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PubMedDate not supplied

The influence of practice type, region, and age on treatment recommendations for primary teeth.

The purpose of this study was to investigate dentists' treatment recommendations for interproximal surfaces of primary molars based on the type of practitioner (general dentist or pediatric dentist), geographic location, and age of practitioner. Simulated cases, which included histories and pictures of bite-wing radiographs, were mailed to a random sample of 2000 general dentists and 1000 pediatric dentists. Dentists were asked to select their treatment recommendations for eight cases involving the interproximal surface of a specified primary molar. The return rate was 42% (1245) overall, with 36% (723) from general dentists and 52% (522) from pediatric dentists. An amalgam restoration was recommended most often for these eight cases. Dentists in the age 60+ category and pediatric dentists were more likely to recommend treatment for smaller interproximal lesions. Composite resins were recommended infrequently; however, dentists in the 60+ age category and dentists in the Northeast and Southwest were somewhat more likely to recommend composite resin than younger dentists, or dentists in other geographic locations. Dentists in the 40-49 age range, pediatric dentists, and dentists in the Southwest were the most likely to recommend stainless steel crowns. These simulated cases demonstrate differences and similarities in the treatment recommendations for interproximal lesions on primary molars based on age, practice type, and region.

Adult↗
PubMed2002

Men's and women's knowledge and perceptions of breast cancer and mammography screening.

BACKGROUND: Although most men are not directly affected by breast cancer, they participate in decisions influencing breast cancer screening and contribute to shaping the social norm on mammography screening. This study tested the hypothesis that men may be less knowledgeable than women about breast cancer and mammography and have less favorable perceptions of mammography screening. METHODS: A survey was mailed to 952 women and 370 men aged 40 to 80 years, randomly selected from the general population of Geneva, Switzerland. Information collected included knowledge and perceptions about breast cancer and mammography, familiarity with screening recommendations, and perceived usefulness of an organized screening program. RESULTS: Men were almost as knowledgeable as women about breast cancer (difference in z-scores: -0.12; 95% CI: -0.25, 0.02; P = 0.10) and breast cancer screening (difference: -0.12; 95% CI: -0.25, 0.02; P = 0.09). Both men and women perceived mammography screening to be useful, but men had significantly higher z-scores of positive attitude toward mammography than women (difference: 0.28; 95% CI: 0.14, 0.42; P < 0.001). Younger and more educated respondents of either sex were both more knowledgeable and more favorably inclined toward screening. CONCLUSION: Men were as knowledgeable about breast cancer and mammography screening as women but had more favorable attitudes toward breast cancer screening than women. Actions to strengthen community support for mammography screening programs should primarily target older and less educated persons of either sex.

Adult↗
PubMed1999

Optimizing utilization of pediatric echocardiography and implications for telemedicine.

Telemedicine can deliver tertiary level services to remote communities where subspecialty care is limited. Locally performed echocardiography has been initiated at several locations around Iowa. The goal of this study was to examine utilization and diagnostic yield of community-based echocardiographic services. Community physicians selected patients for remote echocardiograms (echoes), and studies were performed locally by sonographers trained in recording pediatric echoes. Echoes were sent to the pediatric echocardiography laboratory by mail or via telemedicine systems. Echoes were also ordered locally by pediatric cardiologists during outreach clinics in the same communities. Numbers of normal and abnormal echoes ordered by community physicions and pediatric cardiologists were compared by chi-square analysis. Since January 1996, community physicians ordered 378 echoes, whereas 154 echoes were ordered by pediatric cardiologists at outreach clinics. Stratifying echoes by patient age found that the percentage of normal studies in patients < 1 year of age was no different between groups (27% normal by community physicians vs 15%; chi-square 0.92; p = 0.34). The percentage of normal studies ordered by community physicians was significantly greater in patients > 1 year of age (83% normal by community physicians vs 25%; chi-square 80.2; p <0.0001). Thus, (1) community physicians effectively identified patients < 1 year of age with abnormal echoes, (2) significantly fewer echoes may be required in patients > 1 year of age if patients are first evaluated by a pediatric cardiologist, and (3) patient selection will impact cost effectiveness of remotely obtained echoes.

