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PubMed2006

Stigmatization of newly emerging infectious diseases: AIDS and SARS.

OBJECTIVES: We assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases: AIDS and SARS. METHODS: We conducted a random-digit-dialed survey of 928 residents of the New York City metropolitan area as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents' knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS. RESULTS: In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS. CONCLUSIONS: Personal resources and mental health factors are likely to influence the public's ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Telemedicine in neonatal emergencies].

UNLABELLED: Telemedicine is the transmission of medical notices and images among remote sites, that uses adequate audio-video systems. OBJECTIVE: To increase the quality and the amount of medical informations, avoiding unnecessary carriages. Among main fields of interest in Telemedicine, monitoring of cardiovascular parameters and medical emergency represent situations that need to be promptly and appropriately approached. In such a similar conditions, a preliminary transmission to III level Health Institutions of informations as Electrocardiograms or even Echocardiograms may play an essential role in the diagnosis, prognosis and treatment of emergent cardiovascular disease. METHODS: Since March 1998, an Audio-Video PC-based system that uses integrated services digital network (ISDN) at a bandwith of 384 Kbps, was installed at Pediatric Cardiac Surgery Department of Giovanni XXIII Hospital, Bari, Italy. On July 1999, thanks to Research Funds of the Health Ministry of Italy, similar audio-video systems that use ISDN were installed in the main pediatric institutions of provinces of Puglia and linked in a wide area network. RESULTS: We report the experience of Telemedicine of a Department of Pediatric Cardiology and Cardiac Surgery, and we try to analyze its impact on improvement of quality of care, once employed in provincial field.

Emergencies↗
PubMedDate not supplied

Health care reform and the new economy.

The objectives and assumptions of health care reform have changed repeatedly during the past century and may now be entering a new historical phase as a result of the "new economy" rooted in information technology. In a high-growth context, proponents of reform may no longer feel obliged to bundle expanded coverage with tighter cost containment. At the same time, the new digital environment may facilitate innovations intended to inform and expand consumer choice and to improve quality. The new environment elevates "transparency" to a guiding principle. Health informatics has long been peripheral to reform and must now become more central.

Efficiency, Organizational↗
PubMed2003

A survey of the decision-making needs of Canadians faced with complex health decisions.

OBJECTIVE: To describe the decision-making needs of Canadians when faced with 'complex' health decisions characterized by balancing advantages against disadvantages. Although a national report emphasized that public confidence in the health-care system depends on support for personal knowledge and decision-making, there has been no systematic investigation of the Canadian population's decision-making needs. DESIGN: Cross-sectional telephone survey using random digit dialling. PARTICIPANTS: National sample of 635 adults over 18 years of age, living in Canada. RESULTS: Forty-two percentage of eligible contacts participated. Sixty-five percent of contacts reported making 'complex' health decisions, commonly about medical or surgical treatments or birth control, and more commonly by women and by married/separated individuals. Most respondents took an active role in their decisions, often sharing the process with their partner or family. Being younger was associated with a more independent role. Physicians were more often involved in the decisions of respondents with less education. Fifty-nine percent of respondents experienced decisional conflict; more conflict was seen with those who were female and feeling uninformed about options, pressured to select one particular option, and unready or unskilled in decision-making. Less decisional conflict was seen in those who reported birth control decisions and in those who were 70 years and older. Participants used several strategies when deliberating about choices including: information gathering, clarifying their values, and seeking support and information from others. Personal counselling and printed information materials were commonly preferred methods of learning about options. 'Essential' criteria for judging satisfactory decision-making included: having sufficient knowledge about the options, outcomes, and probabilities; being clear about values; selecting and implementing a choice that agrees with personal values; and expressing satisfaction with the choice. CONCLUSIONS: Canadians, particularly women, face difficult decisions and need support and information from credible sources.

Adolescent↗
PubMed2004

Household food insecurity is associated with adult health status.

