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PubMed1979

Cost containment pressures make suppliers partners in productivity.

As demands for cost containment, productivity, and efficiency continue to be made of health care providers, more and more questions are being asked about the cost benefits and appropriateness of health care products and supplies. And, as hospitals continue to make their purchasing decisions in a regulated economy, it is likely that their decisions will alter the sales, marketing, and service responsibilities of hospital suppliers. In an effort to educate hospital suppliers to what lies ahead, Hospitals and Trustee magazines recently held the first National Symposium on the Hospital Market, the details of which are presented here.

Commerce↗
PubMed1995

Clinical profile, comorbidity, and treatment history in 123 hair pullers: a survey study.

BACKGROUND: Trichotillomania, characterized by an irresistible urge to pull one's hair, may be more prevalent than previously believed. Despite increasing attention devoted to this topic in the recent literature, there are few studies based on large samples that are potentially generalizable to a community population. METHOD: Surveys addressing clinical profile, comorbidity, and treatment history were mailed to all responders to a nationally distributed magazine article on trichotillomania. Out of 772 surveys sent, 123 completed surveys were returned. RESULTS: While there was a predominance of females in the whole sample, female-to-male prevalence was lower in children than adults. Onset was predominantly in childhood (mean age = 11 years), most frequently in middle childhood and least frequently before age 6. Subjects pulled hair from a variety of sites, including scalp, eyelashes, eyebrows, pubic region, face, and body, but the highest incidence and severity involved scalp hair. Children under 6 were more likely than other age groups to pull scalp hair and possibly less likely to pull other hair. In adults, symptom profile was not associated with age at onset. While subjects reported high rates of comorbid conditions in both self and family, trichotillomania was reportedly formally diagnosed in only 40% of the subjects. Although subjects reported a range of treatments, the majority (58%) reported no treatment history. Finally, only minimal improvement was reported for all modalities, with no significant difference in response to psychotherapy, behavior therapy, clomipramine, or fluoxetine. CONCLUSION: Trichotillomania is a chronic illness that may be difficult to treat. Controlled studies on comorbidity, epidemiology, treatment-seeking patterns, and long-term treatment response are needed.

Adolescent↗
PubMed1979

A low-cholesterol menu in a steak restaurant.

A twelve-month pilot project was conducted to test public reaction to a special restaurant menu identifying food choices low in cholesterol and saturated fat. The Houston steak house in which the "Help Your Heart" menu was tested prepared foods according to guidelines from dietitians of the Diet Modification Clinic, Baylor College of Medicine. Two newspaper articles, a brief magazine feature, and regularly scheduled radio advertising spots publicized the special menu. At the end of each month of the test period, the number of orders from the special menu was tallied for fourteen randomly selected days. Monthly sales from the special menu ranged from 2.5 to 5.1 per cent, with an overall average of 3.4 per cent. There was no statistically significant change from the mean of the percentage of total sales from the special menu over the months. Despite the relatively low percentage of total sales, restaurant executives were pleased with the results of the study and planned to offer the low-cholesterol menu indefinitely, eventually in an expanded form.

Behavior Therapy↗
PubMed1995

[Presentation of the Salas obstetrical forceps (Forceps Salas)].

In the magazine of Gineco Obstetricia de México, January 1988, 30 to 34, I presented the three first models of the Salas forceps. In this article I describe the fourth and last design of my invention which has been patented in the USA as "Salas Obstetric Spatulas". It is mentioned in this article, the advantages of this instrument, which after being used in 533 applications by Dr. Fernandez del Castillo, SC and Dr. Viesca, MA they have come to the conclusion that the Salas instrument is excellent. Laufe et al in his book describe: There is no doubt that these forceps (Salas) could be made more acceptable to US practitioners. It is insisted in the modern classification of the forceps.

Delivery, Obstetric↗
PubMed1995

Fibromyalgia syndrome and myofascial pain syndrome. Do they exist?