Age Distribution↗
PubMed1998

Age limitation on provision of orthopedic therapy and orthognathic surgery.

Canadian orthodontists were surveyed by mail to determine the latest skeletal age at which they would recommend orthopedic therapy and orthognathic surgery and the earliest at which they would recommend orthognathic surgery. For the purposes of this introductory study, orthopedic therapy implied stimulation of physiologic response using appliance force, without specification of appliance type. Response rate from 512 orthodontists was 65% (n = 334), with the response rate by item varying from 92% to 95%. By Greulich and Pyle standards, the latest recommended age for orthopedic therapy was at 97% completion of skeletal growth (females 13.5 years, males 15 years), whereas the earliest recommended age for orthognathic surgery was when skeletal growth is 99% complete (females 14.9 years, males 16.5 years). Surgery would be recommended by 32% of respondents for a patient before the age of 8 years, if deformity is severe. For orthognathic surgery, respondents either perceived no age maximum or recommended 69 years, the maximum age on the questionnaire item. Orthodontists' traits influenced recommendations for timing treatment.

Adolescent↗
PubMed1995

The concept of individualized hypertension care in general practice and outpatient clinics. The general practitioner hypertension practice study (III).

OBJECTIVE: To examine test ordering practice among general practitioners and hospital medical specialists according to the concept of individualized hypertension care. DESIGN: Mailed hypothetical case histories, with reference panels to categorize tests. SETTING: Uppsala-Orebro region in mid-Sweden. SUBJECTS: General practitioners (N = 90) and hospital medical specialists (N = 69) in randomly sampled primary health care centres and hospitals. MAIN OUTCOME MEASURES: Test ordering scores. RESULTS: 84% of invited GPs and 72% of specialists participated. According to reference panel standards, primary care physicians performed 75% of obligatory tests and specialists 88%. Superfluous tests constituted a larger proportion of the practice of hospital specialists (11-28%) than GPs (2-12%) in the six cases. Summarized examination scores revealed a wide practice variation within and between the two physician categories, specialists scoring significantly higher in three cases. Standardization of practice was more common among specialists, and differed significantly regarding serum potassium test, chest X-ray and ECG. Both groups deviated from current guidelines by omitting metabolic parameters. CONCLUSION: There is considerable practice variation in individualized hypertension care, which might influence treatment outcome. Practice audit and continuing medical education could contribute to care standardization according to guidelines.

Adult↗
PubMedDate not supplied

Impact of the Iowa S-SCHIP program on access to dental care for adolescents.

PURPOSE: This study examined whether providing insurance through Iowa's State Children's Health Insurance Program, S-SCHIP, had an impact on dental care access for adolescents that was similar to children of other age groups. METHODS: Using a pretest, post-test panel study design, an 80-item questionnaire was mailed to the parents of one S-SCHIP enrollee per household at enrollment. A similar instrument was mailed after 1 year. A mixed-mode data collection process was used. Children were compared by age groups (1 to 6, 7 to 12, and 13 to 18). Statistical tests evaluated differences in: (1) demographics between age groups at baseline; (2) outcomes at follow-up; and (3) differences between matched-pair responses prepost. RESULTS: Baseline and follow-up responses were received from 39% of sampled children (N = 1,399). After 1 year, access to and utilization of dental services improved for all age groups. Adolescents, however, were least likely to have had an annual dental visit; 1 in 6 still had unmet dental need or delays. Relative to other health services, dental care was reported to be the highest area of unmet need at both baseline and follow-up, especially for adolescents. CONCLUSIONS: Iowa's S-SCHIP program was found to improve dental care access for children of all ages. Nonfinancial barriers, however, still exist for a significant number of adolescents.

Adolescent↗
PubMed2005

Prevalence and consequences of insomnia in New Zealand: disparities between Maori and non-Maori.

