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PubMed1994

A 2-year self-help smoking cessation manual intervention among middle-aged Finnish men: an application of the transtheoretical model.

BACKGROUND: A 2-year self-help manual smoking cessation intervention was conducted among a panel of middle-aged Finnish men (n = 265) who were recruited proactively in a longitudinal cardiovascular risk factor surveillance study. METHODS: Intervention utilized the stages of change concept of the transtheoretical model. The stages were assessed in the treatment condition at baseline of the cessation study and after that by mail every sixth month. Assessments were followed by an immediate mailing of a stage-based self-help manual matching the stage of change at that time. A usual care group was assessed annually but received no treatment. RESULTS: A significant time x intervention effect (P < 0.05) and time x baseline stage effect (P < 0.001) on quit rates were observed in the panel data over the 2-year period. An analysis of changes in the stages of change also revealed an accelerated cessation process in the treatment condition. CONCLUSIONS: We conclude that mailed stage-matched self-help smoking cessation manuals were able to accelerate the smoking cessation process but manuals alone may not constitute a sufficient long-term intervention. The effects of differential exposure to intervention, subject characteristics, measurement reactivity, and secular trends are discussed as potential confounds.

Adult↗
PubMed2001

Working with licensed cosmetologists to promote health: results from the North Carolina BEAUTY and Health Pilot Study.

BACKGROUND: Beauty salons are located in all communities and represent a promising channel for delivering health promotion programs. No previous salon-based health promotion program has assessed the needs, interests, and preferences of licensed cosmetologists about sharing health information with their clients. METHODS: Licensed cosmetologists in one town completed a mailed survey assessing (1) health topics typically discussed with clients, (2) interest in delivering messages about beauty and health, and (3) preferred methods for learning about and sharing health information with their clients. RESULTS: The average cosmetologist sees 47 clients per week and spends 30-60 min per appointment. Eighty-two percent report that they are interested in talking about health with their clients. Most cosmetologists already discuss a wide range of health topics with their clients and are most comfortable discussing healthy eating (65.3%), physical activity (63.3%), and dieting (63.3%). Cosmetologists preferred reading pamphlets (55.1%) and watching educational videos (46.9%) to learn about beauty and health. Distributing pamphlets (69.4%), talking with clients (61.2%), and placing posters/mirror stickers in the salons (59.2%) were the methods cosmetologists most preferred for sharing health information with their clients. CONCLUSIONS: Licensed cosmetologists are in a unique position to serve as "natural helpers" by delivering health messages to their clients and reinforcing those messages over time. Partnerships with licensed cosmetologists should be developed to deliver salon-based health promotion programs.

Adult↗
PubMed1996

A survey on (operative) laparoscopy in The Netherlands in 1992.

OBJECTIVE: A quantitative inventory of (operative) laparoscopic surgery practiced by Dutch gynecologists in 1992 was made. METHODS: A written inquiry was mailed to all 145 departments of Obstetrics and Gynecology (including 28 teaching hospitals), where all 630 practicing gynecologists in The Netherlands are established. The questionnaire included questions about diagnostic laparoscopies, sterilizations, laparoscopy for infertility reason and operative laparoscopies. General information about follow-up training of the practitioner was also collected. All data were analyzed and comparisons were made between teaching and non-teaching hospitals. Statistical significance was calculated with the chi-square test. RESULTS: The response rate was 78%. A total of 419 respondents represented in 99 clinics reported performing 33,676 laparoscopic procedures, which makes an average of 80 procedures per physician per year. Distribution of procedures showed that 36% was for diagnostic laparoscopy, 33% for tubal sterilization, 19% laparoscopy for infertility work-up and 12% counted for therapeutic laparoscopy. Comparison of procedures in teaching hospitals (n = 27) and non-teaching hospitals (n = 72) showed only slightly more diagnostic laparoscopies for infertility in the first and more tubal-sterilizations in the latter. A statistically significant difference was found for the ring or clip sterilization in teaching hospitals, compared with the coagulation technique in non-teaching departments (P < 0.001). More difficult laparoscopic procedures such as ovarian cystectomy and conservative surgery of ectopic pregnancy were more frequently performed by those who had followed additional laparoscopic training (P < 0.02). CONCLUSIONS: The results of this survey are representative for (operative) laparoscopic practice of gynecologists in the Netherlands, because of the high response rate. Relatively, a small proportion of all laparoscopic procedures performed in 1992 are due to the therapeutic laparoscopy (12%). The great majority of therapeutic laparoscopic procedures was reported by a relatively small number of practitioners. Gynecologists who followed an additional laparoscopic training (30%) performed statistically more difficult laparoscopic procedures.

