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PubMedDate not supplied

Prostate cancer screening: clinical applications and challenges.

Prostate cancer is a serious illness warranting appropriate screening measures. However, current screening tests that include prostate-specific antigen and digital rectal examination must be proven to save lives to be considered truly legitimate and appropriate public health tools. Even though these tests are associated with the diagnosis of disease, important questions remain as to how well these tests identify all disease and whether screening leads to interventions that save lives. Prostate cancer is undoubtedly a killer, yet there appear to be large numbers of detectable prostate cancers that are of little threat to life. Some men with this grade of cancer receive curative treatment, even though their disease does not require treatment. Some studies suggest that more than three of four men with screen-detected localized disease may not need treatment. One of the great challenges of cancer communications is how to convey the hope of prostate cancer screening while adequately acknowledging the boundaries of our knowledge. The current absence of an appropriate informed consent tool points to the necessity to develop an easy to understand informed consent that allows men to evaluate screening decisions with a clear understanding of what is known, what is not known, and what is believed to be true about prostate cancer screening.

Ethics, Medical↗
PubMed2004

Colorectal cancer screening disparities related to obesity and gender.

BACKGROUND: Obesity is associated with a higher incidence of colorectal cancer and increased colorectal cancer mortality. Obese women are less likely to undergo breast and cervical cancer screening than nonobese women. It is not known whether obesity is associated with a lower likelihood of colorectal cancer screening. OBJECTIVE: To evaluate whether there is an association between body mass index (BMI) and rates of colorectal cancer screening. To examine whether BMI-related disparities in colorectal cancer screening differ between men and women. DESIGN AND SETTING: The Behavioral Risk Factor Surveillance System, a cross-sectional random-digit telephone survey of noninstitutionalized adults conducted by the Centers for Disease Control and Prevention and state health departments in the 50 states and Washington, DC in 1999. PATIENTS: Survey respondents (N= 52886) between 51 and 80 years of age representing 64563332 U.S. adults eligible for colorectal cancer screening. INTERVENTIONS AND MEASUREMENTS: Adjusted rates of self-reported colorectal cancer screening with fecal occult blood testing within the past year or endoscopic screening (sigmoidoscopy or colonoscopy) within the past 5 years. RESULTS: The colorectal cancer screening rate was 43.8% overall. The rate of screening by FOBT within the last year or endoscopic screening within the past 5 years was 39.5% for the morbidly obese group, 45.0% for the obese group, 44.3% for the overweight group, and 43.5% for the normal weight group. The difference in screening rates was entirely attributable to differences in BMI among women. After statistical adjustment for potential confounders, morbidly obese women were less likely than normal weight women to be screened (adjusted rate difference, -5.6%; 95% confidence interval, -8.5 to -2.6). Screening rates among normal weight, overweight, and obese women, and among men in different weight groups did not differ significantly. CONCLUSIONS: Colorectal cancer screening rates among age-eligible persons in the U.S. are disturbingly low. Morbidly obese women, who are at higher risk than others to develop and to die from colorectal cancer, are less likely to be screened. Efforts to increase colorectal cancer screening are needed for all age-eligible groups, but should also include targeted screening of morbidly obese women since they could reap substantial clinical benefits from screening.

Aged↗
PubMed2002

Tobacco use among adults with disabilities in Massachusetts.

OBJECTIVES: To examine the characteristics of smoking among adults with disabilities in Massachusetts. DESIGN: Data were obtained from the 1996-1999 Massachusetts Behavioral Risk Factor Surveillance System, a random digit dial telephone survey. Respondents reporting use of special equipment or a limitation caused by impairment or health problem were classified as having a disability. Adults with disabilities were further classified by level, based on need for assistance, and type of disability. Logistic regression models were used to assess the association between disability status and smoking. SETTING AND PARTICIPANTS: Random sample of non-institutionalised Massachusetts adults, 18 and older, with disabilities (n = 2985) and without disabilities (n = 14 395). MAIN OUTCOME MEASURES: Smoking status, intensity, and factors related to quitting. RESULTS: Compared to those without disabilities, adults with disabilities were more likely to have ever smoked (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.25 to 1.61) and to be current smokers (OR 1.52, 95% CI 1.32 to 1.76). Smoking rates varied by type of disability. Among current smokers, adults with disabilities smoked more cigarettes per day (OR 1.65, 95% CI 1.31 to 2.16), sooner after waking (OR 1.50, 95% CI 1.13 to 1.99), and were more likely to be advised by a doctor to quit (OR 2.07, 95% CI 1.60 to 2.69). Adults with disabilities who needed assistance were more likely to be planning to quit (OR 1.50, 95% CI 0.99 to 2.26). CONCLUSIONS: There are disparities in smoking rates between adults with and without disabilities. Smoking cessation programmes targeted to the disabled community are needed.

