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Practice profile: the first twelve years.

In a mailed questionnaire study of a 1/3 sample of recent graduates of the UOP School of Dentistry (57 percent response rate), most respondents felt competent in the majority of procedures they perform. Most procedures not performed were not performed because they are easily referred. Sources of learning about procedures differed according to frequency of performance (frequently performed: 95 percent-dental school; infrequently performed: 82 percent-continuing education). Differences also were noted according to years of practice.

California↗

Competence in nursing informatics among nursing students and staff at a nursing institute in Sweden.

BACKGROUND: Information technology (IT) has slowly been implemented in many health-care organizations (i.e. hospitals). The use of computers has advanced to home care and long-term facilities. Consequently, it is important that nurses are able to demonstrate competence and feel confident in the use of IT. Yet, research has reported that nursing students have varying degrees of competence and experience with IT. AIMS: The purpose of this study was to ascertain nursing students' and nursing educators' self-reported attitudes, skills and experiences using IT. METHODS: Data were collected through a written survey distributed and completed by 247 nursing students (45 of whom were registered nurses who participated in extension courses) and 52 staff members from the nursing faculty at a university in Sweden. RESULTS: Two-thirds of the students and 92% of the nursing educators had access to the Internet from their homes. Of the students, 71% identified their IT skills as being sufficient for their current or future work as a registered nurse. Nurse educators were less confident in the students' ability, reporting that only 29% of nursing students had sufficient IT skills. Comparatively, 48% of the nursing educators believed that they themselves had sufficient IT skills for their role as a nurse educator. CONCLUSIONS: It is important that nursing students have basic IT skills and are familiar with e-mail, word-processing and various databases on the World Wide Web. Findings indicate that participants had a deficit in these skills, suggesting the need to integrate IT into the nursing curriculum.

Adult↗

Characteristics of tinnitus: investigation of over 1400 patients.

The data in the literature concerning tinnitus characteristics are few and contrasting. Almost all data were collected by means of questionnaires mailed to the subjects, without considering the type of tinnitus and the eventual association with other otologic symptoms. To collect, in a homogeneous way and directly from patients, personal and relevant tinnitus data, we adopted a protocol of study that allowed us to select all patients suffering from idiopathic tinnitus, to obtain a wide range of information concerning the symptoms, and to compare qualitative and quantitative tinnitus data referred by patients with those obtained through audiometry. The age at which tinnitus appears more frequently is between 40 and 50 years. No significant differences between males and females were observed. The percentage of those reporting noise exposure was low. In most cases, the duration of the tinnitus was less than 1 year and more than 5 years. Loudness matching values show a homogeneous distribution for levels between 0 and 12 dB and over 15 dB, without correspondence with the subjective judgement of tinnitus intensity. Frequencies resulting high are those between 0 and 1000 Hz and those at 8000 Hz. There is a correspondence between loudness level and masking level and between loudness level and residual inhibition. Data resulting in this study underline the importance of a global evaluation of patients suffering from tinnitus, including subjective data and tinnitus measurements.

Adolescent↗

Involvement of cardiovascular rehabilitation programs in advance directive education.

BACKGROUND: Cardiac rehabilitation programs represent opportunities to educate patients with cardiac disease about living wills and durable powers of attorney for health care. The extent of advance directive education that is currently provided in cardiac rehabilitation programs, however, is unknown. METHODS: A questionnaire was mailed to nonphysician directors of cardiac rehabilitation programs to determine the programs' involvement in educating enrollees about end-of-life issues and the directors' opinions regarding the appropriateness of such education in cardiac rehabilitation curricula. Data were presented as proportions with 95% confidence intervals (Cls). RESULTS: Of the 1013 cardiac rehabilitation program directors, 845 (83%) responded to the questionnaire, of which 48 stated they were no longer enrolling patients. Of the remaining 797 program directors (83%), 71% (95% CI, 67%-74%) informed patients of their prognosis, but only 18% (95% CI, 15%-20%) and 12% (95% CI, 9%-14%) asked patients if they had a living will or a durable power of attorney for health care, respectively. Only 9% (95% CI, 7%-11%) offered educational sessions on advance directives and 17% distributed advance directive informational material. Education about cardiopulmonary resuscitation was provided by 27% (95% CI, 23%-30%), but only 3% (95% CI, 2%-4%) provided information on do-not-resuscitate topics. Fifty percent (95% CI, 46%-53%) were in favor of including advance directive education and 49% (95% CI, 45%-52%) favored inclusion of do-not-resuscitate topics into curricula. CONCLUSIONS: Cardiac rehabilitation programs are potentially valuable but not widely used sites for educating patients with cardiac disease about advance directives.