Chi-Square Distribution↗
PubMed1997

Pharmaceutical services in the United States Air Force.

The status of pharmaceutical services in the United States Air Force medical service is described. Air Force pharmacy is adopting new programs, staffing standards, inventory methods, and roles for pharmacists and technicians. One of the most visible changes is TRICARE, an interservice program that provides improved access to care. Many Air Force medical treatment facilities have been closed; prescription mail-out programs and networks of community pharmacies are filling the gap. The Air Force pharmacy team consists of more than 1300 pharmacists and technicians. Air Force pharmacists are military officers first. Great emphasis is placed on medical readiness training and continuing education. Some Air Force pharmacies are very small outpatient operations filling fewer than 300 prescriptions per day; others fill well over 4000. Many hospitals are being considered for more outpatient-focused operations. Because of anticipated minor reductions in pharmacist staffing, Air Force pharmacists will have to maximize efficiencies to maintain or improve current levels of service. More and better patient information will be provided and distributive processes streamlined. A greater role for technicians is anticipated. The future includes pharmacists serving in a wide variety of leadership and staff positions, improving the use of computers, and incorporating new technologies. Air Force pharmacy is changing to ensure uninterrupted fulfillment of its responsibilities.

Automation↗
PubMed1999

A survey of the computer literacy of undergraduate dental students at a University Dental School in Ireland during the academic year 1997-98.

As dental practice management becomes more computer-based, the efficient functioning of the dentist will become dependent on adequate computer literacy. A survey has been carried out into the computer literacy of a cohort of 140 undergraduate dental students at a University Dental School in Ireland (years 1-5), in the academic year 1997-98. Aspects investigated by anonymous questionnaire were: (1) keyboard skills; (2) computer skills; (3) access to computer facilities; (4) software competencies and (5) use of medical library computer facilities. The students are relatively unfamiliar with basic computer hardware and software: 51.1% considered their expertise with computers as "poor"; 34.3% had taken a formal typewriting or computer keyboarding course; 7.9% had taken a formal computer course at university level and 67.2% were without access to computer facilities at their term-time residences. A majority of students had never used either word-processing, spreadsheet, or graphics programs. Programs relating to "informatics" were more popular, such as literature searching, accessing the Internet and the use of e-mail which represent the major use of the computers in the medical library. The lack of experience with computers may be addressed by including suitable computing courses at the secondary level (age 13-18 years) and/or tertiary level (FE/HE) education programmes. Such training may promote greater use of generic softwares, particularly in the library, with a more electronic-based approach to data handling.

Chi-Square Distribution↗
PubMed1985

National survey of hospital pharmaceutical services--1985.

The results of a 1985 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, and 1982. A sample of 809 hospitals was selected randomly from among the estimated 5480 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had an 84.6% response. Fewer than 10% of respondents did not have and were not planning for unit dose systems. The percentage of hospitals with complete or partial pharmacy-based i.v. admixture services increased since 1982 from 67.4% to 80.6%. More than half the respondents said floor-stock i.v. solutions were distributed by a department other than pharmacy. Only about half the respondents had both unit dose drug distribution and i.v. admixture services. Prime vendors were used by 87% of small hospitals, 75% of medium hospitals, and 51% of large hospitals. The percentage of pharmacies involved in patient monitoring increased from 27% in 1982 to 44% in 1985. The survey also collected data on other clinical services, computerization, inventory turnover, use of prime vendors, and selection of therapeutic alternates. Drug distribution services are improving, but the distribution of injectable drugs often is not under pharmacy control. Only 10% of respondents had comprehensive pharmaceutical services, defined as complete unit dose drug distribution and i.v. admixture services plus three or more clinical services.

Computers↗
PubMed2006

Genetic testing of minors for alpha1-antitrypsin deficiency.

