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Biomedical subjects

P Zazove

Publications and source records attributed to P Zazove.

At least 19 recordsLinked to original sources
PubMed2000

Preventive attitudes and beliefs of deaf and hard-of-hearing individuals.

OBJECTIVE: To investigate the unique health care issues of deaf and hard-of-hearing (D&HH) persons by studying their attitudes, beliefs, and behaviors toward preventive medicine. DESIGN: A self-administered, cross-sectional survey, written in a format comprehensible to persons whose primary language is American Sign Language. POPULATION: One hundred forty D&HH persons recruited from southeastern Michigan, Chicago, Ill, and Rochester, NY, and 76 hearing subjects from southeastern Michigan and Rochester. RESULTS: No significant differences existed between D&HH or hearing persons from different states. However, numerous differences existed between D&HH and hearing persons. Deaf and hard-of-hearing persons were less likely to report receiving preventive information from physicians or the media, and more likely to report receiving it from a Deaf club. They rated the following physician-initiated procedures as less important than hearing persons: discussion of alcohol consumption, smoking, depression, and diet, plus screening for hypertension, hearing loss, and cancer. Deaf and hard-of-hearing persons often considered a preventive procedure important if it was reported performed at their last health maintenance examination. They were less likely to report being asked about alcohol consumption and smoking, or to having been examined for hypertension, cancer, height, and weight. They were more likely to report receiving a hearing examination, mammogram, and Papanicolaou smear. Deaf and hard-of-hearing persons were less likely to report believing that smoking less, exercising regularly, maintaining ideal weight, and regular physical examinations improve health. Differences existed within the D&HH cohort depending on the respondent's preferred language (oral English vs American Sign Language); our sample size was too small for a complete assessment of these differences. CONCLUSIONS: Deaf and hard-of-hearing persons appear to have unique knowledge, attitudes, and behaviors regarding preventive medicine, and their attitudes are influenced by their personal experiences with physicians. Preventive practices addressed during health visits may differ between D&HH and hearing patients. Further research is needed to clarify the reasons for these differences, including within D&HH subgroups, and to develop effective mechanisms to improve the health care of all D&HH persons.

Adult↗
PubMed1999

The psychosexual impact of human papillomavirus cervical infections.

BACKGROUND: Occult human papillomavirus (HPV) infection, present in approximately 20% of women in the United States, is usually sexually transmitted, associated with substantial health risks, and unpredictable in its resolution. The potential for adverse psychosexual alterations due to HPV infection in women considered at low risk for bacterial sexually transmitted diseases is substantial, but data is lacking. METHODS: This cross-sectional study was conducted with sexually active women aged 18 to 60 years who had been enrolled at community-based offices in the University of Michigan Vaginitis Study. Women found to have occult HPV infection of the cervix were notified, received physician consultation, and were encouraged to have colposcopy performed to assess lesion status. Responses to a follow-up written questionnaire for differences in psychosexual functioning and attitudes following diagnosis were compared among these women and those without HPV infection. RESULTS: The women enrolled were primarily white and had a current sexual partner at the time of enrollment. They had few sexually transmitted infections and few risk factors, yet 20% had unsuspected HPV infection. Psychosexual characteristics at baseline and at follow-up, as well as perceived changes in these characteristics by the women, did not differ between women with HPV infection and those without. Stratification by potential confounders, including the presence of a vaginal infection at the time of study enrollment, household income level, ethnic background, age, marital status, and sexual history, did not alter these results. CONCLUSIONS: Women at low risk for sexually transmitted diseases, but who had a cervical HPV infection, were similar to those not infected in reported psychosexual characteristics and functioning. Adverse changes in these characteristics between the time of the diagnosis and subsequent follow-up were no more likely in those with the diagnosis than in those without.

Adolescent↗
PubMed1998

Developing a CQI program in a family medicine department.

BACKGROUND: Efforts to implement continuous quality improvement (CQI) principles in ambulatory or primary care settings still lag behind efforts in the hospital setting. Many physicians view the concept of CQI with unconcealed skepticism; the process of ambulatory care is very different from that of hospital-based care; and the data necessary to guide CQI efforts are often either missing or inaccurate in the outpatient setting. Since fall 1995, the Department of Family Medicine (DFM) at the University of Michigan (Ann Arbor), including approximately 35 faculty members at seven family practice sites, has been engaged in CQI projects. PLANNING AND IMPLEMENTATION: The CQI committee had a six-month deadline to lay out a plan for educating all faculty and staff in the importance of the CQI approach to problems; design methods for all faculty and staff to buy in to the concepts; and develop a plan to address basic clinical CQI activities, administrative systems change and work environment improvement, and larger ad hoc projects in clinical care, educational programs, and research programs. IMPLEMENTATION: CQI activities were incorporated into the routine monthly business agendas at each clinical site, each of which had a functioning local committee and had begun development of at least one CQI project. PROJECTING INTO THE FUTURE AND CONCLUSIONS: Cost cutting has further moved CQI from the sideline to center stage in the DFM's activities. An effective CQI program can be a major asset in the current competitive health care market, but designing and implementing an outpatient CQI program is a difficult and complex process. Three major problems--the ongoing resistance to change, the slow pace of adding CQI projects to already overburdened work schedules, and the need to conduct the program with ever-decreasing resources available-persist.

