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PubMedDate not supplied

Actors play patients. Using surrogate patients to look into private practice.

The authors describe a prospective research design in which actors serve as surrogate patients; this approach can be used to study health care delivery in providers' private offices. A previously published study -- in which an actor with actual dental pathology played the roles of a heterosexual, a homosexual, and an intravenous drug user to learn how dentists would respond to a new patient who appeared to belong to a group at hgh risk for AIDS -- offers an example of the design methodology. The authors discuss the benefits and limitations of the design and note that the behavior of other health care practitioners can be examined using simulated patients. Using carefully selected and trained professional actors rather than untrained patients or students can increase the reliability of findings and protect the rigor of the research.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Infection control in the dental office: has anything changed?

Using data collected in two studies, the authors compare infection control practices used in dental offices in 1988 and 1992. During that time, dentists increased their use of barrier protection but still asked and learned very little about their patients. This lack of communication hinders dentists' ability to deliver the best care possible. The authors recommend that dentists improve communication with their patients to obtain better information about their health status.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Horseback riding injuries among children and young adults.

BACKGROUND: Horseback riding injuries are responsible for an estimated 2300 hospital admissions annually among persons younger than 25 years of age in the United States, but injury rates, patterns of injury, and risk factors for this population have not been well studied. METHODS: Study participants were selected from a list provided by a national mail-order company that sells riding equipment. A total of 557 persons younger than 25 years of age who rode horses at least six times a year completed survey questionnaires. RESULTS: Among the study participants, 34 (6.1%) had been hospitalized at least once because of a riding injury and 153 (27.5%) had been treated by a physician within the previous 2 years for such an injury. The overall injury rate was 0.6 per 1000 riding hours. Among those injured, sprains or strains (41.8%), lacerations or bruises (40.0%), and fractures or dislocations (33.3%) were the most common types of injury. A total of 27.5% of those injured sustained concussions or other head injuries. Riding 15 to 24 hours per month (odds ratio [OR] = 2.04), being female (OR = 1.81), and riding English style (OR = 1.77) were the characteristics most strongly correlated with injury. CONCLUSIONS: Horseback riding injuries among participants in this study tended to be serious. Family physicians should inform their patients who ride horses about the risks associated with equestrian activities and should emphasize helmet use.

Adolescent↗
PubMed2004

Using science to assess environmental vulnerabilities.

Beginning in 1995, the U.S. Environmental Protection Agency (U.S. EPA), Office of Research and Development has focused much of its ecological research in the Mid-Atlantic as part of the Mid-Atlantic Integrated Assessment (MAIA). The goal of MAIA is to improve the assessability of scientific information in environmental decision-making. Following the Environmental Monitoring and Assessment Program (EMAP) whose goal is to guide monitoring that effectively reflects current ecosystem condition and trends, MAIA's second, current, phase of research under the Regional Vulnerability Assessment (ReVA) program is designed to target risk management activities using available data and models. The papers presented here are from a conference held in May 2003 that presented results of research in this second phase of MAIA. The conference was organized into the following topics: 1. Assessing Current Impacts and Vulnerabilities 2. Forecasting Environmental Condition and Vulnerabilities 3. Developing Management Strategies to Optimize the Future, and 4. Assessing and Responding to Environmental Vulnerability.

Environmental Monitoring↗
PubMed2005

SunSmart? Skin cancer knowledge and preventive behaviour in a British population representative sample.

The incidence of skin cancer has risen rapidly in the UK over the last 20 years, prompting public health organizations to try and raise awareness of the dangers of sun exposure and the need to practice sun-safe behaviour. This study aimed to assess baseline levels of sun-safe knowledge and behaviour in a British population-representative sample, prior to the launch of Cancer Research UK's 'SunSmart' campaign. A face-to-face survey was conducted through the Office for National Statistics as part of their Omnibus survey. In total, 1848 men and women aged 18 and over were interviewed. Knowledge of what to do to reduce skin cancer risk was modest. Two-thirds mentioned avoiding the sun by seeking shade, 50% mentioned covering up and only 43% said to use high factor sunscreen. Practice of sun-safe behaviours was also poor, with only one-third saying they sought shade, covered up or used high factor sunscreen to protect themselves from the sun. Men and those from lower socioeconomic groups were least informed and least likely to report using sun-protective behaviours. Increases in both knowledge and use of appropriate sun-protective behaviours are needed if skin cancer incidence rates are to decrease.

Adult↗
PubMedDate not supplied

Oral sexual experience among young adolescents receiving general health examinations.

