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PubMed2003

Are there regional variations in the diagnosis, surveillance, and control of methicillin-resistant Staphylococcus aureus?

OBJECTIVE: To assess the way healthcare facilities (HCFs) diagnose, survey, and control methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: Questionnaire. SETTING: Ninety HCFs in 30 countries. RESULTS: Evaluation of susceptibility testing methods showed that 8 laboratories (9%) used oxacillin disks with antimicrobial content different from the one recommended, 12 (13%) did not determine MRSA susceptibility to vancomycin, and 4 (4.5%) reported instances of isolation of vancomycin-resistant S. aureus but neither confirmed this resistance nor alerted public health authorities. A MRSA control program was reported by 55 (61.1%) of the HCFs. The following isolation precautions were routinely used: hospitalization in a private room (34.4%), wearing of gloves (62.2%), wearing of gowns (44.4%), hand washing by healthcare workers (53.3%), use of an isolation sign on the patient's door (43%), or all four. When the characteristics of HCFs with low incidence rates (< 0.4 per 1,000 patient-days) were compared with those of HCFs with high incidence rates (> or = 0.4 per 1,000 patient-days), having a higher mean number of beds per infection control nurse was the only factor significantly associated with HCFs with high incidence rates (834 vs 318 beds; P = .02). CONCLUSION: Our results emphasize the urgent need to strengthen the microbiologic and epidemiologic capacities of HCFs worldwide to prevent MRSA transmission and to prepare them to address the possible emergence of vancomycin-resistant S. aureus.

Cross Infection↗
PubMed1994

Real and apparent tuberculin skin test conversions in a group of medical students.

OBJECTIVE: To evaluate tuberculin skin test (TST) conversions among a group of medical students. DESIGN: Questionnaire sent to a medical school class in whom a cluster of TST conversions was noted, and interview and repeat TST of students with conversion. SETTING: County hospital and associated medical school. SUBJECTS: Medical students, after their third year in medical school. RESULTS: Of 165 students in the class, 115 (70%) responded; 10 reported TST conversions between the beginning of the third and the fourth year. Seven of 10 were interviewed, and all 10 were retested. Five students, all in a cohort who tested each other during a clinical clerkship with a tuberculin material previously reported to be associated with a high rate of false-positive TSTs, were TST negative on repeat. Five had persistently positive TSTs. One was exposed during a psychiatry clerkship to a resident with pulmonary tuberculosis. Four students appeared to have converted their TST during their third year in medical school. All four did their medicine clerkship at a large county hospital (P < 0.02; odds ratio = 16.4) that had few infection control measures in place for tuberculosis isolation during the time of their exposure. CONCLUSIONS: We recommend that medical students, as well as other healthcare professions students, be educated about infection control practices and skin tested at least annually during clinical training years.

Chicago↗
PubMed1997

Continuing medical education in Wales: a survey of geriatricians.

OBJECTIVE: to determine what practising geriatricians in Wales do to continue their education; what they would prefer to do; and what their views are on study leave, resources and funding. DESIGN: questionnaire survey. SETTING: the principality of Wales. PARTICIPANTS: hospital-based, career-grade geriatricians. RESULTS: the overall response rate from a total of 56 questionnaires was 87%. More than half [26 (53%)] of the respondents stated they were able to take only half of their study leave entitlement of 10 days a year. Twenty-five (51%) considered this to be due to service commitment. Geriatricians regarded attendance at routine hospital meetings [47 (96%)] and specialist society meetings [45 (92%)], reading books and journals [49 (100%)] and discussion with colleagues [44 (90%)] as their preferred methods of keeping up to date. Most respondents [44 (90%)] said that the resources and funding required to underpin the system of continuing medical education (CME) should be provided by the employing authority. CONCLUSIONS: the many barriers to the continuing education of geriatricians in Wales include service commitments and funding constraints. Geriatricians placed great emphasis on the traditional CME methods such as reading books and journals, attending meetings and conferences and discussion with colleagues and were reluctant to use technology-based educational methods. The results of this study have implications for the way in which geriatricians fulfil CME obligations in the future and provide directions for the planners of CME.

Adult↗
PubMed1998

Factors influencing decisions about donation of the brain for research purposes.