Advance Care Planning↗

Effect of mammography outreach in women veterans.

We undertook this study to test whether progressive intervention would increase the use of mammography. In 1995, we randomly assigned into 2 groups 717 underserved women veterans in the Veterans Affairs Palo Alto (California) Health Care System (VAPAHCS) who earned less than $22,000 a year. The women were sent an informational letter and brochure explaining why mammography is needed and how often. The letter further requested that if the woman was due for a screening mammogram or if a lump or other recent change in her breast had occurred, that she call for scheduling of a free mammogram and a visit to the breast clinic. Women in group I (n = 351) received no further intervention. Women in group II (n = 366) received a follow-up phone call by a breast care nurse if they had not responded within 45 days of the informational mailing. The nurse talked to each woman about her particular needs, explained to her that the screening mammogram would be provided free of charge, and discussed transportation arrangements to the mammography facility. A total of 17 women in group I had mammograms versus 100 in group II during the same time period. We conclude that the additional intervention of a phone call by a breast care nurse increased use by more than 5-fold, which reached significance (P < .01).

Adult↗

"Safety for agricultural educators": evaluation of an intervention to enhance awareness of agricultural hazards.

Safety for Agricultural Educators (SAGE) is a two-sided fact sheet on agricultural hazards that has been distributed by the New York Center for Agricultural Medicine and Health (NYCAMH) to Northeastern high school agriculture educators over the past six years. It was intended to supplement and stimulate the teaching of safety principles in agricultural education classes and thus enhance the awareness and knowledge of young people working on farms. This paper describes an evaluation of SAGE's success at achieving these goals. Postal surveys from 29 teachers who had not previously received SAGE gathered data on class demographics and the amount of class time devoted to a variety of agricultural topics including tractor operation and agricultural health and safety. Teachers were asked to assess their students' awareness of safety and health issues and also to estimate the number of students working in the farm environment. Following a year of SAGE mailings, the same information was gathered from the 24/29 post-SAGE responders. Comparison of pre-post responses from the 24 matched responding educators showed: limited increase in the teachers' knowledge of basic agricultural safety information; a decline in the amount of class time devoted to health and safety; a marginal increase in estimated student awareness of health and safety and very little evidence of teacher awareness of SAGE as a safety resource. Most notable was the fact that only 8% of all students were currently working on a farm and teachers estimated that only 6% would be working on farms in five years.

Accident Prevention↗

Reporting instruction for radiology residents.

RATIONALE AND OBJECTIVES: To determine the amount of formal instruction and evaluation about reporting given to radiology residents in the U.S.A., to document report generation methods and to quantify the performance of physician coding. MATERIALS AND METHODS: E-mail requests with links to a web-based, anonymous survey were sent to program directors of all accredited radiology residencies in the USA. Demographic questions included university or private affiliation, number of residents, geographic location, and number of hospitals covered. Subject-specific items covered the amount of didactic instruction, formal evaluation of reports, and use of structured reports. A didactic activity index (DAI) was calculated as the sum of answers to domain-specific questions and tested for relation to demographic variables. We also asked about dictation methods and International Classification of Diseases (ICD) or Common Procedural Terminology (CPT) coding of examinations by radiologists. RESULTS: Of the 191 active radiology residencies, 151 (79%) completed the survey. Responses for hours of didactic instruction in reporting given more than a 4-year residency were distributed as follows: 0-1 = 40%, 2-4 = 46%, >4 = 14%. The percentage of resident reports formally graded was distributed as follows: 0-1 = 82%, 2-4 = 8%, >4 = 10%. The extent to which faculty-designed, structured reports were used by residents was distributed as follows: none = 16%, minimal = 25%, few = 17%, some = 33%, most = 9%. The DAI was normally distributed with a mean of 14.8 and a standard deviation of 2.4. Military programs had higher DAIs than university residencies (P = .03). There was no significant relation between any other program demographic variables and the DAI (P > .05). A substantial number of programs reported that physicians performed coding for some or most studies: ICD-9 = 30%, CPT = 26%. The dominant method for report generation was human transcription in 79% followed by speech recognition at 19%. Speech recognition penetration (departments reporting use of the technology for at least some dictation) was estimated to be 38%. CONCLUSION: In 86% of sampled radiology residencies, trainees receive no more than one hour of didactic instruction in radiology reporting per year. An aggregate measure of didactic activity about interpretative reporting was identical across all program demographic variables except that military residencies seemed to do slightly more than those located at universities.