The prevalence of household food security, which reflects adequacy and stability of the food supply, has been measured periodically in the United States and occasionally in high-risk groups or specific regions. Despite a plausible biological mechanism to suggest negative health outcomes of food insecurity, this relation has not been adequately evaluated. This study was conducted in the Lower Mississippi Delta region to examine the association between household food insecurity and self-reported health status in adults. A two-stage stratified cluster sample representative of the population in 36 counties in the Delta region of Arkansas, Louisiana, and Mississippi was selected using list-assisted random digit dialing telephone methodology. After households were selected and screened, a randomly selected adult was interviewed within each sampled household. Data were collected to measure food security status and self-reported mental, physical, and general health status, using the U.S. Food Security Survey Module and the Short Form 12-item Health Survey (SF-12). Data were reported on a sample of 1488 households. Adults in food-insecure households were significantly more likely to rate their health as poor/fair and scored significantly lower on the physical and mental health scales of the SF-12. In regression models controlling for income, gender, and ethnicity, the interaction between food insecurity status and race was a significant predictor of fair/poor health and lower scores on physical and mental health. Household food insecurity is associated with poorer self-reported health status of adults in this rural, high-risk sample in the Lower Mississippi Delta.

Adult↗
PubMed2000

Multipoint videoconferencing in health: a review of three years' experience in Queensland, Australia.

The objective was to review multipoint videoconferencing in Queensland Health from July 1996 to June 1999. Most videoconferencing has been conducted using desktop systems connected by integrated systems digital network (ISDN) at 128 kbps. Data on utilization and problems were extracted from monthly reports and a survey was conducted. Multipoint videoconferencing increased steadily over the 3 years from just and handful of conferences per month to 101 conferences and 703 hours of bridge use per month. Primary uses were education and administration. Relatively few technical failures and operator errors were recorded. But by 1999, late connection and low attendance were major problems. Survey responses indicated that multipoint videoconferencing met expectations at the great majority of sites. Most respondents were satisfied with the level of administrative and technical support provided. In this large and decentralized state, multipoint videoconferencing has proven a useful and effective means of bringing healthcare workers together for a common purpose, supplementing face-to-face events and other encounters mediated by communications technology such as satellite broadcasts and audioconferences.

Attitude of Health Personnel↗
PubMed1999

Future priorities for a successful dental school.

Priorities for success for a dental school of the future are considered. University relations, demographic changes, digital information technology and functional genetic technology are emphasised as important environmental pressures that will influence the priorities. The goal advocated for university relations is creating a culture in which the dental school is viewed as integral and necessary to the University's mission. Financial stability, quality research and scholarship and provision of health care for employees may be important ingredients. Keeping an eye on demographic changes and taking the school's business where the customers are is another key to success in the future. Ethnic diversity, changing approaches with changing disease patterns, flexibility in schedule and collaborations in areas of need are strategies to be considered. The emerging field of functional genetics typifies a new biology with which currency will be needed in a health-sciences field. Necessity for faculty development, adoption of molecular diagnostic technologies, emphasis on risk assessment and preventive counselling, and a shift to a wellness model are likely consequences. Digital information technology will result in increased distance-learning opportunity. Dental schools will also need to make accommodating changes in curriculum structure available. Conversion to electronic imaging and totally electronic patient records are likely to become standard.

Curriculum↗
PubMed2003

Terminal digit bias in a specialty hypertension faculty practice.

Traditional blood pressure (BP) methodology is subject to observer error such as terminal digit preference and single number preference leading to inaccuracies in measurement. A high percentage (60-90%) of terminal BP readings digit being zero has been reported from general medical- and hospital-based clinics. This study examined terminal digit preference in a hypertension specialty practice and assessed clinical factors that may be associated with zero preference in this setting. A retrospective chart review of patients presenting to the hypertension clinic at the University of Connecticut Health Center during the month of September 2001 was performed. Data were extracted on age, gender, height, weight, treatment status, and systolic and diastolic BP measurements taken by nursing staff and attending physicians. Terminal digit preference was apparent in BP readings taken by both nursing staff and physicians. Zero was the terminal systolic BP digit in 40% of readings taken by the nursing staff and 31% of readings taken by physicians. For diastolic BP readings, the percentages were 23 and 36%, respectively. Nurses also recorded 43% of diastolic BP readings with terminal digit 2. Age was significantly higher in those persons in whom the physician diastolic BP terminal digit was zero than in those with nonzero terminal digits (67+/-14 vs 59+/-18 years, P=0.008). Body mass index was lower in the patient group with diastolic terminal digit zero bias compared to those with nonzero terminal digits (28+/-5 vs 32+/-6 kg/m(2), P=0.02). In conclusion, although the frequency of zero digit preference did not reach the 60-80% levels found in previous studies, there was evidence of terminal digit preference in the systolic and diastolic measurements taken by nursing staff and attending physicians in a specialist hypertension clinic. We believe that the lower levels of terminal digit preference observed are an effect of increased training in proper BP measurement and technique. However, the observed bias in measurement even in a hypertension unit argues for regular monitoring and feedback to minimize such errors.

