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PubMedDate not supplied

Maryland dentists' attitudes regarding tobacco issues.

Due to increased national interest in tobacco intervention roles for oral health professionals, a survey of Maryland dentists' attitudes toward tobacco issues was conducted. A convenience sample of 700 members of the Maryland State Dental Association was drawn from the total membership list (N = 2200). A 30% response rate was obtained. Subjects were mailed a twelve-item questionnaire that elicited primarily attitudinal information. Results revealed that 54.3% of the subjects never smoked, 39% formerly smoked and 6.1% currently smoke. Smoking behavior was associated with numerous attitudinal variables including dentistry's role in promoting tobacco-use cessation. Relatively few of the respondents were aware of federal initiatives regarding the oral health professions' roles in intervention. Less than half viewed tobacco-use cessation interventions as a practice builder, yet 82.1% believe cessation advice is the dentist's responsibility. Respondents' interest in obtaining free training in tobacco-use interventions was positive and was significantly related to several attitudinal variables. Dentists in Maryland appear to appreciate their role in tobacco-use interventions at both the clinical and community levels. However, they exhibit ambivalence regarding the economic value of office interventions and the need for formalized training. Maryland dentists also need to be apprised of federal initiatives concerning tobacco use interventions.

Attitude of Health Personnel↗
PubMed1997

Skin cancer prevention education: a national survey of YMCAs.

High skin cancer incidence and mortality rates have created a need for skin cancer prevention education. Children are an important target for this education, as overexposure to sun and sunburns at an early age have been linked to the development of skin cancer. This study identified the prevalence of skin cancer prevention education and the need for this education at YMCA swim classes. This study also assessed the feasibility of implementing Project SUNWISE, an existing skin cancer prevention curriculum, developed for YMCA swim classes. A 51-item survey was mailed to Aquatics Directors at all YMCAs with outdoor pools. Based on a 63% response rate (N = 208), only 28% of YMCAs thought the children in their swim classes were adequately protected from the sun, and only 28% offered skin protection or sun safety education in swim classes. Only 50% of YMCAs trained their swim instructors on skin cancer prevention. While 91% of YMCAs had one or more sun protection items near the pool (e.g., sunscreen, umbrella, covered area), 93% of YMCAs saw the need for additional protection. The majority of YMCAs (95%) were willing to incorporate a skin cancer prevention education curriculum, similar to Project SUNWISE, into their swim classes. This study emphasized the need for more skin cancer prevention education programs targeting children and examined the correlates of skin cancer prevention education at YMCAs. Geographic region, percent of possible sunshine, and ultraviolet radiation were significantly associated with the skin cancer prevention education program status at the YMCAs.

Administrative Personnel↗
PubMed2006

Prevalence of xerostomia in population-based samples: a systematic review.

The consequences of xerostomia on oral health have been studied for decades; however, the actual prevalence of this disorder on the general population remains controversial. The purpose of this systematic review was to determine the prevalence of xerostomia in population-based samples. Electronic databases were screened for relevant articles and reference lists of pertinent articles were also hand-searched. Thirteen articles meeting the final inclusion criteria were identified. Based on the definition of xerostomia used in this review, only publications including a subjective diagnosis of the disorder were included. All of the self-reported diagnoses were achieved through a questionnaire either by mail, telephone, interview or self-administered by the patient. There was a variation across papers regarding number and content of the questions as well as guidelines for the diagnosis of xerostomia (i.e. answer yes to one or more than one question). The prevalence of xerostomia in the selected articles ranged from 0.9% to 64.8%. The majority of these studies were performed in Scandinavia. In 9 of the articles, the studied samples were 50 years and older. None of the studies evaluated the prevalence xerostomia among individuals younger than 18 years. Based on these observations, it can be concluded that there is a need for population-based studies on prevalence of xerostomia in regions other than Scandinavia. A standardized protocol to diagnose xerostomia needs to be developed. Patient-perceived treatment needs and impact on quality of life should be included to have a complete picture of public health implications of the disease.

Age Distribution↗
PubMed2001

Cigarette smoking, alcohol consumption, and risk of hip fracture in women.

