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PubMed2005

Disability management practices in education, hotel/motel, and health care workplaces.

BACKGROUND: The high costs and the impact of work disability have become a growing concern for workplaces. As a result, workplace disability management approaches have been developed to lower disability costs, protect the employability of workers, and promote early return to work. METHODS: A stratified random sample of 455 employers in education (n = 157), hotel/motel (n = 110), and health care (n = 188) sectors who completed a mailed Organizational Policies and Practices (OPP) questionnaire is reported. The OPP questionnaire asked questions about eight workplace disability management practices. The article examined the multi-dimensionality, internal consistency, and discriminant validity of the OPP and compares disability management practices across the three sectors. RESULTS: The OPP questionnaire showed good internal consistency (Cronbach's alpha = 0.95) and discriminant validity. A one-way analysis of variance (ANOVA) for each of the eight subscales demonstrated that there were statistically significant differences between the sectors in ergonomic practices (F (2,452) = 15.8, P < 0.001), disability case management (F (2,452) = 4.6, P < 0.01), return to work (F (2,452) = 10.3, P < 0.001), and people-oriented culture (F (2,452) = 4.5, P < 0.01). CONCLUSIONS: On examining disability management practices in education, hotel/motel, and health care sectors, the OPP seems to be a promising instrument that can be used to assess and monitor how employers are managing disability.

Analysis of Variance↗
PubMed2006

A survey of the pain experienced by males and females with Fabry disease.

BACKGROUND: The clinical onset of Fabry disease, a rare, X-linked, multisystemic disorder, is marked by neuropathic pain. Males suffer extensively from this disease. Females, as genetic 'carriers', have traditionally been viewed as either asymptomatic or mildly afflicted with this disease. OBJECTIVES: To describe Fabry-related pain and compare experiences between the sexes. Patients' perceptions of physician pain assessments were also examined. METHODS: A disease-specific questionnaire was accessible on-line (www.fabry.org) and mailed to 552 members of a Fabry disease support group. RESULTS: The response rate was 14.3% for the support group-based mail questionnaire. Females (58.0%) were significantly older (mean +/- SD 45.9+/-13.5 years) than males (mean +/- SD 40.0+/-12.1; t [86]=-2.11, P<0.05). Females were diagnosed with Fabry disease later (31.1+/-14.0 years) than males (24.2+/-11.9 years; t [86]=-2.43, P<0.05). Females (mean score for pain disability rating 3.0+/-1.4) suffered more extensive disability from migraine pain (mean score 2.2+/-1.3; F [1, 74]=45.0, P<0.005), and, unlike males, did not exhibit a decline in pain intensity with disease duration. Satisfaction with physician pain assessments was moderate. CONCLUSIONS: Contrary to the traditional view of females as carriers, females with Fabry disease experienced intense disease-related pain; pain produced comparable distress and impairment in both sexes. The diagnostic delay and absence of a decline in pain symptoms over time in females suggest additional disease burden. Females may be triply disadvantaged in the health care system due to disease rarity, devalued carrier status and sex.

Adult↗
PubMed2000

Demographic characteristics of US medical school admission committees.

CONTEXT: Although concerns continue to be raised about the diversity of the US physician workforce, there has never been a nationwide survey of both the sex and underrepresented minority (URM) composition of medical school admission committees. OBJECTIVE: To document US medical school admission committee membership in several demographic domains, including sex and URM (African American, Mexican American, mainland Puerto Rican, Native American, Native Hawaiian, and Native Alaskan) status. DESIGN: Mailed survey. SETTING AND PARTICIPANTS: Deans or directors of admission at 85 US medical schools that were members of the Association of American Medical Colleges (response rate, 70%). MAIN OUTCOME MEASURES: Prevalence of 1999-2000 school-year committee members in demographic categories, such as sex, URM status, physician or medical student status; compensation status. RESULTS: The overall ratio of men to women on admission committees was 1.77 to 1. On average, 16% of committee members were from URM groups. Physicians with URM status comprised 8% of committee membership; 51% of committees had 1 or 0 URM physicians. Seventy-four percent of committees had at least 1 medical student; medical students comprised 15% of total membership. Ninety-one percent of committees operated on a volunteer basis. CONCLUSION: Although representation of women and persons with URM status on medical school admission committees has improved since 1972, URM membership, in particular, remains low. JAMA. 2000;284:1111-1113

Data Collection↗
PubMed2005

Frequency of persistent anal symptoms after first instrumental delivery.