BACKGROUND: Alpha(1)-antitrypsin deficiency (AATD) is a genetic disorder primarily affecting the lungs and liver of affected individuals, causing severe panlobular emphysema and cirrhosis. OBJECTIVE: To describe the demographics and feasibility of a home test for AATD in children and adolescents. DESIGN: Case series of parents who test their children for AATD. SETTING: Nonprofit supported program in which participants telephoned or e-mailed requests for alpha(1)-antitrypsin testing. PARTICIPANTS: All persons younger than 18 years whose parents or guardians chose to test for AATD from January 1, 2002, to October 1, 2004. INTERVENTIONS: Home-administered finger-stick blood spot test for alpha(1)-antitrypsin genotype and questionnaire. MAIN OUTCOME MEASURES: The alpha(1)-antitrypsin genotypes and questionnaire responses. RESULTS: The Alpha Coded Testing Study tested 422 children and adolescents with a confidential test for AATD. Testing was suggested by a family member in most (76.7%) of the cases and was responsible for the many carrier (PIMZ and PIMS) genotypes (51.9%) in the study. Interest in testing was equally distributed among all ages. Test confidentiality was seen as an important reason to test (64.1% with a Likert scale score of 4-5 on a 5-point scale). Parents and guardians of the minors suggested that testing benefits (mean [SD] Likert score, 3.5 [1.4] on a 5-point scale) were higher than risks (mean [SD] Likert score, 1.7 [1.2]) (P=.001). CONCLUSION: Parents value genetic testing of their children at risk for AATD when testing can be done in a confidential setting.

Adolescent↗
PubMed1991

Pharmacist salaries and hiring practices in teaching hospitals.

A survey of selected teaching hospitals was conducted in early 1990 to determine salary ranges for pharmacist positions, salaries at which pharmacists were typically hired for these positions, differences in salary between clinical practitioner and managerial positions, and geographic differences in these salaries. Surveys were mailed to 50 members of the University Hospital Consortium (UHC) and 50 other university-affiliated and non-university-affiliated hospitals believed to be comparable to the investigators' hospital. Hospital capacity and census data, numbers of pharmacist and support staff positions, qualifications preferred and required for those positions, and salary information were requested. Data from 22 UHC hospitals and 23 non-UHC hospitals were evaluated. Relative to average daily census, UHC hospitals indicated higher pharmacist staffing levels and non-UHC hospitals reported higher support staff levels. More non-UHC hospitals than UHC hospitals (69.2% versus 43.5%) used an integrated model for delivery of clinical and distributive services. Nationally, the reported annual salaries were as follows: staff pharmacist, $34,881 to $47,906; clinical pharmacist, $37,768 to $51,564; clinical specialist, $38,905 to $55,282; supervisor, $39,905 to $54,416; assistant director, $43,554 to $58,758. Overall, typical hire rates (THRs) exceeded mean minimum salaries by about 10%. The percentages by which THRs exceeded mean minimum salaries were greatest in the West for staff pharmacist, clinical pharmacist, and clinical specialist positions and greatest in the Midwest for supervisor and assistant director positions. THRs for supervisors and assistant directors exceeded those for clinical specialists. Respondents' preferences varied regarding advanced education and training, and their actual requirements did not match their stated preferences.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed1993

Varicose veins in a Finnish population aged 40-60.

STUDY OBJECTIVE: To assess the prevalence and the extent of treatment of varicose veins in a Finnish population. DESIGN: A prevalence study in a defined cohort was performed by using a mailed questionnaire. The method's validity was tested in a random sample of 166 individuals who were studied clinically. SUBJECTS: In 1989 a questionnaire was mailed to every resident born in 1929, 1939, and 1949 who was living in Tampere, the second largest town in Finland. The eligible population comprised 3284 men and 3590 women. MEASUREMENTS AND MAIN RESULTS: The response rate was 75% in men and 86% in women. Both the sensitivity and specificity of the self assessed diagnosis were 0.92. The life time prevalence of varicose veins was 18% for men and 32% for women, with an increasing prevalence in relation to age. Twenty five per cent of the men and 41% of the women who reported varicose veins had received treatment. CONCLUSIONS: Self reporting of varicose veins by mailed questionnaire was a relatively valid method. The prevalence of varicose veins was high in the population studied, and the disease is more common in women than men. Moreover, the prevalence increased with age. The results are comparable with other western populations. Preventive methods are needed because treatment alone seems to be inadequate in the control of varicose veins.