BACKGROUND: Previous studies regarding the impact of cigarette smoking on the risk of hip fracture in postmenopausal women have been inconsistent, suggesting different effects in different groups. The effect of alcohol intake on fracture risk is puzzling: moderate alcohol intake appears to increase bone density, and its association with hip fracture is not clear. METHODS: To assess the associations of cigarette smoking and alcohol consumption with hip fracture risk among postmenopausal women, we conducted an analysis of a population-based case-control study from Sweden. Cases were postmenopausal women, aged 50 to 81 years, who sustained a hip fracture after minor trauma between October 1, 1993, and February 28, 1995; controls were randomly selected from a population-based register during the same period. A mailed questionnaire requesting information on lifestyle habits and medical history was used 3 months after the hip fracture for cases and simultaneously for controls. Age-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed by means of logistic regression. RESULTS: Of those eligible, 1328 cases (82.5%) and 3312 controls (81.6%) responded. Compared with never smokers, current smokers had an increased risk of hip fracture (age-adjusted OR, 1.66; 95% CI, 1.41-1.95). Duration of smoking-particularly postmenopausal smoking-was more important than the amount smoked. Former smokers had a small increase in risk (age-adjusted OR, 1.15; 95% CI, 0.97-1.37) that decreased with the duration of cessation. The age-adjusted OR for women consuming alcohol was 0.80 (95% CI, 0.69-0.93). CONCLUSIONS: Cigarette smoking is a risk factor for hip fracture among postmenopausal women; risk decreases after cessation. Alcohol consumption has a weak inverse association with risk.

Age Distribution↗
PubMed2005

Hearing loss among cancer survivors.

Cancer therapies may cause hearing loss (HL) in some patients. The purpose of this study is to examine at risk factors for HL and its impact on the health of a large cohort of cancer survivors. This is a descriptive, cross-sectional study of long-term cancer survivors who reported that they have experienced HL as a result of their cancer. Of 3571 respondents who answered a mailed survey, 243 (6.8%) reported HL. We analyzed the responses to discern the potential impact of demographics, cancer type or disease treatments on hearing, as well as the potential impact of HL on socioeconomic parameters (education, family and work). Survivors of head and neck cancer, sarcoma and testicular cancer reported HL most frequently. Among the younger survivors, the frequency of HL was higher than age-matched persons from the general U.S. population. Cancer survivors with HL were more likely to report that cancer had affected their overall health (71 vs. 32%) and were unable to work. While cisplatinum exposure was noted more frequently in respondents with HL, no other treatments, including radiotherapy, were shown to have a significant impact on hearing. There were no differences with respect to age, gender or family dynamics. Hearing loss affects a minority of long-term cancer survivors and may have an impact on their education, ability to work and overall health.

Adolescent↗
PubMed1998

Prevention of elderly suicide. Physicians' assessment of firearm availability.

INTRODUCTION: Physicians have a unique role to play in the prevention of elder suicide, yet they may not be sufficiently attentive to the prominence of firearms in the rising trend in suicide by elder persons. This study sought to examine the extent to which physicians inquired about firearms with their depressed and suicidal elderly patients and further identified factors associated with physicians' likelihood of asking about firearms. METHODS: A probability sample of 300 primary care physicians in Illinois was drawn from the American Medical Association Physician Masterfile. Physicians were chosen from the specialties most likely to be involved with elderly persons: internal medicine and family practice. A mailed questionnaire yielded a 63% response rate. RESULTS: Although they were treating depressed and suicidal older patients, a sizable proportion of the respondents (42%) reported that they did not ask such patients or their family members whether they had access to a firearm. Several factors distinguished physicians who assessed for firearms from those who did not. The most salient predictors were: continuing medical education training in suicide risk assessment, expertise in geriatric mental health, confidence in diagnosing depression, having a patient mention suicide in the past year, and indicating patient reluctance as a barrier to mental health treatment. DISCUSSION: Physicians working with depressed and suicidal elderly persons need to be informed about the prevalence of elder suicide and about the likelihood of elderly persons using firearms as a method of suicide. Effective suicide prevention will require physician training that directly addresses geriatric mental health and firearm suicide, in particular, at the student, residency, and continuing education levels.

