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PubMed2002

Short screening scales to monitor population prevalences and trends in non-specific psychological distress.

BACKGROUND: A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS). METHODS: Initial pilot questions were administered in a US national mail survey (N = 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N = 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey (N = 1000 telephone screening interviews in the first stage followed by N = 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 (N = 36116) and 1998 (N = 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N = 10641) Australian National Survey of Mental Health and Well-Being. RESULTS: Both the K10 and K6 have good precision in the 90th-99th percentile range of the population distribution (standard errors of standardized scores in the range 0.20-0.25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV/SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0.87-0.88 for disorders having Global Assessment of Functioning (GAF) scores of 0-70 and 0.95-0.96 for disorders having GAF scores of 0-50. CONCLUSIONS: The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.

Adult↗
PubMed2006

Prevalence of self-reported epilepsy or seizure disorder and its associations with self-reported depression and anxiety: results from the 2004 HealthStyles Survey.

PURPOSE: To examine the prevalence of self-reported epilepsy or seizure disorder and its association with self-reported recent depression and anxiety in a large sample of the U.S. adult population. METHODS: We analyzed data from adults aged 18 years or older (n = 4,345) who participated in the 2004 HealthStyles Survey, a large mail panel survey designed to be representative of the U.S. population. RESULTS: Among U.S. adults aged 18 years or older, we estimated that 2.9% have been told by a doctor that they had epilepsy or seizure disorder, and an estimated 1.6% and 0.9% had active and inactive epilepsy, respectively. After controlling for demographic characteristics, we estimated that adults with self-reported epilepsy were twice as likely to self-report depression or anxiety in the previous year as were adults without epilepsy, and adults with active epilepsy were 3 times as likely to self-report depression and twice as likely to have anxiety in the previous year as were adults without epilepsy. CONCLUSIONS: Our findings highlight the burden of self-reported depression and anxiety among adults with self-reported epilepsy or seizure disorder, and suggest that healthcare providers should attempt to determine whether adult patients with epilepsy have any psychiatric comorbidity potentially to improve health outcomes. Questions about epilepsy and related factors should be routinely included on population-based surveys so that we can better understand the epilepsy distribution in the U.S. population and identify the unmet health and psychosocial needs of people with epilepsy.

Adolescent↗
PubMed2004

Practice analysis: defining the clinical practice of primary contact physical therapy.

STUDY DESIGN: Nonexperimental descriptive research design. OBJECTIVE: To describe the frequency of use and perceived level of importance of professional responsibilities, procedures, and knowledge areas by physical therapists practicing in primary contact care settings and to compare these data to similar data from physical therapists practicing in nonprimary contact care settings. BACKGROUND: Physical therapy services have moved toward a primary contact model of practice in response to changes in the health care delivery system. Several studies have reported the effectiveness of primary contact physical therapy. However, a practice analysis has not been performed to define the clinical practice of primary contact physical therapy. METHODS AND MEASURES: A sample of 212 physical therapists practicing as primary contact providers in the military and civilian sectors, and a comparison group of 250 physical therapists not practicing as primary contact providers were surveyed. A Delphi technique was used to develop the survey instrument, which was pretested by a pilot group. The final survey instrument consisted of 171 items. Chi-square and Kruskal-Wallis tests were conducted to examine significant differences among the 3 groups (P<.001). RESULTS: Of the 212 surveys mailed to the primary contact group, 119 (56.1%) responses were received (82 military physical therapists and 37 civilian physical therapists). Of the 250 surveys mailed to the comparison group, 103 (41.2%) responses were received. There were numerous significant differences among the 3 groups in professional responsibilities, procedures, and knowledge areas, most notably in the areas of selecting and ordering of imaging procedures, identifying signs and symptoms of nonmusculoskeletal conditions, establishing physical therapy diagnoses, and prescribing over-the-counter medications. CONCLUSION: The study describes the clinical practice of physical therapists functioning in the role of primary contact providers or as members of a diverse team of health care professionals in primary care, which may provide curricular direction to professional, postprofessional, and clinical residency or fellowship-based educational settings.

Adult↗
PubMedDate not supplied

Prevalence and patterns of environmental tobacco smoke exposures among California teachers.

