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PubMedDate not supplied

Delay in obtaining conventional healthcare by female internal medicine patients who use herbal therapies.

The use of herbal products has been studied in the general population, but few studies have focused on the prevalence of herbal therapy use for treatment of symptoms or disease among female internal medicine patients or on predictors for delaying obtaining conventional care while using herbal therapy. Cross-sectional 34-item self-report surveys were mailed to female patients in two private practice internal medicine sites and interviewer administered to patients in a resident ambulatory clinic. The survey included sociodemographics, medical problems, use of herbal therapies, and whether conventional care was delayed while using herbal therapy. Of 354 patients, 220 (62%) participated. Their mean age was 51 years, and most were Caucasian (77%) and had more than a high school education (60%). Of these, 81 (37%) women used herbal therapies for treatment of symptoms or disease, and use did not differ by study site. Twenty-six (32%) delayed obtaining conventional care while waiting for an herbal product to work, although most eventually obtained conventional care. In multivariate analysis, predictors for delay of care included negative experience with prescription medicines, history of failed treatments, and desire for increased control over personal healthcare. Among female patients of general internists, there was a high prevalence of herbal therapy use for treatment of illness, and some women delay obtaining conventional care while using an herbal product. Predictors for delay may alert physicians to educate their patients before delaying care.

Age Distribution↗
PubMed2000

Body size and hip fracture risk. Swedish Hip Fracture Study Group.

The objective of this population-based case-control study was to determine the independent association between height, weight at different ages and adult weight change on hip fracture risk, and the joint effects of these factors. The study base comprised postmenopausal women 50-81 years of age who resided in six counties in Sweden during the period October 1993 to February 1995. The study included 1,327 cases with an incident hip fracture and 3,262 randomly selected controls. We obtained information on body measures and other factors possibly related to hip fracture through mailed questionnaires and telephone interviews. Height and weight change were dominant risk factors. Tall women (> or = 169 cm) had an odds ratio of 3.16 (95% confidence interval = 2.47-4.05) compared with women shorter than 159 cm. Weight gain during adult life was strongly protective: compared with those with moderate weight change (-3 to 3 kg), those with substantial weight gain (> or =12 kg) had a markedly decreased risk of hip fracture (odds ratio = 0.35; 95% confidence interval = 0.27-0.45), whereas weight loss was associated with an increased risk. Weight change retained important effects among all subjects, even after controlling for current weight and weight at age 18. In contrast, among women who gained weight, the separate effects of current weight and weight at age 18 were small or absent. Among women who lost weight, both current weight and weight at age 18 had effects that remained after controlling for weight change. Adult weight change and height are dominant body size risk factors for hip fracture. Weight loss vs weight changes demarcates different patterns of hip fracture risk.

Age Distribution↗
PubMed2001

[Preliminary information to patients and presentation by Burkinabe physicians of the results of HIV detection test in Burkina Faso].

BACKGROUND: The action of individuals and their family is determining in the result of AIDS control and the knowledge of people's serological situation facilitates their involvement in AIDS control. This study was carried out in order METHODS: A transversal investigation through a self-administered anonymous questionnaire was carried out among the 250 Burkinabe physicians working in a public, private or religious health care sector. The questionnaire was sent by mail, attached to a response coupon. A response of 74% was obtained. RESULTS: Seventy seven physicians, that is 48.7% of the sample, informed patients who were likely to be HIV infected about their intention to ask for an HIV test. Seventy five physicians, that is 47.5% of the sample informed patients on the results of their serological tests on HIV infection. The characteristics of physicians who informed customers on the results of their serological test were similar to those of physicians who informed their patients on the demand for test concerning them. There were often specialists, physicians with long experience in medical practice and physicians more involving in curative consultations than in preventive ones (respectively 54.7% versus 23.3%, p=0.002). CONCLUSIONS: These results show the necessity of providing young physicians with counselling training, especially general practitioners who should be working in prevention services. Moreover, they constitute a basis for an objective discussion between physicians working in hospital, officials in charge of the national program for AIDS control and medical training schools.

Burkina Faso↗
PubMed1989

[Case-control study of moyamoya disease].