OBJECTIVE: To investigate the prevalence of self-reported insomnia symptoms among Maori (Indigenous people) and non-Maori adults in the general population of New Zealand. To explore the consequences for health and quality of life experienced by those who report common insomnia complaints and sleeping problems. METHODS: In 2001, a two-page questionnaire was mailed to a stratified random sample of 4,000 adults aged 20-59 years nationwide. Participants were selected from the New Zealand electoral roll. The sample design aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each decade of age (72.5% response rate). RESULTS: Population prevalence estimates indicate that self-reported insomnia symptoms and sleeping problems are higher among Maori than non-Maori. Multiple logistic regression analyses showed that self-reported insomnia symptoms and/or sleeping problems are significantly associated with reporting poor or fair health and quality of life outcomes. CONCLUSIONS: Approximately one-quarter of adults in New Zealand may suffer from a chronic sleep problem, highlighting insomnia as a major public health issue in New Zealand. IMPLICATIONS: Significant differences in the prevalence of insomnia symptoms and current sleeping problems with respect to ethnicity have implications in the purchase and development of treatment services, with greater need for these services among Maori than non-Maori.

Adult↗
PubMed1993

Nurse attendee purchasing patterns.

Retention of nursing professionals is crucial in responding to the increasing demand for and complexity of nursing care. Augmenting the decision-making role of nurses is one important retention-related strategy. Purchasing patterns reflect one aspect of nurses' decision-making role. National meetings provide nurses with an opportunity to investigate educational and employment options, as well as to preview technological advances in patient care products and supplies. Yet, the purchasing patterns of nurses related to the marketing of patient care supplies, or educational material at national meetings have rarely been acknowledged or researched. This study investigated the purchasing patterns of nurse attendees as revealed at a national meeting and how attendance influenced purchasing input following the meeting. The study addressed differences in purchasing patterns between specific groups of nurse attendees, as well as the relationship between meeting attendance motivators and purchasing patterns. A descriptive methodology utilizing participant observation at four national nursing meetings and mail survey in four phases was used to determine if there were: (1) identifiable purchasing patterns for nurses attending specific nursing-organization sponsored national meetings, (2) differences in purchasing patterns between nurse attendees from these meetings, (3) differences in self-reported post-meeting purchase input, and (4) relationships between meeting attendance motivators and purchasing patterns. The findings demonstrate that nurse attendee purchasing patterns can be identified and do vary among nursing groups. Nurse attendees at specialty meetings were more likely to act as specifiers, have a more dominant role in purchasing and were more likely to influence product purchases than were nurse attendees from generalist meetings. Self-reports of post-meeting purchasing input demonstrated that nurse attendees utilized information gained at national meetings in subsequent patient care product selections, product utilization and specification of new products/equipment/protocols for trial within the practice site. Positive relationships between meeting attendance motivators and purchasing patterns were most evident for those nurse attendees with greater purchasing involvement and influence.

Adult↗
PubMed2003

Heritability and validity of healthy physical aging (wellness) in elderly male twins.

The authors define a trait "wellness" for good health in 6109 men in the National Academy of Sciences-National Research (NAS-NRC) twin panel aged 70 years and up surveyed by mail in the fall of 1998. Men who responded that they had not had a heart attack, coronary surgery, stroke, diabetes or prostate cancer in the survey questionnaire (Q8) met the broad definition of wellness. A more narrow definition included the absence of hypertension. Genetic analysis indicated that over 50% of the population variance for liability to either wellness definition was genetic. A subset of the NAS-NRC twins also participates in the National Heart, Lung and Blood Institute (NHLBI) twin study. NHLBI examinations and medical record review was done in 1986-1987 and 1995-1997 for 389 individuals who completed Q8. Excellent agreement (kappa > 0.8) was found between Q8 and outcome review for each condition comprising the wellness definition, ranging from 0.81 for coronary surgery to 0.88 for diabetes. Substantial agreement (kappa = 0.67) was found for hypertension. Kappa values for wellness were 0.82 for the broader definition and 0.74 if high blood pressure was included. Fraternal twin-pairs concordant for the wellness definitions are currently being recruited for linkage studies.