"It is in the healing business that the temptations of junk science are the strongest and the controls against it the weakest." Despite their subjective nature, these syndromes (particularly MPS) have little reliability and validity, and advocates paint them as "objective." Despite a legacy of poor-quality science, enthusiasts continue to cite small, methodologically flawed studies purporting to show biologic variables for these syndromes. Despite a wealth of traditional pain research, disciples continue to ignore the placebo effect, demonstrating a therapeutic hubris despite studies showing a dismal natural history for FS. In reviewing the literature on MPS and FS, F.M.R. Walshe's sage words come to mind that the advocates of these syndromes are "better armed with technique than with judgment." A sympathic observer might claim that labeling patients with monikers of nondiseases such as FS and MPS may not be such a bad thing. After all, there is still a stigma for psychiatric disease in our society, and even telling a sufferer that this plays only a partial role may put that patient on the defensive. Labeling may have iatrogenic consequences, however, particularly in the setting of the work place. Furthermore, review of a typical support group newsletter gives ipso facto proof of this noxious potential. The author of a flyer stuffed inside the newsletter complains that getting social security and disability benefits for "the invisible disability" can be "an uphill battle. But don't loose (sic) hope." Apparently the "seriousness of the condition" is not appreciated by the medical community at large, and "clinician bias may well be the largest threat," according to Boston epidemiologist Dr. John Mason. Sufferers are urged to trek to their local medical library and pull four particular articles claiming FS patients have more "stress," "daily hassles," and difficulty working compared with arthritis patients. If articles can't be located, patients are told to ask their lawyers for help. Although "Chronic Fatigue Syndrome" and FS are not considered by everyone to be the same malady, the "National Institute of Health (sic) has lumped these two conditions together. This could work in your favor." (A U.S. political advocacy packet is available for $8, but a list of U.S. senators with Washington, DC addresses is freely provided.) These persons see themselves as victims worthy of a star appearance on the Oprah Winfrey show. A sense of bitterness emerges; one literally bed-bound Texas homemaker writes in Parents magazine that "Some doctors may give up and tell you that you are a hypochondriac."(ABSTRACT TRUNCATED AT 400 WORDS)

Disability Evaluation↗
PubMed1995

A framework for identifying and managing risk in the operating theatre.

There is much advice available about the development of risk management strategies within the NHS. There are booklets and magazines and there are many management consultancies willing to give advice on the development of strategies. NATN is also working on the development of advice on risk management within the operating theatre department and a document should be available at Congress this year. It was felt, however, that it may be useful to hear a little about the specific experience of the development of a strategy within one operating theatre area and Andrea Simpson, Directorate Nurse Manager for Clinical Services, West Lothian NHS Trust has recorded the development within the directorate. There has been some additional comment from the Director of Nursing and Quality within the Trust, Libby Campbell, who is responsible for risk management there.

Humans↗
PubMed1995

The health beliefs and skin cancer prevention practices of Wisconsin dairy farmers.

PURPOSE/OBJECTIVES: To assess and describe health beliefs, level of knowledge about skin cancer, current skin cancer prevention practices, and cues to preventive action of Wisconsin dairy farmers. DESIGN: Descriptive survey. SETTING: Rural Wisconsin. SAMPLE: A stratified random sample of 535 male dairy farmers from the Wisconsin Department of Agriculture mailing list; 202 farmers (38%) returned the survey. METHODS: A survey instrument developed by the researcher was mailed to the farmers. Descriptive statistics were used to analyze data. MAIN RESEARCH VARIABLES: Susceptibility, seriousness, benefits, barriers, current practices, knowledge, and cues to preventive action in regard to skin cancer. FINDINGS: Farmers were knowledgeable about skin cancer and felt that they were susceptible, that it was a serious disease, and that protective actions were beneficial; however, they did not practice sun protection. "Too hot to wear" was the most frequent reason given for not wearing protective clothing, and "I forget to wear it" was the most common reason for not using sunscreen. CONCLUSIONS: Barriers to the use of sunscreen may be the most amenable to intervention. The utility of the Health Belief Model with this population is questioned and may require additional research. IMPLICATIONS FOR NURSING PRACTICE: Farming-related magazines and newspapers can be used to provide health information. Skin cancer education should be provided at schools, work sites, outpatient clinics, hospitals, and community screening events to remind farmers to practice sun protection.