Aged↗
PubMed1999

Prostate-specific antigen for prostate cancer screening. Do physician characteristics affect its use?

PURPOSE: Screening for prostate cancer with the prostate-specific antigen (PSA) test remains controversial. This controversy is reflected in a lack of consensus in the medical literature and among professional and policy organizations regarding routine screening by PSA. It is not known how physicians respond when recommendations from experts are inconsistent. METHODS: A questionnaire was mailed to 1369 primary care physicians in active practice in Washington State in 1994. Response rate to the survey was 63%. Chi-square tests and multivariate logistic regression analysis were used to examine the effects of physician characteristics on physicians' self report of use of the PSA test for screening asymptomatic male patients, aged 50 to 80, for prostate cancer. RESULTS: Of the 714 physicians included in the analysis, 68% reported routine use of PSA. Use of PSA varied among physicians on the basis of practice setting, years since medical school graduation, and whether compensation was fee-for-service or salaried. Male physicians trained before 1974 and physicians receiving fee-for-service were significantly more likely than other physicians to recommend screening by PSA. CONCLUSIONS: Results suggest that physicians' personal characteristics such as year of medical school graduation, gender, and mode of reimbursement are related to self-reported PSA use.

Chi-Square Distribution↗
PubMed2000

Prevalence of cardiovascular risk factors in a rural population between 25 and 44 years old.

OBJECTIVES: The objective of this study was to evaluate the prevalence of the following cardiovascular risk factors, in the 25 to the 44 year age group, in persons attending the Goes Health Center: hypertension, high blood cholesterol, obesity, smoking and family history of coronary disease. METHODS: 340 individuals were selected, for random sample stratification by sex and age groups. They were summoned by mail to come to the Health Center for an evaluation of the factors studied. Hypertension was defined if systolic blood pressure was > or = 140 mmHg and/or diastolic arterial pressure was > or = 90 mmHg and/or if the participant was currently under therapy. High blood cholesterol was defined if the determination made at the time with a strip-test "Accutrend Cholesterol" was > or = 200 mg/dl and/or under specific therapy. Obesity was defined as a body mass index > or = 30 kg/m2. Tobacco consumption was defined as an affirmative reply to the question "Do you currently smoke?". Previous family history of coronary heart disease was defined as an affirmative reply to the question "Do you know of anybody in your family who has died or suffers from coronary disease?". RESULTS: The global prevalence of hypertension, high blood cholesterol, obesity, smoking and previous family history of coronary heart disease was of 20.3%, 32.1%, 11.8%, 21.5% and 26.8%, respectively. There was an association of risk factors in 22.3%.

Adult↗
PubMed2001

How do skilled nursing rehabilitation managers track efficiency and costs?

Financial and efficiency indicators have not been used extensively by skilled nursing (SNF) rehabilitation managers, but may prove useful in the prospective payment system (PPS)-dominated long-term care (LTC) environment. The purpose of this pilot study was to demonstrate a method for measuring the extent of SNF rehabilitation managers' use of volume, revenue, cost, and manpower indicators; and whether usages differ among occupational, physical, and speech therapy managers. The subjects were 74 occupational, 75 physical, and 72 speech therapy managers employed by a multinational health care corporation. A total of 221 Likert scale surveys were mailed to SNF rehabilitation managers to obtain data on use of 32 efficiency and financial indicators. The 32 indicators were in four categories: visit volume, revenue, costs, and manpower utilization. Twelve indicators were used regularly by at least 60% and three were used regularly by 85-100% of respondents. The response rate was 17.89%. Chi-square analyses were performed for therapy discipline and response frequency. None was significant at 0.05. Three of the payermix indicators demonstrated post-hoc significance in "regular" or "sometimes" use by the physical therapy managers. The results show discipline-specific differences among LTC rehabilitation managers in the extents of efficiency and financial indicator usage for decision making. Suggestions for future use of the survey instrument are provided. The method proved useful for demonstrating differences in the combinations and degrees of use of the 32 indicators. The results point to a need to educate SNF rehabilitation managers in cost-monitoring techniques. Recommendations for cost monitoring are provided.