Adolescent↗
PubMed1999

The effect of apolipoprotein E epsilon4 in the relationships of smoking and drinking to cognitive function.

OBJECTIVES: To investigate the joint effect of the apolipoprotein E epsilon4 (APOE epsilon4), smoking and drinking on cognitive performance in a population-based longitudinal study of elderly men. DESIGN AND SETTING: The NHLBI Twin Study, a longitudinal cardiovascular study of World War II, white, male veterans. PARTICIPANTS: A total of 589 male participants in the third cardiovascular examination of this panel and aged 59-69 when assessed for cognitive function. OUTCOME MEASURES: Cognitive function assessed by the Mini-Mental State Examination, the Digit Symbol Substitution Test, the Benton Visual Retention Test, APOE epsilon4 allele frequency and cardiovascular disease (CVD) health status. RESULTS: For the sample as a whole, after adjustment for age, education and CVD, smoking was significantly associated with poor cognitive function (odds ratio (OR) = 2.0, 95% confidence interval (CI) 1.2-3.2, in current smokers compared with never smokers), whereas light drinking (one or fewer drinks per day) showed a protective effect (OR = 0.6, 95% CI 0.4-0.9 compared with abstainers). Stratification by APOE epsilon4 indicated that the protective effect of light drinking was stronger and the harmful effect of smoking was weaker among APOE epsilon4 carriers than among noncarriers. CONCLUSIONS: These data suggest a possible mediating effect of the APOE epsilon4 allele in the relation of smoking and drinking to cognitive function in the elderly.

Aged↗
PubMed1995

Short-term and long-term memory in elderly patients with NIDDM.

OBJECTIVE: To determine cognitive and memory dysfunction associated with non-insulin-dependent diabetes mellitus (NIDDM) and its relationship with depression, metabolic control, and serum lipids. RESEARCH DESIGN AND METHODS: We studied a well-characterized group of 20 elderly patients with NIDDM and 22 control subjects with normal glucose tolerance recruited from a larger population-based sample. In addition to clinical and laboratory examinations, self-rating questionnaires that assess minor psychiatric disorder (General Health Questionnaire) and depression (Zung scale) were completed by patients and control subjects. Memory was examined with digit and block-span tests, word-list learning, Heaton Visual Memory Test, and Moss Visual Span Test. Executive functions were examined by Trail-Making A and B test and by Verbal and Category Fluency Tests. Visuoconstructive reasoning was examined with the block design subtest of the Wechsler Adult Intelligence Scale. RESULTS: The NIDDM patients showed preserved memory span, but poor performance in learning tasks compared with control subjects. The patients recalled no fewer words than the control subjects, but the process of of learning seemed to be different in the two groups. The recognition of the learned words was not impaired. Elevated serum total and very-low-density lipoprotein triglyceride levels, measured either before examinations or 5 or 10 years earlier, were associated with effects on retrieval from semantic memory in NIDDM patients. CONCLUSIONS: The NIDDM patients had impaired control of their learning processes. Elevated serum triglyceride levels may be related to control of mental processing in diabetic patients.

Adult↗
PubMed1989

A financial analysis of digital image acquisition for portable and table-top radiography.

The use of photostimulable phosphors as a method for obtaining digital radiographic images during traditional portable and table-top radiography has become a subject of increased interest and controversy in recent years. Proponents of this technology argue that a Picture Archival and Communications System--or PACS--is now within the grasp of most medical communities. However, there still exists concerns relating to the financial and economic effectiveness of this technological development. Does direct digital image acquisition during portable and table-top radiography present a financial benefit to the average health care facility? An in-depth financial analysis of the costs incurred by computed radiographic imaging provides sufficient information to state that financial benefits are a function of exposure-related repeat procedure volumes which can be reduced or eliminated through the use of this new technology. Repeat procedure volumes must be reduced by at least 6,000 procedures if the health care facility intends to avoid a financial loss from the use of photostimulable phosphor technology during portable and table-top radiography.