The cause of Moyamoya disease is still unknown. We made a research about the factors closely related to Moyamoya disease through a case-control study. The number of cases studied was 66. Controls were selected from among patients' friends, matched as to sex, age and residential area. Questionnaires were sent to the cases and the respective controls by mail. The questions were about past history, developmental history, school records, habitual factors, dietary habits and pets. The first symptoms and age at onset were also surveyed in the cases. The response rate was 84.8% (56 cases) of the cases and 76.5% (101 cases) out of the 132 controls. There was no significant difference in the prevalence of tonsillitis, conjunctivitis, otitis media, and bronchitis. Odds ratio of fever of unknown origin is 2.793 and X2 is 7.213. Diseases whose odds ratio was over 1 were herpes, appendicitis, bronchitis, asthma, anemia, dental caries, head injury and drug allergy. But all of them were not significantly prevalent. Odds ratios of school records were 4-9 and X2 were 4-17 from elementary to junior high school. Odds ratio of western dishes was 2.709 and X2 was 5.189. There was no significant difference as to pets kept. We could not find overt relationships between Moyamoya disease and diseases of head and neck like tonsillitis.

Adolescent↗
PubMed1998

Prevalence of asthma and asthma-like symptoms in an adult population sample from Verona. ECRHS Verona. European Community Respiratory Health Survey.

The aim of the study was to assess the prevalence of asthma and asthma-like symptoms in the general population of Verona. A screening questionnaire, with seven questions on respiratory symptoms, was sent by mail to 3000 randomly selected subjects, aged 20-44 yrs. After three subsequent mailings, nonresponders were interviewed by telephone. The overall response rate was 92%. At least one respiratory symptom was reported by 44% subjects. The prevalence of the most frequent symptoms differed according to the type of contact: early respondents (i.e. those who responded by mail) were more likely to report symptoms than late respondents (i.e. those who were interviewed by telephone). Wheezing was reported by 11.3% of males and 8.0% of females (p < 0.01). The allergic rhinitis and hay-fever prevalence was 16.9% with no differences owing to sex or age. The prevalence of an "episode of asthma" (defined as a self-reported attack of asthma or treatment for asthma) and of "current asthma" (defined as a self-reported attack of asthma, treatment for asthma or wheezing other than due to a cold with dyspnoea in the last 12 months) was 4.1 and 4.7%, respectively. No differences were found on the basis of age and sex. The prevalence of asthma was greater in urban (5.0%) than in suburban (2.7%) areas (p < 0.05), where lower pollution levels were registered. The greater prevalence in urban areas suggests that some factors related to the urban environment could play a role in the development of asthma and asthma-like disorders.

Adult↗
PubMed2001

Preventive and other interactional skills of general practitioners, surgeons, and physicians: perceived competence and endorsement of postgraduate training.

BACKGROUND: Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups. METHODS: All eligible final year students and recent graduates of the three major Australian medical colleges (n = 767) were mailed a questionnaire examining communication skills in four domains: preventive, educational, therapeutic, and general. RESULTS: Overall consent rate was 45%. For most items, at least one-third of each group reported low competence. On preventive items, low competence ratings ranged from 5 to 39% in general practice, 38 to 67% in surgery, and 33 to 51% in the speciality physician group. Significant intergroup differences occurred on eight competence items. Agreement with training on preventive topics ranged from 80 to 91% in general practice, 48 to 69% in surgery, and 72 to 82% in the specialty physician group. On all 11 training items where significant differences occurred, the general practice group reported the highest level and the surgeon group the lowest level of endorsement for formal training and assessment. CONCLUSIONS: Substantial proportions in the general practice, surgery, and the physician specialty report lack of competence in common interactional skills. There were high levels of support for formal training in preventive and other interactional skills. The strong endorsement supports the development of effective, tailored interactional skills training programs.

Adult↗
PubMed2002

[Variables associated with the risk of postpartum depression. Edinburgh Postnatal Depression Scale].

