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Biomedical subjects

S E Landis

Publications and source records attributed to S E Landis.

At least 19 recordsLinked to original sources
PubMed2000

Using focus groups to assess primary care patients' satisfaction.

The present report describes the use of patient focus groups by a primary health care facility. We review our rationale for using focus groups and the process we used to prepare for and conduct them. We then highlight the results and lessons learned through this experience. Focus groups can be an excellent method for primary care practices to assess the complexities of patient satisfaction issues and engage patients in the continuous quality improvement process. Focus groups can uncover unanticipated issues that surveys fail to identify. Our experience demonstrated that this benefit can be critical in identifying and prioritizing quality of care improvements and that focus group results can be used to make immediate improvements in the quality of care, even though this type of study is not intended to generalize.

Data Interpretation, Statistical↗
PubMed1997

A pilot study for the development of a hospital-based immunization program.

Adult immunization is often overlooked as an effective, cost-efficient means of preventing disease. Recently, support for the promotion of adult immunizations has grown in the healthcare community. One way of accomplishing timely immunization of adults is the concept of vaccinating patients before hospital discharge. This study compared two methods for implementation of a hospital-based immunization program. Six nursing units in a 500-bed community hospital participated. Three units integrated immunization into the jobs of the staff nurses and private physicians. On three units, immunizations were administered by a family nurse practitioner (FNP) who did assessments, orders, consents, injections, and documentation. After 3 months the two methods were compared. In the FNP protocol, 69 of 431 patients received vaccines. On the floors where physicians managed vaccines, 10 of 821 patients received vaccines. An ongoing immunization program continues to encourage vaccination before discharge and promotion of immunizations in the community.

Adult↗
PubMed1995

The Claxton Elementary School Health Program: merging perceptions and behaviors to identify problems.

The Claxton Elementary School Health Program was developed to improve the health of a school community in a western North Carolina city of 60,000. Using the principles of Community-Oriented Primary Care (COPC) in fall 1991, a health advisory board composed of interested parents, teachers, and physicians was organized. A comprehensive needs assessment was implemented, including focus groups with teachers and parents, a self-administered health behavior survey for children in grades three-five, and a self-administered survey of parents' health problems. Teachers, children, and parents agreed on perceived problems requiring attention. The Board then prioritized health problems, selecting nutrition and self-concept as the most critical areas in which to develop programs. Using target population members to identify needs can be a valuable approach to the development of community-based programs for improving children's health behaviors.

Attitude to Health↗
PubMed1994

Development and evaluation of a sexual history-taking curriculum for first- and second-year family practice residents.

BACKGROUND: Primary care physicians need to assess their patients' sexual behaviors to help prevent, diagnose, and treat sexually transmitted diseases. However, few physicians take sexual histories. We developed an educational curriculum aimed at increasing the frequency with which our residents take sexual histories from patients. METHODS: Residents were observed for 5 months through video monitoring of patient encounters to document the precurriculum rate of taking sexual histories. Residents also completed a sexuality questionnaire about the likelihood of encountering certain patient problems and the residents' degree of comfort and competence with these problems. They then completed the educational curriculum and were monitored for 3 months for any change in taking sexual histories. We added follow-up telephone interviews with the residents to determine the effect of the curriculum and the extent of taking sexual histories. RESULTS: Due to insufficient data collected with video monitoring in the postcurriculum phase, we used telephone interviews to evaluate the curriculum. Prior to the curriculum, only 7% of the residents reported routinely asking patients about their sexual history, compared to 36% of residents 6 months after implementation of the curriculum. CONCLUSION: The sexual history-taking curriculum improved the frequency with which residents collected information from patients on sexual activity. In addition, this article addresses the development of the curriculum based on a needs assessment, and the difficulties in and possible solutions to evaluating curricular changes within family practice residency programs.

Adult↗
PubMed1993

HIV seroprevalence in sexually transmitted disease clients in a low-prevalence southern state. Evidence of endemic sexual transmission.

We studied human immunodeficiency virus (HIV) seroprevalence and risk factors in 3052 clients attending three large public, sexually transmitted disease (STD) clinics in central North Carolina in mid-1988. Anonymous self-administered questionnaires linked to HIV serologies obtained by testing extra blood from syphilis serologies without personal identifiers showed the following characteristics of the respondents: 60% were men, 81% were black, the median age was 24 years, 5% were injecting drug users since 1978, 7% reported a history of syphilis, and 8% of men were homosexual or bisexual. HIV seropositivity was found in 76 subjects (2.5%), including 46% of the homosexual men, 25% of the bisexual men, 1.6% of the heterosexual men, and 0.6% of the women. Elevated HIV seroprevalence rates were found in subjects with a history of or seroreactivity for syphilis (HIV-positive rate of 53% in homosexual or bisexual men, 9% in heterosexual men, 3% in women) and with histories of gonorrhea (HIV-positive rate of 37% in homosexual or bisexual men, 2.6% in heterosexual men, 1% in women), and intercourse (41% in homosexual or bisexual men, 2% in women), prostitute contact (5% in heterosexual men), and sex with casual partners (2% in women). Even a state with a low incidence of acquired immunodeficiency syndrome can include subpopulations with a high HIV seroprevalence, apparently disseminated endemically in association with bacterial STDs.

