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PubMed2006

Results of a questionnaire survey for symptom of late complications caused by radiotherapy in breast conserving therapy.

PURPOSE: The present study aimed to determine the prevalence of subjective symptoms of late complications mainly caused by radiotherapy in breast-conserving therapy (BCT), and to identify patients and treatment factors that may predict such complications. MATERIALS AND METHODS: A cross-sectional survey was conducted on 247 patients who had had early breast cancer and who were free of recurrence after BCT. Self-administered questionnaires were mailed to the 247 patients. Patient and treatment factors were analyzed. RESULTS: Responses were received from 193 of the 247 patients. Common perceptions of late complications included shrinking in size (85%), pain (73%), firmness (65%), thickening of the arm (34%), and changes in skin color (19%). However, high-grade toxicity (above Grade 2) was perceived in only 0.52-7.8% of patients. In multivariate models, shrinking in size was associated with age (P=0.020), pain was associated with additional boost irradiation (P=0.015), and firmness was associated with time after surgery (P=0.004). CONCLUSIONS: Late complications as perceived by the patient herself after BCT are common, but tend to be of minimal severity. Most predictive factors are inevitably associated with late complications. However, the boost irradiation may not be indicated for every patient from a QOL perspective.

Adult↗
PubMed1998

How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women.

In a population-based, retrospective study, we investigated the effect of a previous fracture on the risk of a later fracture. A questionnaire was mailed to 46,353 postmenopausal women aged 50-80 years and 29,802 (64%) responded. Questions were asked about fractures after age 25 and in what year they had occurred. The fractures were grouped according to whether they occurred within 5 and 10 years before answering the questionnaire. The occurrence of a fracture preceding these time intervals increased the odds ratio (OR) of having sustained a hip fracture to 1.6 (95% CI 1.1-2.3) for a previous ankle fracture and to 3.5 (95% CI 2.4-5.0) for a previous humerus fracture. Corresponding figures for having sustained a spine fracture were 1.5 (95% CI 1.1-2.1) for a previous ankle fracture and 4.5 (95% CI 3.4-5.9) for a previous spine fracture. It seems possible to select women for evaluation and intervention against osteoporosis by using information on previous fragility fractures.

Age Distribution↗
PubMed2001

Risk factors for back pain among male farmers: analysis of Iowa Farm Family Health and Hazard Surveillance Study.

BACKGROUND: Back pain causes considerable morbidity, disability, and economic loss among workers. Farmers handle heavy objects, often in awkward postures. However, the prevalence of back pain among farmers and the risk factors associated with back pain are not well known. METHODS: In this study, we assess the frequency of risk factors for back pain among 287 Iowa male farmers. From 1992 to 1994, using a mail questionnaire, we collected data on potential risk factors for back pain. Eighteen months later, we surveyed occurrence of back pain as the outcome measure. RESULTS: Thirty-one percent of farmers reported having daily back pain for a week or more during the past 12 months compared to 18.5% in the general working population. Using a multiple logistic regression model, we found two factors associated with back pain: 45-59 years of age (OR = 2.13, 95% CI 1.02-4.43) and having a non-agricultural job as the major occupation (OR = 2.02, 95% CI 0.98-4.17, P = 0.055). CONCLUSIONS: Farmers had a significantly higher prevalence of back pain than the general working population. Middle-aged farmers and those with additional non-agricultural jobs had the highest risk for back pain.

Adult↗
PubMed2005

Survival after hip fracture.