Data Collection↗

SPINE 2: a system for collaborative structural proteomics within a federated database framework.

We present version 2 of the SPINE system for structural proteomics. SPINE is available over the web at http://nesg.org. It serves as the central hub for the Northeast Structural Genomics Consortium, allowing collaborative structural proteomics to be carried out in a distributed fashion. The core of SPINE is a laboratory information management system (LIMS) for key bits of information related to the progress of the consortium in cloning, expressing and purifying proteins and then solving their structures by NMR or X-ray crystallography. Originally, SPINE focused on tracking constructs, but, in its current form, it is able to track target sample tubes and store detailed sample histories. The core database comprises a set of standard relational tables and a data dictionary that form an initial ontology for proteomic properties and provide a framework for large-scale data mining. Moreover, SPINE sits at the center of a federation of interoperable information resources. These can be divided into (i) local resources closely coupled with SPINE that enable it to handle less standardized information (e.g. integrated mailing and publication lists), (ii) other information resources in the NESG consortium that are inter-linked with SPINE (e.g. crystallization LIMS local to particular laboratories) and (iii) international archival resources that SPINE links to and passes on information to (e.g. TargetDB at the PDB).

Cooperative Behavior↗

Syringe exchange in the United States, 1996: a national profile.

OBJECTIVES: This paper provides 1996 information on the status of US syringe exchange programs and compares these findings with data from our 1994 survey. METHODS: In November 1996, questionnaires were mailed to 101 syringe exchange programs. Program directors were contacted to conduct telephone interviews based on the mailed questionnaires. Data collected included number of syringes exchanged, syringe exchange program operations, legal status, and services offered. RESULTS: Eighty-seven programs participated in the survey. A total of 46 (53%) were legal, 20 (23%) were illegal but tolerated, and 21 (24%) were illegal-underground. Since 1994, there has been a 54% increase in the number of cities and a 38% increase in the number of states with syringe exchange programs. Eighty-four programs reported exchanging approximately 14 million syringes, a 75% increase from 1994. Syringe exchange programs also provided a variety of other services and supplies, and legal programs were more likely than illegal ones to provide these services. CONCLUSION: Despite continued lack of federal funding, syringe exchange programs expanded in terms of the number of syringes exchanged, the geographic distribution of programs, and the range of services offered.

Health Care Surveys↗

Phosphoglycerate kinase deficiency: biochemical studies on hair follicles.

A fluorimetric procedure for the determination of phosphoglycerate kinase in single human hair follicles is described. Enzyme studies on different parts of hair follicles after dissection show that the distribution of glucose-6-phosphate dehydrogenase matches that of phosphoglycerate kinase. Glucose-6-phosphate dehydrogenase can therefore be used as a reference enzyme to compensate for differences in hair follicle sizes. It was shown that the variation in the values found in individual hair follicles is improved by relating phosphoglycerate kinase to glucose-6-phosphate dehydrogenase activity. In areas of the world where glucose-6-phosphate dehydrogenase deficiency occurs frequently, an autosomally inherited reference enzyme may be preferred. It is shown that 6-phosphogluconate dehydrogenase is useful in this respect. Upon storage a gradual drop in the activity of all three enzymes was observed, but the rate of decrease was about equal: the enzyme activity ratio was, therefore, almost unaffected for a period of one week. This allows the determination of phosphoglycerate kinase even in mailed hair follicles.

Enzyme Stability↗

[Information to young people about HIV/AIDS and drug abuse. A study of the knowledge and use of the information material in the youth center in Copenhagen].

A mailed questionnaire was carried out in the city of Copenhagen in which the leaders of 106 youth centres expressed their opinion on different publications concerning drug abuse and HIV/AIDS. The knowledge of the publications among the leaders was less than expected. The last known publication was recognized by 7% of the leaders, the most well known by 55%. A considerable part of the leaders stated that they had never received the publications. In centres where the leaders knew of the publications they were widely used, most often in centres for older members. A group of leaders stated, that the publications were irrelevant for members aged 9-14 years. The study points out specific problems in the health educations process: The publication should aim more specifically at the group and at subpopulations in the group. The distribution should be secured and the knowledge of the supply of health education material among the leaders of the youth centres should be raised.