Adolescent↗
PubMed1993

A community-oriented primary care experience for medical students and family practice residents.

BACKGROUND AND OBJECTIVES: Medical students and residents are more likely to understand the health needs of a community if they have community-based practical experience during their training. This report describes a community-oriented educational experience for medical students and family practice residents in rural North Carolina. METHODS: Medical students and residents from the University of North Carolina at Chapel Hill and residents from Asheville spend one month in a small community in western North Carolina. During the month-long experience, these trainees live in the community and provide clinical care to patients. They also meet with local health officials, service agencies, and community organizations to learn about the community's health system. The trainees then prepare a written report about the community's health system, a community health problem identified by the trainee, and a proposal to solve the problem. RESULTS: Trainees report that the rotation provides a unique opportunity to understand the health system of a community. Some of the trainee-proposed solutions to problems have been implemented by community leaders. CONCLUSION: A community-oriented primary care rotation can provide students and residents with an important understanding of the health system and health problems of a community.

Community Medicine↗
PubMed1992

Results of a randomized trial of partner notification in cases of HIV infection in North Carolina.

BACKGROUND: We sought to compare two methods of notifying sex partners of subjects infected with the human immunodeficiency virus (HIV) or persons who had shared needles with them (needle-sharing partners): "patient referral," in which the responsibility for notifying partners was left to the patient, and "provider referral," in which providers attempted to notify partners. METHODS: Names of sex partners and needle-sharing partners and information on how to locate them were obtained from consenting HIV-infected subjects identified in the HIV-testing programs at three public health departments in North Carolina. The subjects were randomly assigned to a patient-referral group (in which patients had the initial responsibility for notifying their partners) or a provider-referral group (in which the study counselor notified the partners). The success of attempts to notify partners was monitored by means of interviews with counselors conducted both in the field and at the health department. RESULTS: Of 534 HIV-positive persons identified at the health departments, 247 (46 percent) did not return for counseling after the test, 8 were counseled outside the study, and 117 (22 percent) were ineligible. Of the 162 invited to participate, 88 (54 percent) declined and 74 (46 percent) agreed. The subjects were mostly male (69 percent), black (87 percent), homosexual or bisexual (76 percent of the men), and had a median age of 30 years. Thirty-nine were assigned to the provider-referral group and 35 to the patient-referral group. In the provider-referral group 78 of 157 partners (50 percent) were successfully notified, whereas in the patient-referral group only 10 of 153 (7 percent) were notified. Of the partners notified by the counselors, 94 percent were not aware that they had been exposed to HIV. Overall, 23 percent of the partners notified and tested were HIV-positive. CONCLUSIONS: In this trial, leaving the notification of partners up to the subjects (patient referral) was quite ineffective, despite the North Carolina law requiring that partners be notified. Partner notification by public health counselors (provider referral) was significantly more effective. Although the effectiveness of notification procedures is constrained by the accuracy of the information provided by HIV-infected patients, counselors who notify the partners of an infected patient can refer them to educational, medical, and support services targeted to persons at high risk for HIV infection and may encourage the adoption of less risky behavior.

Adult↗
PubMed1992

Impact of HIV testing and counseling on subsequent sexual behavior.

To assess sexual behavior changes after voluntary HIV testing and routine counseling, we interviewed 235 persons at 2 anonymous test sites in North Carolina. Among the 57 (24%) persons returning for follow-up 1 year later, 70% were male; 44% were black, 37% were homosexual, 10% were bisexual; and 16% were HIV positive. Overall, 28% of returnees at the initial visit and 33% on the follow-up visit admitted to having 2 or more sexual partners in the past month. At the initial interview and at follow-up, 21% of returnees reported condom use in the past month. Homosexual men were significantly less likely to use condoms during anal sex over time (58% non-use initially vs. 74% non-use at follow-up, p = 0.04). No significant net change in high-risk sexual behaviors was found at follow-up. Overall findings indicate that the standard HIV testing and counseling provided by health departments anonymously and free of charge does not result in elimination of high-risk sexual behaviors or initiation of safer sex behaviors among those at high risk for HIV infection.

AIDS Serodiagnosis↗
PubMed1991

Child care options for ill children.

Care of ill children who normally attend out-of-home child care programs poses a problem for many working parents, employers, and child care workers. Children cared for in child care centers have an increased incidence of illness and consequently their parents miss work more often compared with children cared for in other child care arrangements. Programs for the care of ill children are discussed to provide the practicing pediatrician with an understanding of the various programs currently or potentially available in the community. The paper ends with a discussion of the various solutions to enhance the economic gains of working parents while serving the need of children for nurturant care.

Child Care↗
PubMed1991

Interpretive criteria of the Western blot assay for serodiagnosis of human immunodeficiency virus type 1 infection.