OBJECTIVE: To examine whether oral sex occurs among young adolescents receiving general health examinations and warrants inclusion in sexual risk assessments. METHODS: Confidential, interviewer-assisted questionnaires completed by 12 to 15-year-olds (n=335). RESULTS: Overall, 18% of adolescents reported having oral sex. Among adolescents who had oral sex, 25% reported no vaginal sex. Few adolescents reported using barrier protection during oral sex. Most adolescents thought that penile-vaginal sex (96%) and penile-anal sex (81%) can transmit HIV, but 68% thought that penile-mouth sex can transmit HIV. CONCLUSION: Unprotected oral sex among young adolescents warrants attention in research and clinical sexual assessment.

Adolescent↗
PubMed1983

Age-specific morbidity among Navy pilots.

This study compares the morbidity (hospitalization) rates by age of male Navy aviators (n = 22,417) with rates for three male control populations: nonpilot aircrew officers (n = 9,483), unrestricted line officers (n = 55,593), and staff officers (n = 46,565). Aircrew members and pilots have the highest hospitalization rates of the four officer groups for both total admissions and for most of the 16 major diagnostic categories. Younger pilots have the highest rates for the disorders of tooth development and eruption and accidental injuries (primarily sports-related) while one of the highest rates for older pilots is observed for circulatory diseases. Compared to civilian samples, the four officer populations are considerably healthier. To further protect the health of Navy personnel, a health risk profile should be developed, implemented, and used as the initial step in reducing and eliminating health risk factors.

Adult↗
PubMed2000

White-coat hypertension and carotid artery atherosclerosis: a matching study.

BACKGROUND: Blood pressure (BP) measurements obtained in the clinic have long served as the basis for determining risk of hypertensive vascular disease, yet many patients with high BP in the physician's office are normotensive elsewhere. It remains unclear whether such patients with "white coat" hypertension elude the risk of atherosclerosis. METHODS: Community residents 40 to 70 years of age and not receiving any cardiovascular medications were recruited to participate in a study of cardiovascular risk factors. On the basis of clinic and daytime ambulatory BP and a threshold criterion of 140/90 mm Hg, subjects were classified as having persistent hypertension, white-coat hypertension, or persistent normotension. One-to-one matching was conducted in male participants on the basis of race and BP. Subjects with persistent hypertension and white-coat hypertension were matched on clinic BP, and those with white-coat hypertension and normotension were matched on daytime ambulatory BP. RESULTS: The 3 matched groups of men (n=40 in each group) were similar in age, smoking status, and fasting glucose and lipid levels. Compared with the normotensive subjects, subjects with either persistent or white-coat hypertension had greater mean body mass index, waist-hip ratio, and fasting insulin concentration. On the basis of standardized duplex ultrasound examination of the carotid arteries, mean maximal intimal-medial thickness and plaque index in subjects with white-coat hypertension were greater than among normotensive subjects and equal to that of the subjects with persistent hypertension. CONCLUSION: When compared with unmedicated individuals with comparable elevations in clinic BP, individuals with white-coat hypertension appear not to be protected from the atherosclerotic sequelae of hypertension.

Adult↗
PubMed2004

Health services use and health care expenditures for children with disabilities.

OBJECTIVE: To examine health care utilization and expenditure patterns for children with disabilities. METHODS: Secondary data analysis was conducted of the 1999 and 2000 editions of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey conducted in 5 rounds by household interview. Two years of MEPS data were combined in this analysis to improve the precision of estimates. Disability was defined by the presence of a limitation in age-appropriate social role activities, such as school or play, or receipt of specialized services through the early intervention or special education programs. The survey sample included 13,792 children younger than 18 years. The overall response rate was 65.5%. RESULTS: Our findings demonstrate that the 7.3% of US children with disabilities used many more services than their counterparts without disabilities in 1999-2000. The largest differences in utilization were for hospital days (464 vs 55 days per 1000), nonphysician professional visits (3.0 vs 0.6), and home health provider days (3.8 vs 0.04). As a result of their greater use, children with disabilities also had much higher health care expenditures (2669 dollars vs 676 dollars) and higher out-of-pocket expenditures (297 dollars vs 189 dollars). We also found that the distributions of total and out-of-pocket expenses were highly skewed, with a small fraction of the disabled population accounting for a large proportion of expenditures: the upper decile accounted for 65% of total health care expenses and 85% of all out-of-pocket expenses for the population with disabilities. Health insurance was found to convey significant protection against financially burdensome expenses. However, even after controlling for insurance status, low-income families experienced greater financial burdens than higher income families. CONCLUSIONS: The skewed distribution of out-of-pocket expenses found in this and earlier studies indicates that the financial burden of childhood disability continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. Additional efforts are needed to protect these high-risk families.