Aged↗
PubMed1996

Detection of HIV type 1 env subtypes A, B, C, and E in Asia using dried blood spots: a new surveillance tool for molecular epidemiology.

Global surveillance of HIV-1 subtypes for genetic characterization is hampered by the biohazard of processing and the difficulties of shipping whole blood or cells from many developing country regions. We developed a technique for the direct automated sequencing of viral DNA from dried blood spot (DBS) specimens collected on absorbent paper, which can be mailed unrefrigerated in sturdy paper envelopes with low biohazard risk. DBS were collected nonrandomly from HIV-1-infected, mostly asymptomatic, patients in five Asian countries in 1991, and shipped via airmail or hand carried without refrigeration to Bangkok, and then transshipped to North America for processing. After more than 2 years of storage, including 6 months at ambient temperatures, proviral DNA in the DBS was amplified by nested PCR, and a 389-nucleotide segment of the C2-V3 env gene region was sequenced, from which 287 base pairs were aligned and subtyped by phylogenetic analysis with neighbor-joining and other methods. From southern India, there were 25 infections with subtype C and 2 with subtype A. From Myanmar (Burma), we identified the first subtype E infection, as well as six subtype BB, a distinct cluster within subtype B that was first discovered in Thailand and that has now appeared in China, Malaysia, and Japan. From southwest China, one BB was identified, while a "classical" B typical of North American and European strains was found in Indonesia. From Thailand, five DBS of ambiguous serotype were identified as three B, one BB, and one E. A blinded control serotype E specimen was correctly identified, but a serotype BB control was not tested. Most HIV-1 in southern India appears to be env subtype C, with rare A, as others have reported in western and northern India. The subtypes BB and E in Myanmar, and the BB in China, suggest epidemiological linkage with these subtypes in neighboring Thailand. DBS are a practical, economical technique for conducting large-scale molecular epidemiological surveillance to track the global distribution and spread of HIV-1 variants.

China↗
PubMed2006

Orthodontic treatment provided by general dentists who have achieved master's level in the Academy of General Dentistry.

INTRODUCTION: The purposes of this study were to document orthodontic treatment currently provided by general dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. METHODS: A 21-item survey was mailed to 750 master's level members of the Academy of General Dentistry. Surveys returned within 8 weeks were included for statistical analysis. RESULTS: The response rate was 62%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Many provided orthodontic treatment in the permanent dentition, and the most common conditions or malocclusions treated were space maintenance, anterior crossbite, rotation, habits, molar uprighting, and posterior crossbite. The most common orthodontic appliances used were removable Hawley appliances with finger springs, straight wire orthodontic therapy, rapid palatal expanders, and functional appliances. CONCLUSIONS: The number of general dentists providing comprehensive orthodontic treatment has not changed since previous surveys; practitioners also do not expect a change in the next 5 years. Factors that influenced the orthodontic treatment provided included the primary source of orthodontic training, the number of orthodontic continuing education hours earned per year, the practitioner's location, and the proximity to the nearest orthodontist.

Adult↗
PubMed2002

Antibiotics after rattlesnake envenomation.

To record the outcome, with regard to infection rate, of patients with rattlesnake bites (RSBs) who do not receive prophylactic antibiotics, a prospective observational study was performed of patients with RSBs treated at our institution during a consecutive 18-month period. The inclusion criteria were RSBs <24 h old and completion of follow-up (telephone call, mail reply, medical toxicologist, or private physician examination) 7-10 days following envenomation. Fifty-six consecutive patients (Median age: 32.8 years [range 4-67 years]) were enrolled. One patient was excluded because of presentation 38 h after envenomation and two patients failed to complete the required follow-up. One patient received a dose of antibiotics before transfer. Antibiotics were discontinued upon arrival. Of the total 56 RSB patients, 34 (61%) RSBs involved the upper extremity and 22 (39%) involved the lower extremity. Six patients (11%) applied ice and two (4%) used a tourniquet before evaluation. The mean arrival time was 2.7 h (Range <1-24 h). Forty-three patients (81%) received antivenin. Fifty-three patients (100%) had extremity swelling and 38 patients (72%) had tender proximal lymph nodes. Of the 53 patients who completed the study, 3 (6%) received antibiotics from their primary care physicians at 7-10 day follow-up, with no cases (0%) of documented infection. Prophylactic antibiotics are not indicated in patients with rattlesnake bites.