Capital Expenditures↗
PubMed2000

Intimate partner violence among men and women--South Carolina, 1998.

Few studies provide population-based estimates of intimate partner violence (IPV) for men and women, especially at the state level. IPV may result in adverse health effects for victims and perpetrators (1-3). To estimate the lifetime incidence of IPV by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women, the South Carolina Department of Health and Environmental Control and the University of South Carolina conducted a population-based random-digit-dialed telephone survey of adults in the state. This report summarizes the results of the survey, which indicated that approximately 25% of women and 13% of men have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.

Adult↗
PubMed2002

The USU medical PDA initiative: the PDA as an educational tool.

A medical personal digital assistant (PDA) initiative for healthcare students began in 2000 at the Uniformed Services University of the Health Sciences (USU). The University issued PDAs to Graduate School of Nursing (GSN) and School of Medicine (SOM) students. These devices were used to provide clinical reference material to the students, to facilitate clinical experience log collection, and the normal organizer functions of a PDA. Both medical and graduate nursing students were surveyed both before and during clinical training to determine the perceived usefulness of the PDA. A quantitative approach was utilized to emphasize the measurable variables.

Attitude to Computers↗
PubMed1994

The absence of vaginal human papillomavirus 16 DNA in women who have not experienced sexual intercourse.

OBJECTIVE: To determine whether young women who have not experienced sexual intercourse may harbor genital human papillomavirus (HPV) infection in the vaginal-ectocervical mucosa. METHODS: We included 151 women, 10-25 years of age, attending two adolescent health care units (Stockholm and Uppsala) and one primary health care center (Umeå). The size of the hymenal orifice, use of tampons, and the habit of digital vaginal manipulation were registered. Samples of epithelial cells were collected from the vagina and analyzed for the presence of HPV using polymerase chain reaction. RESULTS: One hundred thirty of 154 samples contained an adequate number of cells. Two samples were HPV 6 DNA-positive. None were HPV 16 DNA-positive. None of the women had external genital warts. In 84%, the hymenal opening was 15 mm or less. Forty-eight percent of the women used tampons during periods. Fifty-four percent had inserted their own finger into the vagina and in 23%, a boyfriend's finger had penetrated the vagina. CONCLUSION: Human papillomavirus is rarely present vaginally in virginal women, even with the use of tampons or digital penetration.

Adolescent↗
PubMed1996

Florida physicians' guide to on-line information and the Internet.

The combination of new computing technology with progress in data communications over wide geographic areas offers computer users the opportunity to publish information to each other rapidly across wide geographic expanses. The concept of networking computers to gain access to the most recent and widest range of available information is consistent with the aims and methods of quality health care. The Internet is the ultimate extension to the computer network concept- an unlimited link of digital servers and users world-wide, united by common protocols for purposes of information exchange, self-policed and without central controls. Although the concept is attractive, on-line servers and the Internet are sophisticated information tools whose most effective use requires that users be oriented to basic concepts and conventions. This article summarizes the basic conventions in computer networking and data security; the differences in concept and use between bulletin board systems (BBSes), online systems, and the Internet for information access; the various classes of Internet information resources and their uses; the basic use of search engines to expedite information retrieval in the Internet; and offers practical advice in choosing methods of Internet access.

Computer Communication Networks↗
PubMed1998

Hypertension in the elderly: a community study.

Hypertension in the elderly features differently from its younger counterpart in terms of diagnosis, associated condition, atypical manifestation, management and complication. Epidemiological study in this increasing age group in the community is, therefore, needed. 334 elderly subjects living in various parts of Bangkok were randomly recruited by appointment at 7 geriatric day centers situated in local health offices of Bangkok Metropolitan Authority. Each subject received blood tests before being interviewed and measured by digital sphygmomanometer. Blood pressure and heart rate changes were recorded during lying, sitting and standing. The prevalence of hypertension was 36.5 per cent, 33.2 per cent were already aware of its existence while 3.3 per cent were newly detected by the survey. Isolated systolic hypertension, a unique subtype found in the elderly, was 4.5 per cent of all or 37.5 per cent among the hypertensive group. The associated medical conditions among the case group were diabetes mellitus 22.9 per cent, hyperlipidemia 13.9 per cent, hyperuricemia 33.3 per cent and heart disease 18.0 per cent. As far as postural hypotension is concerned, 14.8 per cent of case group whereas 11.3 per cent of the control group were affected. On the other hand, the symptom of postural dizziness was found to be 31.1 per cent and 55.2 per cent in the case and control group respectively. Following the statistical logistic regression analysis, the independent associated factors in the hypertension group were: history of hyperlipidemia, increased serum uric acid and poor heart rate response after standing. These findings, as parts of the multiple pathology and potential complications prevalent among this group, should be of concern by any physician looking after the elderly.