Arizona↗
PubMedDate not supplied

Survey of Iowa general dentists regarding the age 1 dental visit.

PURPOSE: The purpose of this study was to assess Iowa general dentists regarding the age 1 dental visit. METHODS: A 15-item survey was mailed to 1,521 licensed dentists to address their knowledge, attitudes, and behavior regarding the age 1 dental visit. Chi-square statistics and logistic regression models were used to analyze data. RESULTS: Seven hundred fifteen (47%) useable surveys were returned from 2 mailings. Five hundred forty (76%) general dentists were familiar with the American Academy of Pediatric Dentistry (AAPD) age 1 dental visit recommendation. Most reported obtaining this information through continuing education (37%). Eleven percent believed the first dental visit should occur between 0 and 11 months of age, and 66% reported seeing children younger than 2. "Prefer to refer infants to a pediatric dentist" (20%) was the most common reason for not seeing children 0 to 23 months old. Bivariate and multivariate logistic regression analyses indicated that dentists who believed children should have their first dental visit at 0 to 23 months and those willing to see children at age 0 to 23 months were younger, more recent graduates, more likely to be female, aware of the AAPD recommendations, and were already seeing children 0 to 23 months. CONCLUSIONS: The majority of Iowa general dentists are aware of the AAPD age 1 dental visit recommendation.

Adult↗
PubMed1997

Factors related to non-attendance in a population based melanoma screening program.

A total of 127 non-attenders in a population-based melanoma screening program, 58 women and 69 men, were asked in a telephone interview about reasons for non-attendance. Of those, 105 also completed a mailed questionnaire, measuring perceived susceptibility to and knowledge about melanoma. During the same period, attenders (n = 286) at the screening clinic completed the same questionnaire. The most commonly reported reasons for non-attendance were 'I forgot about it', 'lack of time' and 'no need for examination'. A majority of non-attenders held a positive attitude towards preventive programs in general and to the present invitation. Most of the improvements suggested by the non-attenders were strategies to reduce practical barriers. Non-attenders scored lower than attenders on perceived susceptibility. High and equal levels of knowledge about melanoma were found among attenders and non-attenders. Men were more likely to be non-attenders. Higher perceived susceptibility and a higher level of knowledge about melanoma were found among women as compared to men. The results suggests that there is potential to increase attendance in future melanoma programs by reducing practical barriers.

Adult↗
PubMed1994

The conceptualization of health among residents of Saskatoon.

Health for all by the year 2000 is a goal for many professionals. Health promotion is a key strategy for attaining that goal. An essential step in the process is defining the term health. A review of literature reveals that the public was not consulted regarding their definition of the term, although it is their health that everyone is trying to promote. The aim of this study was to find out how lay people in Saskatoon define health, and investigate the effects of several independent variables on their conceptualizations. One hundred residents participated in the study. The mail and telephone survey method was used to collect the data. Chi-square tests, Mann-Whitney and Kruskal-Wallis were used to analyze the data. The results of the study show that the respondents preferred functional and wellness definitions of health. They disagreed though that health is wellness despite the presence of disease, which is contrary to the expectations of many health professionals. They, moreover, disagreed with economical and religious definitions of health. Several independent variables were tested for their influence on the respondents' conceptualization. Sex seems to have a major impact on one's definition of health, and the value one places on the different aspects of life determines how one defines health. It is recommended that health professionals always assess their clients' definition of health prior to prescribing interventions. Health is not a commodity, but a basic right of human beings; and if community involvement is to become a reality, it should start with a public definition of the term "Health."

Adult↗
PubMed2005

Factors associated with rural doctors' intention to continue a rural career: a survey of 3072 doctors in Japan.

