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PubMedDate not supplied

Stages of change for physical activity, diet, and smoking among HMO members with chronic conditions.

PURPOSE: This paper investigated whether stage of change for health behaviors was associated with the presence of chronic conditions. DESIGN: A stratified cross-sectional survey by mail with telephone follow-up. SETTINGS: This study was conducted at a mixed-model HMO with 650,000 members based in Minnesota. SUBJECTS: The sample consisted of a random sample of 8000 HMO members age 40 or over with systematic oversampling of members with hypertension, diabetes, dyslipidemia, or heart disease. MEASURES: In addition to demographics, readiness to change for physical activity, fat intake, fruit and vegetable intake, and smoking were assessed. RESULTS: The adjusted response rate was 82.4%. In a logistic regression analysis, members with one or more than one chronic condition had greater readiness to change for three out of four risk factors compared to members with no chronic conditions. CONCLUSIONS: The stage-of-change distribution of HMO members with chronic conditions suggests that members at highest risk of adverse health outcomes have the greatest readiness to change behavioral risk factors. Based on these observations, targeted, stage-specific efforts to support behavior change are likely to be both acceptable and effective in HMO members with chronic conditions. Improving stage of change for behavioral risk factors for members with diabetes may present special problems and opportunities.

Adult↗
PubMed2001

First offers as anchors: the role of perspective-taking and negotiator focus.

Three experiments explored the role of first offers, perspective-taking, and negotiator self-focus in determining distributive outcomes in a negotiation. Across 3 experiments, whichever party, the buyer or seller, made the 1st offer obtained a better outcome. In addition, 1st offers were a strong predictor of final settlement prices. However, when the negotiator who did not make a 1st offer focused on information that was inconsistent with the implications of the opponent's 1st offer, the advantageous effect of making the 1st offer was eliminated: Thinking about one's opponent's alternatives to the negotiation (Experiment 1), one's opponent's reservation price (Experiment 2), or one's own target (Experiment 3) all negated the effect of 1st offers on outcomes. These effects occurred for both face-to-face negotiations and E-mail negotiations. Implications for negotiations and perspective-taking are discussed.

Decision Making↗
PubMed2004

Hospital bioterrorism preparedness linkages with the community: improvements over time.

BACKGROUND: Strong linkages between hospitals and community response entities such as fire safety, law enforcement, emergency management agencies, emergency medical services, public health, and local government administration are an essential element of overall hospital preparedness. These pre-established relationships enable an integrated community response during an emergency. METHODS: This pilot study assessed changes in linkages between hospitals and key community entities related to preparedness for a bioterrorism (BT) event before and after the events of fall 2001. A 51-item questionnaire was mailed to two consecutive hospital samples scheduled for accreditation surveys (April-May 2001 and May-June 2002; n=68 and n=97 responses, respectively). On-site visits by surveyors verified the presence of a plan addressing bioterrorism issues. RESULTS: Substantial improvement in collaborative planning for surge capacity and lab/pharmacy issues occurred. Hospital plans that addressed BT increased significantly (47.1% to 90.7%), as did awareness of community BT-related plans (48.5% to 74.2%). Hospitals that conducted a BT-related drill increased from 19.1% to 48.5%. CONCLUSIONS: Adequate resources are needed, but opportunities remain to further improve collaborative planning, such as agreements with other hospitals on a single media spokesperson or development of a protocol for pharmaceutical distribution. Additional guidance is needed on expected levels of performance regarding linkages.

Bioterrorism↗
PubMed1994

The role of cigarette smoking in the etiology of cervical dysplasia.

We evaluated the effect of smoking on the risk of cervical dysplasia in a large case-control study, obtaining smoking information from a mail questionnaire. We observed higher risks with increasing numbers of cigarettes smoked, but not with longer duration of smoking. The risk for ex-smokers was between those of current smokers and nonsmokers and was lower for women who had stopped more than 10 years ago than for those who had quit more recently. Starting to smoke at an early age did not increase the risk of cervical dysplasia.

Adult↗
PubMed2004

Patient preference for being informed of their DXA scan results.

