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PubMed2002

Effects of efforts to increase response rates on a workplace chronic condition screening survey.

OBJECTIVE: Expanded health risk appraisal (HRA) surveys can help employers target chronic conditions for outreach or disease management interventions by providing data on the prevalences of conditions and their effects on work performance. However, concerns exist about the accuracy of this data because most HRAs have low response rates. We evaluated these concerns by examining the prevalences and work impairments associated with chronic conditions across four HRA subsamples that differed in intensity of recruitment effort. METHODS: Two thousand five hundred thirty-nine working people were invited to complete an expanded HRA survey that included questions about chronic conditions, work impairments, and demographics. Condition prevalences and associations between conditions and work impairment were compared across subsamples who responded after a single mailing, after two mailings, and in a telephone interview after the mailings either with or without a 20 dollars incentive. RESULTS: Consistent with previous research, response rates varied dramatically across the four subsamples (from 20.1% with only one mailing to 67.7% with telephone administration and a financial incentive). However, the estimated prevalences of chronic conditions, levels of work impairment, and effects of chronic conditions on work impairment did not differ with intensity of recruitment effort. CONCLUSIONS: Expanded HRAs can provide useful data on the prevalences and work impairments associated with chronic conditions even if response rates are low. Confirmation of these results is required, however, in new samples. Additional research is also needed on innovative and cost-effective strategies to improve HRA response rates.

Absenteeism↗
PubMed2004

Knowledge, attitudes, and predictors of advance directive discussions of registered nurses.

The purpose of this study was to describe nurses' knowledge, attitudes, and experiences regarding advance directives. A secondary purpose was to examine predictors of advance directive discussions between nurses and patients. Seven-hundred and nineteen respondents, randomly selected from a list of registered nurses in the state of Ohio, completed mailed questionnaires. Descriptive t test, chi-square, and logistic regression statistics were used in the data analyses. The respondents were knowledgeable and possessed positive attitudes about advance directives. Higher self-perceived confidence in advance directive discussion skills and the experience of caring for at least one patient with a current advance directive were found to be significant predictors of advance directive discussions. These findings suggest that experience with advance directives documents is critical for nurses' comfort and that developing interventions to further nurses' confidence in their discussion skills may increase advance directive discussions.

Adult↗
PubMed2006

Development of quality indicators for diagnosis and treatment of patients with non-small cell lung cancer: a first step toward implementing a multidisciplinary, evidence-based guideline.

BACKGROUND: While developing and distributing clinical practice guidelines are important in optimising clinical healthcare, insight into actual care is necessary to achieve successful implementation. Developing quality indicators may be the first step to becoming aware of actual care. The Dutch national practice guideline Non-small cell lung cancer: staging and treatment is one of the first clinical, multidisciplinary guidelines for oncology in the Netherlands for which quality indicators were developed systematically. We describe indicator development based on this guideline as a practical experience. METHODS: To develop a set of indicators for diagnosis and treatment of patients with non-small cell lung cancer, we systematically achieved consensus on the basis of a national, multidisciplinary, evidence-based guideline and the opinions of professionals and patients. After the researchers extracted the recommendations from the guideline, we carried out a so-called Rand-modified-Delphi procedure. This consisted of three rounds: a national panel of professionals and representatives of the national patient organization scored all recommendations, the professionals had a consensus meeting, and the final set of indicators was e-mailed for a last check. Subsequently, some clinimetric characteristics of this final set were assessed in a practice test. RESULTS: Thirty-two of 83 recommendations were selected in the first round. After the consensus meeting, 8 recommendations met the final criteria and were incorporated into 15 indicators, which were tested in practice. The most successful indicators for quality improvement are indicators that are measurable, have potential for improvement, have a broad range between practices and are applicable to a large part of the population. CONCLUSIONS: For successful implementation of evidence-based guidelines, each new guideline should be developed and tested with a set of indicators based on the guideline. The procedure we describe can serve as an example for other new guidelines.