This project was designed to evaluate different criteria used in the interpretation of the human immunodeficiency virus type 1 (HIV-1) Western blot assay on a group of serum samples blinded to the examiner that were collected from individuals attending three different public health departments in central North Carolina. Each individual also completed an anonymous linked questionnaire regarding sociodemographics and risk factors for blood-borne infections. All of the Western blot assays for human immunodeficiency virus type 1 were interpreted according to the criteria established at the University of North Carolina Hospitals, Chapel Hill, the Centers for Disease Control, Atlanta, Ga, in association with the Association of State, Territorial, and Public Health Laboratory Directors, Iowa City, Iowa, the American Red Cross, Washington, DC, the Consortium for Retrovirus Serology Standardization, Davis, Calif, and the Food and Drug Administration, Washington, DC. The results obtained were grouped as positive, negative, and indeterminate according to each organization's criteria and analyzed in the context of the associated risk factors. The results indicate that institutions performing human immunodeficiency virus type 1 Western blot confirmatory testing should adopt the criteria of the Centers for Disease Control and the State, Territorial, and Public Health Laboratory Directors.

AIDS Serodiagnosis↗
PubMed1988

Day care center illness: policy and practice in North Carolina.

We surveyed 62 North Carolina day care centers (DCCs) to determine their policies for excluding children. We found that the addition of a temperature of 100-101 degrees F to each of eight symptoms was associated with an increase in the percentage of DCCs choosing "immediate pick-up." Non-profit centers were more likely to send children home (70 per cent) than for-profit centers (48 per cent). Centers with and without written illness policies did not differ in their management of sick children.

Adult↗
PubMed1988

Day-care center exclusion of sick children: comparison of opinions of day-care staff, working mothers, and pediatricians.

Day-care center staff are often faced with the decision of whether to send sick children home. Some pediatricians may question the criteria used by day-care centers to exclude children who have mild infectious illnesses. To determine whether there is a consensus on illness policy, we asked day-care center staff, mothers, and pediatricians which sick children in day care should be excluded. Randomly selected day-care center staff, mothers, and pediatricians in three North Carolina counties completed self-administered questionnaires. We asked how combinations of temperature and symptoms that occur with common childhood infections should affect the staff's decisions to "call the parent for immediate pickup." Response rates were 302 of 347 staff (87%), 134 of 200 mothers (67%), and 69 of 80 pediatricians (86%). A temperature of 37.2 degrees to 37.7 degrees C (99 degrees to 99.9 degrees F) was considered a fever by 35% of staff, 24% of mothers, and 6% of pediatricians (P less than .01). At every level of elevated temperature from 37.2 degrees to 38.9 degrees C (99 degrees to 102 degrees F), day-care center staff were more likely to request immediate pickup than mothers or pediatricians (P less than .01). For each of eight symptoms and for all three groups of respondents, the addition of a temperature of 37.8 degrees C (100 degrees F) increased the proportion of children sent home (P less than .01). Day-care center staff, mothers, and pediatricians differ in their reported exclusionary practices for ill day-care children.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Day Care Centers↗
PubMed1987

Sick child care options: what do working mothers prefer?

More than half of all mothers with children under age 6 are in the labor force. Working mothers must take off anywhere from 5.6 days to 28.8 days per employee per year to care for their sick children. In a survey of 134 working mothers with children in day care centers, 70% expressed an interest in sick child care options outside the home, especially a sick room at the child's regular day care center or an infirmary at the parent's workplace. Mothers who chose "out-of home care" were more likely to: be minority (p less than 0.01); be single parents (p = 0.06); earn less than $10,000 annually (p = 0.03); want their children with temperatures of 100-100.9 F to remain in school until the end of the day (p less than 0.01). Communities and day care centers serving especially lower income, minority or single-parent working mothers should consider investigating these out-of-home sick child care options; the savings to employers could be $2 to $12 billion per year, not to speak of the personal savings to the mothers themselves.

Absenteeism↗
PubMedDate not supplied

Hepatitis C virus seroprevalence in clients of sexually transmitted disease clinics in North Carolina.

BACKGROUND AND OBJECTIVES: The major routes of transmission for hepatitis C virus (HCV) appear to be blood transfusion and injecting drug use (IDU). There is still some controversy concerning the role of sexual transmission in HCV infection. GOAL OF THIS STUDY: To use a well characterized, high-risk population of STD clinic patients to investigate the role of sexual transmission of HCV and to determine any association between HCV, HBV, and HIV. STUDY DESIGN: We tested stored sera obtained anonymously from clients attending three STD clinics in North Carolina in 1988 for antibodies to HCV and hepatitis B virus (HBV). An anonymous, self-administered client questionnaire provided patient history and demographic information. RESULTS: The most important risk factor for either HCV or HBV seropositivity was IDU. The only risk factor associated with HCV seropositivity after the removal of IDUs was age older than 30 years. In contrast, risk factors associated with HBV seropositivity after the removal of IDUs included male gender, age older than 30 years, HIV seropositivity, homosexuality/bisexuality, syphilis seropositivity, and a history of syphilis. CONCLUSION: Our study of STD clients confirms the important role that IDU plays in infection with HCV, but suggests that sexual transmission plays only a minor role in HCV epidemiology.

Adolescent↗