OBJECTIVE: To find some of the variables associated with values on the Edinburgh Postnatal Depression Scale (EPDS) which suggest postnatal depression in women living in the province of Soria. DESIGN: Population-based case study with controls. SETTING: Soria Health Region. PARTICIPANTS: Women living in Soria giving birth in the INSALUD General Hospital between January and October 2000. MAIN MEASUREMENTS: Questionnaire sent by mail, containing socio-economic variables, pathology background, gynaecological and obstetric details, the EPDS and the APGAR Family score. Those questionnaires filled in between the third and eighth week after birth were considered valid. RESULTS: 340 questionnaires out of 556 sent out were received back (61.2% reply rate). 34 were excluded for lack of data or evident mistakes. 15.7% (95%, CI, 11.6-19.8) of the women scored 13 or more on the EPDS and were at risk of suffering postnatal depression. The independent variables associated with postnatal depression were: age of mother, poor or very poor economic situation, personal history of disturbed states of mind, being anaesthetised during birth and family dysfunction. CONCLUSIONS: The risk of postnatal depression was mainly related to socio-economic and family variables. Identification of these variables along with application of the EPDS after giving birth raises the alarm for a possible postnatal depression, and enables the study and follow-up in benefit of the mother and of the subsequent evolution of the new-born to be initiated.

Adult↗
PubMed2000

Identifying dyspepsia and irritable bowel syndrome: the value of pain or discomfort, and bowel habit descriptors.

BACKGROUND: The utility of current diagnostic criteria for dyspepsia and irritable bowel syndrome (IBS) in clinical practice is largely unknown. We aimed to compare the diagnostic value of different definitions and questionnaires in a population. METHODS: The Abdominal Symptom Questionnaire (ASQ) was mailed to a representative sample (n = 1506, 20-87 years old), and every fifth person (n = 302) concomitantly received the Bowel Disease Questionnaire (BDQ). The diagnostic agreement for dyspepsia and for IBS, defined in accordance with the Manning and the modified Rome criteria and a new simple definition, was analysed. RESULTS: In the ASQ the agreement on the IBS status for the three IBS definitions was > or = 88%, and in the BDQ > or = 93%. Agreement for the three definitions on the two questionnaires was > or = 88% regardless of which definition of IBS was applied. Agreement between questionnaires was similar (88%) for dyspepsia. For both IBS and dyspepsia the kappa coefficients indicated moderate to substantial concordance. 'Pain or discomfort' did not cover all linguistic aspects of dyspepsia. Prevalence rates of dyspepsia were comparable in the ASQ and BSQ, whereas higher prevalences of IBS with the ASQ was related to the cutoff levels for reporting abdominal pain or discomfort. CONCLUSION: It is possible to identify IBS more simply by self-report questionnaires.

Adult↗
PubMed2006

The demographic bias of email as a survey method in a pediatric emergency population.

UNLABELLED: Email has been considered as a communication medium between patients and clinicians in pediatric emergency departments, but the demographic bias involved in using email has not been fully explored. We developed a paper based survey to explore access, willingness to participate and the demographic bias of email within our parent population. METHODS: To 1733 possible subjects, 1200 surveys were distributed with a return of 1018, a survey response rate of 85%, and a population response rate of 59%. RESULTS: Subjects from families with incomes less than $60,000 per year had lower access rates (OR = 0.40, 95 (OR = 0.37, [0.17, 0.81]). Employment outside of the home was associated with increased email access rates (OR = 1.79, 95% CI [1.19, 2.70]). Visible minority status was associated with an increased willingness to participate (OR = 1.84, 95 as was low education (OR = 2.12, 95% CI [1.04, 4.32]). The population of theoretical responders to an email based quality assurance process would have been significantly different from the base population of adults accompanying children to our emergency department as a result of these biases. CONCLUSIONS: We have demonstrated a degree of demographic bias in email access rates, negatively affecting those individuals with lower income, less employment, and lower education. Email based surveys directed at parents in pediatric emergency departments should include questions on income, employment and education in order to permit those who analyze the data to correct for these variables. More research is needed to confirm these findings.

Bias↗
PubMed1998

Are drivers with CVD more at risk for motor vehicle crashes? Study of men aged 45 to 70.