Adult↗
PubMed2002

Current practice in the intramedullary nailing of tibial shaft fractures: an international survey.

BACKGROUND: Tibial fractures are the most common of all long bone fractures. Although many tibial fractures may be managed conservatively, a certain subset, including unstable fractures and open fractures, require operative stabilization. Intramedullary nails have become the popular choice of implant in the treatment of tibial shaft fractures. The variability in outcomes with tibial shaft fractures may reflect technical aspects of the surgical procedure and perioperative care regimens among surgeons. Identifying the distribution of surgeons' preferences in nailing technique, and the rationale for their choices, will aid in focusing educational activities for the orthopedic community and planning future clinical trials. Our objectives were to clarify surgeons' opinions regarding technical aspects of surgery and perioperative care after intramedullary nailing of closed and open tibial shaft fractures, and to identify predictors of surgeons' preferences in technique and perioperative care. METHODS: This study was a cross-sectional survey using focus groups, key informants, and sampling to redundancy strategies to develop a survey to examine surgeons' preferences in the treatment of tibial shaft fractures. The survey was pilot tested for clarity and content validity. We mailed this survey in July 2000 to 577 orthopedic surgeons who have an interest in trauma care. These were members of the Orthopaedic Trauma Association, American Academy of Orthopaedic Surgeons, or European AO International affiliated trauma centers. We used several strategies to improve response rates including personalized cover letters, stamped return envelopes, follow-up telephone calls, and repeat mailing of questionnaires. Main outcome measures included technical issues such as reduction, exposure, intramedullary reaming, and interlocking screws; and factors associated with surgeons' preferences such as age, fellowship, academic practice, and geographic location. RESULTS: Four hundred forty-four surgeons (77%) responded. Sixty percent of respondents had an academic practice, 84% supervised residents, and 65.1% had fellowship training in trauma. Approximately half (51.5%) of surgeons used a tourniquet. The odds that a surgeon in Asia or Africa used tourniquets was 10 times that of a North American surgeon (p = 0.004 and p = 0.002, respectively). Patellar tendon retraction and an inferior-based entry portal was the popular choice among surgeons (70.1% and 70.8%, respectively). Surgeons from Australia (odds ratio [OR] = 50, p < 0.001), South America (OR = 9.0, p < 0.001), Europe (OR = 3.7, p = 0.001), and Asia (OR = 3.8, p = 0.006) were significantly more likely to use a patellar splitting approach compared with North American surgeons. In the perioperative care of open tibial shaft fractures, there was consensus in the use of intravenous antibiotics and wound irrigation (96.5% and 95.6%, respectively). However, we found considerable variability in surgeons' preference in wound irrigation pressures (high, 38.7%; low, 45.4%). Surgeons in South America were 10 times more likely to use low-pressure irrigation than North American surgeons (p = 0.0005). In grade IIIB open tibial shaft fractures, 94% of surgeons believed wound closure should be obtained within the first 7 days after the injury. A surgeon's geographic location was a significant predictor of the timing of soft tissue coverage (p = 0.001). CONCLUSION: Consensus in the use of irrigation and intravenous antibiotics in open fractures was achieved among surgeons. However, there remains considerable variability in the surgical technique of intramedullary nailing, the duration of antibiotic use, and the timing of wound closure in open tibial fracture care. Continued education and large multicenter trials are needed to establish best practice in the operative treatment of tibial shaft fracture.

Adult↗
PubMed1999

Comparative microbiological characteristics of failing implants and periodontally diseased teeth.

