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PubMed2005

Collecting saliva by mail for genetic and cotinine analyses in participants recruited through the Internet.

The authors assessed whether collection by mail of saliva and buccal cells for genetic analysis was feasible in participants recruited through the Internet. In 2003, 14,773 visitors of a smoking cessation website were invited by e-mail to take part in the study. Salivettes (plastic vials containing a cotton roll) were mailed to participants, for collection of saliva and buccal cells. Because of limited resources, the authors stopped recruitment when 392 participants (3% of 14,733) were registered. They received 315 saliva samples back (80% of 392). Salivary cotinine was analyzed in 145 daily smokers. Cotinine concentration could be assessed in 141 samples (97%) (range 0.7-899 ng/ml, median 260 ng/ml). DNA extraction was achieved in all the 285 samples in which it was attempted. Quality of DNA was assessed by optical density measurements and by polymerase chain reaction amplification of a gene coding for the alpha-4 nicotinic receptor, with the detection of a known polymorphism. Successful results were obtained in 235 samples (82% of 285). Thus collecting saliva by mail for cotinine and DNA analysis in participants recruited through the internet produced samples of good quality at a reasonable cost. This approach should be valuable for genetic epidemiology and pharmacogenetic research.

Adult↗
PubMed1996

Attitude of physicians toward patient package inserts for medication information in Belgium.

In Belgium, the distribution of medications to outpatients in community pharmacies is almost exclusively by branded unit-of-use packages, with a package insert inside every package. At the time of the study (spring 1990), the implementation of legislation that mandated a shift from highly technical documents to patient package inserts (PPIs), understandable by the lay person, had begun. This study explores the attitude of practising physicians toward written medication information for patients. A mail questionnaire was sent to 1500 (8% random sample) Belgian general practitioners and to 500 (22% random sample) internal medicine specialists. A total of 543 usable questionnaires were returned (27.5% return rate). Ninety-two percent of the physicians stated that their patients seldom or never requested additional information on drug efficacy or side effects, during routine consultation; 30% estimated that more than half of their patients read the PPI; 75% expect that a patient would experience side effects after reading about them in the PPI; 59% agreed that the PPI could help the patient react more adequately in unforeseen situations. It was possible to cluster the respondents in a stable segmentation of three clusters: moderately positive physicians (20%), ambiguous to neutral physicians (44%), physicians overtly negative to written drug information (36%). The low response rate to this extensive postal questionnaire limits the conclusions to a qualitative description of relevant clusters of respondents. In contrast with the opinion of physicians about patient readership, results from other studies indicate that the vast majority of patients read the package inserts.

Adult↗
PubMed2005

Report of the First International Workshop on molecular blood group genotyping.

The use of molecular genetic technology for blood group typing is becoming routine procedure in many reference laboratories worldwide. A First International Workshop was organized on behalf of the International Society of Blood Transfusion (ISBT) and the International Council for Standardization in Haematology (ICSH). Thirty laboratories that provide a molecular diagnostic service participated in the workshop. Six samples were distributed: two represented DNA from transfusion-dependent patients for testing for multiple polymorphisms; two represented fetal DNA prepared from amniotic fluid for RhD, Rhc and K-testing; and two represented plasma from RhD-negative pregnant women for fetal RhD testing. Error rates varied from 0 to 11% for different polymorphisms. A consensus arising from discussion on the workshop results between participants at a feedback meeting and by e-mail has resulted in seven recommendations for molecular blood group genotyping. Further international workshops will take place every 2 years, with a more limited exercise being organized in the intervening years.

Blood Group Antigens↗
PubMed2003

[E-commerce of pharmaceuticals].