Aged↗
PubMed1994

A survey of health care and child protective services provider knowledge regarding the toe tourniquet syndrome.

Recent efforts to increase public awareness of child abuse may result in an increased number of inappropriate reports of suspected child abuse. The authors believe that digital hair strangulation should be included among the conditions that may be confused with child abuse. Digital hair strangulation (toe tourniquet syndrome) occurs primarily in infants and is characterized by a constricting band of foreign material that becomes tightly wrapped around a digit or digits (most often the toes). The consensus in the medical literature is that this condition is not the result of intentional injury. As no reference to the toe tourniquet syndrome exists in the child abuse literature, it was hypothesized that child welfare workers would be more likely than physicians and public health nurses to misinterpret this condition as resulting from intentional injury. A survey was conducted to test this hypothesis. Professionals from the fields of medicine, nursing, and child welfare were provided with a history and photographic findings of a child with a typical case of the toe tourniquet syndrome. Participants were surveyed regarding their interpretation of the described injuries. More than 50% of all respondents indicated that they would report this case as suspected abuse. Child welfare workers responded that the injuries were suggestive of abuse (83%), significantly more often than public health nurses did (45%), (chi 2 = 4.55, p = .03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2026

Educational approaches to enhance genomics competencies among health sciences students: A scoping review with implications for nursing education.

INTRODUCTION: Genomics is increasingly recognized as essential for precision health, yet its integration into undergraduate nursing and other health sciences curricula remains limited. Persistent gaps in genomics literacy and confidence among students and professionals indicate that current educational approaches may not adequately prepare graduates for genomics-informed care and precision health. The aim of this review is to map educational approaches and methods used to enhance genomic competencies among undergraduate health sciences students and discuss implications for nursing education. METHODS: Scoping review, reported in accordance with PRISMA-ScR recommendations. Systematic search in CINAHL Ultimate, ERIC, and MEDLINE for studies published in English between January 2015 and December 2024 was undertaken. Data were charted using a standardized extraction form and synthesized descriptively and narratively, grouping interventions by educational approach, methods, strategies, techniques, and tools. RESULTS: Thirty-one studies were included, mostly from the United States, involving primarily medical and nursing students. Educational approaches centered on experiential and practice-based learning, simulation, case- and problem-based learning, flipped classrooms, collaborative or interprofessional learning, narrative and arts-based methods, and technology-enhanced strategies such as virtual labs, online modules, and digital storytelling. These approaches were associated with improvements in genomic knowledge, application to clinical scenarios, ethical awareness, engagement, and self-reported confidence, although outcomes were predominantly short-term. CONCLUSIONS: Genomics education for health sciences students is characterized by diverse, largely experiential and student-centered approaches. Integration into curricula remains fragmented and often focused on genetics rather than broader genomics and precision health. Nurse educators should prioritize integrated, authentic, and ethically informed genomics education, supported by educator development and digital technologies, including generative AI, to prepare graduates for precision nursing care.

Genomics↗
PubMed2002

A national survey of Canadian women: breast health practices, influences, and satisfaction.

In an earlier survey of over 900 women in the local automobile industry, several influences and preferences for breast screening were identified. The purpose of the current study was to extend the survey population to women across Canada, as well as to ascertain women's satisfaction with organized (governmental) screening programs within their geographic areas. Using random-digit-dialing, 1,224 women 25 years and older were interviewed in French or English and their responses entered in a CATI system. The interviewers used a modified version of Health Care Practices: A Worksite Survey. Results were analyzed by age and geographic region. Results indicated support for earlier local findings, as well as high satisfaction, but low knowledge and usage of organized breast screening clinics.

Adult↗
PubMed1999

Common colds. Reported patterns of self-care and health care use.

OBJECTIVE: To describe the self-reported prevalence and patterns of self-care and health care use for colds and flu. DESIGN: Using the expert panel method, a questionnaire was developed to explore self-care practices, attitudes, pharmaceutical use, and health care use for a range of cold and flu symptoms. SETTING: London and Windsor, Ont. PARTICIPANTS: Using a random-digit-dialing survey method, 210 residents were interviewed between November and December 1993. Of 1484 telephone numbers called, 1179 calls were ineligible. Two hundred ten questionnaires were completed for 305 eligible respondents. MAIN OUTCOME MEASURES: Demographic data, typical self-care practices, actual practice during respondents' last cold, opinions on appropriate practices, and knowledge of how to treat colds. RESULTS: Self-care was respondents' treatment of choice, and most respondents use over-the-counter drugs. Prescription drug use was low. Only 1% reported seeing a physician for their last cold. As the number of symptoms increased, however, reported use of over-the-counter drugs and calls or visits to doctors increased. CONCLUSIONS: Results are congruent with other studies showing that the health care practices of most respondents are consistent with low use of the health care system and high levels of self-care for colds and flu.