PURPOSE: This study was designed to evaluate persistent anal symptoms after first instrumental delivery beyond the postpartum period. METHODS: This prospective study was performed in a cohort of primiparas who underwent instrumental delivery from January 1, 2001 to September 30, 2002. Questionnaires for anal symptoms were completed in the maternity ward on the day after delivery and by mail or telephone up to 12 months after the end of the inclusion period. Symptoms of fecal incontinence (solid and/or liquid stool) and precursor symptoms (flatus incontinence, soiling, and/or fecal urgency) were recorded. RESULTS: Of the 212 females who completed the first questionnaire, 159 (75 percent) responded to the second. Overall, 8.8 percent of females had solid and/or liquid stool incontinence, 7.5 percent had involuntary flatus, 8.2 percent had symptoms of fecal urgency, and 24.5 percent experienced new anal symptoms, Of the five females with third-degree tears, none complained of anal incontinence. The only significant difference in delivery data between females who did and did not develop new anal symptoms was larger fetal head size in the new symptom group (96.4 vs. 93.9 mm, respectively; P < 0.05). CONCLUSIONS: Frequency of new anal symptoms other than incontinence beyond postpartum period is underestimated in primiparas after instrumental delivery. Only fetal head size was found to predict occurrence of persistent anal incompetence after instrumental delivery.

Adult↗
PubMed2006

Exposure to environmental tobacco smoke in a general population.

AIMS: To estimate how the level of exposure to environmental tobacco smoke (ETS) in pregnancy, childhood and adulthood vary with personal characteristics in a general population. METHODS: In 1996/1997, a community sample of 3181 adults, aged 26-82, received a mailed questionnaire, to which 2819 subjects responded. The prevalences of ETS exposure were estimated according to sex, age, educational level, smoking, occupational dust or gas exposure and exposure to moulds. Logistic regression was used to estimate the adjusted odds ratios for the different ETS exposures with respect to these covariates. RESULTS: Altogether 9% reported exposure to maternal smoking in foetal life and 23% in childhood. Fourteen percent reported current domestic ETS exposure, while 13% reported current occupational ETS. Occupational ETS exposure was more frequent among men (16%) than women (10%). The oldest subjects (61-82 years) reported less ETS exposures than the younger subjects. Current smokers and subjects with occupational dust or fumes exposure had a higher prevalence for all the ETS exposures compared to ex- and never smokers and subjects without occupational exposure, respectively. CONCLUSION: From a general population sample male sex, younger age, current smoking, and occupational dust or fumes exposure were associated with higher level of ETS exposure.

Adult↗
PubMed1994

Spinal cord injuries in Japan: a nationwide epidemiological survey in 1990.

To survey the situation of traumatic spinal cord injuries (SCI) in Japan, the SCI Prevention Committee of the Japanese Medical Society of Paraplegia sent out by mail study charts in the form of questionnaires to institutions nationwide. Using the statistical method of the nationwide epidemiological survey described by Hashimoto et al,1 the annual estimated incidence was obtained from the number of patients registered, and from the questionnaire reply rate at each prefecture. The number of registered patients in 1990 was 3465 and the mean reply rate was 56.6%. There were 2665 registered patients with a neurological deficit (Frankel A-D) and the annual SCI incidence was 39.4 per million. The male:female ratio was 4.3:1 and the ratio of cervical cord injures to those caudal to the cervical cord was 2.9:1. The mean age at the time of injury was 48.5 years. The cause most frequently seen was traffic accidents, the second most frequent being falls from a height. Besides those two, sports injuries and falls on level ground were the third most frequent causes of SCI in the young generation and in elderly people respectively.

Accidental Falls↗
PubMed2006

The working practices and job satisfaction of dental hygienists in New Zealand.

OBJECTIVES: To describe the current working practices and level of job satisfaction of dental hygienists in New Zealand. METHODS: Postal survey of all dental hygienists on the New Zealand Dental Council's database. An initial mailing was followed by a 3-week follow-up. Information was sought on respondents' demographic characteristics, current occupation and working practice, history of career breaks, continuing education and career satisfaction. RESULTS: 213 responses were received (73.2%); 90.6% were currently working as hygienists, mostly in private practice. Many worked part time, particularly those with children. Almost 50% of respondents had taken at least one career break, most frequently for childrearing. The mean time taken in career breaks was 3.6 years. Overall, dental hygienists reported high levels of satisfaction with their careers and their income. Older hygienists had higher career satisfaction scores. Most respondents were actively involved in continuing education. Almost half were interested in expanding the range of procedures they perform. Over one-third plan to retire within the next 10 years. CONCLUSIONS: While many hygienists take career breaks and work part time, most have a high level of career satisfaction, actively participate in continuing education, and are satisfied with their remuneration.