The emergence of the Internet as a new communications and information technology caused major social and cultural changes. The dramatic increase in accessibility and availability of information empowered the consumer by closing the information gap between the consumer and different suppliers. The objective of this article is to review many new internet-supported applications related to the pharmaceutical market. E-commerce is divided into two major components: Business to Consumer (B to C), and Business to Business (B to B). The main applications in B to C are dissemination of medical and drug information, and the sale of drugs through the Internet. Medical information on the Internet is vast and very helpful for patients, however, its reliability is not guaranteed. Online pharmacies increase the accessibility and availability of drugs. Nevertheless, several obstacles such as security of the data provided (both financial and clinical) prevent the widespread use of online pharmacies. Another risk is the health authorities' inability to regulate Internet sites effectively. Therefore, unregulated sale of prescription drugs, fake or substandard, often occurs on the Internet. B to B relates to physicians, clinics, hospitals, HMO's and pharmaceutical companies. There is a vast number of applications ranging from clinical research, marketing and sales promotion, to drug distribution and logistics. In conclusion, the Internet is dynamic and has contributed to the development of numerous new applications in the field of pharmaceuticals. Regulatory authorities should be active in developing new policies that will deal with those new Internet-based applications.

Drug Industry↗
PubMed1995

RDA: a standard for client server communication in a hospital information system.

The University of Erlangen-Nürnberg contains a large medical faculty with many hospitals, laboratories, and other departments distributed in the town of Erlangen, and it is necessary to exchange medical data between them. For example the basic patient data which are held on central computers, must be distributed to various stations and departments. In addition medical reports which are prepared on or generated by computers in central departments must be transmitted to various points in the hospitals [1]. When the network, based on ethernet cabling within the hospitals and a glass fiber backbone, has been completed, the Erlangen hospital communication system will support an electronic exchange of medical information. Two separate communication methods are used: data exchange via electronic mail according to the international standard X.400 and remote access to central databases using the software product NET-WORK.

Computer Communication Networks↗
PubMed1998

Relationship between dietary habits, age, lifestyle, and socio-economic status among adult Norwegian women. The Norwegian Women and Cancer Study.

OBJECTIVE: To examine how dietary intake varies with age in a nation-wide sample of adult Norwegian women, and to evaluate the impact of lifestyle and socio-economic status on important dietary aspects. DESIGN: Cross-section study. SETTING AND SUBJECTS: A food frequency questionnaire was mailed to a random, nation-wide sample of 20 000 women aged 45-69y, and 9885 questionnaires were accepted for nutritional analyses. RESULTS: Dietary habits differed moderately with age. The oldest women reported a higher consumption of potatoes and fish, whereas the youngest reported more coffee, meat, and alcohol. The reported intake of fruit, vegetables, and potatoes was lower than recommended in all age groups. Older women had a slightly better distribution of energy yielding nutrients than younger women, although the median percentage of energy from fat was too high in all age groups. The median dietary fibre density of the diet was close to the recommended level in all age groups, yet lowest among the youngest women. Practising a healthy lifestyle and having a higher socio-economic status were associated with reporting a healthier diet. However, adjusting for lifestyle and socio-economic factors did not substantially alter the associations between diet and age. CONCLUSIONS: Older women tend to have a healthier diet than younger women. The relationship does not seem to be strongly confounded by lifestyle and socio-economic status, although these factors are also related to dietary habits.

Aged↗
PubMed1995

A time to pregnancy questionnaire designed for long term recall: validity in Oxford, England.

STUDY OBJECTIVE: To establish the degree of validity of data on time to pregnancy, derived retrospectively using a short questionnaire. DESIGN: Information from the questionnaire was compared with data that had been collected concurrently from the same individuals. SETTING AND PARTICIPANTS: Questionnaires were mailed to 1647 women who continue to be followed up by the Oxford Family Planning Association contraceptive study, and a further 424 were approached for personal interview. Response rates were 91% and 79% respectively. MAIN RESULTS: Matching was successful in 91% of pregnancies. Median recall time was 14 years (interquartile range, 11-16 years). At the group level, remarkably good agreement was found between the two sources of information, presented as cumulative percentage distributions of live births. The findings were at least as good with longer recall (> 14 years) as with shorter recall. Digit performance was present to a limited degree. At the individual level, some misclassification was evident, which has implications for statistical power. For detection of clinical infertility (no conception within 12 months), the sensitivity was in the range 67%-91%, and the specificity was 92%-96%. Variations with format, duration of recall, age at delivery, year of birth, parity, social class, smoking habit, last contraceptive method, and outcome (live birth or not) were generally small, and were not statistically significant. CONCLUSIONS: Time to pregnancy is a sensitive way of assessing reproductive function in either sex. Valid data at a group level can be derived retrospectively, with a long duration of recall, using a short questionnaire.