OBJECTIVES: to find out the attitudes to brain donation for research purposes and factors involved in decision-making in elderly people. DESIGN: questionnaire administered after the decision had been made. SETTING AND SUBJECTS: 200 of the 640 people in Nottingham aged 67-100 who were assessed as part of the Medical Research Council multicentre Cognitive Function and Ageing Study of 2,518 people over 65 and were approached to consider brain donation for the neuropathology component of the study of dementia incidence. RESULTS: Most people completing the questionnaire had positive or neutral feelings about being approached. Positive influences included: personal approach, awareness of need for research and of suffering caused by dementia and a desire to help others. Many had fears about not being really dead, about post mortem examinations and feeling pain after death. Most preferred cremation and these were much more likely to donate. Two-thirds thought death was not talked about enough: 65% of those visited found talking helpful. Relatives had an important influence, usually dissuading the person from donating. CONCLUSIONS: some families who agreed to a relative's decision to donate only did so after discussing it together well in advance of death would have been unlikely to have agreed had they been approached for the first timeonly after death. There is a need to: (i) talk more about death, addressing people's fears, (ii) increase awareness of the need for autopsies and donation for research and (iii) provide more training in talking about death andautopsies.

Aged↗
PubMed2006

Health-protective behaviours and risk of fall-related hip fractures: a population-based case-control study.

BACKGROUND: Fall-related hip fractures are one of the most common causes of disability and mortality in older age. The study aimed to quantify the relationship between lifestyle behaviours and the risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for the promotion of healthy ageing as a population-based intervention for falls injury prevention. METHODS: A case-control study was conducted with 387 participants, with a case-control ratio of 1:2. Incident cases of fall-related hip fracture in people aged 65 and over were recruited from six hospital sites in Brisbane, Australia, in 2003-04. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire designed to assess lifestyle risk factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. RESULTS: Behavioural factors which had a significant independent protective effect on the risk of hip fracture included never smoking [adjusted odds ratio (AOR): 0.33 (0.12-0.88)], moderate alcohol consumption in mid- and older age [AOR: 0.49 (0.25-0.95)], not losing weight between mid- and older age [AOR: 0.36 (0.20-0.65)], playing sport in older age [AOR: 0.49 (0.29-0.83)] and practising a greater number of preventive medical care [AOR: 0.54 (0.32-0.94)] and self-health behaviours [AOR: 0.56 (0.33-0.94)]. CONCLUSION: With universal exposures, clear associations and modifiable behavioural factors, this study has contributed evidence to reduce the major public health burden of fall-related hip fractures using readily implemented population-based healthy ageing strategies.

Accidental Falls↗
PubMed2000

Psychological measures of eating behavior and the accuracy of 3 common dietary assessment methods in healthy postmenopausal women.

BACKGROUND: Factors affecting the accuracy of reported energy intake (rEI) need to be identified. OBJECTIVE: Our objective was to investigate the association of psychological measures of eating behavior with the accuracy of rEI assessed by 7-d weighed intakes, a 24-h recall, and a food-frequency questionnaire. DESIGN: Subjects were 26 restrained eaters aged 60.3 +/- 0.6 y (mean +/- SEM) and weighing 63.8 +/- 1.7 kg and 34 unrestrained eaters aged 59.4 +/- 0.6 y and weighing 64.0 kg. rEI was assessed by using 3 dietary assessment methods and total energy expenditure (TEE) was determined by using doubly labeled water. Calculated EI (cEI) was determined as TEE corrected for the estimated change in body energy. Subjects completed the Eating Inventory. RESULTS: rEI values were significantly lower than TEE values for all 3 dietary assessment methods (P < 0.05); there was no significant relation between rEI and TEE by any method. There was no significant difference in 100 x rEI:TEE between restrained and unrestrained eaters by any of the dietary assessment methods. When combined data from the 3 methods were used, 100 x rEI:cEI was not significantly different from 100% in unrestrained eaters (99 +/- 6.8%) but was lower in restrained eaters (89.1 +/- 5.3%; P < 0.05). There was a positive relation between hunger and 100 x rEI:TEE (P < 0.05). CONCLUSIONS: Low hunger is associated with undereating relative to normal eating during measurement of dietary intake; high dietary restraint may be associated with a reduction in reporting of consumed foods. Dietary hunger and restraint assessed with use of the Eating Inventory may help to identify subjects likely to underreport dietary intake.

Body Weight↗
PubMed2003

Expert judgment and occupational hygiene: application to aerosol speciation in the nickel primary production industry.