OBJECTIVE: To examine whether male drivers aged 45 to 70 years suffering from cardiovascular disease (CVD) are more likely to be involved in motor vehicle crashes (MVC) that are reported to the police. DESIGN: Population-based case-control study. SETTING: Data on drivers' ages and medical conditions were compiled from the Societé de l'assurance automobile du Québec's (SAAQ) computerized files. A questionnaire was mailed to all subjects to collect additional information on annual distances driven and various driving behaviours. PARTICIPANTS: Age-stratified population-based random sample. Subjects were 2504 drivers involved in MVCs during a 6-month period; controls were 2520 drivers not involved in crashes. MAIN OUTCOME MEASURES: Proportion of drivers with CVD involved in MVCs. RESULTS: Response rate to the questionnaire was 35.5%. Analysis of the SAAQ files' entire sample of 5024 drivers showed that drivers suffering from CVD were less likely to be involved in MVCs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.67 to 0.99) than drivers without CVD. Although the estimate of risk remains unchanged when adjusted for age, it becomes statistically insignificant. It also remains unchanged and statistically insignificant when adjusted for yearly distance driven and driver behaviour, as shown by responses to the questionnaire. Drivers suffering from CVD drove significantly less each year (8900 km) than drivers without medical conditions (13,000 km). CONCLUSION: This study shows no increased risk of motor vehicle crashes for drivers suffering from CVD.

Accidents, Traffic↗
PubMed2001

Is participation in cardiac rehabilitation programs associated with better quality of life and return to work after coronary artery bypass operations? The Israeli CABG Study.

OBJECTIVE: To explore the putative effect of cardiac rehabilitation programs on the 'health-related quality of life' and 'return to work' in pre-retirement patients one year after coronary artery bypass grafting. METHODS: Of the 2,085 patients aged 45-64 who survived one year after CABG and were Israeli residents, 145 (6.9%) had participated in rehabilitation programs. Of these, 124 (83%) who answered QOL questionnaires were individually matched with 248 controls by gender, age within 5 years, and the time the questionnaire was answered. All patients had full clinical follow-up including a pre-operative interview. The Short Form-36 QOL questionnaire as well as a specific questionnaire were mailed to surviving patients one year after surgery. Study outcomes included the scores on eight scales and two summary components of the SF-36, as well as 'return to work' and 'satisfaction with medical services' from the specific questionnaire. Analysis was done for matched samples. RESULTS: Cardiac rehabilitation participants had significantly higher SF-36 scores in general health, physical functioning, and social functioning. They had borderline significant higher scores in the physical summary component of the SF-36. The specific questionnaire revealed significantly better overall functioning, higher satisfaction with medical care, and higher rate of return to work. While participants in cardiac rehabilitation and their controls were similar in their socio-demographic and clinical profiles, participating patients tended to be more physically active and more fully employed than their controls. CONCLUSIONS: Rehabilitation participants had a self-perception of better HRQOL, most significantly in social functioning. Our findings of more frequent return to work and higher satisfaction with medical care should induce a policy to encourage participation in cardiac rehabilitation programs after CABG.

Case-Control Studies↗
PubMedDate not supplied

Use of alternative therapies and their impact on compliance: perceptions of community pharmacists in Texas.

OBJECTIVE: To assess community pharmacists' experiences with the use of alternative therapies by their patients with chronic illnesses. DESIGN: Mail survey. SETTING: State of Texas. PARTICIPANTS: 142 community independent and chain pharmacists. MAIN OUTCOME MEASURES: Pharmacists' recollections about patients' use of alternative therapies. RESULTS: Pharmacists estimated that 17% of their patients with chronic illnesses used some form of alternative therapy. A majority (66.9%) indicated that they have patients who used some type of alternative therapy for chronic conditions and that a majority (59.7%) of these patients consulted with them regarding those therapies. However, in only 11.1% of these cases did pharmacists document alternative therapy use in patients' pharmacy records. Pharmacists reported that 25.9% of these patients who use alternative therapies for chronic conditions were not compliant with their prescribed medication regimen. One-third (33.1%) of respondents indicated they knew of no patients who used alternative therapies, and 35.9% had never asked. CONCLUSION: Pharmacists need information on patients' use of alternative therapies for chronic illnesses to make valid therapy decisions and to monitor outcomes. Future research should identify actions that pharmacists take to address drug-related problems among alternative therapy users and assess the impact of these actions on drug therapy-related outcomes.