BACKGROUND: The purpose of this report was to compare the distribution of periodontal pathogens recovered from failing implants and teeth with adult and recurrent forms of periodontitis. METHODS: A total of 41 consecutive microbial samples from patients with failing implants (IMP) were received at the Microbiology Testing Laboratory (MTL) of the University of Pennsylvania over a 2-year period. Paired control samples were selected from samples received concurrently by MTL from 41 patients with a diagnosis of adult periodontitis (AP) and 41 with a diagnosis of recurrent or refractory periodontitis (RP). Patients' mean ages for the 3 categories were 59, 47, and 53 years, respectively. Samples were collected with paper points or scalers and shipped in prereduced medium by express mail to the laboratory where they were processed within 48 hours from the time of collection. Culture was used for detection of A. actinomycetemcomitans, C. rectus, P. intermedia/nigrescens, E. corrodens, P. micros, Capnocytophaga and Fusobacterium sp., enteric Gram-negative rods, Enterococcus and Staphylococcus sp., and yeast. P. gingivalis and B. forsythus were detected by indirect immunofluorescence. Morphotypes were enumerated by dark-field microscopy. RESULTS: The most frequently detected microorganisms from IMP were B. forsythus (59%), spirochetes (54%), Fusobacterium (41%), P. micros (39%), and P. gingivalis (27%). Recovery levels (mean +/- SD) were 1+/-1, 4+/-5, 4+/-5, 9+/-11, 1+/-2, respectively. The most frequently detected organisms for AP were B. forsythus (83%), Fusobacterium (80%), spirochetes (79%), P. gingivalis (59%), P. micros (51%), and E. corrodens (37%), at levels 2+/-2, 5+/-4, 9+/-6, 4+/-5, and 6+/-7, respectively. Corresponding data for RP were B. forsythus (85%), Fusobacterium (83%), P. gingivalis (60%), spirochetes (59%), C. rectus (56%), and P. micros (56%), at levels of 3+/-2, 8+/-8, 4+/-4, 2+/-2, 1+/-1, and 9+/-10, respectively. CONCLUSIONS: These results indicate that the detection frequency and levels of recovery of some periodontal pathogens in failing implants are significantly different from that of teeth with periodontitis; however, the detection frequency and levels of recovery are similar in teeth affected by adult and refractory (recurrent) forms of periodontitis.

Aggregatibacter actinomycetemcomitans↗
PubMed1998

Electronic patient-physician communication: problems and promise.

A critical mass of Internet users will soon enable wide diffusion of electronic communication within medical practice. E-mail between physicians and patients offers important opportunities for better communication. Linking patients and physicians through e-mail may increase the involvement of patients in supervising and documenting their own health care, processes that may activate patients and contribute to improved health. These new linkages may have profound implications for the patient-physician relationship. Although the federal government proposes regulation of telemedicine technologies and medical software, communications technologies are evolving under less scrutiny. Unless these technologies are implemented with substantial forethought, they may disturb delicate balances in the patient-physician relationship, widen social disparities in health outcomes, and create barriers to access to health care. This paper seeks to identify the promise and pitfalls of electronic patient-physician communication before such technology becomes widely distributed. A research agenda is proposed that would provide data that are useful for careful shaping of the communications infrastructure. The paper addresses the need to 1) define appropriate use of the various modes of patient-physician communication, 2) ensure the security and confidentiality of patient information, 3) create user interfaces that guide patients in effective use of the technology, 4) proactively assess medicolegal liability, and 5) ensure access to the technology by a multicultural, multilingual population with varying degrees of literacy.

Communication↗
PubMed2001

Neurobehavioral deficits in Persian Gulf veterans: additional evidence from a population-based study.