Adult↗
PubMed1992

Multiple personality disorder in Switzerland.

OBJECTIVE: There are no reliable data on the prevalence of multiple personality disorder. The objective of the study was to determine whether and, if so, how frequently patients with multiple personality disorder are encountered and diagnosed in Switzerland. METHOD: All qualified Swiss psychiatrists were sent a questionnaire on multiple personality disorder along with the DSM-III description of multiple personality disorder and three case examples. A total of 836 psychiatrists (66%) answered after two mailings, and 770 questionnaires qualified for evaluation. In addition, a random sample of nonresponders were contacted by telephone. RESULTS: Three percent of the psychiatrists indicated that, at the time of the inquiry, they were treating or examining one or more patients who met DSM-III criteria for multiple personality disorder, and 10% indicated that they had seen multiple personality disorder at least once during their professional career. The patients were not equally distributed among the psychiatrists; three colleagues reported that they had seen much higher numbers of patients with multiple personality disorder. The point prevalence of multiple personality disorder among patients seen by psychiatrists in Switzerland amounts to 0.05%-0.1%. CONCLUSIONS: Multiple personality disorder appears to be a disorder that genuinely exists, even though it occurs relatively rarely.

Adolescent↗
PubMed2004

Effect of periodic letters on evidence-based drug therapy on prescribing behaviour: a randomized trial.

BACKGROUND: The effect of regular and expected printed educational materials on physician prescribing behaviour has not been studied. We sought to measure the impact of a series of evidence-based drug therapy letters mailed to physicians in British Columbia on prescribing to newly treated patients. METHODS: A paired, cluster randomized community design was used. The study population included 499 physicians from 24 local health areas in British Columbia. Local health areas were paired by number of physicians, and 1 of each pair was randomly selected and its physicians assigned to an intervention group or a control group. The intervention was 12 issues of an evidence-based series called Therapeutics Letter. Physicians in the control group (n = 241) received the letters 3-8 months after physicians in the intervention group (n = 258). The impact on prescribing to newly treated patients (defined as patients who had not previously made a claim for any medication from the class of drugs profiled in the letter) was analyzed using the drug claims database of BC Pharmacare, a publicly funded drug benefits program that covered all seniors and people receiving social assistance. RESULTS: The probability of prescribing a drug recommended in the Therapeutics Letter rather than another drug in the same class increased by 30% in the 3 months after the mailing of the letter relative to the preceding 3 months, adjusted for any before-after changes in the control group (relative risk 1.30; 95% confidence interval 1.13-1.52). No letter achieved statistical significance on its own. However, 11 of the 12 letters produced prescribing changes in the predicted direction such that the overall result was significant when their effect was combined. INTERPRETATION: The combined effect of an ongoing series of printed letters distributed from a credible and trusted source can have a clinically significant effect on prescribing to newly treated patients.

Adult↗
PubMed1985

The influence of a hospital pharmacy residency program on career advancement and satisfaction.

A mail survey of practicing hospital pharmacists in British Columbia who graduated since the introduction of hospital residency programs was conducted to determine the influence of a hospital pharmacy residency program on career advancement and satisfaction. Respondents included 33 past residents and 38 non residents. Career advancement was measured by union grade level. Professional and employment satisfaction were assessed using a five-level satisfaction scale. Percentage time allocated to each of administrative, clinical, distributional and research activities was determined for each group. Past residents were also requested to estimate residency program time allocation devoted to these activities which would best prepare them for their present employment. The results of this study indicate that in the ten years the program has been in operation, no difference can be demonstrated between past residents and non residents with respect to career advancement, professional satisfaction or employment satisfaction. Past residents recommend that a hospital residency should consist of approximately 40% clinical activities, 30% distributional activities and the remainder time allocated equally to administrative and research activities. Further research is recommended to evaluate the impact of a hospital pharmacy residency program in a location independent of union grade restrictions and later in the career of past residents to determine the influence of these factors on career advancement and satisfaction.

British Columbia↗
PubMedDate not supplied

Incentives to increase participation in an Internet survey of alcohol use: a controlled experiment.