In many situations characterized by sparse data, occupational hygienists have used subjective judgments that are claimed to be derived from their experience and knowledge. While this practice is widespread, there has been no systematic study of 'expert judgment' or the 'art' of occupational hygiene. Indeed, there is a need to address the question of whether there is such a thing as 'expert opinion' in occupational hygiene that is broadly shared by practicing professionals. This research, employing 11 experts who estimate an exposure parameter (the percentages of four nickel species) in 12 workplaces in a nickel primary production industry, provides a large dataset from which useful inferences can be drawn about the quality of expert judgments and the variability among the experts. A well-designed questionnaire that provided succinct information about the processes and baseline data served to calibrate the experts. The Bayesian framework has been used in this work to develop posterior means and standard deviations of the percentages of the four nickel species in the 12 workplaces of interest in the company. These estimates of the nickel speciation are at least as precise as--and most of the time more precise than--those provided by the sparse measurement data. There was a very high degree of agreement among the experts. A majority of the experts agreed among themselves 92% of the time, while almost two-thirds agreed 73% of the time. This, coupled with the fact that the experts came from varied backgrounds, seems to suggest that there is indeed some broad body of specialized knowledge that the experts are drawing on to reach similar judgments. It also seems that one type of expert is not necessarily any better than any other kind, and expertise does not necessarily require intimate familiarity with the workplace. In this example, the expert judgment exercise has indeed enhanced the quality of our knowledge of the exposure 'fingerprints' for the nickel industry workplaces studied and the combination of expert judgment and sparse data is better than the sparse data alone. For occupational hygiene exposure assessment, our experience suggests that such expert judgment methods can provide a cost-effective means to improve and refine information about workplace hazards. However, more study is warranted for situations where the domain of the quantity of interest has a much wider range of values, e.g. actual exposure values.

Air Pollutants, Occupational↗
PubMed1993

Long-term backache after extradural or general anaesthesia for manual removal of placenta: preliminary report.

A questionnaire designed to investigate the incidence of newly acquired, long-term backache was sent to women who had previously undergone manual removal of the placenta during a 12-month period in one maternity hospital. There was a significantly greater incidence of long-term backache in patients who had extradural anaesthesia specifically for manual removal of the placenta compared with patients receiving a general anaesthetic for the same procedure. The results of this retrospective study in a small population warrant examination in a large, prospective, controlled investigation.

Anesthesia, Epidural↗
PubMed2001

Professional perceptions of the benefits of orthodontic treatment.

The aim of this study was to assess general dental practitioners' and orthodontists' perceptions of the benefits of orthodontic treatment. A specially designed questionnaire was sent to a random sample of 150 general dental practitioners (GDPs) and all orthodontists in Northern Ireland (excluding hospital practitioners) with a postgraduate qualification (n = 29). There was a 93 per cent response rate by the general dental practitioners and all but one specialist practitioner returned the questionnaire. The questionnaire comprised 14 visual analogue scales (VAS) whereby participants were asked to rate the importance of various possible dental health and psychosocial benefits of orthodontic treatment. In addition to the VAS, the influence of dentist variables such as number of years since qualification, orthodontic cases completed, referral rates and attendance at postgraduate lectures were examined. When ratings on the 14 dental health and psychosocial scales were examined overall, GDPs rated an improvement in self-esteem while orthodontists considered an improvement in physical attractiveness as the most important benefit of orthodontic treatment. Even though psychosocial variables received the highest ratings, examination of the mean ratings (and 95 per cent confidence intervals) revealed that some dental health factors were also rated highly by both groups. While the results do indicate an encouraging awareness of the psychosocial benefits of orthodontic treatment, they also suggest that both GDPs and orthodontists have an unrealistic expectation of the dental health gain likely to result from orthodontic treatment.

Dentists↗
PubMed2006

Prevalence of malocclusions in Hungarian adolescents.

The aim of this epidemiological study was to assess the prevalence of malocclusion, associated caries experience, and level of oral hygiene in the Hungarian population using the World Health Organisation (WHO) questionnaire designed to assess dentofacial anomalies. A total of 483 adolescents (289 girls, 194 boys), aged 16-18 years, were assessed. Orthodontic anomalies were detected in 70.4 per cent of the sample. Crowding and spacing were observed in 14.3 and 17 per cent, respectively, with the latter being more prevalent in the maxilla than in the mandible (10.4 and 2.9 per cent, respectively). A Class I occlusion was found in 52.8 per cent of the subjects. A half cusp anomaly in the antero-posterior molar relationship was more prevalent than a full cusp anomaly (26.9 and 20.3 per cent, respectively). The decayed, missing, and filled teeth (DMFT), the decayed, missing, and filled surfaces (DMFS), and the visible plaque indices scores (VPI) of the 340 adolescents with malocclusion were significantly higher (P < 0.05) than those of the adolescents who displayed no anomalies. The prevalence of malocclusion in the Hungarian population seems to be comparable with other European communities.