Reports of low-concentration nerve gas exposures during the Gulf War (GW) have spurred concern about possible health consequences and symptoms reported by many returning veterans. The Portland Environmental Hazards Research Center is studying veterans from the northwest United States who report persistent, unexplained "Gulf War" symptoms (cases) and those who do not report those symptoms (controls). An epidemiological survey focused on exposures and symptoms was mailed to a random sample of GW veterans from Oregon and southwestern Washington. Volunteers recruited from survey respondents agreed to undergo a thorough medical examination and psychological and neurobehavioral assessment. Persistent symptoms with no medical explanation associated with Persian Gulf service (e.g., fatigue, muscle pain, memory deficits) beginning during or after the war qualified respondents as cases. The 239 cases with unexplained symptoms and the 112 controls without symptoms were administered a computerized assessment battery of 12 psychosocial and 6 neurobehavioral tests. Replicating and extending previous interim findings, a subgroup of veterans emerged from the initial analysis in the form of extreme outliers which produced a visually and quantitatively obvious bimodal distribution. This led, as it had previously, to analyses of the outliers as a separate group (labeled "slow ODTP"), which confirmed the initial findings of neurobehavioral differences between the outliers and the other cases and controls and provided more convincing evidence that the majority of cases who report neurobehavioral symptoms have no objective evidence of neurobehavioral deficits. However, the larger group of symptomatic veterans do have highly significant and compelling evidence of psychological distress based on scores from 11 separate psychological tests. Whereas the cases differed from the controls by poorer neurobehavioral test performance, extraction of the slow ODTP participants (almost all cases) eliminated neurobehavioral performance differences between the remaining cases and the controls and provided support for the hypothesis that the slow ODTP cases might have been from the unhealthy end of the GW population prior to the war. However, there was no evidence of poor motivation, pre-GW educational differences, or greater association with abnormal psychological function in this group than in other cases or controls.

Adult↗
PubMedDate not supplied

Measuring stage of change for assessing readiness to increase fruit and vegetable intake among 18- to 24-year-olds.

PURPOSE: To examine the appropriateness of the five-stage schema developed for addictive behaviors when applied to nonaddictive behaviors such as fruit and vegetable consumption. DESIGN: A cross-sectional mail survey was conducted. SETTING: Self-administered questionnaires were mailed to the home addresses of respondents recruited in 10 states and returned upon completion. SUBJECTS: In all, 116 male and 185 female young adults (response rate = 70%) completed the questionnaires. Most respondents were Caucasian (74.4%) and college students (62.2%). MEASURES: Statistical analyses included analysis of variance with Scheffe's test, Pearson correlation and Cronbach's alpha coefficients, factor analysis, and cluster analysis. RESULTS: Staging algorithms for fruits and vegetables were developed according to the five-stage schema, and their construct validity was verified by the incremental trend of food intakes. The algorithms identified more than 80% of the subjects as precontemplators, preparers, or maintainers for both food groups. This distribution pattern agreed well with the three-factor solution generated from the stages of change questionnaire, for which internal reliability and validity were confirmed. Seven cluster profiles of the respondents were derived based on the three generated factors and appeared to represent stage subgroupings of those factors. The two food groups shared marked similarities regarding the profiling of the clusters, which was validated by comparing food intake. The results, however, cannot be generalized because of limitations involved in the current sample. CONCLUSIONS: The original five stages of change and traditional staging measures may need to be adapted and/or extended for dietary change.

Adolescent↗
PubMed1999

Fifty-year follow-up of cancer incidence in a historical cohort of Minnesota breast cancer families.

A family history of breast cancer is well established as a risk factor for the disease. Because family history is a dynamic rather than a static characteristic, longitudinal studies of entire families can be very instructive in quantifying the significance of risk classification. The Minnesota Breast Cancer Family Study is a historical cohort study of relatives of a consecutive series of 426 breast cancer cases (probands) identified between 1944 and 1952. The incidence of cancer and the measurement of risk factors in sisters, daughters, granddaughters, nieces, and marry-ins was determined through telephone interviews and mailed questionnaires. Ninety-eight percent of eligible families were recruited, and 93% of members participated. A total of 9073 at-risk women were studied: 56% were biological relatives of the case probands, whereas the others were related through marriage. Through 1996, 564 breast cancers were identified in nonprobands. Compared to the rate of breast cancer among marry-ins (188 cases), sisters and daughters of the probands were at a 1.9-fold greater age-adjusted risk (128 cases; 95% confidence interval, 1.4-2.4); granddaughters and nieces were at a 1.5-fold greater risk (248 cases, 95% confidence interval, 1.2-1.8). The breast cancer risk since 1952 was not distributed equally across families: although all biological relatives had a family history of breast cancer, 166 families (39%) experienced no additional cases. Most of the cases occurred among a subset of families: 21 families had 5 breast or ovarian cancers, 8 had 6, 2 had 7, and 4 had > or =8. There was no evidence of significantly increased risk for cancer at other sites, including the ovaries, cervix, uterus, colon, pancreas, stomach, or lymphatic tissue, although there was some evidence that stomach cancer in previous generations may help define the susceptible subset. These families contain four to five generations of validated occurrences of cancer, thus minimizing the uncertainty of genetic risk inherent in a disease with a late and variable age at onset. The patterns of breast cancer in these multigeneration families is consistent with the influence of autosomal dominant susceptibility in a subset, low penetrance genes in another, and purely environmental influences in the remainder.