Adolescent↗
PubMed1971

Multiphasic health testing in the clinic setting.

The economy of automated multiphasic health testing (amht) activities patterned after the high-volume Kaiser program can be realized in low-volume settings. amht units have been operated at daily volumes of 20 patients in three separate clinical environments. These programs have displayed economics entirely compatible with cost figures published by the established high-volume centers. This experience, plus the expanding capability of small, general purpose, digital computers (minicomputers) indicates that a group of six or more physicians generating 20 laboratory appraisals per day can economically justify a completely automated multiphasic health testing facility. This system would reside in the clinic or hospital where it is used and can be configured to do analyses such as electrocardiography and generate laboratory reports, and communicate with large computer systems in university medical centers. Experience indicates that the most effective means of implementing these benefits of automation is to make them directly available to the medical community with the physician playing the central role.Economic justification of a dedicated computer through low-volume health testing then allows, as a side benefit, automation of administrative as well as other diagnostic activities-for example, patient billing, computer-aided diagnosis, and computer-aided therapeutics.

Computers↗
PubMed1995

A guide to the interpretation of serum prostate specific antigen levels.

OBJECTIVE: To review the factors that affect the concentration of prostate specific antigen (PSA) in the serum. RESULTS: The discussion includes the structure of PSA; its distribution and metabolism; various analytical aspects of PSA measurements; the effects of clinical manipulations on PSA, including digital rectal examination, transrectal ultrasound, cystoscopy, biopsy and transurethral resection of the prostate; factors affecting PSA levels in health, in benign disease, and in prostate cancer; the effect of various treatments on PSA; and the issue of reference ranges. CONCLUSION: Laboratory staff and physicians must take many factors into consideration when interpreting PSA results.

Humans↗
PubMed2026

One Year After a Cyberattack: Lessons Learned and Dosimetric Analysis of Contingency Radiotherapy Plans.

PURPOSE: Cyberattacks on health care institutions pose significant risks to patient care, particularly in radiotherapy departments, which are heavily reliant on digital systems. This study examines the impact of a ransomware attack on our hospital and evaluates the effectiveness of the contingency measures implemented to resume radiotherapy treatments. METHODS AND MATERIALS: Following the cyberattack, our radiotherapy department faced a complete shutdown. After an initial estimate considering a shutdown of several weeks, a contingency plan was executed, including manual patient data retrieval and collaboration with a backup hospital. Contingency plans were prepared and delivered within hours, despite a partial lack of information. These plans allowed some patients to restart treatment 3 days after the attack. A dosimetric analysis was performed for the contingency plans, including various pathologies, mainly glioblastoma, head and neck cancers, and lung cancer. We compared the original and contingency plans in terms of dose coverage to the clinical target volume, biological effective dose, and their clinical impact as assessed at the 1‑year follow‑up after the cyberattack. RESULTS: Treatments resumed within 12 days at our hospital. Patients with glioblastoma showed good target coverage because of generous margins, resulting in favorable outcomes. In head and neck cases, the lack of detailed imaging led to significant target volume misses, suggesting that more conservative initial treatments could have been beneficial. Lung cases demonstrated accurate peripheral lesion targeting but faced challenges in central lesions because of the absence of positron emission tomography information. In most cases, the approach of using a contingency plan, even with limited information, led to a higher biological effective dose than would have been achieved if treatment had been stopped until full recovery at our hospital. CONCLUSIONS: The study highlights the critical importance of robust contingency planning in radiotherapy departments, emphasizing the need for backup systems and tailored approaches based on tumor location and available diagnostic information. These lessons emphasize that preparedness for digital disruptions should not focus exclusively on information and technology infrastructure.

Humans↗
PubMed2006

Racial/ethnic differences in preferences for total knee replacement surgery.