Academic Medical Centers↗
PubMed1998

Knowledge and attitudes about AIDS among deaf and hard of hearing persons.

We investigated whether the public information being dispensed about Acquired Immunodeficiency Syndrome (AIDS) reaches Deaf and Hard of Hearing (D&HH) persons to the same extent as the rest of the American population. Using a self-administered written survey, modified so that D&HH persons whose primary language is American Sign Language (ASL) could understand the questions, we studied 40 D&HH and 37 hearing persons in southeast Michigan. There were no significant demographic differences between the two populations, but there were differences regarding attitudes towards and knowledge about AIDS. D&HH persons were less likely to associate sexual contact with drug users and number of sexual partners as high risk sexual behaviours, were more likely to believe that storing blood for future personal use lowers their chances of contracting AIDS, and believed that using public restrooms, kisses on the cheek and visiting an AIDS patients increased their chance of contracting AIDS. Furthermore, they were more likely to believe they did not need to change their sexual behaviour as a result of the AIDS epidemic. D&HH persons also reported different attitudes towards AIDS patients, such as they were not important to their community, dentists with AIDS should not be allowed to continue working, and landlords should be able to evict people with AIDS. Our findings suggest differences in receiving, trusting, and/or being exposed to current information about AIDS by the Deaf community, consistent with the fact that they are a minority population with distinct knowledge and cultural traditions.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Low false-negative rate of PCR analysis for detecting human papillomavirus-related cervical lesions.

Although PCR analysis is a sensitive test for detection of human papillomavirus (HPV) in the cervix, the proportion of cases of cervical dysplasia missed, or the false-negative rate, has been unknown. We determined the accuracy of PCR analysis for HPV DNA as a predictor of HPV-related cervical lesions in a cross-sectional study of sexually active women, aged 18 to 50 years, from the University of Michigan Family Medicine HPV study. Of 133 eligible participants, 41 underwent colposcopy because of a positive result for HPV of the cervix by the PCR method and 92 underwent screening colposcopy with biopsy prior to knowing the HPV PCR results. Twenty-four of those screened were subsequently found to also be HPV DNA positive. In those found to be HPV positive, histological studies revealed the presence of condyloma or cervical intraepithelial neoplasia in 16 women (24.6%) and changes suggestive of condyloma in 5 (7.6%). No HPV-negative woman had an abnormal biopsy or cytology report (P = 0. 000001). The false-negative rate (1 - sensitivity) for HPV PCR analysis for detection of the presence of a cervical HPV-related lesion was 0% (95% confidence interval, 0 to 0.047), and the specificity was 60.7%. In summary, PCR analysis for HPV DNA had a very low false-negative rate for predicting HPV-related lesions of the cervix in a community-based population. This supports the validity of using the absence of HPV at the cervix, as determined by PCR testing, as an inclusion criterion for patients in control groups in studies dealing with low-grade cervical lesions.

Adolescent↗
PubMed1994

The silent health care crisis: ethical reflections of health care for deaf and hard-of-hearing persons.

Although hearing loss is the second most common disability in this country, comparatively little attention has been directed toward this medical entity. In view of the known poor health status and high health care utilization patterns of deaf and hard-of-hearing (D&HH) persons, this paper analyzes this population's ethical claims to autonomy, beneficence, and justice. Available evidence indicates that the American health care system inadequately acknowledges and fulfills the bioethical claims of the D&HH population. Specific modifications of the medical education and health care system should remedy these shortcomings.

Beneficence↗
PubMed1993

Factors associated with human papillomavirus infection in women encountered in community-based offices.

