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PubMed1993

Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization.

OBJECTIVE: To establish basic epidemiological data on chronic pain (duration > 3 months) in a defined population. Relationships between age, gender, and social class were tested. DESIGN: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. SETTING: General populations in two Swedish primary health care districts. Medical care was provided in a state health system. SUBJECTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. OUTCOME MEASURES: Descriptive epidemiologic data in relation to objectives of the study. RESULTS: Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. CONCLUSION: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.

Adult↗
PubMedDate not supplied

Patient satisfaction in a regular and after-hours dental clinic.

To determine whether financial incentives would have an impact on the quality of care, we compared patient satisfaction in a "regular" daytime postdoctoral general dentistry clinic and an "after-hours" clinic, using a 14-item mail questionnaire to a randomly selected sample of adult patients, stratified by age and gender. The providers in both clinics were identical; however, the method of compensation was different. When residents treated patients in the regular clinic, they were paid a fixed stipend, while the "after-hours" clinic residents' compensation was fee-for-service. The percentage of patients giving very favorable or favorable responses was high in both clinics. However, the response of patients in the "after-hours" clinic was more favorable for total number of visits required for care to be completed, management of pain, and politeness of receptionists. This study demonstrated that the payment of financial incentives to residents did not reduce and may even have enhanced patient satisfaction.

Adult↗
PubMed2004

Epidemiology of acute myocardial infarction in Romanian county hospitals: a population-based study in the Baia Mare district.

UNLABELLED: The epidemiological characteristics, the methods used in treating the patients, as well as the evolution of the myocardial infarction are not known in the Romanian county and municipal hospitals. MATERIAL AND METHODS: Six hundred and fifty one cases of acute myocardial infarction were retrospectively recorded in the Emergency County Hospital of Baia Mare from 1.01.1999 till 30.09.2003. Data on treatment delay, therapeutic strategies, duration of hospitalization and outcome were collected. The study was completed by a postal investigation which was carried out from the 1st of October until the 31st of December 2003. This investigation consisted in one application form (multiple choice answers were requested) which had been handed out to the patients who survived the acute episode and left the hospital. RESULTS: The first medical care took place for 60.9% of the patients in hospital. About 72% of these patients were male and the mean age was 66 +/- 12 years. The types of myocardial infarction with ST-segment elevation STE-MI represented 67%, followed by 29.5% with no ST-segment elevation NSTE-MI, and 3.5% with undetermined ECG. The maximum values of Killip class during the first 48 hours were: I in 55% of the patients, II in 23%, III in 14% and IV in 9% of them. The thrombolytic therapy was done in 31% of the patients who were recommended to receive a reperfusion treatment. During their first period in hospital, 37% of the patients had an effort test and 2.45% were transferred to a tertiary care hospital for invasive procedures. The overall median hospital stay was 9 days. The mortality in hospital was 13.6%, respectively 8.1% in the study group who received the reperfusion therapy and 15.2% among those who had followed the standard care. The results of the mail survey revealed that only 62% of the patients who answered the questionnaire (N=498) had regular cardiologic check ups and 43% underwent a treatment with beta-blockers and 12% a treatment with statins. Out of these patients 16% had a revascularization procedure that was performed in a specialised University Hospital. The overall mortality in the responder group was 35.5% with an estimate 7.5% year rate. CONCLUSIONS: The analysis of the present data and especially the rate of mortality suggest until two times higher values in comparison to the European average. These results demonstrate the fact that it is imperative to generalize the thrombolytic therapy in all the hospitals in Romania and give a wider access to the myocardial revascularization therapies.

Aged↗
PubMed1998

Regional disparities in cardiovascular risk factors in France: a five-year analysis of the GAZEL cohort.

OBJECTIVES: the study was set up to explore regional disparities in France in the annual prevalence of cardiovascular risk factors (hypertension, high lipids, obesity, diabetes and tobacco consumption) and protective factors (alcohol intake) in members of the GAZEL Cohort and to determine which, if any, risk factors followed the same north-south gradient as the one known for cardiovascular mortality. METHODS: the population studied comprised 18,070 subjects aged from 35 to 50 years, employed by the French national gas and electricity company. Every year from 1989 to 1993 they received a self-administered questionnaire by mail. From the replies, differences in risk factor prevalence were evaluated by an odds ratio adjusted for sex and age, using a marginal model. RESULTS: a regional effect was found (p < 0.001) for arterial hypertension, with high odds ratios in northern France and low ratios in the south east, for high lipids, with high odds ratios in Champagne, the Loire region and Upper Normandy and low ratios in the south east and the Paris area, and for obesity, with high odds ratios in the north and north east and low ratios in the south, south east and west. CONCLUSION: these results show a gradient between the north and south east for hypertension, obesity, and to a lesser degree high lipids. This gradient corresponds to the known regional disparities for cardiovascular mortality.