Adolescent↗
PubMed1999

The Physical Activity for Total Health (PATH) Study: rationale and design.

PURPOSE: Physical activity has been associated with a decreased risk for breast cancer. Mechanisms for this association may involve hormonal pathways. The Physical Activity for Total Health study is testing the effect of a 1-yr moderate intensity physical activity intervention on the endogenous sex hormone profile of postmenopausal women in a randomized controlled study. METHODS: Women (N = 168) who are aged 55-75 yr, not using sex hormones, sedentary, nonsmokers, have no endocrine-related disease or cancer, and with body mass index of 25.0 or greater, are eligible. Women are recruited through mass mailings and media advertising and are randomized to either a 1-yr moderate intensity aerobic and strength training exercise program (monitored group exercise sessions plus home exercise) or a control program (stretching classes). RESULTS: Serum hormones to be assayed at baseline and at the end of the study include: total estrone, total estradiol, free estradiol, percent bioavailable estradiol, estrone sulfate, sex hormone binding globulin, albumin, testosterone, free testosterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, insulin, glucose, and triglycerides. Other outcome measures include: the ratio of urinary 2-hydroxyestrone: 16alpha-hydroxyestrone (an estrogen metabolite ratio that may be associated with risk for breast cancer), weight, body mass index, total fat mass, and body fat distribution (waist:hip circumference ratio, DEXA scan, and abdominal fat measured by computed tomography). CONCLUSION: This study is the first to examine the effect of change in physical activity level on sex hormones in postmenopausal women. It will provide insight into possible mechanisms through which physical activity might be associated with reduced risk of breast cancer.

Aged↗
PubMed1991

National survey of pharmaceutical services in psychiatric hospitals.

The results of a summer 1989 nationwide mail survey of psychiatric hospital pharmaceutical services are reported and discussed. A simple random sample of 200 hospitals was selected from 600 psychiatric hospitals registered by the American Hospital Association. Questionnaires were mailed to the director of pharmacy at each institution. Usable responses were received from 114 hospitals, for a net response rate of 57%. Responses were categorized by hospital size, ownership status, geographic region, and average length of stay. Substantial differences were noted between government and nongovernment hospitals in the number and types of pharmaceutical services provided, as well as in the manner in which services are provided. Non-government hospitals generally appeared to offer more progressive pharmaceutical services. Psychiatric hospitals in western states appeared to offer more advanced clinical pharmacy services than institutions in other geographic areas. The survey established baseline data on the nature and extent of both clinical and distributive services in psychiatric hospital pharmacy departments.

Clinical Pharmacy Information Systems↗
PubMed2001

Chlamydia trachomatis infections--a major concern for reproductive health. Where do we stand regarding epidemiology, pathogenesis, diagnosis and therapy?

The current article deals with the problem of distinguishing between relapse and reinfection of genital chlamydial infections due to the chronic character of such infections. The problem of detecting and treating chlamydial pelvic inflammatory disease is considered. Factors that may affect the clinical presentation of such infections, such as hormonal therapy, are also highlighted. Observations on novel manifestations of Chlamydia trachomatis infections, such as spontaneous abortion, prematurity and intrauterine infections as well as a statistical correlation of a certain serovar to cervical cancer, are described. The representivity of the data on infections with C. trachomatis monitored in national surveillance programs is questioned. The paper also elaborates on which type of sample, sample site and detection method may be optimal for the diagnosis of such infections in women. Whether to screen at clinics and self-sampling at home of specimens from an index case and a sexual partner to be mailed to a laboratory for testing is discussed. Whether or not females are more susceptible to genital chlamydial infections and their sequelae than males is also discussed. The effectiveness of recommended antibiotic regimens is considered, e.g. in relation to the recent detection of the existence of strains of C. trachomatis that show heterotypic resistance to drugs commonly used for their treatment.

Animals↗