Adolescent↗
PubMed2006

Key scientific issues in the health risk assessment of trichloroethylene.

Trichloroethylene (TCE) is a common environmental contaminant at hazardous waste sites and in ambient and indoor air. Assessing the human health risks of TCE is challenging because of its inherently complex metabolism and toxicity and the widely varying perspectives on a number of critical scientific issues. Because of this complexity, the U.S. Environmental Protection Agency (EPA) drew upon scientific input and expertise from a wide range of groups and individuals in developing its 2001 draft health risk assessment of TCE. This scientific outreach, which was aimed at engaging a diversity of perspectives rather than developing consensus, culminated in 2000 with 16 state-of-the-science articles published together as an Environmental Health Perspectives supplement. Since that time, a substantial amount of new scientific research has been published that is relevant to assessing TCE health risks. Moreover, a number of difficult or controversial scientific issues remain unresolved and are the subject of a scientific consultation with the National Academy of Sciences coordinated by the White House Office of Science and Technology Policy and co-sponsored by a number of federal agencies, including the U.S. EPA. The articles included in this mini-monograph provide a scientific update on the most prominent of these issues: the pharmacokinetics of TCE and its metabolites, mode(s) of action and effects of TCE metabolites, the role of peroxisome proliferator-activated receptor in TCE toxicity, and TCE cancer epidemiology.

Dose-Response Relationship, Drug↗
PubMed2005

Work factors as predictors of smoking relapse in nurses' aides.

OBJECTIVES: The prevalence of tobacco smoking in nurses' aides (assistant nurses) is high. Many smokers make attempts to stop smoking, but a large portion of these relapse after some period of time. The objective of this study was to identify work factors that predict smoking relapse in nurses' aides. METHODS: Of 1,373 Norwegian nurses' aides--who were former smokers, not current smokers, and not on leave when they completed a questionnaire in 1999--1,203 (87.6%) filled in a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were assessed by validated questionnaires at baseline. Respondents who reported smoking at least one cigarette per day at the follow-up were considered having resumed daily smoking (relapse). RESULTS: Social climate in the work unit (index with 3 items: supportive, trustful, relaxed) and frequency of exposure to threats and violence were the only work factors that were associated with the occurrence of relapse after adjustments for background factors. In a logistic regression analysis, frequent exposure to threats and violence at work (odds ratio (OR)=2.08; 95% confidence interval (CI): 1.01-4.29), and the lowest quintile of the social climate index (OR=2.12; CI: 1.03-4.36) were associated with increased risk of smoking relapse, after adjustments for age, gender, marital status, and having preschool children. CONCLUSIONS: A poor social climate in the work unit and frequent exposure to threats and violence at work may be predictors of smoking relapse in nurses' aides. It is essential that leaders in the health services put more emphasis on creating a supportive, relaxed, and trustful social climate in the work unit. It is also important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy.

Adult↗
PubMed2002

Overview of EPA Superfund human health research program.

This paper presents major research needs for the Superfund program, and provides an overview of the EPA Office of Research and Development's (ORDs) current human health research program designed to fill some of those data gaps. Research is presented in terms of the risk paradigm and covers exposure, effects, and assessment activities directly funded by Superfund, as well as research not funded by Superfund but directly applicable to Superfund research needs. Research on risk management is not covered. Current research activities conducted by the Superfund program office are also included to provide a full picture of Superfund human health research activities being conducted by EPA.

Environmental Exposure↗
PubMed2002

[In the consumers' interest: precautionary principles for protection against electromagnetic fields].

The considerable increase in using mobile communication which will increase when new technologies, such as UMTS, are introduced has resulted in further public interest concerning the possible health risks from electromagnetic fields of cellular phone networks. In view of evaluating the scientific state-of-the art, it has been shown that based on the available scientific results, the individual risk in view of proved health consequences is considered low. There are, however, indications of biological effects of high-frequency electromagnetic fields, even at intensities below the currently applied limit values or recommendations for limit values. Although the health relevance of these effects is still unclear, they give reason to precautionary measures with the object to minimise possible health risks which might affect a large number of persons. The precautionary measures recommended by the Federal Office for Radiation Protection include three principles: 1. Exposure of the general public to electromagnetic fields should be as low as possible. This applies for both the fixed parts of cellular phone networks and for mobile phones. 2. The population should be informed of risks in an objective and comprehensive way and be involved in the decisions on the construction and operation of cellular phone networks. 3. Scientific uncertainties should be reduced by means of well-directed research programmes. These precautionary measures and the significance of limit values are explained below.

Cell Phone↗
PubMed2006

Endocrine disrupting chemicals research program of the U.S. Environmental Protection Agency: summary of a peer-review report.