Although it is known that overall mortality is increased after hip fracture, the influence of hip fracture risk factors on the subsequent mortality and cause of death has not been well studied. The objective of this study was to establish the survival after hip fracture in women and to assess the impact of comorbidity on mortality. We identified a complete population-based set of 2,245 incident hip fracture cases and 4,035 randomly selected population-based controls among women 50-81 years old in Sweden and followed these subjects for an average of 5 years through the Swedish National Inpatient and Cause-of-Death Registers. Information on factors related to hip fracture was obtained through linkage to hospital discharge data and through a mailed questionnaire. We studied excess mortality of hip fracture patients compared to controls using survival curves and proportional hazard regression models. During follow-up, 896 hip fracture patients (40%) and 516 (13%) controls died. The relative risk (RR) of death, adjusted for age and previous hospitalization for serious disease, was 2.3 (95% CI 2.0-2.5). Although the highest mortality risks were in the 1st 6 months post-fracture, RRs for fractures versus controls were increased for at least 6 years. Increased mortality was apparent both in those with evidence of comorbidity and those without. Hip fracture patients have a substantially increased risk of death that persists for at least 6 years post-fracture. The relative excess mortality is independent of comorbidity and known hip fracture risk factors.

Age Distribution↗
PubMedDate not supplied

Measuring patients' medical care preferences: care seeking versus self-treating.

The objectives of this study were (1) to develop a scale to measure patient preferences for using medical care, (2) to assess the reliability and validity of the scale, and (3) to examine factors predicting preferences. Preferences were defined along a continuum, anchored by self-treating preferences and care-seeking preferences. A 9-item scale was developed and mailed to a random sample of 3500 Wisconsin consumers age 50 and older. Ordinary least squares regression was used to examine whether preferences were predicted by demographic and health status variables. A 56.9% usable response rate was obtained. The Medical Care Preference Scale was unidimensional and had a Cronbach's alpha of 0.879. Younger individuals, women, individuals in better health, and individuals from rural areas had significantly stronger self-treating preferences. Significant correlations between the preference scale and 2 measures of health care utlization provided evidence of predictive validity. Individuals with care-seeking preferences used an average of 1.98 more prescription drugs and had 0.50 more physician visits in the past month than individuals with self-treating preferences. The Medical Care Preference Scale should be a useful tool for research on health care utilization.

Adult↗
PubMed1995

Recruitment and retention strategies used by occupational therapy directors in acute care, rehabilitation, and long-term-care settings.

OBJECTIVES: Occupational therapy directors need to recruit and retain therapists to ensure both the delivery of high-quality services and the viability of their departments. At present, research on the recruitment and retention of occupational therapists is limited; recruitment and retention strategies can be cited, but their utility and effectiveness have not been determined. METHOD: A survey was designed to identify the recruitment and retention strategies used in various practice settings and the perceived level of effectiveness of those strategies that were used. The surveys were mailed to 500 occupational therapy directors. Once the sample size was adjusted to exclude ineligible subjects, the eligible sample size was 471. Of these, 320 (68%) were usable. RESULTS: Ten of the 23 recruitment strategies listed on the survey were used by more than 70% of the respondents. The top three recruitment strategies were staff member referrals, professional development opportunities, and newspaper advertisements. Seventeen of the 23 retention strategies listed on the survey were used by more than 70% of the respondents. The top three retention strategies were interpersonal staff member relationships, employee appraisals, and continuing education. CONCLUSION: Findings suggest that occupational therapy departments' recruitment and retention plans could be improved by expanding the number of strategies used and by incorporating techniques that appeal to a broader range of therapists.

Ambulatory Care↗
PubMed1997

Genetic and environmental contributions to healthcare need and utilization: a twin analysis.

OBJECTIVE: An exploratory study to examine the genetic and environmental influences on healthcare-seeking behavior for four health conditions (high blood pressure, mental health problems, joint disorders, and hearing problems). DATA SOURCES: Data collected from 3,602 male-male twin pair members of the Vietnam Era Twin (VET) Registry. STUDY DESIGN: Varying models for the relationship between genetic and environmental influences on health condition liability and on treatment use were tested in an attempt to explain the relative contributions of additive genetic, common, and unique environmental effects to health condition and treatment use. DATA COLLECTION: A mail and telephone survey of general health status was administered in 1987 to VET Registry twins. PRINCIPAL FINDINGS: Variance component estimates under the best-fitting model for the genetic component ranged from 24 percent to 52 percent for the condition status and from 42 percent to 56 percent for treatment-seeking behavior. CONCLUSIONS: Utilization models that consider only environmental parameters will leave a large percentage of variability unexplained. Familial patterns have an impact not only on disease susceptibility but also on healthcare utilization, thereby having lifelong implications for social and fiscal constraints placed on the healthcare system. Thus, explanatory models for healthcare utilization behavior should consider the contribution of genetic factors in the decision to seek and use health services.