Adolescent↗
PubMed2001

Effect of vaccination by community pharmacists among adult prescription recipients.

BACKGROUND: Millions of doses of influenza vaccine are administered each year in the United States at nontraditional sites and by nontraditional vaccine providers. Pharmacists are increasingly becoming vaccine providers. OBJECTIVES: To measure association between availability of pharmacist-immunizers and immunization delivery to adult prescription recipients, and the relative contributions of various types of vaccine providers. RESEARCH DESIGN: Mailed survey in spring 1999, contrasting adults in urban Washington State, where pharmacists administer vaccines, to adults in urban Oregon, where pharmacists did not. SUBJECTS: Cluster sample based on October 1998 prescription records suggesting need for influenza vaccine, derived from 24 community pharmacies belonging to one pharmacy chain. MEASURES: Vaccination status and choice of vaccine provider. RESULTS: Influenza vaccination rates among respondents 65 years or older increased 4.7% more in Washington than in Oregon between 1997 and 1998 (P = 0.20). The net increase in influenza vaccination rate among younger respondents taking indicator medications for chronic diseases for which influenza vaccination is recommended was 10.6% (P = 0.05). Among respondents unvaccinated against influenza in 1997, the 1998 influenza vaccination rate was 34.7% in Washington, compared with 23.9% in Oregon (P = 0.01). CONCLUSIONS: Vaccine delivery by pharmacists is associated with higher rates of vaccination among those younger than 65 taking indicator medications medications for chronic diseases, as well as prescription recipients unvaccinated against influenza in the previous year.

Adult↗
PubMed1995

Men and women in optometry. I: Economic issues and professional profiles.

BACKGROUND: Optometry is experiencing a sharp increase in the number of women entering practice. How is this demographic shift likely to affect the profession? This survey was designed to describe current economic and professional profiles of men and women in optometry. METHODS: A survey questionnaire was mailed to a nationwide random sample of optometrists, equal numbers of men and women. RESULTS: Data were analyzed from 353 men and 356 women. Margin of error: +/- 4 percent. On average, women optometrists are younger than men, work 9.4 percent fewer hours, and spend 8.1 percent more time away from their regular professional duties. In 1991 men's optometry income averaged $72,200; women's, $54,400. The income differential persisted after adjusting for age, practice setting, work week, time off, and specialty. Men are more likely to be in solo practice; women in group practice or salaried positions. Similar proportions of men and women are employed in corporate optometry. Few gender differences exist in patient services or other professional activities. CONCLUSIONS: Women optometrists have not yet gained economic equity with men. Male-female similarities in practice patterns suggest that optometry is unlikely to experience major changes in consequence of more women entering the profession.

Adult↗
PubMed2002

Compliance and findings in a Swedish population screened for colorectal cancer with sigmoidoscopy.

AIM: The aim of this study was to evaluate the patterns of compliance and the frequency of adenomas and neoplasms in a Swedish population. METHODS: In 1996, 2000 men and women born in 1935 or 1936 were selected at random from the population registers of Uppsala and Malmö/Lund. All subjects were invited by mail to participate. In a randomised study design, subjects were either called up by a nurse to schedule the appointment for sigmoidoscopy or instructed to call themselves. At sigmoidoscopy subjects with a cancer, an adenoma (neoplastic polyp) or more than three hyperplastic polyps were scheduled for a complete colonoscopy. RESULTS: Thirty-nine percent (770/1988) of all the invited subjects had a sigmoidoscopy. The participation differed between the two centres, 47% at the Uppsala centre and 30% at the Malmö/Lund centre (P<0.01). There was no statistically significant difference between the two different invitation groups. In all, 98 subjects (13%) were planned for colonoscopy. Thirty-one (35%) of the subjects having a colonoscopy were women and 57 (65%) were men. Fifty-five true adenomas were found in 46 subjects. All together, six subjects had proximal adenomas. Five adenocarcinomas were diagnosed, all within the reach of the sigmoidoscope. CONCLUSIONS: The compliance was lower and the adenomas were fewer than expected. To increase compliance it is necessary with rigorously controlled invitation routines.