Adolescent↗
PubMed1993

Is there a relationship between a mother's mental state and consulting the doctor by the family? A study in a military general practice.

A total of 174 families of service personnel with children between 3 and 6 years of age were studied over a 6 month period. All contacts with the general practitioner, both in and out of hours together with the local casualty department were recorded. Mothers of the children were posted a specially designed questionnaire to measure how seriously they perceived various childhood symptoms to be and a copy of the general health questionnaire, 28 question version (GHQ 28). The perceived severity questionnaire had been piloted previously in a neighbouring practice. The overall response rate was 77%. Analyses of the data showed that the factors most significantly associated with a child's consultation frequency were the psychological state of the mother, the mother's own consultation frequency and the number of children in the family; the last being an inverse relationship. No evidence was found to suggest that the perception of the severity of illness varied with the psychological state of the mother. In addition, the childhood consultation rate was not influenced by the mother's perception of the severity of childhood illness as measured by the perceived severity questionnaire. Other factors such as the age of the mother or child, within the age range studied, were not found to be significantly related to the child's frequency of consulting. A mother's own consultation frequency was highly correlated with her GHQ 28 score, but more specifically with the subsections that scored for depression and somatic symptoms. From the study, doctors who see children should seriously consider the main reasons for a child's consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Educating asthmatic patients in primary care: a pilot study of small group education.

Patient education is an important part of asthma management. Individual education is usually used for this task. The object of this study was to assess whether another educational technique, educating patients in small groups, would be as effective and as acceptable as individual counselling in improving knowledge about asthma. A specially designed questionnaire was used to assess knowledge and other variables before and after education. Thirty-four patients were educated individually and 34 patients were educated in small groups. There were significant improvements in knowledge scores after both types of education. However group education took 4.5 hours for 34 patients whereas individual counselling took 14.25 hours for the same number. The results of this study suggest that educating patients in small groups is as effective as individual counselling in improving knowledge of asthma, is acceptable to patients and takes much less time.

Adult↗
PubMed2006

End-of-Life decision making for nursing home residents with dementia: a survey of nursing home social services staff.

The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives, medical interventions, and comfort levels with withholding and withdrawing of treatment. Results showed a high degree of involvement in advance directive discussions, problems in the implementation of advance directives, and wide variation in comfort levels with treatment issues. Results of this study indicate areas of need for further research and training of nursing home social services staff.

Adult↗
PubMed2005

Relationships in couples after failed IVF treatment: a prospective follow-up study.

BACKGROUND: There are few studies of couples that analyse satisfaction with treatment, adoption plans and relationships in couples after unsuccessful IVF. METHODS: ENRICH marital inventory was used to describe marital dynamics and to gain information about treatment and adoption plans. A specially designed questionnaire was used. Of the 51 couples without previous children who were asked to participate after their first failed IVF cycle, 45 participated. The next stage of the study was carried out when the couples had reached the 6 months point after the first IVF cycle, and the last stage after the couples had been through one to three treatments, 1(1/2) years after the last treatment. RESULTS: The couples displayed a stable relationship from the start as well as 1 year after the last IVF cycle. The vast majority of the couples had decided to go through with an adoption. Seventy-three per cent of the women were interested in more IVF treatment compared to 33% of the men. CONCLUSION: The stresses associated with IVF treatment did not have a negative impact on the couples' appreciation of their relationships during and after the treatment period. After treatment had been completed, the couples seemed to have reoriented themselves toward other solutions to childlessness.

Adoption↗
PubMed1984

Evaluation of a new course to teach the principles and clinical applications of epidemiology to medical students.

A new short course to teach clinical medical students the principles of epidemiology and their applications to clinical practice was introduced at St. Thomas's Hospital Medical School. During the first year one half of the students took the new course. All the students also received the previous epidemiological teaching which was performed on the wards in the context of individual patients with a particular disease. In the next year all students were given only the new course. One year after attending these courses, students completed a questionnaire designed to test how well the course objectives had been met. A comparison was made between those who had received the new course and those who had received only ward round teaching. Students exposed to both the ward rounds and the course were more satisfied with the latter and had a greater appreciation of the importance of epidemiology to clinical practice than students receiving only ward rounds. This improvement was maintained in the subsequent year when the ward rounds were dropped. Students who had the new course also performed relatively better than the others in the Community Medicine multiple choice questions in the Medicine Finals examination, and the marks improved in the subsequent year. This evaluation was also useful in identifying those aspects of the course that need further development.