Adult↗
PubMed2000

Differences in tobacco assessment and intervention practices: a regional snapshot.

BACKGROUND: This research describes tobacco attitudes and practices of health care providers in the Upper Midwest. A baseline measure of preventive practices by providers was needed to plan effective tobacco intervention education programs. METHODS: Health care providers in a 16-county region received a mailed survey regarding tobacco assessment practices, intervention practices, attitudes, skills/knowledge, barriers, and desire for tobacco education. The survey was sent to all chiropractors, dentists, nurse practitioners/physician assistants, physicians (primary care and specialist), and public health nurses in the region. A total of 51.9% (n = 614) of all providers returned usable surveys. RESULTS: Significant differences were found between provider groups on all measured concepts. Primary care physicians, nurse practitioners/physician assistants, and public health nurses were more likely than specialist physicians, dentists, and chiropractors to assess, intervene, be supportive of tobacco cessation, have skills/knowledge about cessation, perceive fewer barriers, and want further education. CONCLUSIONS: In this region, provider groups differed in tobacco use assessment and treatment. All provider groups desired education regarding tobacco intervention. Region-wide tobacco cessation educational initiatives need to take into account differences between provider groups.

Adult↗
PubMedDate not supplied

A survey of selected Internet pharmacies in the United States.

OBJECTIVE: To determine whether differences in the provision of pharmacy services exist among different types of Internet pharmacies. DESIGN: Survey of selected pharmacies with a presence on the Internet. Data were abstracted onto a data collection form for further analysis. Data collection was limited to 3 weeks. SETTING: U.S.-based Internet pharmacies that allow patients to purchase prescription medications online. Pharmacies were identified using a metasearch engine with the search terms "Internet pharmacy" and "Internet pharmacist." INTERVENTION: Survey. MAIN OUTCOME MEASURES: Comparisons of availability of 10 commonly used products representing a variety of product categories, prescription verification methods, and privacy issues; and determinations of site navigability, drug information and provider access, and payment methods. Sites were categorized as "chain pharmacy extensions," "mail order pharmacies," "independent pharmacy extensions," and "online pharmacies." RESULTS: Thirty-three sites were reviewed. There was significant variation among the four types of pharmacies selling prescriptions over the Internet. Most pharmacies provided all of the drugs in the survey. Patients were required to provide their own prescription at 88% of the sites, and 75% of sites used mail or fax to verify prescription integrity. More than 50% of sites had privacy policies posted, and 64% used cookies. Chain pharmacy extensions required completion of an average of 10.2 pages to order drugs versus 2.4 to 4 pages for all other site types. Drug information was written at an eighth-grade reading level at 36% of the sites. More than two-thirds of the sites provided a toll-free telephone for a health care professional. Nearly 80% of the sites accepted health insurance, and 95% accepted credit cards; however, only 40% used a secure transmission mechanism for patient or payment information. CONCLUSION: Internet pharmacies provide varying levels of service. Policies regarding the use of the Internet for obtaining medications should focus on improving the privacy of consumer information and ensuring the secure transmission of financial information.

Analysis of Variance↗
PubMed2003

Health professionals' views on standards for decision-making capacity regarding refusal of medical treatment in mild Alzheimer's disease.