OBJECTIVE: To assess risk factors for cervical human papillomavirus (HPV) infection in women presenting to community-based offices because of vaginal symptoms or for preventive screening. DESIGN: Cross-sectional analysis of history, physical examination, and microbiological infection variables. SETTING: Two community-based family practice offices in southeastern Michigan. PATIENTS: Two hundred seventy-three women, 18 to 50 years of age, presenting to the study sites because of vaginal symptoms or for a pelvic examination for preventive screening. MAIN OUTCOME MEASURE: Human papillomavirus infection of the uterine cervix as determined by polymerase chain reaction testing. RESULTS: Human papillomavirus infection was detected in 21.2% of the women (24.9% and 13.1% of women with and without vaginal symptoms, respectively); 34% of these infections were HPV types 16 or 18. Fifty-four percent of the women with HPV infection who underwent colposcopy had condyloma or cervical intraepithelial neoplasia verified on biopsy. Independent associations were found between HPV infection and the following female risk factors: the presence of vaginal itching, odor, or swelling; knowing the current sexual partner less than 24 months; age less than 40 years; household income of $14,000 or less; and ever having had six or more sexual partners. CONCLUSIONS: In addition to three previously described risk factors for genital HPV infection, two previously unrecognized risk factors were identified in this lower-risk population. These risk factors included the presence of vaginal symptoms of itching, odor, or swelling and having known the current sexual partner less than 24 months. Nevertheless, using risk factors alone, two thirds of the women infected with HPV in this population were not identified as being at high risk of infection. No subset of sexually active women was identified who were at no risk of HPV infection.

Adolescent↗
PubMed1993

Presence of human papillomavirus infection of the uterine cervix as determined by different detection methods in a low-risk community-based population.

OBJECTIVE: To evaluate the effectiveness of various screening tests for detecting genital human papillomavirus (HPV) in a community-based population and to determine the prevalence of cervical lesions on colposcopically directed biopsies in patients found to have HPV by any screening test. DESIGN: Cross-sectional analysis of 208 female patients screened for HPV by clinical examination, Papanicolaou test, dot blot hybridization test (ViraPap, Digene Inc, Silver Spring, Md), and polymerase chain reaction (PCR) analysis. All persons with abnormal or positive results by any method were offered colposcopic evaluation. SETTING: Two community-based family practice offices in southeastern Michigan. MAIN OUTCOME MEASURES: The presence of HPV as determined by each test and results of colposcopic biopsies (gold standard) in patients who had HPV identified by any test. RESULTS: The prevalence of HPV infection was 20.3% by PCR analysis, 3.1% by ViraPap, 3.0% by the Papanicolaou test, and 0% by clinical examination. Symptomatic patients (those with complaints of vaginal odor, swelling, or itching) were more likely to harbor HPV as determined by PCR analysis than were asymptomatic women (P = .03, odds ratio = 2.65). Human papillomavirus type 16 or 18 was found in 41% of patients with positive PCR analyses and in all patients with positive ViraPap tests that were typed. Colposcopy with biopsy (gold standard for the presence of HPV disease) was performed on 34 of the 41 patients who tested positive for HPV by PCR analysis. Histologic results revealed that 79.4% of these patients had cervical disease: 14.6% had cervical intraepithelial neoplasia, 38.3% had condyloma, and 26.5% had cervicitis. CONCLUSIONS: Human papillomavirus as detected by PCR analysis was present in 20.3% of women in our population and was often one of the higher-risk types (16 or 18). A positive PCR analysis was predictive of cervical disease on colposcopic biopsy. The ViraPap test, Papanicolaou test, and clinical examination were insensitive measures for detecting HPV-related lesions in this population.

Adolescent↗
PubMed1993

The health status and health care utilization of deaf and hard-of-hearing persons.

OBJECTIVE: To evaluate whether health habits, self-reported health status, and communication with physicians play a role in the known altered health care utilization patterns of deaf and hard-of-hearing persons. DESIGN: A cross-sectional survey. Respondents were given the choice of completing either a self-administered written survey or an American Sign Language interview-administered survey. POPULATION: Eighty-seven deaf and hard-of-hearing members of various organizations serving this population in southeastern Michigan and 88 hearing patients from a family practice clinic in the same area. RESULTS: Deaf and hard-of-hearing persons visit physicians more frequently (P = .01), have a lower incidence of ever smoking tobacco (P < .0006) and of alcohol use (P = .04), have more difficulties communicating with physicians (P < .001), have trouble understanding physicians (P < .001), and feel less comfortable with physicians (P < .001). Lower current tobacco use among deaf and hard-of-hearing persons was only seen in persons who were not educated beyond high school. Increased frequency of physician visits for deaf and hard-of-hearing persons was especially noticeable in the group of persons 60 years of age and older. Our finding that use of interpreters is associated with increased utilization and decreased understanding suggests deaf and hard-of-hearing patients presenting with interpreters warrant more focused attention from physicians. Reasons for seeing physicians did not explain the difference in frequency of physician visits between the two groups. CONCLUSIONS: Deaf and hard-of-hearing persons report a lower subjective health status and higher physician utilization, as well as substantial communication difficulties with physicians. They also report better health-related behaviors, namely less use of tobacco and alcohol. The use of interpreters did not decrease physician utilization or improve the understanding of physicians by these persons. Overall, our results underscore the fact that deaf and hard-of-hearing persons constitute a minority population that experiences considerable difficulties in the patient-physician relationship.