Acquired Immunodeficiency Syndrome↗

Cocaine abuse in North America: a milestone in history.

The euphoric effects of coca leaves have been known to mankind for thousands of years. Yet the first epidemic of cocaine use in America occurred during the late 19th century. Initially, there were no laws restricting the consumption or sale of cocaine. In fact, cocaine was freely available in drug stores, saloons, from mail-order vendors, and even in grocery stores. It is reported that one drug manufacturer, in 1885, was selling cocaine in 15 different forms, including cigarettes, cheroots, inhalants, cordials, crystals, and solutions. Many famous imported wines, such as "Vin Mariani," contained a mixture of wine and coca. For consumers on budgets, the wonder drug was available as Coca-Cola and dozens of other soda pops and pick-me-up drinks. One of them even had a simple and direct name, Dope. Soon enough, the ill effects of cocaine became apparent, and by the 1920s cocaine was the most feared of all illicit drugs. Most states began enacting laws against cocaine use. President William Taft proclaimed cocaine as Public Enemy No. 1, and in 1914 the Congress passed the Harrison act, which tightly regulated the distribution and sale of cocaine. By the late 1950s, cocaine use in the United States was simply considered a problem in the past. Unfortunately, the people who were aware of the nation's first cocaine epidemic gradually passed away, and America once again was ready for its fling with cocaine in the 1960s. Today, it is estimated that upwards of 50 million Americans, that is one in four, have used cocaine. In addition, another fifty thousand people use this substance for the first time each day. More than 6 million Americans use cocaine on a regular basis. Little wonder, then, that America as well as the other countries have declared a "War on Drugs." In this review, pharmacology of cocaine, major complications arising from its use, and efforts to curb its abuse are discussed.

Cardiovascular System↗

Encouraging GPs to undertake screening and a brief intervention in order to reduce problem drinking: a randomized controlled trial.

BACKGROUND: GPs are in a key position to screen the population for problem drinking. However, so far this has not been extensively undertaken in general practice. Thus, studies relating to encouraging the undertaking in general practice of screening and initiating a brief intervention for problem drinking are needed. OBJECTIVES: We aimed to compare three approaches direct mail, telephone contact and academic detailing to encourage GPs to undertake screening and a brief intervention (SBI) for problem drinking. METHODS: A total of 143 GPs in Copenhagen County were randomly assigned to the three approaches. The outcome measures were the proportion of GPs who requested the SBI package (uptake rate) and the fraction of GPs who started using the package (utilization rate). The costs of each approach were calculated. RESULTS: Compared with the direct mailing approach, uptake rates were significantly higher among GPs approached by telephone (30 versus 72%; P = 0.0001) and in the academic detailing approach (30 versus 67%; P = 0.0006). There was no significant difference between telephone contact and academic detailing (72 versus 67%; P = 0.75). There was a higher utilization rate in the academic detailing approach than in telephone contact (61 versus 31%; P = 0.023). There was no significant difference between direct mail and telephone contact (57 versus 31%; P = 0.16) or between direct mail and academic detailing (57 versus 61%; P = 0.95). The respective costs of the telephone and academic detailing approaches were 10 and 16 times that of the direct mailing approach. CONCLUSION: Telephone contact and academic detailing are more effective than direct mail in encouraging GPs to request an SBI package, but GPs who were approached by academic detailing were more likely to have utilized the package than GPs who were approached by telephone. The relatively high uptake and utilization rates obtained in the academic detailing approach suggest that this approach is to be preferred in encouraging a rapid uptake of SBI among GPs. However, the high costs associated with this approach need to be taken into consideration.

Adult↗

Levels of mental health problems among UK emergency ambulance workers.

This study examined the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety in a sample of emergency ambulance personnel. Of 1029 personnel in one ambulance service mailed a questionnaire, 617 were returned. Among respondents, the overall rate of PTSD was 22%. Levels of PTSD did not differ according to grade, but men had a higher prevalence rate than women (23% compared with 15%). Nearly one in ten reported probable clinical levels of depression, 22% reported probable clinical levels of anxiety based on Hospital Anxiety and Depression Scale scores.

Adult↗

Factors that influence African-Americans' willingness to participate in medical research studies.