Adult↗
PubMed2002

Sociodemographic differences in the occurrence of teenage pregnancies in Finland in 1987-1998: a follow up study.

STUDY OBJECTIVE: To analyse sociodemographic differences in the occurrence of pregnancies to 14 to 19 year olds and changes in these differences from 1987 to 1998. DESIGN: Follow up of adolescent survey respondents using registers. SETTING AND SUBJECTS: The dataset includes information on all registered pregnancies (abortions, births, and miscarriages, n=2743) of the female respondents (n=28 914) to the Adolescent Health and Lifestyle Survey (AHLS) from 1987 to 1998. In the AHLS, self administered questionnaires were mailed every second year to independent samples of 12, 14, 16, and 18 year olds representative for Finland. MAIN OUTCOME MEASURE: Relative risk (hazard) of becoming pregnant at teenage. MAIN RESULTS: Girls from lower socioeconomic background had a higher pregnancy risk. Girls who did not live with both parents at the baseline survey had higher pregnancy risk than those who did, and girls who lived in a stepfamily had a higher risk than those who lived in a one parent family. Swedish speaking girls had a lower pregnancy risk than the Finnish speaking girls. There was no systematic change from 1987 to 1998 in most sociodemographic differentials in the teenage pregnancy risk, however, there was some increase in the differences by family structure. Changes in the sociodemographic structure did not explain the levelling off of the downward trend in teenage pregnancy risk, nor did the regional socioeconomic differences explain regional differentials in teenage pregnancy risk. CONCLUSION: Although the reduction of socioeconomic and regional differences has been a general objective in Finnish social and health policies, the relative differences in teenage pregnancies have not decreased.

Adolescent↗
PubMed1999

Impact of menstrual cycle on the diagnostic performance of LCR, TMA, and PCE for detection of Chlamydia trachomatis in home obtained and mailed vaginal flush and urine samples.

OBJECTIVES: To assess the impact of the menstrual cycle on the diagnostic performance of various assays for detection of Chlamydia trachomatis in home obtained and mailed vaginal flush and urine specimens. METHODS: A ligase chain reaction assay (LCR; Abbott Laboratories), a transcription mediated amplification assay (TMA; Gen-Probe), and an enzyme amplified immunoassay (PCE; Dako Diagnostics) were evaluated for their validity in detecting C trachomatis in vaginal flush, first void urine, and midstream urine specimens obtained by female high school students at home and mailed directly to the diagnostic laboratory. RESULTS: C trachomatis was detected in 45 of 889 females (5.1%). The vaginal flush material was positive by TMA and LCR in 84% and 82% of the chlamydia positive females, respectively. First void urine was positive by TMA in 73% and by LCR in 49% of the cases. Midstream urine was positive by TMA and LCR in 69% and 42% of the females, respectively. On a pool of first void and midstream urine, PCE detected 49% of the chlamydia positive females. The overall prevalence of C trachomatis increased with increasing time after the last menstrual bleeding. In urine samples, but not vaginal flush specimens, obtained 3 weeks after the last menstrual bleeding, the sensitivities of TMA, LCR, and PCE decreased markedly suggesting that inhibitors to the assays are excreted in the urine but not in vaginal secretions at this time. CONCLUSION: Vaginal flush samples are superior to urines for detection of chlamydia infections in females. In screening of young asymptomatic females, samples should be obtained in the latter part of the menstrual cycle.

Adolescent↗
PubMed2002

Military and VA general dentistry training: a national resource.

In 1999, HRSA contracted with the UCLA School of Dentistry to evaluate the postgraduate general dentistry (PDG) training programs. The purpose of this article is to compare the program characteristics of the PGD training programs sponsored by the Armed Services (military) and VA. Surveys mailed to sixty-six VA and forty-two military program directors in fall 2000 sought information regarding the infrastructure of the program, the program emphasis, resident preparation prior to entering the program, and a description of patients served and types of services provided. Of the eighty-one returned surveys (75 percent response rate), thirty were received from military program directors and fifty-one were received from VA program directors. AEGDs reported treating a higher proportion of children patients and GPRs more medically intensive, disadvantaged and HIV/AIDS patients. Over half of the directors reported increases in curriculum emphasis in implantology. The program directors reported a high level of inadequate preparation among incoming dental residents. Having a higher ratio of residents to total number of faculty predicted inadequate preparation (p=.022) although the model was weak. Although HRSA doesn't financially support federally sponsored programs, their goal of improved dental training to care for medically compromised individuals is facilitated through these programs, thus making military and VA general dentistry programs a national resource.