AIMS: To examine the use of the Internet in a survey of drinking among students, and the effectiveness of incentives to encourage participation. METHODS: In a survey of drinking in university students, a random sample of 160 students were randomly assigned to one of four token incentive conditions. All received posted invitations, and reminders by e-mail and telephone. RESULTS: Overall response was 85% and did not differ significantly by incentive condition. CONCLUSION: Internet surveys are effective in obtaining alcohol use information from students. Minimal incentives may suffice if coupled with intensive follow-up.

Adult↗
PubMed2000

Content of non-mercury-associated selenium in human tissues.

Recent studies have shown that at a higher mercury (Hg) burden, the molar ratio of selenium (Se) and Hg in tissues tends to approximate 1:1 by the formation of biologically largely inert adducts. From the toxicological standpoint, this trapping of free Hg is welcome. However, this binding of Se to Hg reduces the portion of Se in tissues, which is available for the formation of essential selenoenzymes like glutathione peroxidase, type I deiodase, and so forth and could result in a relative deficiency of Se. Therefore, we tried to determine the concentration of non-Hg-associated Se in several human tissues. As there is no proved trace method for the speciation of non-Hg-bound and Hg-bound Se in tissues, the total concentrations of Hg and Se were determined and the portion of non-Hg-associated Se was calculated by the difference of the molar concentrations of Se and Hg. For this investigation, the following tissues were obtained by autopsy from 133 adults: kidney cortex, thyroid gland, liver, spleen, cerebrum cortex, and pituitary gland. In no case was an occupational Hg burden known. The results confirm the assumption of a 1:1 association of Hg and Se in human tissues. The mean concentration of non-Hg-bound Se was calculated to 576 microg/kg in the kidney cortex, 363 microg/kg in the thyroid gland, 308 microg/kg in the liver, 205 microg/kg in the spleen, 111 microg/kg in the cerebrum cortex, and 545 microg/kg in the pituitary gland. In none of the cases under investigation in any tissue was the molar Se/Hg ratio below 1. This means that a total deficiency of non-Hg-bound Se could not be seen in this normal population, even at a higher Hg burden. Nevertheless, at a suboptimal Se supply like in Germany, any reduction of the part of Se, which is available for the formation of essential seleno-enzymes, should be avoided. Therefore, any additional Hg burden such as from dental amalgam should to be considered critically. The different distribution of Hg and Se in the body confirms that there is a controlled hierarchy in the Se supply of different organs, which tries to prevent a Se deficiency in organs with essential seleno-enzymes like the thyroid gland even under an suboptimal Se supply.

Adolescent↗
PubMedDate not supplied

Screening seniors for risk of functional decline: results of a survey in family practice.

OBJECTIVE: To measure functional status, determine risk of functional decline and assess consistency between responses and standardized instruments. DESIGN: A mailed survey which measured functional impairment, recent hospitalization and bereavement. A positive response on at least one of these factors indicated that the individual was "at risk" for functional decline. A random sample (n = 73) of "at risk" subjects (specifically, family practice patients aged 70 and older) were assessed by a nurse. RESULTS: The response rate was 89% (369/415), 59% of seniors were female and the mean age was 77.1 (SD = 5.5) years. Self-reported risk, based on activities of daily living (ADLs), was associated with impairment in at least one basic ADL (p < 0.0005) using a standardized instrument. The positive predictive value of the survey for ADL impairment was 65%. CONCLUSION: Response to a mailed survey was high and self-reported ADL risks were consistent with findings from standardized assessment tools.

Activities of Daily Living↗
PubMed2000

Social inequality, population health, and housing: a study of two Vancouver neighborhoods.

An emerging 'population health' framework for understanding inequalities in health identifies the structure of social relations as a crucial factor in shaping human health and well-being. However, there remain many unanswered questions about the mechanisms through which social relations might shape the health status of individuals and populations. Housing plays a central role in routinized, everyday life and is fundamentally bound up in one's sense of control over life circumstances. Housing and property markets are significant in the distribution of wealth and are an important arena for the exercise of power relations. Housing circumstance is crucial in the production and reproduction of social identity and social status. Yet little has been written on the influence of inequalities generated by housing and housing markets on the differential distribution of health status. This paper reports the findings of an empirical study of relationships between socioeconomic status, material and meaningful dimensions of housing and home, and health status. Our objective is to investigate ways in which material and meaningful factors related to housing, in conjunction with other dimensions of the social environment, could operate to produce systematic inequalities in health status across social strata. The data for this study were obtained through a mailed survey of residents in the Mount Pleasant (n = 322) and Sunset (n = 206) neighborhoods of Vancouver, Canada. They suggest that, in concert with commonly used measures of socioeconomic status, both material and meaningful dimensions of housing and home are associated with health status in a direction consistent with expectations following from our analytical model.