Evidence suggests that patients diagnosed with osteoporosis are often undertreated. One potential solution to undertreatment is to enhance patient involvement in their osteoporosis care (a.k.a. patient activation) by having the dual-energy X-ray absorptiometry (DXA) center directly provide patients with their test results and educational material. However, little is known about patient interest in such an intervention. Consecutive patients presenting to an academic medical center DXA scanning unit were given a questionnaire to assess their preferences for being informed of their test results and interest in receiving their results plus educational material by mail from the testing center. Two hundred and two (202) of 206 (98%) of patients agreed to complete the survey. Fifty-one percent of participants preferred receiving their results by mail directly from the DXA center, followed by phone call (28%) and office visit (11%). Overall, 90% of patients reported interest in receiving results and educational material by mail. Younger patients were more interested in receiving their results by mail when compared with older patients, but this difference did not reach statistical significance (odds ratio [OR] = 2.40: 95% confidence interval [CI]: 0.91-6.31, p = 0.14). Patients undergoing DXA scanning were interested in receiving their scan results and educational material directly from the testing center. This might represent an effective intervention for improving care of patients with osteoporosis.

Absorptiometry, Photon↗
PubMed2005

Reactive joint symptoms following an outbreak of Salmonella typhimurium phage type 135a.

OBJECTIVE: To quantify the incidence and clinical features of reactive arthritis (ReA) developing in a cohort exposed to an outbreak of Salmonella typhimurium phage type 135a, and factors affecting host susceptibility to ReA. METHODS: A screening questionnaire was mailed to 493 patients with confirmed Salmonella infection. Musculoskeletal symptoms and extraarticular manifestations of ReA were quantified. Positive responders with joint pain were invited to participate further, with a detailed history, examination, and investigations including HLA-B27 status. RESULTS: A total of 261/461 (57%) subjects responded to the questionnaire, with 23/54 adults (43%) and 41/207 children (20%) reporting joint symptoms. Although joint pains were less common in children compared with adults, those children affected usually had eye (34%) or mucocutaneous (37%) symptoms. The incidence of ReA was 14.6%, with adults more frequently affected (24%) than children (12%). This may be an underestimate given the large proportion of children involved. Associated clinical features were similar to previous studies, with the distribution of arthritis affecting the lower limbs predominantly in an oligoarticular pattern, as were the extraarticular manifestations and enthesopathy. We found 17% of subjects were HLA-B27 positive, and 55% were still symptomatic after 6 months. CONCLUSION: In an Australian cohort study of a S. typhimurium phage type 135a outbreak, joint symptoms were common, affecting 25% of subjects. The incidence of ReA of 14.6% and the clinical features were comparable to previous studies. There was a small effect of HLA-B27 status on the development of ReA.

Adolescent↗
PubMed1985

ASHP special interest group professional practice survey--1984.

Personal characteristics and professional practice patterns of enrollees in ASHP special interest groups (SIGs) were surveyed in early 1984. The mail questionnaire consisting of 23 items was sent to the entire universe of 3595 SIG enrollees, 514 of whom belonged to more than one SIG. The response rate was 64.7%. About two thirds of the respondents were between 25 and 39 years old; 73% were men. Nearly 36% had earned more than one academic degree, and 30% had completed an ASHP-accredited pharmacy residency. Most respondents spent a majority of their work time in a community nonprofit hospital (46%) or a university teaching hospital (22%). The following percentage of respondents spent some time in the functions indicated; the mean percentage of time those respondents spent in a function is given in parentheses: administration, 76% (52%); education, 69% (16%); drug distribution and control, 60% (17%); patient-oriented services, 47% (17%); drug information, 54% (12%); research, 28% (17%); pharmaceutical marketing/sales, 6% (25%); other, 12% (29%). The following percentage of respondents spent half or more of their practice time in the functions indicated: administration, 48%; drug distribution and control, 26%; education, 5%; and patient-oriented activities, 4%. By and large only a small percentage of SIG enrollees spent a majority of their practice time providing patient-specific services. This suggests that for most SIGs enrollment corresponds to an interest in a special practice area, not a heavy practice commitment to that area.

Adult↗
PubMed2005

Attitudes and behaviours in smoking cessation among general practitioners in Finland 2001.

OBJECTIVES: To investigate whether smoking by general practitioners (GPs) and gender influence smoking cessation advice. METHODS: A self-administered questionnaire, originally developed by the WHO and modified according to the Finnish health care system was sent by mail to physicians who were members of the Finnish Medical Association (FMA). Participants were restricted to those who were living in Finland and were younger than 65 years. Numbers of participants was 3,057 and the response rate 69%. RESULTS: Smoking male GPs gave less smoking cessation advice only to patients with a stomach ulcer or patients using oral contraceptive pills compared with their non-smoking colleagues. Male GPs gave less smoking cessation advice to pregnant patients or patients using contraceptive pills than female GPs. Female smoking GPs less likely advised patients who were pregnant or who were using oral contraceptive pills to stop smoking than non-smoking female GPs (p <0.001). The percentage of GPs who have never distributed smoking cessation information was lower in men (41%) than in women (45%; p-value: 0.052). CONCLUSION: Minor differences in anti-smoking advice to patients between smoking and non-smoking general practitioners were found. The little involvement of GPs in health promotion activities regarding tobacco control is of concern.