Aged↗
PubMedDate not supplied

Things to come: postmodern digital knowledge management and medical informatics.

The overarching informatics grand challenge facing society is the creation of knowledge management systems that can acquire, conserve, organize, retrieve, display, and distribute what is known today in a manner that informs and educates, facilitates the discovery and creation of new knowledge, and contributes to the health and welfare of the planet. At one time the private, national, and university libraries of the world collectively constituted the memory of society's intellectual history. In the future, these new digital knowledge management systems will constitute human memory in its entirety. The current model of multiple local collections of duplicated resources will give way to specialized sole-source servers. In this new environment all scholarly scientific knowledge should be public domain knowledge: managed by scientists, organized for the advancement of knowledge, and readily available to all. Over the next decade, the challenge for the field of medical informatics and for the libraries that serve as the continuous memory for the biomedical sciences will be to come together to form a new organization that will lead to the development of postmodern digital knowledge management systems for medicine. These systems will form a portion of the evolving world brain of the 21st century.

Artificial Intelligence↗
PubMed2005

Associations of frequent sleep insufficiency with health-related quality of life and health behaviors.

BACKGROUND AND PURPOSE: Sleep-related problems, which affect 50-70 million Americans, involve all areas of life, including cognitive performance, emotional well-being, work and leisure-time activities, and general physical and mental well-being. We examined the association of insufficient sleep with health-related quality of life (HRQOL) and health behaviors. PATIENTS AND METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit telephone survey of the non-institutionalized US population aged >or =18 years. In 2002, HRQOL measures were administered in 18 states and the District of Columbia, yielding complete responses to questions regarding sleep and demographic characteristics from 98% of study participants (n=79,625). RESULTS: An estimated 26% of adults reported frequent (> or =14 days in the past 30 days) sleep insufficiency. They were significantly more likely than those without frequent sleep insufficiency to report fair/poor general health, frequent physical distress, frequent mental distress, activity limitations, depressive symptoms, anxiety, and pain. In addition, they were significantly more likely to smoke, to be physically inactive, to be obese, and, among men, to drink heavily. CONCLUSION: Insufficient sleep is associated with a variety of adverse health behaviors and impairment in all HRQOL domains investigated. Accordingly, assessment of sleep appears to be an important component of general medical care. Moreover, expanded assessment of sleep in the general population may provide a better understanding of prevalence of impaired sleep and its many implications.

Adult↗
PubMed2002

[Photographic screening for diabetic retinopathy in the county of North Jutland. The first fully digitalized telemedicine-screening clinic].

Screening for diabetic retinopathy was introduced in Denmark in 1988. At present, screening is carried out in four of the 14 counties, thus being available to a minority of diabetic subjects. According to the WHO but also the National Board of Health, all diabetic patients should undergo screening for diabetic retinopathy. Not only does screening pay off in terms of preservation of vision, it is also cost-effective, as confirmed in the present study. The first fully digitized clinic for retinopathic screening in diabetic patients was recently introduced in the County of North Jutland. Preliminary results from this clinic indicate that all procedures can be handled in this fully digitized system. We therefore predict that fully digitized clinics for retinopathic screening will be introduced throughout Denmark in the future.

Denmark↗
PubMedDate not supplied

The information revolution: opportunities and pitfalls for patients and providers.