PURPOSE: This study describes the prevalence and patterns of environmental tobacco smoke (ETS) exposure in a large, well-defined cohort of professional, female school employees in California. DESIGN: This is a cross-sectional study based on survey responses from members of the California Teachers Study (CTS) cohort. SUBJECTS: The analyses focused on lifetime nonsmokers (N = 61,899) in the CTS cohort who responded to detailed questions on lifetime ETS exposures in the home, workplace, and other social settings. MEASURES: Demographic characteristics, smoking status, and ETS exposure were based on self-reported data from two mailed surveys. Prevalence estimates within the cohort were compared with those from the California Behavioral Risk Factor Survey and the California Adult Tobacco Survey. RESULTS: ETS exposures were highest for never smokers born in the 1930s (78% in the home, 66% in the workplace, and 48% in other social settings) and steadily declined among participants born in later years. ETS exposure from spousal smoking peaked during the 1950s (37%). In the 1980s, the workplace (28%) replaced the household (19%) as the primary exposure setting. CONCLUSIONS: Consideration of these patterns in the prevalence of ETS exposures is important in the interpretation and design of tobacco-related health studies.

Adult↗
PubMed2000

Conference formats in family practice residencies.

BACKGROUND: This study was intended to establish national baseline data of the current structure of conferences at family practice residencies and to determine if there are differences in conference formats among types of residencies. METHODS: An author-developed survey was mailed to 331 programs stratified by type and randomly selected. Statistical analysis included chi-square tests and non-parametric tests. RESULTS: The response rate was 84%. The average time devoted to lectures was 4.5 hours a week, with the noon hour the most common time. Most speakers were from within the program, and community-based family physicians were rarely present. Structural changes were frequent. CONCLUSIONS: Results indicate that a variety of formats are implemented for meeting Residency Review Committee requirements in the structure of family practice residencies' conferences. Program settings do influence how conferences are structured. More research is needed on this neglected area of formal resident education.

Chi-Square Distribution↗
PubMedDate not supplied

A comparison of general dentists' and pediatric dentists' treatment recommendations for primary teeth.

A survey which included a series of demographic questions, a brief clinical history, and pictures of eight radiographs was mailed to 2000 general dentists and 1000 pediatric dentists. Usable responses were received from 1369 (45%) dentists--765 (38%) general dentists, and 604 (60%) pediatric dentists. The dentists were asked to select the optimal treatment for a specified tooth in each radiograph. The results of this survey indicate that there were differences in the treatment recommendations of general and pediatric dentists. Whether or not pulp therapy was recommended, general dentists frequently recommended restoring teeth with amalgam. Pediatric dentists more frequently recommended restoring primary teeth with stainless steel crowns. There were differences in treatment recommendations within each group of practitioners, as well as between the two groups.

Chi-Square Distribution↗
PubMed1995

Prevalence and work-relatedness of self-reported carpal tunnel syndrome among U.S. workers: analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey.

To estimate the prevalence and work-relatedness of self-reported carpal tunnel syndrome (CTS) among U.S. workers, data from the Occupational Health Supplement of 1988 National Health Interview Survey (NHIS) were analyzed. Among 127 million "recent" workers" who worked during the 12 months prior to the survey, 1.47% (95% CI: 1.30; 1.65), or 1.87 million self-reported CTS, and 0.53% (95% CI: 0.42; 0.65), or 675,000, stated that their prolonged hand discomfort was called CTS by a medical person. Occupations with the highest prevalence of self-reported CTS were mail service, health care, construction, and assembly and fabrication. Industries with the highest prevalence were food products, repair services, transportation, and construction. The risk factor most strongly associated with medically called CTS was exposure to repetitive bending/twisting of the hands/wrists at work (OR = 5.2), followed by race (OR = 4.2; whites higher than nonwhites), gender (OR = 2.2; females higher than males), use of vibrating hand tools (OR = 1.8), and age (OR = 1.03; risk increasing per year). This result is consistent with previous reports in that repeated bending/twisting of the hands and wrists during manual work is etiologically related to occupational carpal tunnel syndrome.

Adolescent↗
PubMed2005

Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings.

Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women.

Adolescent↗
PubMed2001

Professional integrity in the age of managed care: views of physicians.

At the end of 1997, one quarter of the American public used health maintenance organizations. This paper reports findings on physicians' perspectives on the role of managed care in their professional practices. The research data come from mailed surveys to physicians who are selected from the Cigna Directory of Physicians practicing in the State of Ohio. Subjects were asked to explain what managed care meant to them, and how long they have been practicing medicine. Questions also focused on professional autonomy, quality of care and career aspirations for the future. The results from the study suggest that managed care has had a negative impact on how physicians practice medicine. Several of our respondents reported that they are playing the role of a "double agent" and feel a sense of frustration in doing so. The degree of antipathy toward managed care differs between primary care physicians and specialists.

Age Factors↗
PubMed2005

Reasons for delaying childbearing--a survey of women aged over 35 years seeking assisted reproductive technology.