BACKGROUND: The underrepresentation of African-Americans among medical research participants is receiving considerable attention because of recent government mandates for the inclusion of all racial/ethnic groups in human subject research. Therefore, there is a need to determine factors that influence minority enrollment in medical research studies. METHODS: Between 1998-1999, 91 African-American residents of the Detroit Primary Metropolitan Statistical Area participated in a mail and telephone survey designed to examine impediments to participation in medical research studies. Chi-square tests and multiple logistic regression analyses were used to examine the association between race, issues related to trust in medical researchers, and the willingness to participate in medical research studies. RESULTS: African-American respondents were somewhat less willing to participate if they attributed high importance to the race of the physician when seeking routine medical care, believed that minorities or the poor bear most of the risks of medical research, and, most especially, their knowledge of the Tuskegee Study resulted in less trust in medical researchers. CONCLUSIONS: These data reiterate the need for medical researchers to build trusting relations with African-Americans and to conduct research in an ethical manner. This includes maximizing benefits, reducing risks, and assuring distributive justice to all medical research study participants.

Adult↗

At what price? The current state of subject payment in adolescent research.

PURPOSE: To examine how subject payment was associated with study features, such as investigator characteristics and project specifics, among randomly selected studies using adolescent subjects. METHODS: Using Psychinfo we gathered a list of original research studies published in 1999 that used adolescent subjects. We randomly selected corresponding authors and mailed confidential questionnaires on subject payment. We gathered complete data from 127 authors of adolescent research. While our main outcome was subject payment, we also examined the monetary value and form of the payment. Predictor variables included the principal investigator's demographics and professional information and the project's design and sample. Data were analyzed using Student's t-tests, Pearson correlations, and logistic regression. RESULTS: Of the studies using adolescent subjects, 55% (n=61) involved payment. Total payment varied (range $1 to $600, mean=$82.35) and the mean value per session was $26.61. Investigator characteristics associated with payment were a principal investigator's current discipline area and the decade, level and area of highest educational degree obtained. Funding and protocol complexity were related to payment, as was the sample's size, gender composition, ethnic makeup, SES distribution, and at-risk status. Logistic regression analyses found that researchers using payment were 7.2 times more likely to have funding, 2.8 times more likely to work with at-risk youth, and for every unit increase in positive attitude toward compensation, there was a 1.1-fold increase in the likelihood of using payment. CONCLUSIONS: Of those who responded to our questionnaire, slightly more than one-half the 1999 published studies done with adolescents used payment; however, the amount paid varied tremendously.

Adolescent↗

Substance use among a regional sample of female nurses.

We assessed the prevalence of licit (e.g. alcohol) and illicit (e.g. cocaine) drug use, as well as prescription (e.g. tranquillizers) and over-the-counter medications (e.g. analgesics), in a regional sample of female nurses. Surveys were mailed to a random sample of 4000 nurses in Western New York. The survey focused on lifetime and current use of substances, negative consequences of alcohol consumption and dependence. Three mailings resulted in a return of 2400 (60%) surveys, of which 1951 (49%) were usable. We examined lifetime and current use in each of the four classes of substances in the context of nursing related-factors (e.g. type of nurse, nursing specialty, work setting) and demographic characteristics (e.g. age, marital status). There were significant differences within each of the different groupings. Lifetime experience of negative consequences were relatively rare and few nurses reported dependence on substances other than tobacco and caffeine.

Adolescent↗

Developing empirical models to enhance stroke rehabilitation.

PURPOSE: Models identifying functional indicators most strongly associated with favourable and unfavourable outcomes may bolster evidence to improve stroke rehabilitation assessment and intervention. This study examined the feasibility of decision analysis methods for developing data-driven models that examined associations between specific functional indicators and global disability. METHOD: Data were derived from functional assessment of 67 participants 3 months following stroke. Decision analysis methods were used to examine specific activity and body function indicators associated with global disability, and the degree of limitation or impairment that contributed to favourable and unfavourable outcomes, in 2 models. The feasibility of decision analysis methods was evaluated. RESULTS: Of the 26 activity indicators, dressing was most strongly associated with global disability, followed by bill mailing, shopping and sweeping. Of 15 body function indicators, facial weakness and mental functions were most strongly associated with global disability. The misclassification risk estimates were fair for the two models. CONCLUSIONS: Findings suggest that decision analysis methods show promise for developing models examining associations between specific functional indicators and disability. Further study with these methods may identify specific priorities for functional assessment and intervention in stroke rehabilitation.

Activities of Daily Living↗