The Information Revolution is changing everything in our world. Although this era is developing and evolving, some have described networks, globalization, diffusion of power away from professionals, and information overload as direct results of the Information Revolution. These megatrends are affecting every person and every organization in the world, and this article examines them to see how they might affect medicine and the delivery of health care in the millennium. What is truly significant about the changes brought about by the creation of cyberspace is that through computers, digitized information can be inexpensively and quickly transmitted anywhere in the world. Many of the traditional ethical and professional standards of medicine are feeling the strain of being applied to the strange, unfamiliar world-cyberconsultations and other virtual medical applications are explored. Physicians who understand this revolution will have a far better chance of controlling their destinies--and more importantly, aiding their patients in the quest for good health.

Attitude to Computers↗
PubMedDate not supplied

Assessment of community-level influences on individuals' attitudes about cigarette smoking, alcohol use, and consumption of dietary fat.

A basic premise of community-based health promotion is that enduring changes in health behaviors are facilitated by changing community norms or the standards of acceptable behavior in the community. We examine whether community-level influences on individuals' normative attitudes can be related to cigarette smoking, alcohol consumption, and dietary fat intake. We conducted a random-digit dialing survey of 8,849 adults in 15 communities in the western United States as part of the evaluation of the Henry J. Kaiser Family Foundation Community Health Promotion Grant Program. We found independent associations among attitudes for tobacco, alcohol, and diet and both individual-level and community-level characteristics. A significant community effect on attitudes remained even when we controlled for individual demographics and health behaviors, as well as for the overall prevalence of the target health behavior in the community. The specific community characteristics that account for this effect were not clear in our analyses, suggesting that influential characteristics vary from community to community.

Adult↗
PubMed1985

Teleradiology: part of a comprehensive telehealth system.

Present technologic limitations do not allow completely accurate reproduction of a chest film, the gold standard of teleradiology. Although interpretation accuracy of broad-band teleradiographs is reasonably good and encouraging, the low level of confidence engendered by teleradiology interpretations in narrow-band transmission is self-evident in view of the tendency to provide an immediate provisional report followed later by a signed report after direct viewing of the film. Despite this, the important observation, putting things into perspective, was made by Andrus and Bird, namely that "the question is not whether teleradiology is preferable to direct visualization when either is available, but whether teleradiology offers an acceptable universally applicable method to augment the usefulness of the radiologist." Although fiberoptic guides may well lace the country in a few years, providing ample capacity and superb transmitted images, there are several options presently worth investigating now. These could provide teleradiology services to remote and rural communities, depending on the level of need and skills at the remote site, the availability and cost of transmission, and the need for access to 24-hour consultation services. The future role of teleradiology on a much larger scale within a regional network of health care facilities has yet to be defined, based on the perceived need for reasonable access to expensive but precise imaging methods. On the face of it, it would seem unlikely that small community hospitals will be able to afford the cost and maintenance of CT and MR scanners, digital angiography, and other useful and accepted imaging services.(ABSTRACT TRUNCATED AT 250 WORDS)

Comprehensive Health Care↗
PubMed2006

Associations between health-related quality of life and demographics and health risks. Results from Rhode Island's 2002 behavioral risk factor survey.

BACKGROUND: Health-Related Quality of Life (HRQOL) has received much attention in recent years. HRQOL indicators have been used to track population trends, identify health disparities, and monitor progress in achieving national health objectives for 2010. Prior studies have examined health risks and HRQOL at the national level as well as at the state level. This paper examines multiple indicators of HRQOL by demographic characteristics and selected health behaviors for Rhode Island adults. METHODS: Data from Rhode Island's 2002 Behavioral Risk Factor Surveillance System (BRFSS), a random digit dialled telephone survey, were used for this study. The state wide sample contained a total of 3,843 respondents ages 18 and older. Multiple Imputation (MI) was applied to handle missing data, and data were modelled for each of 10 HRQOL indicators using multivariable logistic regression. RESULTS: By examining HRQOL through a multivariable approach we identified the strongest predictors for multiple indicators of poor HRQOL as well as predictors for specific indicators of poor HRQOL. Predictors for multiple indicators of poor HRQOL were: disability, inability to work, unemployment, lower income, lack of exercise, asthma, and smoking (specifically associated with poor mental health). CONCLUSION: Using multiple measures of HRQOL can help to assess the burden of poor health in a population, identify subgroups with unmet HRQOL needs, inform the development of targeted interventions, and monitor changes in a population's HRQOL over time. Use of these HRQOL measures in longitudinal and intervention studies is needed to increase our understanding of the causal relationships between demographics, health risk behaviors, and HRQOL.

Adult↗