Adult↗
PubMed1989

Analysis of a progressive addition lens population.

Analysis of 98 progressive addition lens (PAL) wearers was undertaken using both mailed questionnaires and by assessing patient records. Statistical analysis was undertaken to investigate the nature and dependent variables of a PAL population. The PAL patients were from the Aston University undergraduate optometric clinic. Social survey techniques, such as the use of personalized mail, first-class stamps, and follow-up letters, were employed to produce a high return rate for the questionnaire. The number of returned questionnaires reached 89.9% of those originally sent which may be considered to be highly representative. The clinical survey showed the success rate for the undergraduate clinic to be either 85.7% or 80.6% depending upon the criterion for successful wear.

Adaptation, Psychological↗
PubMed2006

Assessment of the Japanese Inflammatory Bowel Disease Questionnaire in patients after ileal pouch anal anastomosis for ulcerative colitis.

BACKGROUND: The Inflammatory Bowel Disease Questionnaire (IBDQ) is the most widely used disease-specific health-related quality of life questionnaire for patients with inflammatory bowel disease. However, little has been reported about the validation of IBDQ for patients with ulcerative colitis after surgery. The aim of this study was to assess the validity and reliability of the Japanese version of IBDQ in patients with ulcerative colitis after total proctocolectomy and ileal pouch anal anastomosis (IPAA). METHODS: The validity and reliability of the Japanese IBDQ were assessed in patients with ulcerative colitis who had received IPAA in our hospital. We mailed them the Japanese IBDQ and a supplemental questionnaire on bowel function, which was developed at our institution. Internal consistency, discriminative validity, and factor validity were assessed. RESULTS: Of the 121 patients to whom we sent the questionnaires, 64 patients (53%) participated in this study. The Japanese IBDQ scores correlated well with Cronbach's alpha value (0.800 to 0.923) and daily life satisfaction score (Pearson's r, 0.492 to 0.700). The total IBDQ score and two subscale scores of the IBDQ, "bowel symptoms" and "systemic symptoms," correlated well with daily bowel-movement frequency (Pearson's r, -0.256 to -0.329). Factor analysis revealed a four-factor structure, and all correlations among factors were moderately positive (0.337 to 0.465). Although the factor distribution was not clearly divided into the four IBDQ subscales, these four factors showed a marked tendency to represent the IBDQ subscales independently. CONCLUSIONS: The Japanese IBDQ is a valid and reliable instrument for the assessment of Japanese patients with ulcerative colitis after IPAA.

Adult↗
PubMedDate not supplied

Attitudes of non-oncology physicians dealing with cancer patients. A survey based on clinical scenarios in Ancona province, central Italy.

AIMS AND BACKGROUND: With this study we attempted to determine to what extent recent acquisitions in clinical oncology had reached categories of physicians involved in the management of patients with cancer, namely general surgeons, internists and family doctors. METHODS: A questionnaire was prepared with scenarios based on the following clinical situations: Scenario A, Adjuvant therapy in colon cancer; Scenario B, Treatment of small-cell lung cancer; Scenario C, Adjuvant therapy in high-risk, node-negative breast cancer; Scenario D, Treatment of early stage breast cancer; Scenario E, Asymptomatic transient myelosuppression during chemotherapy. Questionnaires were mailed to 365 family doctors, 54 general surgeons and 61 internists of the Province of Ancona in central Italy. RESULTS: A total of 198 completed questionnaires were returned (41%). Respondents were 36.7% of family doctors, 54.1% of internists and 57.4% of surgeons. Less than half of respondents selected an adequate approach such as adjuvant chemotherapy for colon cancer and high-risk, node-negative breast cancer or chemotherapy as first-line treatment for small-cell lung cancer. Conservative surgery plus radiotherapy (QUART) for early stage breast cancer was indicated by 69% of respondents. Over three quarters of physicians would give treatment for asymptomatic transient chemotherapy-induced leukopenia. In most of the scenarios, significant differences were detected in the distribution of preferences according to category of physicians. Family doctors and young physicians (< 40 years) generally performed worse than hospital-based physicians (general surgeons and internists) and older physicians. CONCLUSIONS: Non-oncology physicians showed insufficient awareness of currently available knowledge in cancer treatment. Basic concepts in cancer management should be part of the professional knowledge of all medical doctors, and key advances in clinical oncology should spread outside the oncologic environment more promptly, with a wide circulation among all physicians who care for cancer patients.