Carcinoma, Non-Small-Cell Lung↗
PubMed1998

Disease-specific quality of life: is it one construct?

The objective of this study was to examine the structure of disease-specific quality of life (QoL). Models of QoL with either one overall construct or more constructs were tested and the relationships (factor loadings) between the constructs and dimensions were established, using structural equation modelling. The models were tested over time to assess the stability of the structure. To generalize the results further, disease-specific questionnaires of two very different chronic diseases have been compared: inflammatory bowel disease (IBD) and Parkinson's disease (PD). Questionnaires were mailed in 1994 and a repeated measurement was conducted in 1995. Data were obtained from 222 IBD patients and 235 PD patients. The results show that for both diseases, disease-specific QoL can be considered as one construct. The stability over time of the structure of the QoL models was satisfactory. In PD the factor loadings between the dimensions and QoL were within a small range and remained the same over time, while in IBD, the factor loadings had a larger range and fluctuated more. These results imply that one meaningful sum score can be obtained from these questionnaires.

Adult↗
PubMed2006

Support group participation among persons with HIV: demographic characteristics and perceived barriers.

Support groups are widely available for persons living with HIV and some evidence supports their efficacy. However, limited information exists regarding characteristics of those who utilize HIV support groups. The present study examined demographic characteristics and perceived barriers of attenders and non-attenders of HIV support groups via a mail survey. The 35 respondents were predominantly white (71.4%), male (65.7%), homosexual/bisexual (57.1%) and diagnosed with HIV within the last five years (62.8%). Results suggested that HIV support group attenders had higher educational attainment and a longer time since diagnosis than non-attenders. Respondents who expressed interest in HIV support group participation were diagnosed more recently than those who did not express interest. Respondents who had attended other types of support groups reported fewer perceived barriers to participation in HIV support groups. Overall, findings suggest that the perception of barriers may be related to interest and participation in support groups for HIV and other problems.

Adult↗
PubMed1999

An analysis of catering options within NHS acute hospitals.

Reforms of the NHS's healthcare structure have placed additional pressure on all aspects of hospital management. Evaluation of the effects of these reforms is difficult without more information on current conditions. Hospital catering in acute care trusts has little contemporary background research available. With this in mind, a survey of all the acute care NHS trusts within the eight regions in England was undertaken to investigate the hospital meal service process. A mailed questionnaire asked for the meal production system, food service method and food delivery personnel used by each trust, and a copy of a weekly menu. Results, from an 80.7 per cent response rate, indicate that most trusts use batch cooking to prepare their meals, and plated meal service to deliver the food to the wards. Almost 75 per cent of the trusts use nurses, at least in part, to serve food. English foodstuffs dominate the menus. Most of the trusts have moved towards meeting the goals set by the Patients' Charter and other NHS recommendations.

Cooking↗
PubMed2001

Sleep problems: a predictor of long-term work disability? A four-year prospective study.

AIMS: This study investigates sleep problems as a predictor of long-term work disability. METHODS: Data from a community-based four-year prospective study were used. In 1990, all inhabitants of the municipality of Ullensaker, Norway, belonging to six age cohorts (20-22, 30-32, 40-42, 50-52, 60-62, and 70-72 years), were mailed a questionnaire. Of the 1,788 responders who were working and not older than 62 years, 1,426 (80%) returned a second questionnaire four years later (1994). RESULTS: Reporting mediocre or poor sleep (in contrast to good) in 1990 was significantly related to long-term work disability (> 8 weeks) during the previous 12 months in 1994 (odds ratio = 2.16; 95% confidence interval = 1.26-3.72), after adjustments for age, gender, civil status, body mass index, emotional symptoms, musculoskeletal pain, self-evaluated health, smoking, physical exercise, job satisfaction, and work characteristics. CONCLUSION: The study indicates that sleep problems are a predictor of long-term work disability.

Adult↗
PubMed1992

[Diffusion of smoking habit in the commune of Florence in 1989].

