTICAL ANALYSES PERFORMED: Anthropometric variables, nutrient intakes, and eating behavior scores were compared between vegetarians and nonvegetarians using unpaired t tests, and among vegans, lactovegetarians, and nonvegetarians using one-way analysis of variance and Duncan's test. Supplement use was compared using chi 2 analysis. The Pearson correlation coefficient was used to evaluate relationships between variables. RESULTS: Diets of all women adhered closely to current nutrition recommendations. Vegetarians had lower protein and cholesterol intakes and higher percentage of energy as carbohydrate, ratio of polyunsaturated fat to saturated fat (P:S ratio), and fiber intake than nonvegetarians. Vegetarians had lower riboflavin, niacin, vitamin B-12, zinc, and sodium intakes and higher folate, vitamin C, and copper intakes. However, many differences were not apparent between the subgroup of lactovegetarians and nonvegetarians (their P:S ratios and carbohydrate, fiber, riboflavin, folate, vitamin C, and copper intakes were similar). In contrast, differences existed between the lactovegetarian and the vegan subgroups. Supplement use was similar between groups, except for greater vitamin C use by vegetarians. Vegetarians were leaner than nonvegetarians, had lower restraint scores, and had significant associations between restraint and BMI (r = .49; P < .05) and energy per kilogram body weight (r = -.60; P < .01). APPLICATIONS/CONCLUSIONS: Current nutrition recommendations can be attained by vegetarians and nonvegetarians alike, but nutrient intakes cannot be inferred from dietary pattern. In this study, the intakes of health-conscious nonvegetarians and lactovegetarians were more similar than the intakes of lactovegetarians and vegans. Vegans' calcium and vitamin B-12 intakes may need attention. Vegetarians' lower restraint scores suggest that they are not at increased risk for eating disorders.

Adult↗
PubMed1987

Functional disability assessment.

The widespread introduction of computers into clinical settings has increased the feasibility of conducting comprehensive functional disability assessment. The Functional Status Questionnaire (FSQ) is a brief, self-administered questionnaire designed to facilitate clinical assessment of functional disability. The FSQ items can be scored by computer using a simple algorithm and summarized into disability index scores. These scales have alpha reliability coefficients of .64 to .82 and substantial convergent validity when used with primary care patients. Disability assessment tools like the FSQ can be adapted easily for clinical use by physical therapists.

Activities of Daily Living↗
PubMed1978

Career plans of student physical therapists regarding geriatric medicine.

Questionnaires designed to evaluate experience in geriatric medicine and attitudes towards a career with a geriatric service were set to final-year students of eight schools of physical therapy. An analysis of replies indicates that many students are not sufficiently involved in the care of the elderly or with the practice of modern geriatric medicine. The majority of students preferred a career which involved both elderly and younger patients and work in geriatric rehabilitation wards and day hospitals.

Career Choice↗
PubMed2004

Effect of 12 month oral testosterone on testosterone deficiency symptoms in symptomatic elderly males with low-normal gonadal status.

BACKGROUND: Relative androgen deficiency in ageing males is assumed to have adverse health effects. This study assessed the effect of 12 months' standard dose, oral testosterone, on symptoms attributed to testosterone deficiency in older men with plasma testosterone levels in the low-normal range for young men. METHODS: Testosterone undecanoate (TU, 80 mg bid) or placebo was administered for one year to 76 healthy men, 60 years or older, with a free testosterone index (FTI) of 0.3-0.5 and significant symptoms on a questionnaire designed to evaluate androgen deficiency (ADAM). The ADAM was completed at baseline, 6 and 12 months. Hormone and safety data were collected at baseline, 1, 3, 6 and 12 months. RESULTS: After 12 months, plasma total testosterone was unchanged in both groups and sex hormone binding globulin decreased in the testosterone group (P = 0.01). FTI and calculated bioavailable testosterone (cBT) were greater in the testosterone group as compared with the placebo group (P = 0.021 and 0.025, respectively). There was no significant difference in total symptom score between testosterone and placebo groups after 12 months of oral TU. However, there were trends toward improvements in sadness/grumpiness (P = 0.063), reduced erection strength (P = 0.059) and decreased work performance symptoms (P = 0.077), particularly in men with baseline cBT levels below 3.1 nmol/l. CONCLUSIONS: This study concludes that 80 mg bid oral TU does not improve overall ADAM questionnaire scores in older men with low-normal gonadal status. Oral TU may preserve mood and erectile function, as assessed by this questionnaire, particularly in men with the lowest testosterone levels.

Administration, Oral↗
PubMed1991

The use of role-play in teaching medical students obstetrics and gynaecology.

There is a great need to review and critically assess medical education. Role-play has seen increasing use as an educational tool. We investigated its role in a 'conventional speciality', Obstetrics and Gynaecology. This is a part of the medical curriculum where communication skills are particularly important, but difficult to learn in practice. Twenty-one medical students took part in three role-play case studies. An innovation we implemented was the use of 'time outs' which could be called at any time through a session. After the exercise students were required to complete a questionnaire designed to probe their attitudes towards the experience. The results indicate that this technique can be successfully used in teaching a conventional speciality. Unlike some previous studies we also found this to be a satisfactory tool in teaching the factual part of the course. We found the 'time out' innovation to be an important aid. We argue that there is an important niche for role-play in medical education.

Clinical Competence↗
PubMed1981

Ownership and veterinary care of pet skunks.