Agricultural Workers' Diseases↗
PubMed1995

[Health locus of control and acquisition of health-related information].

Relationships between acquisition of health-related information and Health Locus of Control (HLC) were investigated in 204 women aged 29-45 years, using Horige's Japanese version of Health Locus of Control (JHLC) Scales. The acquisition behavior of health-related information was obtained from the question "How often do you get health-related information by newspaper, television or magazine?" The results were as follows: 1) Women who perceived the information related directly to their personal health, acquired health-related information more often than those who did not perceive personal application of the information. 2) The technical school or junior college graduate group had the most health-related information acquisition scores. 3) The university graduate group had fewer Chance HLC beliefs and Supernatural HLC beliefs. 4) Family HLC mean scores were significantly higher in the "high family value" group than in the "high health value" group. 5) Internal HLC mean scores were significantly higher in those self-rated as "very healthy" than in those self-rated as "healthy" group. 6) Women acquiring health-related information the most had Internal HLC mean scores significantly higher than the others. Health-related information acquisition scores correlated significantly with Internal HLC mean scores and Family HLC mean scores.

Adult↗
PubMed1995

Junk!

Each day, the US Postal Service delivers millions of pieces of unsolicited mail to our country's 500,000 physicians. This onslaught includes brochures for meetings in places both exotic and pedestrian, solicitations from financial institutions, newsletters, magazines, and elaborately packaged pharmaceutical promotions that may include such inducements as candy, flashlights, pens, and even golf tees! Our mailboxes groan under masses of unsolicited letters, periodicals, packets, brochures, booklets, and boxes.

Advertising↗
PubMed1995

[AIDS/HIV related knowledge, attitude and behavior of acupuncture therapists in Aichi Prefecture].

To promote AIDS prevention measures in Japan, the actual state of knowledge, attitudes and behaviors (KAB) of workers at risk for HIV infection requires clarification. In the present study, acupuncture therapists in Aichi Prefecture were evaluated for level of their KAB. By using a self-administered questionnaire, the KAB condition of 500 acupuncture therapists was surveyed from September-November in 1993. Responses from 494 (98.8%) were available for analysis. Results showed that knowledge level on general issues regarding HIV epidemics was good. The main sources for information on AIDS/HIV were TV, general lectures, public reports and magazines. More than 80% of acupuncture therapists sterilize their needles by autoclave or boiling and 60% of them use disposable needles. Furthermore, 97% of the therapists reported utilizing one or the other of these methods. More than a half of them have participated in AIDS education programs. While about 30% of them responded that they are able to accept HIV carriers as clients, 20% of them expressed negative responses. There appears to be a discrepancy between their level of knowledge of HIV transmission routes and their practical attitude towards clients with AIDS and/or HIV carriers. A more appropriate education program based on behavioral science is desirable to lessen discrepancy distance between general knowledge and preferable behavior regarding AIDS/HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Sexual asphyxiation: an unusual case involving four male adolescents.

A case of sexual asphyxiation is described involving children, adolescent males, homosexuality and two bizarre strangulations. Two adolescent males (ages 13 & 10) initially engaged in homosexual activity in conjunction with sexual asphyxiation. This unusual activity was by chance observed by one of the boy's younger brother and his friend. The younger children (aged 7 & 8) expressed a desire to join in the activity, which they did by letting ligatures be tied around their necks and engaging in anal intercourse to the point of fatal asphyxiation. The case is of interest in the reported way the younger boys discovered the practice (a sexually explicit magazine) and is unusual because of the young ages of the boys involved.

Adolescent↗
PubMed1995

Tapping into teams.

Team management has a definite cachet in management circles in general industry; business magazines like Fortune regularly write about the concept, and executives in a wide variety of business fields are excited by it. But there's a lot of confusion behind the buzz, and the reality, say experts and those who've tried it, is a lot more complex than it might seem at first. Can the idea even be applied to hospitals and other large health care organizations?

Cost-Benefit Analysis↗
PubMed1994

Sexual behaviour and HIV knowledge among adolescent boys in Zimbabwe.