The results of a study on smoking habits of Florence inhabitants (14 years of age or more) are reported. A random sample of general population of the town (1744 males and 1977 females) was recruited throughout the registration office and interviewed by mail or telephone. General compliance was approximately 85%. Thirty-seven percent of males and 25% of females were current cigarette smokers, 29% of males and 11% of females were ex smokers. Males were heavier smokers both as concerns duration of the habit and daily amount of cigarettes. In males born after 1930 the smoking prevalence decreased gradually by period of birth, while it increased in females born before 1960. As a result the smoking habits of younger cohorts were similar in males and in females. In each sex age-adjusted smoking prevalence showed important differences by educational groups and in respect to national averages.

Adolescent↗
PubMed2006

Distribution of the microelastic properties within the human anterior mitral leaflet.

Knowledge of the biomechanical properties of the mitral valve leaflets and their relation to histologic structure is of importance for understanding the leaflet movement characteristics under normal and pathologic conditions, but such knowledge is not yet available. The aim of this study was to determine biomechanical properties of the human anterior mitral leaflet on a microscopic scale. We used scanning acoustic microscopy (SAM) to examine the human anterior mitral leaflet. Sections of fixed human anterior mitral leaflet tissue were obtained from postmortem human anterior mitral leaflets (n = 5). We measured the speed of sound (nu(L)) in each histologic layer in three regions-of-interest (ROIs): these were at the annular edge, at the valve midpoint and close to the free edge. nu(L) varied in the three histologic layers (p < 0.01). It was higher in the fibrous layer (1.76 km/s) compared with the atrial layer (1.75 km/s) and ventricular layer (1.73 km/s). Also, nu(L) differed between positions along the length of the annulus-free edge line (p < 0.01), showing a decline from the annular edge (1.76 km/s) to the free edge (1.73 km/s), both as a whole and also within the atrial and the fibrous layer. These results demonstrate that the fibrous layer is stiffer than the atrial and ventricular layer and that the leaflet as a whole and within the atrial and the fibrous layer is stiffer at the annulus part in comparison with those near the free edge. (E-mail: ).

Adult↗
PubMed1987

Female-male differences in patients with primary lung cancer.

This report is based on responses to a mailed questionnaire from 927 patients with lung cancer (730 men, 197 women), or their next of kin, and information obtained from the Saskatchewan Cancer Foundation Tumour Registry. Women were diagnosed at an earlier mean age than males (means +/- SE, 63.5 +/- 0.85 years versus 67.6 +/- 0.37 years, P less than 0.001), a finding which was consistent for each major histologic type. Women were more frequently diagnosed before age 60 years (42.0%) than were men (25.6%) (P less than 0.001). Female patients were significantly more likely to be lifetime nonsmokers of cigarettes than male patients (23% versus 3.7%, P less than 0.001). Among current smokers, women started smoking at an older age (19.3 +/- 0.69 versus 16.5 +/- 0.21 years, P less than 0.001), smoked for fewer years (41.0 +/- 1.2 years versus 47.4 +/- 0.57 years, P less than 0.001) and smoked slightly fewer cigarettes per day than male patients (23.6 +/- 1.0 versus 26.7 +/- 0.63, P less than 0.05). Similar results were found for the duration of the smoking habit and number of cigarettes smoked among exsmokers. When current smokers and exsmokers were combined, the distribution of pack years by gender was significantly different. A higher percentage than expected of women as compared to men, are clustered in the lower pack-year categories (P less than 0.0003). No occupational exposure or familial factors which might act in synergism with cigarette smoking were identified. Thus, women developed primary lung cancer at an earlier age while smoking for fewer years than men.

Age Factors↗
PubMed1998

Dietary intervention for cholesterol reduction in public clinic patients.