Adult↗
PubMed2002

Coaching commitment and turnover: a comparison of current and former coaches.

Although coaching continuity is thought to be important in developing and sustaining quality sport programs, coach turnover is not well understood. Consequently, we used a commitment model to address why some coaches maintain their involvement while others discontinue coaching. For this study, 469 USA Swimming age-group coaches completed a mail survey designed to assess commitment model constructs, including coaching satisfaction, benefits, costs, investments, alternative options, social constraints, and commitment. To test the commitment model, we first used structural equation modeling to assess whether the model provided an adequate fit to the data for current and former coaches. Overall, satisfaction and investments were significantly related to commitment. Moreover, the standardized path coefficients between benefits and costs and satisfaction were also significant. Multivariate analysis of variance andfollow-up analyses revealed that current coaches reported higher commitment as well as less attractive alternative options, higher investments, and higher social constraints compared to former coaches. In replication of past research, we compared current andformer coaches on the benefits and costs associated with coaching.

Adolescent↗
PubMed1999

The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change.

Responsiveness is an important property of an outcomes questionnaire. It can be defined as the ability of an instrument to capture important changes in a patient's health status over time. The authors previously designed the Michigan Hand Outcomes Questionnaire (MHQ), a hand-specific outcomes instrument that contains six distinct scales: (1) overall hand function, (2) activities of daily living, (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction with hand function. In the first study, the authors demonstrated that the MHQ is a reliable and valid instrument for the hand. The purpose of this second study is to assess the responsiveness, or sensitivity, of the MHQ to clinical change in patient status. A total of 187 consecutive patients with chronic hand disorders completed a baseline MHQ prior to receiving treatment at a university plastic surgery clinic. Approximately 6 to 18 months after completing the first questionnaire, patients were sent a follow-up MHQ by mail. The second questionnaire was identical to the first, with the exception of one additional question added to each of the six MHQ scales. This additional question asked patients to rate the change in their hands since completing the last questionnaire using a seven-point response scale. Spearman's correlation coefficient was used to correlate the responses from patients' self-assessment questions with the actual score change (after score - before score). The response rate for the second administration was 49% (92 questionnaires returned)-a fairly good rate of return for mail surveys. There were no significant differences in gender, race, education, and income between responders and nonresponders. When patients' self-assessment of change was correlated with the change in the six scale scores over time, all six correlations were statistically significant, with p < 0.05. The correlations ranged from 0.25 for the aesthetics scale to 0.43 for the pain scale. The MHQ was responsive using patients' self-assessment of their clinical change. Future studies will evaluate the responsiveness of the MHQ compared with objective physiological measures such as grip strength, range of motion, and the Jebson-Taylor test. Additionally, research is underway to assess the responsiveness of the MHQ for specific procedures, including metacarpophalangeal arthroplasties for rheumatoid arthritis and microvascular toe-to-hand reconstructions.

Adult↗
PubMed1998

[The coverage of vaccines systematically administered and of a vaccine against Haemophilus influenzae type b prior to its inclusion in the vaccinal calendar in the Valencian Community].

OBJECTIVE: The objective of this study was to estimate the vaccine coverage among children two years of age in the Community of Valencia, Spain, in 1997. PATIENTS AND METHODS: Cluster sampling was used to assess vaccine coverage. Clusters were villages randomized according to their population < 5 years of age. At least 7 children of each of the 30 selected clusters were randomly selected from the database of newborn metabolic screening. Parents were contacted and vaccine registration cards requested by mail. RESULTS: Four hundred forty subjects were selected. Eight percent of the families had moved and were not contacted. Sixty-nine percent participated in the study. Coverage for three doses of DTP was 97.8% and 87.6% for four doses. MMR vaccine coverage was 96.6% and three doses of hepatitis B had been given in 95.1%. H. influenzae type b (Hib) vaccine coverage was 57%. In 70% of the studied cases of non-participants, vaccine coverage was known through vaccination centers and was very similar to that of the participants. CONCLUSIONS: Vaccine coverage in the Community of Valencia is high for the scheduled vaccines. Although Hib is not a scheduled vaccination, its coverage was 57%.