A study on sexual behaviour and knowledge of HIV risk was undertaken amongst 511 male students in Zimbabwe. The study was conducted amongst pupils aged 11 to 19 years drawn from urban and rural secondary schools using a self-administered questionnaire. Thirty seven pc of the students reported that they had experienced sexual intercourse, with up to 63 pc reporting having had more than one partner. Twenty one pc of boys aged 12 years reported having had intercourse and the proportion increased with age. Knowledge about AIDS was high (93 pc) with up to 75 pc of the boys reporting that they received the information through the media and only 31 pc got it from their teachers. Logistic regression used to analyse reasons for variation in HIV/AIDS knowledge and of modes of its transmission determined that educational level, actual school attended, access to information from magazines and educational aspirations were significant predictors (p values = 0,005) of knowledge. Individual risk assessment was higher amongst students who reported sexual experience (p = 0,0001). Sixty pc of the sexually experienced boys reported having used condoms. Six pc of the boys reported having intercourse with a commercial sex worker and of these, 85 pc used condoms. Compared with previous studies there appeared to be a reduction in high risk behaviours amongst male secondary school students. However, there is need for increased HIV preventive information through school educational programmes, as increase and variation in HIV information and modes of transmission was seen depending on access to information.

Adolescent↗
PubMed1994

Psychological and sexual changes after the cessation of breast-feeding.

OBJECTIVE: To characterize the effect of breast-feeding cessation on the mood and sexuality of women after the birth of their first child. METHODS: Women in good physical and psychological health, who had been breast-feeding for 6-23 months and had responded to a request for subjects in a parents' magazine, collected data daily for 2 months before and 2 months after weaning. They were asked to rate 14 measures of psychological, physical, and sexual variables at the same time each day on 3- or 5-point scales. RESULTS: Nineteen women completed the study. Five of these subjects became pregnant before weaning and ceased breast-feeding when pregnancy was confirmed; their last menstrual period was 6 weeks before weaning. The non-pregnant women weaned their babies just before or during menstruation. After weaning, the nonpregnant women reported a significant decrease in fatigue, improvement in mood, and an increase in sexual activity, sexual feelings, and frequency of coitus. Significant changes in fatigue and mood occurred during the second week after weaning; in fatigue, sexual activity, and sexual intercourse during the third week; and in the frequency of sexual intercourse in the fourth week. THe results were not caused by the subjects' expectations about breast-feeding and sexuality or perineal comfort. The women who conceived did not show these changes; a gradual increase in fatigue and decline in sexuality was observed. CONCLUSION: In women who are not pregnant, the cessation of breast-feeding is associated with an improvement in mood, fatigue, and sexuality.

Adult↗
PubMed1994

[Education about dementia and forgetfulness in daily and weekly press].

In the period March 1990-March 1991 the attention for dementia increased in the Dutch printing press in comparison with the period 1987-1990. Despite this increase, the average number of articles on dementia in daily and weekly news magazines is less than one article per two months. This is extremely little for such an enormous medical and social problem. Furthermore, there is a relative decrease in the number of articles on general aspects of dementia. As expected, the number of articles on research in the field of dementia has increased considerably. In contrast with our hypothesis, it appears that in the printing press there is still hardly attention to memory and normal forgetfulness. In future education programs more explicit information should be given not only about dementia (symptoms, progress, consequences, etc), but also about memory complaints and normal forgetfulness. The printing press could make an important contribution towards achieving these goals. An important condition for this is a better cooperation with experts on the subject.

Aged↗
PubMedDate not supplied

Automation of the birth registry log book.

If available resources are limited, a computer novice with basic computer skills can develop and implement an electronic database management system. Commitment and determination to automate manual record keeping of birth registry data are crucial. Some of the database software systems available today were designed to be user friendly. Product reviews published in personal computer magazines will assist an end user to find such user-friendly programs. Once a system is selected and implemented, data can be easily retrieved and used for simple to advanced database functions. Hospital statistics, state-required maternity statistical reports, and research, quality assurance/quality improvement, staffing justification, market research, and critical path variance reports will benefit from the wide array of data manipulation techniques.

Birth Certificates↗
PubMed1994

Overview of methodological issues in the study of chronic care populations.