At the request of the U.S. Environmental Protection Agency (EPA) Office of Research and Development, a subcommittee of the Board of Scientific Counselors Executive Committee conducted an independent and open peer review of the Endocrine Disrupting Chemicals Research Program (EDC Research Program) of the U.S. EPA. The subcommittee was charged with reviewing the design, relevance, progress, scientific leadership, and resources of the program. The subcommittee found that the long-term goals and science questions in the EDC Program are appropriate and represent an understandable and solid framework for setting research priorities, representing a combination of problem-driven and core research. Long-term goal (LTG) 1, dealing with the underlying science surrounding endocrine disruptors, provides a solid scientific foundation for conducting risk assessments and making risk management decisions. LTG 2, dealing with defining the extent of the impact of endocrine-disrupting chemicals (EDCs), has shown greater progress on ecologic effects of EDCs compared with that on human health effects. LTG 3, which involves support of the Endocrine Disruptor Screening and Testing Program of the U.S. EPA, has two mammalian tests already through a validation program and soon available for use. Despite good progress, we recommend that the U.S. EPA a) strengthen their expertise in wildlife toxicology, b) expedite validation of the Endocrine Disruptors Screening and Testing Advisory Committee tests, c) continue dependable funding for the EDC Research Program, d) take a leadership role in the application of "omics" technologies to address many of the science questions critical for evaluating environmental and human health effects of EDCs, and e) continue to sponsor multidisciplinary intramural research and interagency collaborations.

Endocrine System↗
PubMedDate not supplied

Research dissemination and utilization.

Why does sun protection and skin cancer awareness need to be addressed? Skin cancer is the most common form of cancer. There has been a steady increase in the incidence of melanoma every year. Evidence shows that ultraviolet radiation from sun exposure during early life is associated with an increased risk of skin cancer in later life. The majority of skin cancer can be prevented by limiting sun exposure. Children and adolescents spend more time exposed to the sun than adults. What are the obstacles to skin cancer prevention? Public perception of tanning needs to be changed. The public associates well being with a tan. The public is uneducated on skin cancer prevention. Skin cancer awareness does not take precedence in our society. School health providers are not active in stressing the importance of avoiding sun exposure. How can nurses promote sun protection? Become educated in the identification of atypical lesions. Reinforce the benefits of sun protection. Recommend sun protection techniques to clients at every office visit. Partner with parents in stressing to children the importance of skin protection. For more information contact. The American Academy of Dermatology (www.aad.org). The American Medical Association. The Centers for Disease Control and Prevention.

Health Education↗
PubMed2002

Development of a research strategy for integrated technology-based toxicological and chemical evaluation of complex mixtures of drinking water disinfection byproducts.

Chemical disinfection of water is a major public health triumph of the 20th century. Dramatic decreases in both morbidity and mortality of waterborne diseases are a direct result of water disinfection. With these important public health benefits comes low-level, chronic exposure to a very large number of disinfection byproducts (DBPs), chemicals formed through reaction of the chemical disinfectant with naturally occurring inorganic and organic material in the source water. This article provides an overview of joint research planning by scientists residing within the various organizations of the U.S. Environmental Protection Agency Office of Research and Development. The purpose is to address concerns related to potential health effects from exposure to DBPs that cannot be addressed directly from toxicological studies of individual DBPs or simple DBP mixtures. Two factors motivate the need for such an investigation of complex mixtures of DBPs: a) a significant amount of the material that makes up the total organic halide and total organic carbon portions of the DBPs has not been identified; and b) epidemiologic data, although not conclusive, are suggestive of potential developmental, reproductive, or carcinogenic health effects in humans exposed to DBPs. The plan is being developed and the experiments necessary to determine the feasibility of its implementation are being conducted by scientists from the National Health and Environmental Effects Research Laboratory, the National Risk Management Research Laboratory, the National Exposure Research Laboratory, and the National Center for Environmental Assessment.

Chemistry Techniques, Analytical↗
PubMed2003

Decision making by the child protection team of a medical center.

The study in this article examined the decision-making process of a child protection team (CPT) charged with reporting suspected child abuse in a medical center in Israel. The authors focused on the decision whether to conclude that a child was at imminent risk and whether to refer the case to a child protection officer. The authors analyzed the content of 139 case files of the children examined by the CPT in two consecutive years, recorded the case characteristics, and correlated them with the decision in a series of univariate and multivariate analyses. The findings indicate that the characteristics of the family were stronger predictors of the decision than the characteristics of the child and of the event that brought the child to the hospital. Implications of the findings and future research issues are discussed.

Adolescent↗