This study was designed to determine which elements professionals consider important for evaluation of decision-making capacity. Survey with a vignette case report of an individual with mild dementia was mailed to four groups of individuals: 1. members of the Academy of Psychosomatic Medicine, 2. chairs of Veterans Affairs (VA) Ethics Advisory Committees (EACs), 3. randomly selected geriatricians who were members of the Gerontological Society of America (GSA), and 4. randomly selected psychologists who were members of the GSA. Two hundred thirty-seven psychiatrists, 95 VA EAC chairs, 103 geriatricians, and 46 psychologists responded to this survey. The majority of the respondents endorsed all five basic elements as necessary for determination of decision-making capacity in the presented vignette, but only a minority of respondents endorsed all five basic elements, and a small proportion of respondents endorsed only one or two elements. The results indicate that physicians do not use uniform standards for assessment of decision-making capacity.

Aged↗
PubMed1999

Smoking and the functional status of young adults.

OBJECTIVE: To investigate the relationship between smoking and the functional status of young adults. DESIGN: A 4-year prospective questionnaire study. SETTING: The municipality of Ullensaker, Norway. SUBJECTS: 1084 subjects, 20-22 years or 30-32 years of age (the two youngest age-cohorts in a larger population study), completed a mailed questionnaire in 1990. A second questionnaire, mailed to the respondents in 1994, was completed by 753 (69.5%) individuals. MAIN OUTCOME MEASURES: Self-evaluated functional status as measured with the COOP/Wonca Charts. RESULTS: In 1994, respondents who were daily smokers in 1990 reported lower physical fitness, poorer overall health, and more pain, emotional problems, limitations of social activities, and problems in performing daily tasks than nonsmokers. Smoking in 1990 was associated with moderate or low physical fitness (OR = 2.21; 95% CI: 1.19-4.11) and moderate or severe pain (OR = 2.28; 95% CI: 1.32-3.94) in 1994, after adjustment for age, gender, civil state, workplace characteristics, physical exercise, and emotional symptoms. CONCLUSION: Even young adults report a lower functional status if they smoke. If this reflects a causal relationship it could be an important argument when trying to persuade young people to avoid smoking.

Adult↗
PubMed2002

Low back pain as a predictor of long-term work disability.

AIM: To investigate low back pain (LBP), with and without other musculoskeletal pains, as a predictor of long-term work disability. METHOD: A four-year prospective study was conducted. All inhabitants in the municipality of Ullensaker, Norway, born in 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70, received a mailed questionnaire in 1990 and 1994. The present study comprised the 1.788 responders who were working in 1990. Of these, 1426 (80%) returned the questionnaire four years later. The main outcome measure was long-term work disability (>eight weeks) in 1994. RESULTS: LBP in 1990 predicted long-term work disability in 1994 (odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.39-2.74). Localized LBP however, did not predict long-term work disability, while LBP accompanied by widespread pain did (OR = 3.52, 95% CI = 1.09-11.37), also after adjustments for demographic, lifestyle, and work-related factors. Other predictors of long-term work disability were high age, sick leave last year, heavy lifting in the job, poor sleep quality and smoking. CONCLUSION: LBP in persons with widespread musculoskeletal pain predicted long-term work disability, while localized LBP did not.

Adult↗
PubMed2006

Healthcare seeking for constipation: a population-based survey in the Mediterranean area of Spain.

BACKGROUND: The use of healthcare resources for the management of constipation is not well-known. AIM: To analyse healthcare seeking for constipation, defined by three different criteria, and its related factors and to assess the frequency of use of laxatives, suppositories and enemas for the treatment of constipation. METHODS: A cross-sectional study in the general community. A questionnaire comprising 21-items was developed and delivered by mail to a random sample of 506 subjects aged 18-65 years, and belonging to a Spanish population. RESULTS: Seeking of health care was high in the sample (16%) and was similar for all definitions of constipation (over 40% of constipated subjects). It was associated with female gender, a higher educational level and two symptoms, such as prolonged defecation and abdominal pain. A 14% of the sample used laxatives, and about a 25% of constipated subjects used laxatives at least once a week. Utilization was more frequent in women, with no differences by age group. CONCLUSIONS: Chronic constipation is a problem that causes an important consumption of resources in our setting, derived from laxative use and the seeking of medical help to combat the problem. The use of these resources is higher in women.

Adolescent↗
PubMed2003

A snapshot of pulmonary medicine at the turn of the century: the American Thoracic Society membership.