Adult↗
PubMed2005

Cellular telephones and electronic communication patterns among families in metropolitan New York.

OBJECTIVE: The authors gathered survey data regarding the use of cellular telephones among families who reside in the New York metropolitan area and whose children receive medical care in a hospital-affiliated general pediatrics clinic. METHODS: Two investigators distributed a 34-question, self-administered survey in pencil-and-paper format to pediatric patients and the adults who accompanied them in the waiting room of a hospital-affiliated, outpatient pediatric practice in Mineola, New York. RESULTS: Completed surveys were obtained from 35 families. Twenty-eight (80%) of the 35 families completing surveys reported that at least one family member owned and used a cellular telephone. Of these 28 families, 9 (32%) reported that at least one household member aged to 18 years owned and used a cellular telephone. The mean age at which children obtained their first cellular telephone was 15.3 years. The primary reason these respondents cited for providing children with cellular telephones was safety (75%). CONCLUSION: The authors conclude that cellular telephone use is widespread among families in the New York metropolitan area. Although the primary reason families provide for obtaining cellular telephones is safety, convenience to household members and peer pressure also play roles.

Adolescent↗
PubMed2006

Validity and reliability of a questionnaire for evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population.

OBJECTIVES: To validate a new questionnaire evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population of men and women in Denmark. METHODS: The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) emerged from review of the literature and expert consensus. The questionnaire was a subset of a larger questionnaire comprising several domains on health status and voiding. Convergent and discriminatory validity was assessed in an unselected population of 2000 men and 2000 women 60-80 years old. To test reproducibility, 400 respondents were mailed a separate questionnaire 2 weeks apart. A subgroup of men and women with and without nocturia was used for evaluating reliability of number of nocturia episodes. RESULTS: A total of 2825 (70.6%) filled in the questionnaire. A decrease in health status was correlated with increasing bother (range: -0.25 to -0.36, p<0.001, Spearman's r). These findings indicate acceptable convergent validity. Significant discriminatory validity was proven in separate groups of symptom severity (p<0.0001, Kruskal-Wallis test). Median kappa was 0.70 (range 0.58-0.86) indicating substantial agreement in the retest analysis. Number of nocturia episodes in questionnaires correlated with frequency volume charts (Spearman's rho 0.88; p<0.001). CONCLUSION: These data support that the NNES-Q has a good discriminatory and convergent validity, and is reliable over time. The NNES-Q may be useful in epidemiological studies and may also have a potential in daily clinical work up in patients with nocturia and nocturnal enuresis.

Aged↗
PubMed2006

Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption.

OBJECTIVE: This study assessed the effectiveness of a 4-month intervention using stage-based newsletters, computer-based communication, and motivational interviewing to increase fruit and vegetable consumption by college students aged 18 to 24 years. DESIGN: Participants were stratified by stage of change for fruit and vegetable consumption and randomized to an intervention or control group. Participants completed the staging algorithm for fruit and vegetable intake, which included a one-item food frequency question, a 26-item food frequency questionnaire (FFQ), an 18-item decisional balance questionnaire, and a five-item self-efficacy questionnaire at baseline and completion of study. SUBJECTS: A convenience sample of 437 college students enrolled in a rural, land grant university was enrolled in the study. Only nondietetics majors between ages 18 to 24 years were included in the study. A total of 314 students finished the study for a completion rate of 72%. INTERVENTION: After baseline staging and randomization, the intervention group participants received four stage-based newsletters, one motivational interview, and an individually tailored e-mail follow-up over a 4-month period. Control group participants only received assessment at baseline and at completion. MAIN OUTCOME MEASURES: Two fruit and vegetable instruments, a one-item food frequency question, and a 26-item FFQ measured daily consumption of fruits and vegetables at baseline and postintervention. STATISTICAL ANALYSES PERFORMED: The SAS system for Windows, version 8 (1999, SAS Institute, Inc, Cary, NC), was used for analysis, including the following tests: PROC GLM, PROC FREQ, and PROC NPAR1WAY, Kruskal-Wallis, Fisher, Wilcoxon rank sum, and chi(2). RESULTS: Fruit and vegetable consumption increased significantly more for the intervention group than the control group. Consumption increased in the intervention group by one serving a day for both instruments compared with 0.4 servings a day in the control group for a one-item instrument and no change in the control group for a 26-item FFQ. CONCLUSIONS: This intervention is an effective way to increase fruit and vegetable consumption by young adults.