Chi-Square Distribution↗
PubMed2001

Diabetic retinopathy: effects of national guidelines on the referral, examination and treatment practices of ophthalmologists and optometrists.

OBJECTIVE: To investigate the changes in referral, examination and treatment practices for diabetic retinopathy by ophthalmologists and optometrists following the release of national guidelines. METHODS: A two-page self-administered questionnaire was mailed to all Australian ophthalmologists and a random sample of 500 Australian optometrists prior to and 1 year after release of the National Health and Medical Research Council of Australia (NHMRC) clinical practice guidelines for the management of diabetic retinopathy. The questionnaires elicited information about current practice related to the management of patients with diabetic retinopathy. RESULTS: Of the 464 contactable ophthalmologists who responded to the baseline survey, 374 (80.6% response) completed the follow-up survey The response rate for the contactable optometrists was 80.1% (310 of 384). There were almost no significant changes in management practices from baseline to follow up. For example, the percentage of ophthalmologists who reported that they were often or almost always confident in detecting moderate retinal thickening near the macula remained nearly identical from baseline to follow up (80.2% vs 79.1 %). The rate was also similar from baseline to follow up for optometrists (31.1% vs 28.8%). The one area in which ophthalmologists reported significant changes in management towards agreement with the NHMRC guidelines was use of angiography; they were less likely to manage their patients this way (20.4% vs 14.2% with laser and 48.9% vs 38.4% without laser for increasing level of severity in clinical signs; both P < 0.05). CONCLUSIONS: The NHMRC guidelines for diabetic retinopathy have been successfully distributed to ophthalmologists and optometrists in Australia. However, the mere provision of the guidelines has had little impact on management practices. It will be important to determine if ongoing dissemination and implementation strategies not only increase awareness of health-care practitioners to the guidelines, but also change behaviours.

Adolescent↗
PubMed1998

Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants.

Compared to research on displaced persons whose refugee status has been endorsed prior to arriving in Western countries, there is little systematic information available about levels of past trauma, postmigration living difficulties and psychiatric symptoms amongst asylum-seekers who claim refugee status only after arrival. Asylum-seekers, authorized refugees and immigrants of Tamil background were recruited by personal contact and mail-out in Sydney, Australia. A total of 62 subjects, constituting approximately 60% of the estimated pool of Tamil asylum-seekers, agreed to participate in the study. They returned statistically significantly higher scores than immigrants (n = 104) on measures of past trauma, symptoms of anxiety, depression and post-traumatic stress, and on all dimensions of postmigration difficulties. Asylum-seekers did not differ from refugees (n = 30) on measures of past trauma or psychiatric symptoms, but they scored higher on selective components of postmigration stress relating to difficulties associated with their insecure residency status. Although limited by sampling and diagnostic constraints, the present study suggests that asylum-seekers may be a high-risk group in relation to ongoing stress in the postmigration period.

Acculturation↗
PubMed2002

Mode effects for collecting alcohol and other drug use data: Web and U.S. mail.

OBJECTIVE: The present study examined mode effects for collecting alcohol and other drug use data using a Web-based survey mode and a U.S. mail-based survey mode for comparison. METHOD: A survey regarding alcohol and other drugs was administered to a randomly selected sample of 7,000 undergraduate students attending a large midwestern research university in the spring of 2001. The sample was randomly assigned to either a Web-based survey mode (n = 3,500) or a U.S. mail-based mode (n = 3,500). RESULTS: The Web survey mode of administration resulted in a final sample that more closely matched the target sample in gender mix than did the U.S. mail survey mode. The response rate for the Web survey mode was significantly higher than for the U.S. mail survey mode. Chi-square results indicated there were significant differences in response propensity by several sample characteristics including sex, race, class year and academic credit hours. Multivariate logistic regression results revealed significant racial and gender differences in the response propensity between and withinmodes. After controlling for design discrepancies, there were no significant differences between modes in data quality or substantive responses to substance-use variables. CONCLUSIONS: The findings of the present study provide strong evidence that Web surveys can be used as an effective mode for collecting alcohol and other drug use data among certain populations who have access to the Internet and high rates of use. Web surveys provide promise for enhancing survey research methodology among undergraduate college students.

Adolescent↗
PubMed2002

Risk factors for multisymptom illness in US Army veterans of the Gulf War.