To describe the characteristics of the American Thoracic Society, the Membership Committee developed a survey to assess demographics, training, professional activities, and needs of a diverse membership with a growing international segment. It also provided an opportunity to determine how the Society reflects the current state of pulmonary medicine in the United States. A self-administered survey was mailed to active members. Of responding members, 80% reside in the United States or Canada; the remainder come from 90 different countries. The majority of North American respondents (79%) were white, non-Hispanic. Seventeen percent of respondents were female. Female respondents were younger, with a mean age of 42 years, compared with 47 years for males. Sixty-five percent of respondents identified clinical practice, 20% research, and 5% teaching as their major activity. More women (33%) than men (22%) identified themselves as researchers. The majority of respondents (69%) have a medical school faculty affiliation. The American Thoracic Society represents a global organization with diverse clinical expertise and scientific interests. The majority of respondents are clinicians; however, the membership has a strong academic bent with most reporting academic affiliation, and describing teaching as a secondary activity.

Adult↗
PubMed2002

Use of an Internet-based community surveillance network to predict seasonal communicable disease morbidity.

OBJECTIVES: We designed an Internet-based surveillance network that linked community clinic diagnoses with viral isolation rates and admission patterns at a related children's hospital. We hypothesized that community surveillance would successfully predict subsequent hospital admissions and laboratory viral isolations. Secondarily, we expected the network to monitor trends in disease and that posting this information on a Web site would be useful to physicians in daily practice. STUDY DESIGN: Data were collected from December 1999 through August 2000. Information was summarized and posted weekly on a Web site. Active public piloting of the site took place during August 2000, after which the project was evaluated through an electronic mail survey. The predictive ability of the community surveillance data was evaluated by multivariate linear regression. RESULTS: Increases in the community diagnosis of most syndromes under surveillance, including lower respiratory infections (adjusted R(2) = 0.7086) and gastroenteritis (adjusted R(2) = 0.6532) successfully predicted an increase in subsequent hospital admissions. Community surveillance also successfully predicted laboratory isolation of associated viral organisms. Physicians completing the evaluation (N = 11) indicated that the site provided information useful in daily practice for both physician and parent education. CONCLUSIONS: An Internet-based surveillance network linking a hospital with community physicians is beneficial to the hospital in predicting waves of severe cases requiring admission and reciprocally provides useful information to physicians in daily practice regarding the incidence and cause of seasonal disease in the community.

Attitude to Computers↗
PubMed1998

[Unexplained non-cardiac chest pain; its prevalence and natural course].

OBJECTIVE: (a) To assess whether data on prevalence and natural course of unexplained chest pain are similar to previous results reported for patients with unexplained chest pain in foreign literature; (b) to find biographical or medical record variables predictive of continuing pain. DESIGN: Retrospective research of medical records. SETTING: University Medical Centre and Diaconessenhuis (peripheral hospital), Leiden, the Netherlands. METHOD: Medical records of patients who had been newly referred between 1992 and 1995 to the cardiac outpatient clinic were screened on the discharge diagnosis: unexplained chest pain. Patients were approached by mail with a questionnaire, inquiring about duration, frequency, intensity, functional limitations and medical consumption with regard to their unexplained chest pain. RESULTS: In 39.8% (1053/2648) of the patients, no explanation was found for their complaints. After 12 and 24 months, 72% and 56% respectively reported still having complaints. 37% experienced limitations in daily activities at the time of the investigation. Sex and duration of pain before visiting the cardiologist were predictors of the persistence of chest pain. 31% of the patients did consult their general practitioner at least once more after the discharge by the cardiologist. CONCLUSION: Unexplained chest pain is a common complaint of patients visiting an outpatient clinic for cardiology and often persists. The present results are largely similar to those reported in foreign literature.

Age Distribution↗
PubMed2001

Childhood vaccine risk/benefit communication in private practice office settings: a national survey.