OBJECTIVES: To test the feasibility and effectiveness of a diet intervention (consisting of interactive mailings, computer-generated phone calls, and classes) in hypercholesterolemic low-income public clinic patients. METHODS: Clinic patients with serum cholesterol > 200 mg/dl, referred by their primary care physician were randomized to a 6-month special intervention (SI) or usual care (UC). The intervention included mailings, computer phone calls, and four 1-hour classes. Serum total cholesterol (TC) was measured before and after intervention, and participation was monitored. RESULTS: One hundred sixty-five of the 212 patients referred (77.8%) agreed to participate. A medical records review revealed 123 (74.5%) met eligibility criteria. Eligible subjects had a mean age of 56.7 years, 80.0% were African American, 74.8% were female, 33.6% were married, and 89.4% had a high school or lower education. Subjects were randomized with 80.5% (99) completing follow-up cholesterol measures. SI subjects were encouraged to use all three components, with 84.6% (55 of 65) actively participating in at least one component. Seventy-two percent (47 of 65) returned at least one mailing, 49.1% (28 of 57) of those with touch-tone phones accessed the computer system, and 43.1% (28 of 65) attended classes. The TC in SI decreased from 273.2 mg/dl to 265.0 mg/dl (P = 0.05) and in UC 272.4 mg/dl to 267.6 mg/dl (P = 0.32). The net reduction in SI compared with UC was 3.4 mg/dl (P = 0.58). CONCLUSIONS: (1) Low-income public clinic patients will participate in diet interventions, (2) computer-generated interactive phone calls are feasible in this population, and (3) clinically meaningful decreases in serum cholesterol are difficult to achieve with interventions of practical intensity.

Analysis of Variance↗
PubMed1995

A survey of marketing practices by family practice residency programs.

The purpose of the study reported in this article was to identify marketing practices that are being utilized by family practice residencies in the United States and to differentiate which strategies were felt to be most useful. A survey questionnaire on marketing strategies was mailed to 361 civilian family practice residencies listed in the 1992 Director of Family Practice Residency Programs. A total of 151 questionnaires were returned for a total response rate of 42.1 percent. The results were summarized using descriptive statistics and Chi-square analysis. Family practice residency programs use a number of different strategies to attract patients. The effectiveness of a given program is dependent on local factors, program strengths and the target population desired. The three most useful marketing strategies reported in the survey were HMO listings, emergency department referrals, and patient referrals. The three least effective strategies were health fairs, sports physicals, and school presentations.

Academic Medical Centers↗
PubMed2003

[Effectiveness of laparoscopic sacrouterine nerve ablation in our department during the last six years].

INTRODUCTION: Chronic pelvic pain is a very common disease in women. As a final and life-long solution laparoscopic sacrouterine nerve ablation (LUNA) is generally used in the daily practice. OBJECTIVE: To investigate the effectiveness of LUNA by evaluating their results. PATIENTS AND METHODS: Authors performed sacrouterine nerve ablation on 20 patients suffering from chronic pelvic pain. Using visual analogue scale, and with the help of computer database and mailed personal questionnaires efficacy of the method was evaluated. RESULTS: 16 out of 20 cases could be estimated. In 10 patients the level of the pain decreased from 10 to 0, in 2 patients from 8 to 0, while in one from 5 to 0. In 2 patients a decrease from 10 to 4 and 5 was detected in the pain intensity. The level of pain remained unchanged in five patients. There were no side effects during procedures. CONCLUSION: Despite of the low number of the patients authors emphasize the very good effectiveness of laparoscopic sacrouterine nerve ablation in treating of chronic pelvic pain if the procedure is well indicated.

Adult↗
PubMed1999

Interactive versus noninteractive interventions and dose-response relationships for stage-matched smoking cessation programs in a managed care setting.

This study compared interactive and noninteractive smoking cessation interventions for a population of smokers who were all members of 1 division of a managed care company. In addition, it examined whether a dose-response relationship existed. Screening was completed for 19,236 members who were contacted by telephone or mail. Of the 4,653 who were identified as smokers, 85.3% were enrolled. A 2 Intervention (interactive or noninteractive) x 4 Contacts (1, 2, 3, or 6 contacts) x 4 Occasions (0, 6, 12, and 18 months) design was used. The interactive intervention was stage-matched expert-system reports plus manuals; the noninteractive intervention was stage-matched manuals. Contact occurred in 1 of 4 series (1, 2, 3 or 6 contacts) at 3-month intervals. The expert system outperformed the stage-matched manuals, but there was no clear dose-response relationship for either intervention.