Adult↗
PubMed1995

Urinary incontinence among primiparous women.

OBJECTIVE: The purpose of this study was to explore the symptoms of urinary incontinence among primiparous women. METHODS: This descriptive study used a paper and pencil mail survey. A sample of 300 primigravida mothers (aged 16 to 45 years; 10 weeks to 8 months postpartum) was garnered from a university-affiliated city-county hospital. RESULTS: Most respondents (53%, n = 65/122) reported urinary incontinence (UI) symptoms sometime before, during, or after pregnancy. Few respondents (6.2%, n = 4) had UI symptoms continuously across all time periods surveyed. Age did not contribute to UI when a comparison was made among mothers who were very young (aged 16 to 19 years), young (aged 20 to 29 years), and mature (aged 30 to 36 years). None of the respondents with persistent or current UI had reported the symptoms to a health care provider. Of those who had reported their symptoms (n = 11), only four mothers received any recommendations for treatment. CONCLUSIONS: However common UI may be during pregnancy, it is commonly overlooked as a problem amenable to simple and effective behavioral treatments. This study shows that UI is equally problematic for very young mothers and more mature mothers. Additional studies are indicated among very young mothers to document factors related to prevalence and incidence.

Adolescent↗
PubMed2000

Self-reported health complaints among general dental practitioners, orthodontists, and office employees.

Studies in the Scandinavian countries have shown that orthodontists run an equal or even greater risk of contracting dermatitis compared to other dental personnel. The aim of the study was to find out whether the self-reported occupation-related health problems of general dental practitioners and orthodontists differ from those of office employees in Finland. The subjects were 147 general dentists, 81 orthodontists and 99 office employees (77% women and 23% men). The data were collected using a mailed questionnaire. Within the past year, 42% of the subjects had had occupational health problems, while 51% had experienced symptoms in the previous year or earlier. The complaints of hand dermatoses, musculoskeletal, as well as respiratory symptoms were significantly more common among women than among men. Musculoskeletal complaints were the most common symptoms in all occupational groups, but the odds ratio of having them were significantly higher for dental professionals compared to office employees. The frequency of self-reported hand dermatoses was 42% for dental professionals and 26% for office employees, but the difference did not reach statistical significance. The odds of having hand dermatoses were higher for atopic subjects and for women. Orthodontists did not differ from general practitioners in respect of any of the complaints reported. Materials used in dentistry were mentioned as the cause of symptoms by 49 (21.5%) of the dental professionals. The present results show an increased risk of self-reported musculoskeletal symptoms for the dental professionals. Also, a tendency towards increased occurrence of skin symptoms was noted for the dental professionals compared to office employees of this study.

Chi-Square Distribution↗
PubMed2001

A review of family planning services by general practitioners in a health board region.

In 1994 the North Eastern Health Board published a study, which ascertained the range of family planning services provided by General Practitioners (GPs) in the area. This study highlighted some service and training needs, which have since been addressed. This study has been repeated to evaluate service developments. All GPs on the NEHB mailing list were sent a pre-piloted questionnaire about the range of family planning services they provide, their referral patterns should they not provide the service themselves and their comments on how the health board could assist in the enhancement of family planning services. The data were analysed using the software package JMP and statistical analysis was carried out using either the Chi-square test or Fishers exact test. There was a response rate of sixty six percent. There has been a decrease in the number of GPs in single-handed practices (24% vs 50% in 1994) and an increase in the number of practices who employ a practice nurse. Almost one third of GPs providing family planning services are women (18% in 1994) and over half of GPs hold a family planning certificate (33% in 1994). The range of services provided has increased and more GPs are now fitting intrauterine contraceptive devices (19% vs 14%). This study highlights significant developments in the family planning service and indicates that general practice is capable of providing a fully comprehensive service.

Adult↗