Adult↗
PubMed2004

Descriptive epidemiology of pedometer-determined physical activity.

PURPOSE: The dual purposes of this study were: 1) to provide preliminary descriptive epidemiology data representing pedometer-determined physical activity (PA) and 2) to explore sources of intra-individual variability in steps per day. METHODS: All participants (76 males, age = 48.4 +/- 16.3 yr, body mass index (BMI) = 27.1 +/- 5.1 kg x m(-2); 133 females, age = 47.4 +/- 17.5 yr, BMI = 26.9 +/- 5.7 kg x m(-2)) resided in Sumter County, SC, and were recruited by telephone to receive a mailed kit to self-monitor PA for 1 wk. Statistical analyses compared mean steps per day between sexes, races, age groups, education and income levels, and BMI categories. Mean steps per day were also compared between: 1) weekdays versus weekend days, 2) workdays versus nonworkdays, and 3) days of sport/exercise versus no participation. RESULTS: The entire sample took 5931 +/- 3664 steps x d(-1) (males = 7192 +/- 3596 vs females = 5210 +/- 3518 steps x d(-1), t = 7.88, P < 0.0001). Significant differences were also indicated by race, age, education, income, and BMI. In addition, weekdays were significantly higher than weekend days, workdays were higher than nonworkdays, and sport/exercise days were higher than nonsport/exercise days. CONCLUSIONS: The large standard deviations reflect a wide distribution of ambulatory behavior. Regardless, important differences are still evident by demographic characteristics, BMI categories, day of the week, and reported engagement in work or sport/exercise.

Adolescent↗
PubMed1993

Dental underemployment: a study of uncontrolled dental manpower immigration.

In the 1980s three studies were conducted in Israel utilising different methods of dental manpower evaluations. All identified a large future surplus of dentists. The current study re-evaluates the manpower supply and discusses possible solutions. A random sample of 800 dentists was approached by three mailings and a telephone call follow-up with a response of 49.7 per cent. Almost 90 per cent of dentists reported an undersupply of patients, with a mean working load of 26.3 hours/week, but being willing to add up to 3.4 working hours/week. The oversupply of dentists has been dramatically affected by the addition of almost 1000 dentists who emigrated to Israel in 1991-92. To prevent a significant unemployment rate among dentists and an uncontrolled free market, it is urgently suggested for the benefit of both provider and consumer that; the demand for services be increased and additional financing of dental care be made available, that the total number of dentists be decreased by various measures and that their geographical distribution be improved. If necessary limits should be placed on the number of practices or the number of patients permitted per practice.

Adult↗
PubMed1995

Developmental pattern and regulation by androgens of androgen receptor expression in the urogenital tract of the rat.

Distribution and regulation of androgen receptor expression during fetal and neonatal virilization of the rat fetus was assessed by immunohistochemistry. In mesonephric duct derivatives the androgen receptor expression became evident first in the efferent ductules and epididymis (on fetal day 14), subsequently in the vas deferens and finally in the seminal vesicle. Mesenchymal cells of the urogenital tubercle were positive for androgen receptors from fetal day 14 onwards. In the mesenchymal cells of the prostate anlagen, androgen receptor positive cells were found first on fetal day 16. Administration of 5alpha-dihydrotestosterone to pregnant rats from day 11 to day 20 of gestation caused a stabilization of the wolffian duct in female fetuses. The androgen receptor expression pattern became similar as found in mail fetuses, and showed an increase in density and in frequency of androgen receptor positive cells. Administration of the androgen antagonist flutamide during the same interval caused a reduction in density and frequency of androgen receptor positive cells in male fetuses. These findings indicate that androgens enhance the expression of androgen receptors in the developing rat genital tract by induction of androgen receptor positive cells, and by increasing the frequency. The developmental pattern of androgen receptor expression in the rat mesonephric duct system reflects the androgen-responsiveness of the ducts, and is consistent with induction of the androgen receptor along the ducts by testosterone reaching these structures in an exocrine fashion.

Androgen Antagonists↗
PubMed1992

No evidence of acute cardiovascular complications of chemotherapy for testicular cancer: an analysis of the Testicular Cancer Intergroup Study.