This research study examined the prevalence of symptoms and identified risk factors for reported symptoms among a group of Army Gulf War (GW) veterans. A survey was mailed to all members of the Ft. Devens cohort in 1997, representing the third assessment of a group that consisted of 2949 US Army soldiers deployed to the Gulf, and was studied initially in 1991. A total of 1290 subjects responded to the mailed survey; aggressive follow-up methods to address non-response bias were employed. Subjects were classified as having multisymptom illness if they reported symptoms from at least two of three symptom categories (fatigue, mood-cognition, musculoskeletal). Sixty percent of the respondents met criteria for multisymptom illness. Female gender, lower levels of education, psychological symptoms, self-reported use of a medical clinic in the Gulf, ingestion of anti-nerve gas pills (pyridostigmine bromide), anthrax vaccination, tent heaters, exposure to oil fire smoke, and chemical odors were significantly related to multisymptom illness in logistic regression analyses. Analyses in which subjects were stratified by level of psychological symptoms revealed different sets of GW-service environmental exposures and suggest that subgroups of GW veterans may have different sets of risk factors.

Adult↗
PubMed2004

Intrathecal midazolam I: a cohort study investigating safety.

UNLABELLED: Despite conflicting evidence regarding the safety of intrathecal midazolam from animal investigations, its clinical use is increasing. We investigated the potential of intrathecal midazolam to produce symptomatology suggestive of neurological damage. This study compared two cohorts of patients who received intrathecal anesthesia with or without intrathecal midazolam (2 mg). Eighteen risk factors were evaluated with respect to symptoms representing potential neurological complications. The definitions of these symptoms were made wide to maximize the chance of counting patients with neurological sequelae after intrathecal injections. Eleven-hundred patients were followed up prospectively during the first postoperative week by a hospital chart review and 1 mo later by a mailed questionnaire. Symptoms suggestive of neurological impairment, including motor or sensory changes and bladder or bowel dysfunction, were investigated. Intrathecal midazolam was not associated with an increased risk of neurologic symptoms. In contrast, neurologic symptoms were found to be increased by age >70 yr (relative risk, 8.72) and the occurrence of a blood-stained spinal tap (relative risk, 8.07). The administration of intrathecal midazolam, 2 mg, did not increase the occurrence of neurologic or urologic symptoms, as suggested by some preclinical animal experimentation. IMPLICATIONS: Intrathecal midazolam provides segmental analgesia, but conflicting animal studies have cast doubts on its safety. This investigation studied the effect of intrathecal midazolam by observing two cohorts of patients. In clinical practice, intrathecal midazolam (2 mg) did not increase adverse neurological symptoms compared with conventional therapies.

Aged↗
PubMed2001

Influenza vaccination uptake in 1999 and older persons recall of vaccination.

The aims of this study were to assess the uptake of the influenza vaccine by medical card patients aged 65 years and older and to assess if using older persons' recall of vaccination was a reliable method of assessing uptake. A questionnaire was mailed to 360 medical card patients aged 65 years and older and from the returns a subset were selected and the GPs contacted to ascertain whether the patients had received the vaccine or not. A total of 293 questionnaires were returned (response rate of 81.4%). One hundred and forty-four (49.1%) stated that they received the influenza vaccine. GPs were contacted in respect of 64 patients to check on their vaccination record. Only 2 (3.1%) of the questionnaires differed to the GP records in respect of vaccination. The result being that the uptake rates as assessed by the patients' recall and by checking GPs records were almost identical. (Kappa statistic: 0.94) In conclusion the uptake for older persons with medical cards was low at 49.1%. Using older persons recall to estimate uptake is valid and accurate.

Aged↗
PubMed2006

A randomized trial to assess the impact of direct reporting of DXA scan results to patients on quality of osteoporosis care.

Consecutive patients identified as having osteoporosis on screening dual-energy X-ray absorptiometry (DXA) scans were randomized to: (1) a patient activation intervention consisting of mailing patients their DXA scan results supplemented by a call from a nurse educator or (2) usual care. Three months after the DXA scan, patients were contacted to assess: (1) use of antiresorptive therapy, (2) osteoporosis specific knowledge, and (3) satisfaction with their osteoporosis-related care. A total of 1,035 consecutive patients were screened to identify 422 eligible patients. Of these, 56 patients met inclusion criteria and were subsequently randomized. At follow-up, use of antiresorptive agents was numerically more common in the intervention arm (62%) than the control arm (54%), but this difference was not statistically significant (p=0.58). Patients in the intervention group were more likely to report being notified of their DXA results in a timely fashion (p=0.03), but osteoporosis-specific knowledge was similar.