UNLABELLED: Communication about childhood vaccine risks and benefits has been legally required in pediatric health care for over a decade. However, little is known about the actual practice of vaccine risk/benefit communication. OBJECTIVES: This study was conducted to identify current practices of childhood vaccine risk/benefit communication in private physician office settings nationally. Specifically, we wanted to determine what written materials were given, by whom, and when; what information providers thought parents wanted/needed to know, the content of nurse and doctor discussion with parents, and the time spent on discussion. We also wanted to quantify barriers to vaccine risk/benefit discussion and to prioritize materials and dissemination methods preferred as solutions to these barriers. METHODS: We conducted 32 focus groups in 6 cities, and then administered a 27-question cross-sectional mailed survey from March to September 1998, to a random national sample of physicians and their office nurses who immunize children in private practices. Eligible survey respondents were active fellows of the American Academy of Pediatrics or American Academy of Family Physicians in private practice who immunized children and a nurse from each physician's office. After 3 mailings, the response rate was 71%. RESULTS: Sixty-nine percent of pediatricians and 72% of family physicians self-reported their offices gave parents the Centers for Disease Control and Prevention Vaccine Information Statement, while 62% and 58%, respectively, gave it with every dose. In ~70% of immunization visits, physicians and nurses reported initiating discussion of the following: common side effects, when to call the clinic and the immunization schedule. However, physicians reported rarely initiating discussion regarding contraindications (<50%) and the National Vaccine Injury Compensation Program (<10%). Lack of time was considered the greatest barrier to vaccine risk/benefit communication. Nurses reported spending significantly more time discussing vaccines with parents than pediatricians or family physicians (mean: 3.89 vs 9.20 and 3.08 minutes, respectively). Both physicians and nurses indicated an additional 60 to 90 seconds was needed to optimally discuss immunization with parents under current conditions. Stratified analysis indicated nurses played a vital role in immunization delivery and risk/benefit communication. To improve vaccine risk/benefit communication, 80% of all providers recommended a preimmunization booklet for parents and approximately one half recommended a screening sheet for contraindications and poster for immunization reference. The learning method most highly endorsed by all providers was practical materials (80%). Other desirable learning methods varied significantly by provider type. CONCLUSIONS: There was a mismatch between the legal mandate for Vaccine Information Statement distribution and the actual practice in private office settings. The majority of providers reported discussing some aspect of vaccine communication but 40% indicated that they did not mention risks. Legal and professional guidelines for appropriate content and delivery of vaccine communication need to be clarified and to be made easily accessible for busy private practitioners. Efforts to improve risk/benefit communication in private practice should take into consideration the limited time available in an office well-infant visit and should be aimed at both the nurse and physician.

Child↗
PubMed1999

Radon-smoking synergy: A population-based behavioral risk reduction approach.

BACKGROUND: Radon and cigarette smoking have a synergistic, multiplicative effect on lung cancer rates. Smokers, and perhaps nonsmoking residents, of smoking households are at increased risk for lung cancer even when radon levels are relatively low. A behavioral risk reduction strategy emphasizing smoking cessation is proposed and data are presented from pilot studies and a short-term evaluation of a randomized intervention trial. METHODS: Pilot studies, including radon testing, interviews, questionnaires, and focus groups, led to a three-arm randomized intervention trial comparing two kinds of written materials and telephone counseling. Smoking households were recruited by offering free radon test kits through an electric utility companies billing system. Three-month follow-up data were obtained by mail and phone. RESULTS: Of an estimated 2,600 smoking households in the utility district, 1,220 requested a radon test kit, and 714 were randomized into three treatment conditions. Brief phone counseling (up to two short calls) significantly increased smoking quit rates, compared to written materials only, and was also related to other risk reduction behaviors (e.g., household ban on smoking). CONCLUSIONS: Offering free radon testing through a public utility billing system is an effective recruitment tool for reaching households at risk due to radon-smoking synergy. Brief telephone counseling is superior to written materials in reducing smoking and encouraging indoor smoking bans. Methods are needed to better inform smokers of their additional risk from exposure to even low levels of radon.

Adult↗