Approximately 10% of Illinois veterinarians were mailed a questionnaire designed to measure and characterize veterinary care being received by pet skunks in Illinois. Responding private practitioners reported treating 36 skunks, vaccinating 15 skunks, and descenting 9 skunks during 1979. All of the skunks that were vaccinated for rabies received killed vaccines. Using the rate of descenting surgery as an estimate of the rate of acquisition of new pet skunks, extrapolation to the entire population of Illinois veterinarians indicated that about 111 new pet skunks were obtained in Illinois in 1979.

Animals↗
PubMed1997

Long-term results of the Stamey bladder neck suspension procedure: a patient questionnaire based outcome analysis.

PURPOSE: Reported success rates of the Stamey bladder neck suspension procedure vary from 39 to 91%. The disparity is substantially influenced by the methods used to assess the surgical outcome, with best results being found consistently in retrospective chart review studies. We assessed the true long-term outcome of the Stamey bladder neck suspension with a patient questionnaire based outcome analysis using strict definitions for cure and recurrence. MATERIALS AND METHODS: Of 172 consecutive patients 138 (80.2%) returned a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. To our knowledge we report the longest mean followup for this procedure (66 months). RESULTS: Of 130 evaluable patients with hypermobility or intrinsic sphincter deficiency leading to urinary stress incontinence 65 (50.0%) remained completely continent, 15 (11.5%) never became continent and 50 (38.5%) had recurrence 6 to 90 months after initial operative success. However, approximately two-thirds of the patients believed they were cured or substantially improved more than 5 years postoperatively. CONCLUSIONS: Despite the considerable failure rate, the substantial improvement in the quality of life of almost two-thirds of the patients during long-term followup and the lack of superior techniques qualify the Stamey bladder neck suspension as a treatment of choice for urinary stress incontinence in women. We strongly emphasize the need for standardized questionnaire based outcome analyses for the evaluation of incontinence surgery.

Adult↗
PubMedDate not supplied

Facial palsy and Lyme borreliosis: long-term follow-up of children with antibiotically untreated "idiopathic" facial palsy.

We report on the follow-up of 28 patients, who were admitted to our hospitals between 1968 and 1984, and who, at that time, were diagnosed as having idiopathic facial palsy. These children were neither tested for Lyme borreliosis (LB) nor did they receive antibiotic treatment. In those days LB was an unfamiliar infection. Today we can assume that approximately 30%-50% of the patients we studied represent actual cases of neuroborreliosis. We, therefore, considered them an appropriate model in studying the spontaneous course of LB in children. the analysis of the questionnaire designed for our study as well as the supplementary clinical and serological reexaminations in some cases provided no evidence that neuroborreliosis led to relevant health disorders in any of the children (follow-up 10 to 26 years, mean 17). The results of our retrospective study led us to conclude that tick-borne facial palsy is relatively benign in children and that neuroborreliosis is insignificantly related to late complications.

Adolescent↗
PubMed2001

Nurse practitioner preferences for distance education methods related to learning style, course content, and achievement.

The relationships among multiple distance delivery methods, preferred learning style, content, and achievement was sought for primary care nurse practitioner students. A researcher-designed questionnaire was completed by 86 (71%) participants, while 6 engaged in follow-up interviews. The results of the study included: participants preferred learning by "considering the big picture"; "setting own learning plans"; and "focusing on concrete examples." Several positive associations were found: learning on own with learning by reading, and setting own learning plans; small group with learning through discussion; large group with learning new things through hearing and with having learning plans set by others. The most preferred method was print-based material and the least preferred method was audio tape. The most suited method for content included video teleconferencing for counseling, political action, and transcultural issues; and video tape for physical assessment. Convenience, self-direction, and timing of learning were more important than delivery method or learning style. Preferred order of learning was reading, discussing, observing, doing, and reflecting. Recommended considerations when designing distance courses include a mix of delivery methods, specific content, outcomes, learner characteristics, and state of technology.

Achievement↗
PubMedDate not supplied

Models of phonology in the education of speech-language pathologists.

We discuss developments in theoretical phonology and, in particular, at the divide between theories aiming to be adequate accounts of the data, as opposed to those claiming psycholinguistic validity. It would seem that the latter might have greater utility for thye speech-language pathologist. However, we need to know the dominant models of clinical phonology, in both clinical education and practise, before we can promote other theoretical approaches. This article describes preliminary results from a questionnaire designed to discover what models of phonology are taught in institutions training speech-language pathologists in the United States. Results support anecdotal evidence that only a limited number of approaches (phonemic, distinctive features, and processes) are taught in many instances. They also demonstrate that some correspondents were unable to distinguish aspects of theoretical phonology from similar sounding (but radically different) models of intervention. This ties in with the results showing that some instructors of phonology courses have little or no background in the subject.

Humans↗
PubMed2005

Initial validation of the SLEEP-50 questionnaire.

Initial psychometric properties of the SLEEP-50 questionnaire, designed to detect sleep disorders as listed in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision), were examined. The sample consisted of 377 college students, 246 sleep patients, 32 nightmare sufferers, and 44 healthy volunteers. The internal consistency was high (Cronbach's alpha = .85); test-retest correlations fell between .65 and .89. Principal component analysis with a direct oblimin rotation revealed a factor structure that closely matched the designed structure. Sensitivity and specificity scores were promising for all sleep disorders; the agreement between all clinical diagnoses and SLEEP-50-classifications was substantial (kappa = .77). These initial findings indicate that the SLEEP-50 seems able to detect a variety of sleep disorders. The SLEEP-50 can aid in screening for common sleep disorders in the general population.

Adolescent↗