Absorptiometry, Photon↗
PubMed1998

Using reference data on quality of life--the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3).

Interpretation of health related quality of life (HRQOL) results in cancer patients is facilitated by knowledge of the levels of HRQOL in the general population. However, direct comparisons can be misleading unless age and gender are considered. We demonstrate the derivation of age- and gender-specific 'expected' values from population reference values by means of simple calculations. This survey included 3000 randomly selected Norwegians above 18 years of age who received the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30 (+3) by mail. 1965 responses from 2,892 eligible persons (68%) were received. The population was divided into six disease groups based on self-reported health problems. The observed mean scale scores of the different groups deviated greatly from those obtained in the general population. The score for physical function, for example, was 72 for cancer patients and ranged from 73.3 to 82.5 in other disease groups, as opposed to 89.9 in the general population and 98.9 in those with no health problems. The range for one of the quality of life (QOL) scales was 57.7 to 84.7 compared with 73.7 in the general population. Expected mean scores for the patient groups were computed from the reference values, based on the concept of equivalence of age and gender. The differences between the observed mean scores and the reference values were strongly mediated by this method. The expected scores for physical function then ranged from 83.3 to 93.1 and from 70.3 to 75 for the QOL scale. The impact of age and gender on the reference data from the EORTC QLQ-C30 (+3) obtained in a general population shows that these variables must be considered when interpreting data on HRQOL for cancer patients. The demonstration of how to generate mean values which are adjusted according to the age and gender distribution of a population should increase the usefulness of this questionnaire among clinicians.

Adult↗
PubMed2004

Impact of a financial incentive on case and control participation in a telephone interview.

The authors investigated the effect of a 5.00 dollars incentive on participation in a telephone interview among cases and controls in an ongoing study of colorectal cancer. Cases and matched community controls were sent a letter introducing the study. One week later, a nurse called to invite the person to participate in a 30-minute telephone interview. After 1 year of data collection (which began in June 2001), the authors began enclosing a 5.00 dollars bill in the initial letter as an incentive. Incentives were mailed to all potential controls. The authors randomized 50% of a subset of cases to receive the incentive. In the year prior to institution of the incentive, 44.2% of 851 controls participated in the interview, as compared with 56.2% of 1,043 controls in the year after the incentive was instituted (p < 0.001). Among cases randomized to receive the incentive (n = 199), 63.8% participated as compared with 68.4% in the nonincentive group (n = 193) (p > 0.05). Among cases aged 60-69 years, the response rate in the incentive group was reduced by 17% (p = 0.03). Thus, among controls, a small monetary incentive appears to promote a feeling of goodwill toward the research. It does not seem to have an equivalent effect among cases, and in the worst case it may insult or annoy some cases who may otherwise have participated.

Age Distribution↗
PubMed1997

The impact of a required college health and physical education course on the health status of alumni.

The impact of a required college health and physical education course on selected health knowledge, attitudes, and behaviors of alumni was evaluated. The design was a cross-sectional study (mail out/mail back survey) using a stratified random sample of 2,000 college alumni. The overall response rate was 50%. Results were analyzed by college of graduation (college with a required health/physical education course versus no required course). Alumni who took the course were more likely to know their blood pressure, blood cholesterol, and recommended dietary fat intake than the comparison group were. They also reported that the course positively influenced their attitudes toward exercise, eating, and smoking They were more likely to engage in aerobic exercise and less likely to smoke; and they had lower intakes of dietary fat, cholesterol, and sodium. The results suggested that a required college course enhanced selected health-related knowledge, attitudes, and behaviors of alumni.

Adult↗
PubMed1990

The Canadian Optometry Survey: report on the utilization of diagnostic pharmaceutical agents by Canadian optometrists.

This study represents the first national survey of optometrists in Canada. A mailed questionnaire was designed and implemented in order to discover how optometrists have reacted to the introduction of diagnostic pharmaceutical agent (DPA) legislation in Canada and to determine what variables are important predictors of DPA use. The data collected were also used to test the null hypothesis that DPA legislation does not affect the use of mydriatic/cycloplegic agents by optometrists. A stratified random sampling procedure was used to select 230 optometrists (roughly 10% of the practicing profession) for inclusion in the study. Over 90% of the subjects completed and returned the questionnaire. A statistically significant and important association was found between mydriatic/cycloplegic drug use and legislation (p less than 0.05 and odds ratio = 2.18). Legislation, type of practice, age, and optometry school attended were all found to be associated with DPA use.

Age Factors↗