OBJECTIVE: To show the relationship between the personal and educational backgrounds of rural doctors and their intention to continue a rural career. DESIGN: Nationwide postal survey. SETTING: Public clinics or hospitals in municipalities that are classified as 'rural' by the national government. SUBJECTS: A total of 4896 doctors working for 828 public clinics and hospitals. MEASUREMENTS: A questionnaire was mailed. The questionnaire inquired about the subject's age, sex, hometown, exposure to rural practice in undergraduate education, postgraduate training, continuing medical education, current position and affiliation status with a medical school, as well as his or her intention to continue a rural career. RESULTS: Response rate was 64%; 26% answered that they intended to continue a rural career. Postgraduate training in general internal medicine, general surgery, anaesthesiology, paediatrics and gastroenterology were positively related with the intention to continue a rural career (odds ratio = 2.045, 1.59, 1.30, 1.48, 1.38). Rural background, undergraduate exposure to rural practice, multispecialty-rotation in postgraduate training and current administrative position had positive correlations with the intention to continue in logistic regression analysis (odds ratio = 1.80, 2.47, 1.54, 2.17). Affiliation with a medical school department was negatively related with the intention to continue (odds ratio = 0.45). CONCLUSION: In addition to the rural background of physicians, some undergraduate and postgraduate factors were independently associated with the intention to continue a rural career.

Adult↗
PubMed2004

Morbidity associated with axillary surgery for breast cancer.

AIM: To determine the prevalence of long-term complications of axillary surgery for breast cancer and whether preservation of the intercostobrachial nerve (ICBN) reduces this morbidity. METHODS: A self-administered questionnaire was mailed to all patients who had undergone breast cancer and axillary surgery 2.5-6 years previously. The questions addressed symptoms of arm pain, numbness, weakness, stiffness and swelling. The operation notes were reviewed to ascertain the type and extent of surgery and whether the ICBN was preserved or sacrificed. RESULTS: One hundred and seventy of 208 (82%) questionnaires were returned completed. At least one symptom was reported by 130 (76.5%) of patients. Numbness was the most common symptom, present in 60% overall. Patients who had had the ICBN preserved reported significantly less numbness (37.5%vs 71.7% (P < 0.001)). Pain was present in 45.3% of patients and those with the ICBN preserved had significantly less pain (31.3%vs 58.5% (P = 0.02)). Weakness was present in 40%. Swelling was reported in 26.4% and stiffness in 12.2%. CONCLUSION: Axillary lymph node dissection for breast cancer has a high long-term morbidity. Preservation of the ICBN during the axillary procedure significantly reduces this morbidity.

Adult↗
PubMed1998

Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population.

BACKGROUND: The current classification dividing patients with functional gastrointestinal symptoms into subgroups remains controversial. AIMS: To determine whether distinct symptom groupings exist in the community. METHODS: A random sample of Sydney residents in Penrith, Australia was mailed a validated self report questionnaire. Gastrointestinal symptoms including the Rome criteria for irritable bowel syndrome (IBS) and dyspepsia were measured. RESULTS: Among 730 respondents, the 12 month age and gender adjusted prevalence (adjusted to the Australian population) of IBS, dyspepsia, and gastro-oesophageal reflux were 11.8% (95% confidence interval (CI) 9.3 to 14.3%), 11.5% (95% CI 9.6 to 14.6%), and 17.5% (95% CI 14.2 to 19.9%), respectively. In total, 60% of the population reported four or more gastrointestinal symptoms. There was considerable overlap of IBS with dyspepsia and among the dyspepsia subgroups by application of the Rome criteria. Independently, 10 symptom groupings were identified by factor analysis. The underlying constructs measured by these factors were generally the major abdominal syndromes recognised by the Rome classification: dyspepsia, IBS, reflux, painless constipation, painless diarrhoea, and bloating, in addition to a number of more specific symptom groupings. CONCLUSION: Gastrointestinal symptoms are common and overlap in the community, but distinct upper and lower abdominal symptom groupings can be identified.

Adult↗
PubMed1999

Age of onset of dental anxiety.