The intent of the methodology section of this volume was to provide an overview of recent thinking about analytic techniques that can be used to study chronic care populations, particularly dementia SCUs. As discussed earlier in this article, although not unique to these populations, longitudinal analysis of chronic care populations frequently involves several problems: nonequivalent comparison groups, unbalanced designs, censoring and attrition, autocorrelation (correlated repeated measures) and heterogeneous correlations across repeated measures. The last 5 years has witnessed considerable change and growth in the development of longitudinal modelling methodologies. Although developments in modelling cut across disciplines, there has been a focus on certain types of methods in several fields of applied statistics: psychometrics (e.g., analysis of change, item response theory, Rasch modelling of binary outcomes), mathematical sociology (e.g., structural equation modelling), demography (e.g., transition modelling), epidemiology (e.g., risk modelling), and biostatistics (e.g., examination of intervention effects using marginal and random effects modelling of repeated measures). An important issue is the interrelationship between measurement and outcome assessment. Source of measurement error must be considered (see Zimmerman and Magaziner in this volume), as must bias in assessments (see Teresi and Golden in this volume). While it has long been known that poor measurement can attenuate and bias estimates of longitudinal effects, the answer is not to attempt artificial solutions through use of corrections for attenuation (unreliability). Design and sampling issues are also critical to the correct conduct of any longitudinal study. Otherwise, estimates of prevalence, incidence, and intervention effects will be in error (see Beckett and Evans, in this volume). Several modelling approaches have been reviewed. Different points of view regarding change analysis have been presented; controversy remains regarding the "best" methods for examining change (see the commentary by Rogosa in this volume). Theory building using methods such as structural equation modelling remains a staple of longitudinal analysis, although several caveats have been discussed. New or revisited methodologies (random effects modelling, of which growth curve analysis can be viewed as a special case and event history modelling) offer promise in dealing with the knotty problems inherent in the longitudinal study of chronic care populations, namely, censoring, attrition, and unbalanced designs resulting in missing data (see the commentary by Nesselroade, in this issue). However, it remains clear that no one model or approach will be optimal for all applications.

Activities of Daily Living↗
PubMedDate not supplied

Multiple variable motivators involved in the recruitment of physicians for the Indian Health Service.

Attracting physicians to serve in isolated areas, often with marginal facilities, support staff, and remuneration, has long been a problem of the Indian Health Service (IHS). Until recently the physician draft was instrumental in motivating physicians to accept such assignments. Realizing that this "negative incentive" would no longer operate when the draft ended as of July 1, 1973, in the fall of 1972 the IHS staff launched some major "positive" efforts to recruit physicians. The mass media and other communication techniques were used to try to sell U.S. physicians and medical students on what the Service could offer them in terms of adventure, challenge, personal fulfillment, idealism, and the opportunity to be part of a progressive, comprehensive health system. Such efforts assisted in recruiting 69 physicians to begin service in July 1973. These 69 were in addition to approximately 100 who had already been recruited from among persons who had expressed interest in joining the Indian Health Service or who had applied to it before inception of this major recruitment effort. As of July 1, 1973, however, the Service was still approximately 30 physicians short of filling 200 vacancies. In June and July of 1973, an evaluation was done to determine what had motivated the 169 physicians to join the Indian Health Service. They were asked an open ended question: What prompted you to seek employment with the Indian Health Service? Whether physicians listed personal, subjective motivators or recruitment techniques was of as much interest as the specific answers they gave. More than 75 percent (100 of 129) mentioned recruitment techniques, such as magazine advertisements, rather than personal motivating factors, such as challenge. Personal contact with a present or former IHS physician seemed to be especially influential in attracting physicians. The present state of the recruitment art does not provide the means to adequately identify, qualify, quantify, and rank the multiple motivators that prompt physicians to join a program such as that of the Indian Health Service; nor does it allow for meaningful, predetermined identification of a limited pool of physicians who would have a high probability of joining such a program. At present, the best recruitment strategy appears to be to saturate the entire physician "marketplace" stressing with a variety of techniques the positive aspects of IHS employment. Physicians then select themselves for such employment by exhibiting a more than casual interest in the Indian Health Service.

Advertising↗