Adult↗
PubMed2005

Validity of self-reports of reasons for hospitalization by young adults and risk factors for discordance with medical records: the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

This research focused on the validity of young adults' (mean age=33 years; standard deviation, 3.9) self-reports of reasons for hospitalization and factors affecting validity in a longitudinal cohort study of over 5,000 young adults in four US cities (1985-1998). Self-reported reasons were considered discordant if they differed from those in medical records. Of the 321 self-reported hospitalizations, overall concordance was 92.5%; concordance ranged from 80% for infections to 100% for injuries/fractures and procedures/surgeries. There were no significant differences among mail, telephone, or face-to-face methods of collecting self-reports. In generalized estimating equations analyses, Black race (odds ratio=4.23, 95% confidence interval: 1.72, 10.40; p=0.002) and intravenous drug use (odds ratio=6.06, 95% confidence interval: 1.17, 31.22; p=0.03) were positively associated with discordance. Nonetheless, self-reports by Blacks were 90.0% concordant. Self-reports by Whites were 95.7% concordant. These results suggest that young adults' self-reported reasons for hospitalization are overwhelmingly concordant with medical records. This has important implications, since obtaining medical records has become more costly and logistically difficult.

Adult↗
PubMedDate not supplied

A manpower study of orthodontic specialists for the State of Indiana: a preliminary report.

To develop current manpower data and project the future need for orthodontic specialists, a survey questionnaire was mailed to Indiana orthodontists (90 percent response). In addition, a telephone survey of orthodontic receptionists was conducted during the same time period (95 percent response). In general, orthodontists perceived a lower state of business than did their staffs. About 77 orthodontists are expected to retire by the year 2010. Based on maintaining the adjusted potential patient-to-orthodontist ratio (increasing adult and declining children in the population), it was projected that only about 66 (86 percent) of the retirees require replacement. To maintain manpower at eight percent fewer orthodontists than are currently in practice, three to four new orthodontists per year will be needed in Indiana over the next two decades.

Chi-Square Distribution↗
PubMed2006

[Incidence of hypertension in a cohort of Spanish university graduates: the SUN study].

Hypertension is a major public health problem. However, no estimates of age- and sex-specific incidences are available for the Spanish population. Our objective was to estimate the incidence of hypertension in a cohort of university graduates in Spain. We followed up 5648 individuals aged 25-65 years who were initially free of hypertension, diabetes, and cardiovascular disease for a median of 30 months. New diagnoses of hypertension were identified using mailed questionnaires. We verified all self-reported diagnoses of hypertension. In 18 250 person-years of follow-up, we identified 248 new cases of hypertension. The unadjusted incidences of hypertension in women and men were 8.2 per 1000 person-years (95% CI, 6.7-10.1) and 21.8 per 1000 person-years (95% CI, 18.6-25.4), respectively. The cumulative probability of receiving a medical diagnosis of hypertension by the age of 65 years was 50% among women and 72% among men. In conclusion, we have provided new evidence confirming that hypertension is one of the most important public health problems in Spain.

Adult↗
PubMedDate not supplied

Common fears and their relationship to dental fear and utilization of the dentist.

Common fears were studied by household telephone interviews and mail survey in Seattle, Washington, to determine their relationship to dental fear and to utilization of the dentist. Dental fear was either the first or second most common fear, with a prevalence estimated between 183 and 226 persons per 1000 population. Dental fear was associated with fears of heights, flying, and enclosures. Respondents with multiple common fears other than fear of dentistry were more likely to delay or cancel dental appointments, report a longer period since their last visit to the dentist, and report poorer oral health and less satisfaction with oral appearance. Over 22 percent of the dentally fearful group reported two or more accompanying common fears.

Adult↗