PURPOSE: The purpose of this study is to evaluate the risk of acute vascular events in patients receiving cisplatin-based chemotherapy for testicular cancer. PATIENTS AND METHODS: A questionnaire assessing cardiovascular toxicity was distributed to all participants in the Testicular Cancer Intergroup study and details of toxicity from the chemotherapy flow sheets were reviewed. Patients with pathologic stage I testicular cancer were registered on to the study and observed after retroperitoneal lymphadenectomy. Patients with pathologic stage II disease were randomized to receive two postoperative courses of adjuvant cisplatin-based chemotherapy or observation. Any patient who had disease recurrence after observation or adjuvant therapy was given four cycles of cisplatin-based chemotherapy. RESULTS: Review treatment-related toxicity for those patients receiving adjuvant chemotherapy (n = 97) or chemotherapy for recurrent disease (n = 83) showed no cases of acute cardiovascular toxicity. The median follow-up period after study enrollment was 5.1 years; 459 questionnaires were mailed and 270 were returned. The percent return was equal among the observed adjuvant and recurrent groups (59%, 54%, and 64%). There was a significant increase in the incidence of extremity paresthesias in the two groups receiving chemotherapy. Fatal myocardial infarction was reported in two patients in the observation group and one nonfatal infarction was reported in the adjuvant treatment group. No patient in any group reported an incidence of stroke. Three patients in the observation group and one patient in the recurrent group experienced a thromboembolic event. CONCLUSION: Despite sporadic case reports suggesting a causal association between chemotherapy for testicular cancer and acute vascular events, this retrospective analysis provides no evidence of an increased risk for subsequent cardiovascular disease in this patient population.

Acute Disease↗
PubMed1994

Estimated annual number of patients treated for sensorineural hearing loss in Japan. Results of a nationwide epidemiological survey in 1987.

We mailed questionnaires to 98 university hospitals and 939 hospitals with 200 beds or more throughout Japan asking for information on patients treated for sensorineural hearing loss between January 1 and December 31, 1987. The number of patients treated for sensorineural hearing loss in 1987 in Japan was estimated 13,900-19,600, ii) idiopathic bilateral progressive sensorineural hearing loss 13,900-19,600, ii) idiopathic bilateral progressive sensorineural hearing loss in 800-2,000, iii) perilymphatic fistula in 200-310, iv) mumps deafness in 200-400, and v) unilateral profound deafness in 2,000-3,000. Sex ratio (men over women) was 0.9 in sudden deafness and mumps deafness, 1.1 in idiopathic bilateral progressive sensorineural hearing loss and 1.5 in perilymphatic fistula. Patients were distributed with a definite peak from 50 to 59 years old in sudden deafness, from 30 to 39 years old in perilymphatic fistula, and two apparent peaks in teenagers and those aged 60-69 years in idiopathic bilateral progressive sensorineural hearing loss.

Adolescent↗
PubMed2006

Item non-responses in mailed food frequency questionnaires in a Korean male cancer cohort study.

Item non-responses are frequently encountered in mailed food frequency questionnaires (FFQs) in epidemiological studies. The effects of item non-responses in a FFQ on presumed nutrient intake and subject classifications were examined in this study of a male cancer cohort in Korea. A semi-quantitative FFQ was developed and mailed to adult males aged between 40 and 59 in Seoul. Among the 14,533 cohort participants, 7,647 subjects who fully completed the FFQ initially and 216 subjects who completed the frequency missing items at resurvey were compared. When item non-responses were treated as not eaten, the average nutrient intakes of this group were significantly lower than both the average intake of subjects who fully completed at the initial survey and the average intake of those who completed at the resurvey. Increases in nutrient intakes during resurvey were substantively proportional to the number of items originally omitted. Cross classifications of item non-response subjects by nutrient intake after the initial survey and after resurvey showed misclassification towards lower quantile. Moreover, distribution of 'never or seldom' answer of resurvey group was similar to initial complete group. These results indicate that treating item non-responses as not eaten introduces bias when estimating nutrient intakes or when classifying subjects on the basis of nutrient intakes. More study is required to determine how best to treat non-response items in FFQ.

Adult↗
PubMed2002

Comparison of endodontist versus generalist regarding preference for postendodontic use of cotton pellets in pulp chamber.

A degree of uncertainty exists about the use of cotton pellets in the pulp chamber after canal obturation. The purpose of this study was to poll practicing endodontists and generalists regarding their preference. Forty-six endodontists and an equal number of general dentists were polled in a mail survey regarding their preferences for the use of a cotton pellet in the pulp chamber after canal obturation. Eighty-seven percent of the endodontists and 54% of the generalists responded. Of the endodontists, 62.5% said they thought that the general dentist wanted a cotton pellet, contrasted to 80% of the generalists. The difference in proportions was not statistically significant.

Attitude of Health Personnel↗