Little attention has been given to the issue of the age of onset of dental anxiety, even though it may have a bearing on the origins of this type of fear. This study aimed to identify the age of onset of dental anxiety and to identify differences by age of onset with respect to potential etiological factors, such as negative dental experiences, family history of dental anxiety, and general psychological states. Data were collected by means of two mail surveys of a random sample of the adult population. Of 1420 subjects returning questionnaires, 16.4% were dentally anxious. Half, 50.9%, reported onset in childhood, 22.0% in adolescence, and 27.1% in adulthood. Logistic regression analyses indicated that negative dental experiences were predictive of dental fear regardless of age of onset. A family history of dental anxiety was predictive of child onset only. Adolescent-onset subjects were characterized by trait anxiety and adult-onset subjects by multiple severe fears and symptoms indicative of psychiatric problems. The three groups were similar in terms of their physiological, cognitive, and behavioral responses to dental treatment. However, adolescent- and adult-onset subjects were more hostile toward and less trusting of dentists. These results indicate that child-onset subjects were more likely to fall into the exogenous etiological category suggested by Weiner and Sheehan (1990), while adult-onset subjects were more likely to fall into the endogenous category.

Adolescent↗
PubMed1999

Dental health issues in child-care centers.

In 1996, the privately owned licensed child day-care facilities in West Virginia were surveyed by mail to determine the level of compliance with the oral health regulations set by the State Board of Health. The number of children enrolled in the 119 responding facilities ranged from three to 218. Of these, 63 percent included tooth-brushing in the children's daily schedule. The majority of respondents (72%) reported inviting dental health care providers to discuss dental health with the enrollees. However, it was less commor (29%) for dental care providers to address the child-care staff regarding children's dental health. Forty percent of respondents reported that children had sustained dental injuries while at their facility. Nearly one-half (46%) maintained a record of each child's dentist. These findings support the need for establishing partnerships between dental health care providers and child-care centers to initiate continuous dental health programs for enrollees and to develop periodic staff educational workshops that focus on children's dental health. This study was funded by the West Virginia University Dental Corporation.

Chi-Square Distribution↗
PubMed2004

Cost-effectiveness of different combinations of bupropion SR dose and behavioral treatment for smoking cessation: a societal perspective.

OBJECTIVES: To determine the differential cost effectiveness of 2 dosing regimens of bupropion sustained release (SR) in combination with behavioral interventions of minimal intensity (tailored mailings [TM]) or moderate intensity (proactive telephone calls [PTC]) for smoking cessation in an actual practice setting. STUDY DESIGN: Open-label, randomized trial, with 1-year follow-up, conducted in a large health system based in Seattle, Washington. METHODS: A total of 1524 adult smokers interested in quitting smoking were randomly assigned to receive 150 mg bupropion SR daily and PTC (n = 382), 150 mg bupropion SR daily and TM (n = 381), 300 mg bupropion SR daily and PTC (n = 383), or 300 mg bupropion SR daily and TM (n = 378). Sufficient medication for 8 weeks of dosing was provided to patients. The primary outcome measure was self-reported point-prevalence 7-day nonsmoking status at 12 months after the target quit date. RESULTS: Although the 300-mg dose was associated with a higher 12-month nonsmoking rate relative to the 150-mg dose with both PTC and TM, the additional cost resulted in lower cost effectiveness. The PTC behavioral intervention was more expensive than TM, but the additional effectiveness resulted in almost equivalent cost effectiveness at the 150-mg dose. Costs per additional 12-month nonsmoker (above that expected for placebo) for the 150-mg dose groups averaged 950 dollars and per additional lifetime quitter averaged 1508 dollars; for the 300-mg groups these costs were 1342 dollars and 2129 dollars, respectively. Cost per life-year and quality-adjusted life-years (QALYs) saved varied substantially by age and treatment, but were no greater than 1100 dollars for all treatment groups when averaged across the age and sex distribution for the study population. CONCLUSIONS: Although the cost per life-year and QALYs saved were sufficiently low for all doses to rate these smoking cessation interventions as among the most cost effective of life-saving medical treatments, within the regimens tested 150 mg bupropion combined with either PTC or TM was the most cost effective.

Adolescent↗