Education, Medical↗
PubMed1991

A community study of alcohol consumption and dietary habits in middle-aged Italian women.

This population-based study examines whether dietary intake in middle-aged Italian women is influenced by alcohol drinking habits. The 499 participants were interviewed using a dietary history questionnaire designed to investigate alcohol consumption. Mean intake of total and non-alcohol energy increased progressively within categories of increasing alcohol consumption (less than 5, 5-19, 20-39, 40+ g/day). Mean body weight and Quetelet index (kg/m2), however, decreased with increasing alcohol consumption. Once the disparities in energy intake were reduced by computing intake densities, the data suggest that moderate and heavy drinkers have dietary habits similar to those of abstainers or light drinkers. These findings were confirmed by multiple linear regression analyses in which the confounding effects of age, place of residence, occupation, and Quetelet index were taken into account. Increasing alcohol consumption appeared associated only with a modest decrease in the intake of fibre, beta-carotene, and vitamin C. These findings do not support the hypothesis that the observed protection from coronary artery disease among moderate drinkers is related to a chronic reduction in the intake of carbohydrates and fat, at least in middle-aged women.

Adult↗
PubMed1998

The use of calendars to measure child illness in health interview surveys.

BACKGROUND: During the past two decades, health interview surveys have become an increasingly common source of information about current morbidity patterns and utilization of health services in developing countries. This study describes a recent effort to enhance the utility of these surveys by incorporating a calendar format. METHODS: A calendar of morbidity and treatment behaviour during the 2-week period prior to interview was implemented in the Guatemalan Survey of Family Health (EGSF), a large-scale sample survey that was fielded in 60 communities in rural Guatemala in 1995. A total of 2872 women aged 18-35 were interviewed and provided information on 3193 children born since 1990. RESULTS: The EGSF calendar data provide estimates of diarrhoeal illness that are consistent with those obtained from more conventional questionnaire designs. However, in contrast to conventional health survey questions, these calendar data: (1) permit a much more complete evaluation of the accuracy of reporting; and (2) offer a richer and more complex description of child illness and treatment behaviour. For example, the results demonstrate that even the preferred 2-week recall period suffers from underreporting of diarrhoeal illness, that the majority of children with diarrhoea experience at least one additional symptom, and that mothers assess severity of diarrhoea from the type and number of accompanying symptoms. CONCLUSIONS: The findings indicate that additional implementation and evaluation of calendar formats is warranted in order to provide the most useful and accurate data possible at relatively low cost.

Adolescent↗
PubMed2000

National guidelines for Swedish neonatal nursing care: evaluation of clinical application.

OBJECTIVE: To evaluate the clinical application of national guidelines for neonatal nursing. DESIGN: Questionnaire survey. SETTING: Thirty-nine neonatal care units in Sweden. STUDY PARTICIPANTS: Thirty-five of 39 nurse managers at all Swedish neonatal care units. INTERVENTION: Thirteen clinical guidelines for neonatal nursing care were presented in 1997. Recommendations on evidence-based nursing care and auditing measures were given. Most neonatal units in Sweden participated in the guideline development. MAIN OUTCOME MEASURES: Extent of guideline application, ways in which the guidelines were used and perceived usefulness. RESULTS: The guidelines were applied to different extents in 30 of the 35 units. Almost all the guidelines were applied, especially those covering general nursing care. In total, 72 Quality Improvement (QI) projects were reported, of which 51 concerned specific topics covered in the guidelines. Twenty units applied the guidelines as a starting point for QI. Four units evaluated nursing practice against the guidelines. Four factors [Dynamic Standard Setting System (DySSSy) as the QI method, > or = 4 years of practice as nurse manager, experience of nursing research, and good staff resources] were closely related to a more extensive application of the guidelines. Units with both a nurse manager and an assistant nurse manager were more likely to have used the guidelines as the basis for changing clinical practice. CONCLUSIONS: The guidelines were successfully disseminated and diffused, but practitioner involvement in guideline development did not guarantee implementation. Downsizing, leadership and facilitation seemed to be crucial factors when getting evidence into practice. Limited occurrence of evaluations of clinical practice against guideline recommendations suggests a need for valid and user-friendly measures.

Attitude of Health Personnel↗