BACKGROUND: Many women seeking assisted reproductive technology for their first planned pregnancy may be unaware of the impact of age on fertility. METHOD: An anonymous mailed survey to women aged over 35 years with no previous planned pregnancies, registered with Monash IVF between January 2002 and May 2003. RESULTS: One hundred and fifty-two out of 266 surveys were completed (57%). The most common reported reasons for delaying pregnancies were: not having a partner (50%), wanting financial security (32%) and a career (19%) before having a family, only recently becoming interested in having children (26%), and being unaware of the impact of age on fertility (18%). DISCUSSION: Some reported reasons for delaying childbearing were beyond personal control. Lack of awareness of the impact of age on fertility may have contributed to the delay in a proportion of the women surveyed.

Adult↗
PubMed2000

Cigarette smoking and the risk of thyroid cancer.

Thyroid cancer, whose aetiology is largely uncertain, has been negatively associated with cigarette smoking in a number of studies, possibly consistent with the greater occurrence of the disease in women than in men. This association was explored in the context of a Canadian case-control study of thyroid cancer. Newly diagnosed cases were identified primarily through provincial cancer registries in Canada and controls were identified from the general population. Data were collected through mailed questionnaires, yielding 1224 cases and 2659 controls. Reduced risk was observed for ever/never cigarette smoking (risk ratio estimate (RR) of 0.71 (95% confidence interval (CI)=0.60-0.83) for females and 0.77 (95% CI=0.58-1.02)) for males. Dose-response effects were observed with duration, quantity smoked and pack-years of exposure, although there was no decreasing protective effect with the age started smoking or years since stopped smoking. There is evidence of reduced risk for all histological subgroups. The protective effect of smoking may be due to a number of different mechanisms, including an effect on thyroid stimulating hormone and on oestrogen metabolism.

Adolescent↗
PubMed2003

Properties of the Picker Patient Experience questionnaire in a randomized controlled trial of long versus short form survey instruments.

BACKGROUND: The purpose of this study was to compare the performance of the 15-item Picker Patient Experience questionnaire (PPE-15) when embedded in a short form instrument as compared with a longer form measure. METHODS: A postal questionnaire survey of patients recently discharged from two hospital trusts was carried out. Patients were randomized to receive the PPE-15 in either a four-page or a 12-page survey instrument. RESULTS: A total of 1445 questionnaires were mailed to patients in either four- or 12-page formats. A total of 949 (65.67 per cent) forms were returned. No difference in response rate was found between the two versions of the questionnaire. Item completion and psychometric properties of the PPE-15 were not found to differ significantly between the two arms of the trial. CONCLUSION: In this survey the length of questionnaire in which the PPE-15 was embedded had no impact in terms of response rate or data quality. Consequently, the results suggest that length of questionnaire, up to the 108 items included in the 12-page survey, is unlikely to adversely affect results on the PPE-15.

Chi-Square Distribution↗
PubMed2003

Reported exposures, stressors, and life events among Gulf War Registry veterans.

We investigated the association of 15 exposures, 10 stressors, and 18 life events with illness symptoms reported by 978 veterans who believe they suffer from Gulf War-related illnesses. A mail survey was completed by veterans (60% response rate) from the Gulf War Health Registry. Variables most associated with high symptom group membership were reported chemical/biologic warfare (CBW), concerns with infection and faulty equipment, feelings of mistrust in the military, and disability leading to work stoppage within 2 years after the war. These data suggest that belief in CBW exposure, and the experience of war stress and serious negative life events after the war, are important concomitants of Gulf War illness. Models seeking to explain Gulf War symptoms need to incorporate a range of exposure and psychosocial factors to fully account for important influences.

Adult↗
PubMed2000

Telepathology by the Internet.

A new concept for telemicroscopy has recently been introduced using the Internet and conventional web browser, with Java support for microscope remote control as well as image transfer and discussion (http://amba.charite.de/telemic/). The system has two major components: the telemicroscopy server, which is a computer with Internet access connected to the automatic microscope, and the telemicroscopy client, who remotely operates the microscope. This simplified telemicroscopy system allows any Internet user to become a consultant for telepathology without the acquisition of specialized hardware or software. For the inquirer seeking advice, however, this solution is still very expensive, since it requires a fully automated microscope. The present study describes a system that can be used for conventional microscopes. A video camera mounted on a microscope with a photo tube is connected to the frame grabber of a PC. Java-based telemicroscopy software transforms the computer into an Internet server, which automatically distributes new microscope images, after manual operations, to all connected clients. Any Internet user can access the web page of the server to become a telemicroscopy client. A Chat function allows for the online exchange of written text and a Discuss function enables the mouse button to display an arrow to all connected clients, which highlights distinct structures of the images. The system was optimized for simplicity, while presenting all features that are necessary to show and discuss difficult cases with any expert in the field who has Internet access. It offers new perspectives for telepathology and it is envisaged that many pathologists and scientists will use this facility to connect their personal microscopes to the Internet, forming a network for teleconsultation. To foster this development, the software described in this paper is being made freely available. Hopefully, this development will promote communication between pathologists and may thus increase the quality of diagnosis. Information on inquiry and installation of the software is available at the website mentioned above. Telemicroscopy sessions using the Telemic version for conventional microscopes can be scheduled by contacting the authors by e-mail (iver. petersen@charite.de).