Adolescent↗
PubMed2003

Restorative service trends in private general practice in Australia: 1983-1999.

OBJECTIVES: Restorative services are a major component of the annual workload of a dentist, but are undergoing a period of change as population oral health continues to improve and restorative materials and techniques are developed. The aim of this study was to examine trends in the provision of restorative services over a 15-year period spanning 1983-84 to 1998-99. METHODS: A series of cross-sectional surveys was performed in 1983-84, 1988-89, 1993-94 and 1998-99 with response rates of over 70%. Data were collected by a mailed survey from a random sample of dentists from each state/territory in Australia. Dentists provided data on patients treated on a typical clinical day from which annual rates of provision of services per dentist were derived for restorative and related services. RESULTS: The overall number of annual restorative services provided per dentist declined over the four points of the study period. This trend reflected a steady decline in the annual number of amalgams provided per dentist. However, composite resins increased between 1993-94 and 1998-99, while glass ionomers, other-restorative services, crowns and fissure sealants all showed increases over the first three points of the study period. CONCLUSIONS: Over the study period the highest provision of restorative and related services changed from amalgams to composite resins, reflecting trends towards improved oral health and development of restorative materials. The decline in restorative services was not uniform across all age groups of patients, with increases observed among 45-64 and 65+ year olds, reflecting increased retention of teeth among adults.

Adolescent↗
PubMed2003

Assessment of binge drinking of alcohol in highly educated employees.

This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session.

Adult↗
PubMed2001

Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes.

BACKGROUND: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated. METHODS: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs). RESULTS: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practice-related problems. CONCLUSIONS: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy-makers, administrators and nursing home staff.

Attitude of Health Personnel↗
PubMed2006

Chairperson and faculty gender in academic emergency medicine departments.

OBJECTIVES: Despite the influx of female physicians in academic medicine departments, there are a small number of women in faculty and departmental leadership positions in emergency medicine (EM). The objective of this study was to determine if the gender of the chairperson of an academic EM department is associated with the gender of the residency program director (RPD) and gender proportion of its faculty. METHODS: This was a retrospective analysis of 133 academic EM departments using the Society for Academic Emergency Medicine online residency catalog, program Web site, or e-mail. Main outcome measures were proportion of female EM faculty and gender of the RPD. RESULTS: Data were available for 133 academic departments. Women chaired 7.5% (n = 10) of departments and comprised 22.3% of all faculty and 15.0% (n = 20) of RPD positions. EM departments that were chaired by women had a significantly higher percentage of female faculty compared with those led by men (31% vs. 22%; p = 0.01). Similarly, departments that were chaired by women had a significantly higher proportion of female RPDs compared with those chaired by men (50% vs. 12%; p < 0.01). Compared with departments chaired by men, the RPD was 5.0 times (95% confidence interval = 1.9 to 27.8; p < 0.01) more likely to be a woman if the chairperson was also a woman. CONCLUSIONS: An academic EM department was more likely to have a higher proportion of female faculty and a female RPD when the department chairperson was female.

Emergency Medicine↗
PubMed2004

Demographic and health-related correlates of herbal and specialty supplement use.

BACKGROUND: By broadening the definition of a dietary supplement, the 1994 Dietary Supplements Health and Education Act opened the market to many herbals, botanicals, and other food ingredients that would have otherwise needed safety testing before being sold. Information regarding patterns and correlates of herbal and specialty supplement use can help nutritionists understand which compounds are most commonly used, who are likely to use these supplements, and whether the choice of herbal supplements appears motivated by specific health concerns. METHODS: Data are from 61,587 participants, aged 50 to 76 years, who completed a self-administered mailed questionnaire in 2000-2002 on current dietary supplement use (20 herbal/specialty supplements, multivitamins, and 17 individual vitamins or minerals), demographic and lifestyle characteristics, and medical history. RESULTS: When compared with no supplement use, herbal/specialty supplement use was significantly higher among respondents who were older, female, educated, had a normal body mass index, were nonsmokers, engaged in exercise, and ate a diet lower in fat and higher in fruits and vegetables (all P<.001). Similar trends were observed when herbal/specialty supplement users were compared with vitamin/mineral users. For specific supplements and medical conditions, the strongest associations were cranberry pills and multiple bladder infections (odds ratio [OR], 4.66; 95% confidence interval [CI], 4.03-5.38), acidophilus pills and lactose intolerance (OR, 3.37; 95% CI, 2.96-3.84), and saw palmetto and enlarged prostate (OR, 3.33; 95% CI, 3.00-3.72). CONCLUSIONS: Odds of supplement use are high for certain demographic and lifestyle characteristics. Additionally, persons with specific medical conditions are using supplements promoted to reduce risk for their particular conditions.