Adult↗
PubMed1995

Low prevalence of primary biliary cirrhosis in Victoria, Australia. Melbourne Liver Group.

A prevalence study of primary biliary cirrhosis was carried out in the state of Victoria, Australia, by means of a mail survey of specialist physicians and a review of hospital records. Eighty four cases were identified, giving a prevalence of 19.1 per million population (95% confidence limits (CI) 15.3, 23.7), which is among the lowest in published reports. The prevalence in the Australian born, at risk population (women over the age of 24) was 51 per million (95% CI 37.5, 67.9). Both these figures are considerably lower than those in populations of similar age distribution in the UK and northern Europe. Since most Victorians are descended from British or European settlers, the low prevalence of primary biliary cirrhosis in this study supports the hypothesis that local environmental factors may be important in the pathogenesis of this disease.

Adult↗
PubMedDate not supplied

Where are the non-visiting patients?

In a clinical trial to increase the screening of inner-city women for breast cancer, some preliminary data suggested that about 40% of the age-eligible women who had been patients at a primary-care clinic might be expected never to visit that clinic again. The distribution of time between patients' clinic visits was modeled by fitting a distribution function to data on the "time to first visit," and indicated that the true defection rate is probably around 31 to 36%. This result, which is consistent with four related observations, suggests that most of the patients who fail to visit their clinics in a year-long interval may have become clients of other clinics. This conjecture implies massive continuing exchanges of patients among clinics, and may mean that explicit outreach by mail or phone to "non-visiting clients" will add few patient contacts to those based on spontaneous clinic visits.

Black or African American↗
PubMed2002

The occurrence of chronic disease and other conditions in a large population-based cohort of native Californian twins.

We describe the prevalence of chronic diseases and conditions in a large cohort of twins, which has been developed to facilitate studies of the role of genetics and environment in the development of disease. The California Twin Program (CTP) comprises twins born in California between 1908 and 1982. Birth records from all multiple births (256,616 in total) were linked (multiple times between 1990 and 2001) with the California Department of Motor Vehicles (DMV) roster of licensees to obtain address information. The linkages have revealed 161,109 matches and, because of less complete DMV records in some years, were less successful in older females than in all others. To date over 51,000 of these twins have completed a detailed 16-page mailed risk factor questionnaire. Based on estimates of numbers of individuals receiving a questionnaire, our crude response rates are as high as 63.6% (among females currently in their 50s), with an overall crude response rate of 37.9%. Similar to our previous report regarding the first 42,000 twins, the current group who have completed the questionnaire are representative of the population from which they were drawn (in terms of age, sex, race and residential distribution). Self-reported disease frequencies are provided, along with current estimates of future cancer incidence and mortality rates likely to be observed in the group. We outline our plans for cohort expansion, additional studies using the cohort, and future plans for inviting collaboration.

Adolescent↗
PubMed1995

Nationwide incidence estimation of lung cancer in Korea.

The aim of this paper is to estimate the nationwide incidence rate of lung cancer in Korea. The potential incident cases were identified by hospital visiting and mailing, based on the ICD-9 diagnostic codes on the claims as one of the following: ICD-9 162-165 (malignant neoplasms of the respiratory system), 212 (benign neoplasm), 231 (carcinoma in situ), 511 (pleurisy), or 195-199 (malignant neoplasms with uncoded sites) in beneficiaries data of the Korea Medical Insurance Corporation from January, 1988 to December, 1989. Thereafter, the identified cases were confirmed by an oncologist (Dr. DS Heo). When adjusted with age distribution of the Korean population based on the 1985 Population Census, the incidence rate was 22.3 per 100,000 in males (95% CI: 21.70-23.01) and 8.37 (95% CI: 7.97-8.78) in females in 1989. And the age-adjusted rate for the world population was 39.63 in males and 9.95 in females.

Adult↗