Adult↗
PubMed1993

D&HH persons.

Explore the source record for details and available documents.

Aged↗
PubMed1992

Devices for the hearing impaired.

Hearing loss can result in significant communicative and social dysfunction. Various methods of sound amplification are available for the hearing impaired. Hearing aids are becoming more technologically sophisticated, more cosmetically appealing and more commonly used. The choice of hearing aid must be individualized and depends on several factors, including the type of hearing loss, the cost of the device, the patient's work environment, motivation and vanity, and the degree of difficulty in using the hearing aid. Devices are also available to help hearing-impaired persons in specific situations where hearing aids may not be necessary. The cochlear implant is a relatively new device for use in the profoundly hearing impaired.

Cochlear Implants↗
PubMed1992

A criterion-based review of preventive health care in the elderly. Part 2. A geriatric health maintenance program.

Although the geriatric population is growing rapidly and using an increasing portion of health care dollars, no consensus exists about the best approach to preventive medicine in this age group. The most comprehensive review to date is the 1989 United States Preventive Services Task Force (USPSTF) recommendations. However, the USPSTF did not specifically address the unique situation of the elderly. Consequently, we have evaluated numerous screening tests and preventive interventions for the elderly by systematically applying the geriatric-specific criteria for preventive services proposed in Part 1 of this article (J Fam Pract 1992; 34: 205-224). Tests and interventions were measured against specific screening criteria and put into one of three categories: those that have been proven effective, those that may be effective but about which more research is needed, and those that are not effective. Recommendations were compared with those of the USPSTF. Proof of the efficacy of most screening tests and interventions in the current literature was found to be lacking, pointing to the need for substantial future research in this area.

Aged↗
PubMed1992

A criterion-based review of preventive health care in the elderly. Part 1. Theoretical framework and development of criteria.

The magnitude of health care resources devoted to care for the elderly is increasing; however, little is known about the efficacy of the services purchased with those resources. This is especially true in the area of preventive health care. In the absence of a consistent and comprehensive definition of health for the elderly population, it has been difficult either to establish criteria for evaluating preventive services or to assess the impact of those services. This article extends criterion-based review to the assessment of preventive services for the elderly. Health in the elderly can be defined by three related factors: the absence of disease, the maintenance of optimal function, and the presence of an adequate support system. Based on this definition of health, goals for preventive care should include compression of morbidity in addition to prevention of disease, and will require that quality of life be measured to completely assess the value of services. Unfortunately, existing measures of quality of life are difficult to apply to the elderly population, and there are no consistent societal values on which to base a new definition for quality of life. Because existing sets of criteria for the evaluation of preventive services do not address the distinctive health issues affecting the elderly, we have constructed a set of six criteria designed specifically for the well elderly population. In a companion article, we will apply these criteria to candidate preventive services for the elderly population to develop a geriatric health maintenance protocol for use in clinical practice.

Aged↗
PubMed1991

Treatment of beta-hemolytic streptococcal pharyngitis with cefaclor or penicillin. Efficacy and interaction with beta-lactamase-producing organisms in the pharynx.

The recommended treatment for group A beta-hemolytic streptococcal pharyngitis has continued to be penicillin given in parenteral or oral form. Treatment failures, as determined by the continued presence of the streptococcal organism in the pharynx, however, do occur in 6% to 25% of patients treated with penicillin. Furthermore, beta-lactamase produced by other bacteria in the pharynx could potentially inactivate the penicillin, resulting in increased treatment failures or infection relapses. A study was undertaken to compare the efficacy of cefaclor, which is relatively resistant to inactivation by beta-lactamase, with penicillin for eradicating the group A beta-hemolytic streptococcal organism from the throats of 93 patients with pharyngitis. Additionally, extensive cultures for potential beta-lactamase-producing organisms were conducted on 37 patients; 27% of these had one or more pharyngeal organisms that were producing beta-lactamase. No statistically significant difference was found between the clinical responses or the bacteriological cure rates of those treated with cefaclor and those treated with penicillin when stratified by the presence or absence of beta-lactamase-producing organisms. The prevalence of beta-lactamase-producing organisms in the pharynx, however, was increased after treatment with penicillin, whereas no change was noted following treatment with cefaclor.

Adolescent↗