Age Distribution↗
PubMed2000

Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses.

BACKGROUND AND PURPOSE: Physical therapists are at risk for work-related musculoskeletal disorders (WMSDs). Little is known of how therapists respond or of what actions they take to prevent injury. The purpose of this study was to investigate the prevalence and severity of WMSDs in physical therapists, contributing risk factors, and their responses to injury. SUBJECTS: As part of a larger study, a systematic sample of 1 in 4 therapists on a state register (n=824) was surveyed. METHODS: An 8-page questionnaire was mailed to each subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-related risk factors, injury prevention strategies, and responses to injury. RESULTS: Lifetime prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the profession as a result of WMSDs. Younger therapists reported a higher prevalence of WMSDs in most body areas. Use of mobilization and manipulation techniques was related to increased prevalence of thumb symptoms. Risk factors pertaining to workload were related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors were related to a higher prevalence of spinal symptoms. CONCLUSION AND DISCUSSION: Strategies used to reduce work-related injury in industry may also apply to physical therapists. Increased risk of thumb symptoms associated with mobilization techniques suggests that further research is needed to establish recommendations for practice. The issues for therapists who move within or leave the profession are unknown, and further research is needed to better understand their needs and experiences.

Adult↗
PubMed2005

Results of a survey of patients with alpha-1 antitrypsin deficiency.

BACKGROUND: alpha(1)-Antitrypsin deficiency (AATD) is an uncommon genetic disease which occurs in 1-2.5% of Americans with chronic obstructive pulmonary disease (COPD). Little is known about current demographics of AATD. OBJECTIVES: This survey study reviews the clinical characteristics of diseased individuals in North America. METHODS: A survey of members from the mailing lists of US AATD patient support organizations was commissioned with duplicate persons omitted. The survey was mailed to 5,222 unique individuals with AATD. Questionnaires were returned by 1,953 individuals, including 1,810 with severe deficiency, 93 with the carrier state and 41 who were caregivers of others. RESULTS: The majority (81%) of participants reported COPD with symptoms of asthma, chronic bronchitis, and emphysema, usually in combination. The mean age of respondents [53.1 +/- 13.2 (SD) years] is older than the general US population. Lung or liver transplantation was reported by 9% of all respondents (n = 175), including 66 single lung transplants, 68 double lung transplants, and 47 liver transplants. Another 6.6% (n = 128) reported that they were currently on a transplant list. Twenty-one percent of lung transplants report continuing augmentation therapy use. Augmentation use is reported by 75% of those with obstructive lung disease. The majority of patients with liver disease also have COPD. CONCLUSIONS: AATD remains a devastating illness for many of those affected as reflected in a high incidence of transplantation for liver and lung disease.

Adolescent↗
PubMed2004

Functional gastrointestinal disorders among people with sleep disturbances: a population-based study.

OBJECTIVE: To determine whether unexplained gastrointestinal (GI) symptoms are more common in people with self-reported sleep disturbance. PARTICIPANTS AND METHODS: From November 1988 to June 1994, valid self-report questionnaires were mailed to age- and sex-stratified random samples of Olmsted County, Minnesota, residents aged 20 to 95 years. RESULTS: Of 2269 study participants (74% response rate), 52% were women (mean age, 45.0 years). The overall age- and sex-adjusted prevalence of sleep disturbance per 100 population was 13.5% (95% confidence interval [CI], 11.7%-15.3%). Among study participants with sleep disturbance, the prevalence of irritable bowel syndrome (IBS) was 33.3% (95% CI, 26.0%-40.5%) and the prevalence of frequent dyspepsia (FD) was 21.3% (95% CI, 14.4%-28.2%). After adjusting for age, sex, and somatization score, IBS was significantly more common in those with sleep disturbance (odds ratio, 1.6; 95% CI, 1.1-2.2), but the univariate association with FD was no longer statistically significant (odds ratio, 1.3; 95% CI, 0.9-1.9). CONCLUSIONS: Both IBS and FD are prevalent in those with self-reported sleep disturbance. Sleep disturbance was independently associated with IBS but not FD in the general population.

Adult↗