Adenoma↗
PubMed1998

Attitudes of physicians practicing in New Mexico toward gay men and lesbians in the profession.

PURPOSE: To examine the attitudes of physicians practicing in New Mexico toward gay and lesbian medical students, house officers, and physician colleagues. METHOD: In May 1996, the authors mailed a questionnaire with demographic and attitude questions to 1,949 non-federally employed physicians practicing in New Mexico. The questionnaire consisted of questions dealing with medical school admission, residency training, and referrals to colleagues. The response rate was 53.6%. RESULTS: Of all the responding physicians, 4.3% would refuse medical school admission to applicants known to be gay or lesbian. Respondents were most opposed to gay and lesbian physicians' seeking residency training in obstetrics and gynecology (10.1%), and least opposed to their seeking residency training in radiology (4.3%). Disclosure of homosexual orientation would also threaten referrals to gay and lesbian obstetrician-gynecologists (11.4%) more than to gay or lesbian physicians in other specialties. CONCLUSION: Physicians' attitudes toward gay and lesbian medical students, house officers, and physician colleagues seem to have improved considerably from those reported previously in the literature. However, gay men and lesbians in medicine continue to face opposition in their medical training and in their pursuit of specialty practice.

Attitude of Health Personnel↗
PubMedDate not supplied

Method of payment for children's dental services by practice type and geographic location.

The purpose of this project was to evaluate practice type and geographical differences in methods of payment accepted for children's dental services. A survey was mailed to 2000 general dentists and 1000 pediatric dentists randomly selected to provide representation from the 50 United States. Dentists were asked to specify the type of practice and the state in which they primarily practice. The survey included Medicaid, dental insurance, preferred provider organizations (PPO), and self-payment as payment options. Dentists were asked to indicate whether they never, occasionally, or frequently accepted each option of payment for children's dental services. Responses were received from 1245 (42%) dentists, including 723 general dentists and 522 pediatric dentists. Chi-square statistical analysis revealed significant practice type and regional differences in the acceptance of Medicaid for payment. Pediatric dentists accept Medicaid more frequently than general dentists (P < 0.001). Most dentists accept dental insurance and self-payment, while few indicate involvement with a PPO. The study revealed significant practice type differences only in the acceptance of Medicaid as payment for children's dental services. On a geographic basis, there were significant differences in the acceptance of Medicaid and dental insurance.

Adolescent↗
PubMed2005

Hormone therapy use among postmenopausal French women before the publication of the Women's Health Initiative study: duration of use and factors associated with discontinuation.

OBJECTIVE: Compliance with recent recommendations concerning hormone therapy (HT) requires that we understand the reasons why women receiving HT continue or stop their treatment. Our aim was to estimate the duration of HT use and analyze factors associated with its discontinuation during the period before the publication of articles challenging the safety of HT. DESIGN: With data from 3 mail questionnaires--at inclusion (in 1990), 3 years, and 6 years--we estimated the cumulative treatment continuation rate by the actuarial method and used the Cox model to analyze the factors associated with discontinuation. SETTING: French women participating in the GAZEL cohort of employees of the French national power and electricity company (Electricité de France-Gaz de France). PATIENT(S): One thousand eighty-three postmenopausal women who were ever-HT users. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Discontinuation of HT. RESULT(S): A total of 91.6% of women consulted gynecologists, and 88% continued treatment 5 years after they had begun it. Those reporting hot flashes as a reason for taking HT and those younger than 45 years old at menopause were less likely to stop HT, as were women reporting alcohol use. CONCLUSION(S): Our results demonstrate the importance of providing information to physicians, primarily gynecologists, to ensure appropriate treatment of symptoms for menopausal women, especially those younger than 45 years old, while bearing their long-term health in mind.

Chi-Square Distribution↗