OBJECTIVES: To determine whether there are ethnic differences in preferences for surgery vs. medical treatment of knee osteoarthritis (OA). STUDY DESIGN AND SETTING: Cross-sectional in-person interviews using conjoint analysis methodology, a technique often used in marketing, involved individuals making choices between alternative hypothetical scenarios for medical or surgical treatment of knee OA. One hundred ninety-three individuals over the age of 20 were recruited through random digit dialing in Harris County, TX, and 198 individuals with knee OA were recruited from a large outpatient health care provider in Houston, TX. RESULTS: African Americans were significantly less likely to chose surgery than whites (odds ratio 0.63 [0.42, 0.93]). Women and older individuals were also less likely to choose surgery (0.69 [0.51, 0.94], 0.98 [0.97, 0.99]). Larger reductions in negative symptoms with surgery significantly increased the likelihood of choosing surgery. There was no difference between the public and patients, and no effect of income level. CONCLUSIONS: Disparities in knee replacement rates among ethnic groups may be partly due to differences in preferences for surgery. Conjoint analysis was shown to be a feasible methodology for collecting preferences in health research. This methodology has great promise in contributing to our knowledge of drivers of health care decision making in individuals.

Adult↗
PubMed2005

Clinical significance of extrapyramidal signs in patients with cirrhosis.

BACKGROUND/AIMS: Extrapyramidal signs have been described in cirrhosis and there is little information about their clinical significance. The aims of this study have been to investigate the relationship between extrapyramidal signs and cognitive impairment, and what is their influence on quality of life. METHODS: 46 patients with cirrhosis were evaluated for cognitive impairment with psychometric tests (Trail-Making Test part A, Grooved-Pegboard, Block-Design, Oral Symbol Digit and Stroop Test) and cognitive evoked potentials (P300). Extrapyramidal signs were evaluated using the UPDRS scale. Health-related quality of life (HRQL) was measured using SF-36 scale and the Chronic Liver Disease Questionnaire (CLDQ). RESULTS: Twenty-two patients had extrapyramidal signs, and these patients scored worse in all psychometric tests, except Block-Design. Patients with extrapyramidal signs also showed a longer P300 latency. Moreover, patients with extrapyramidal signs had the worst score in all the HRQL scales used. A multivariate analysis disclosed that the only variable showing an independent relationship to the mental component summary of SF-36 and with CLDQ was UPDRS score. CONCLUSIONS: We have found a clear relationship between the presence of extrapyramidal signs and cognitive impairment. Moreover, patients with extrapyramidal signs have worse scores in quality of life scales.

Basal Ganglia Diseases↗
PubMed2006

Laser imaging and computer-aided design and computer-aided manufacture in prosthetics and orthotics.

Although Hanger Orthopedic Group, Inc., has been developing clinical protocols for its INSIGNIA scanner for more than 2 years, there are many applications that are currently in development and will be released over the next 2-year period after this publication. It is the goal of Hanger Orthopedic Group, Inc., to replace all plaster casting procedures with the laser scan and move toward a paperless environment where all images and documents are passed through its virtual network. INSIGNIA currently has five major production centers throughout the United States, which support more than 600 INSIGNIA certified clinicians. These clinicians staff more than 600 clinics in North America, all under the Hanger company name. The central fabrication service and the central design center processes hundreds of shapes per day (Fig. 27). So that any clinician in the field can use the expertise of the central designers and central fabricators to help with overflow or problems they might be having, the network that exists within Hanger is tied together and enhanced by INSIGNIA. Through virtual modification and centralization of these services, each patient receives the virtual collaboration of several clinicians with a total of years of experience. INSIGNIA has enhanced the patient experience. The enhancement is not only in removing the plaster from the process, but also in exposing each patient to the team of prosthetic experts working collaboratively behind the scenes. The rehabilitation industry continues to be bombarded with compliance paperwork and justifications. The INSIGNIA scan and resulting measurement reports give inherent strength to justifications based on volume change, surgical revisions, or tissue change. The files are kept in a data warehouse where they are vaulted and preserved presumably forever. Also, any of the shape graphics or measurement instruments can be printed into a discrete report that can become part of the patient's permanent record. Many physicians receive update letters from their orthotic and prosthetic clinician with a status update before and after treatment of their patient. This update includes a descriptive narrative, a printout of the pertinent metrics, a printout of the scan graphic, and often a digital image of the patient wearing the device (Fig. 28). The network is HIPAA compliant, and all private health information is held in tight security. If a practitioner does not have a HIPAA agreement in place with Hanger Orthopedic Group, Inc., and would like one, or ifa practitioner would like to have an INSIGNIA representative call or visit with more information, the practitioner is encouraged to call 1-800-4-HANGER and request an INSIGNIA in-service or visit INSIGNIA on the web at www.hanger.com.

Adult↗