Communication↗
PubMed2002

Prevalence and methodology of patch testing by allergists in the United States: results of a cross-sectional survey.

BACKGROUND: Patch testing is considered the gold standard for the diagnosis of allergic contact dermatitis. Whereas previous surveys have evaluated the patch testing practices of dermatologists, little information is available on the use of patch testing by allergists. OBJECTIVE: The objective of this study was to examine the prevalence of patch testing and associated methodologies used by allergists in the United States. METHODS: A cross-sectional survey of all US Fellows of the American Academy of Allergy, Asthma and Immunology was conducted. RESULTS: Of 1,239 questionnaires mailed, 519 (42%) were returned. Fifty-three percent of allergists reported performing patch testing. The majority (89%) patch tested 5 or fewer patients per month. Allergists who evaluated for latex allergy were twice as likely to patch test than those who did not. The most common patch test reading schedule was at both 48 and 72 hours (48%). Thirty-three percent of respondents performed only a single patch test reading. The majority (72%) used TRUE Test. Only 4% patch tested for Type IV allergy to dust mites. CONCLUSION: Many more allergists patch test than initially hypothesized. The patch testing methodologies used by allergists are similar to those of dermatologists.

Allergens↗
PubMed2003

The role of medical students in curriculum committees.

BACKGROUND: Medical students often play a role in local curricular issues by assessing the curriculum and bringing consumers' perspectives to curricular committees. PURPOSE: To identify the formal roles that medical students play on curriculum committees. METHODS: Mail survey to associate deans of medical education at all U.S. medical schools (N = 144). RESULTS: A total of 109 surveys were returned (response rate = 75.7%). Students had formal roles on the curricular committees at 100% of the respondent institutions. The majority of medical schools allow peers to elect their representatives to the committee (53.2%). Students have a right to vote on curricular changes at 86% of the respondent institutions. The vast majority of respondents (97.2%) felt that medical students were important in initiating curricular change. CONCLUSIONS: Medical students play an active role on curriculum committees at U.S. medical schools. Further research is needed to fully elucidate these specific roles.

Chi-Square Distribution↗
PubMed1994

Dental caries and fluorosis in 7-9 and 11-14 year old children who received fluoride supplements from birth.

One hundred and sixty children who had lived from birth in a region with low fluoride levels in the drinking water, and who had been offered sodium fluoride supplementation in the form of drops for daily use, were examined to evaluate dental caries and dental fluorosis. Two age ranges were selected: 7-9 years and 11-14 years. In addition to the dental examinations, questionnaires were mailed to the parents, followed-up by telephone interviews, to gather information on compliance with the fluoride supplementation program. The results showed no statistically significant differences in dental caries activity between the regular and irregular users of fluoride supplementation. Considerable dental fluorosis was found in both regular and irregular user groups of the fluoride supplement (38 to 63 per cent of the children seen), however, with no statistical difference between the user groups. Most of the fluorosis detected was of a mild degree. Fluoride supplementation under the daily control of a parent or child is not recommended because of the difficulty in maintaining regular compliance and the risk of fluorosis.

Adolescent↗
PubMed1995

[Image data bases and multimedia works on server and CD-ROM in medical imaging. A French experience].

The CD-ROM technology allows the production of multimedia works which costs far less than books do. The creation of Internet and the servers World Wide Web has the advantage of distributing those works world wide, without the difficulties and the delays related to books and magazines distribution. The Teachers' Council of Radiology of France (CERF) and the French Society of Radiology (SFR) have opted to use these new media and these information highways to spread a part of their radiology teaching work. Iconocerf is a software program which allows to create, store, read and to exchange digitized radiological cases. It's available free of charge, within the CERF and SFR. The CD-ROMs Iconocerf-Medimag contain 3,500 radiological files with 15,000 images, previously on the videodisc Medimag. The Server of the French Radiology is a W3 server which includes: the CERF directory, a guide for the teachers, the research workers and the students in Radiology and Medical Imaging. It also contains the teaching works on Radiology, and some Iconocerf clinical cases translated onto HTML. The aim of this project is to create an evaluation system for radiology. By using key words, this system allows to consult: radiological clinical cases, located on the server or on CD-ROMs; reference texts; and to have access to the experts' addresses to be able to send them eventually a difficult case through electronic mail.

CD-ROM↗