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PubMed1977

The distribution of physician extenders.

As part of the Medicare Physician Extender Reimbursement Study, a mail survey was conducted of 5,572 physician extenders (PEs) to identify potential study participants. Analysis of survey results indicates that PEs are distributed disproportionately more often than physicians to primary care practices and to rural low income areas. However, there are substantial differences among types of PEs with regard to practice location and practice arrangement. The relationship between these findings and the distribution of other medical manpower and innovations is then discussed.

Nurse Practitioners↗

PubMed2004

Factors associated with soft drink consumption in school-aged children.

OBJECTIVE: To identify factors associated with nonalcoholic carbonated beverage (soft drink) consumption in children. DESIGN: Mail-in surveys collected by Dragonfly, a children's educational magazine distributed nationally to elementary and middle schools, were analyzed. The survey included questions about frequency of soft drink consumption and factors related to soft drink consumption. SUBJECTS AND PARTICIPANTS: The sample consisted of 560 children, 8 to 13 years old, who completed and mailed in the survey. There was an equal distribution of boys and girls (51% and 49%, respectively). STATISTICAL ANALYSES: Frequency distributions were calculated and chi(2) tests were conducted to determine whether soft drink consumption and related factors varied by sex and age. Multivariate logistic regression analyses were conducted to examine the association of soft drink consumption with each factor after adjustment for potential confounders. RESULTS: Preference for the taste of soft drinks was the strongest predictor in the analysis, with those who reported the strongest taste preference 4.50 times more likely (95% confidence interval=2.89-7.04) to consume soft drinks five or more times per week than those with a lower taste preference. Youth whose parents regularly drank soft drinks were 2.88 times more likely (95% confidence interval=1.76-4.72) to consume soft drinks five or more times per week compared with those whose parents did not regularly drink soft drinks. CONCLUSIONS: Results suggest that several factors may be associated with soft drink intake in school-aged children, most notably taste preferences, soft drink consumption habits of parents and friends, soft drink availability in the home and school, and television viewing. Additional research is needed to verify these findings in a representative sample of children.

Adolescent↗

PubMedDate not supplied

Subgingival irrigation instruction and utilization in dental hygiene curricula.

PURPOSE: The purpose of this study was to assess subgingival irrigation instruction in accredited dental hygiene programs in the United States; specifically, the number of programs providing instruction; teaching methods used; delivery systems taught didactically and/or clinically; the amount of student clinical experience provided; clinical patient selection criteria; and specific irrigation solutions used. METHODS: A 17-item questionnaire was mailed in January 1989 to 197 accredited dental hygiene programs. Frequency distributions were used to describe the data. RESULTS: A response rate of 85% (N = 167) was obtained after two mailings. One hundred twenty-four dental hygiene programs (74%) provide subgingival irrigation information in their curriculum. Data revealed that although student experiences with subgingival irrigation delivery agents and systems vary greatly, a majority of schools teach the utilization of chlorhexidine delivered via motorized irrigation systems. Students who provide subgingival irrigation usually do so in selected areas for specific patients. CONCLUSIONS: Results from the survey indicate that a majority of dental hygiene programs provide some form of subgingival irrigation instruction, although educational content, experience, and placement of instruction within the two-year curricula varied. Based on these findings, dental hygiene educators may elect to develop standards for teaching subgingival irrigation in their programs.

Curriculum↗

PubMed1996

The amyotrophic lateral sclerosis (ALS) patient perspective on misdiagnosis and its repercussions.

We studied the rate of initial "misdiagnosis', along with factors than might distinguish such patients, in 64 patients with amyotrophic lateral sclerosis (ALS) who completed a survey of 34 questions. Announcement of the survey was made by electronic newsletter and users group bulletin board directed at ALS patients. The questionnaire was distributed to interested ALS patients via electronic mail (e-mail), and 64 ALS patients (81% from the USA) returned their completed questionnaires via reply e-mail or postal mail. Seventeen patients (27% of total group) indicated at least 1 prior misdiagnosis, most commonly spinal stenosis/radiculopathy; 5 listed unnecessary and costly surgical treatments (laminectomy, endarterectomy). Misdiagnosis appeared to be more common in patients above age 60 and may be more common in patients originating in cities versus smaller communities. Mean time from onset of first symptom until definitive diagnosis of ALS was prolonged in patients with initial misdiagnosis (19 months) compared with non-misdiagnosed patients (10 months). Such a previous misdiagnosis may decrease a patient's chance of acceptance into multicenter ALS drug trials.

Adult↗

PubMed1999

Internet for clinical trials: past, present, and future.

The Internet and World Wide Web have recently been introduced into the management of some aspects of large-scale clinical trials such as remote randomization and data entry and the distribution of information on trial progress. Electronic mail and websites have also been used to enhance communication among people involved in a clinical trial. The Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico acuto (GISSI) used telecommunications and the Internet in some recent large-scale clinical trials. GISSI constructed a website to keep the medical and cardiology community informed about the progress of its studies. Websites for clinical trials could play an important role in the future, especially in international clinical trials. The website could provide information such as study material and study news and tools such as electronic forums on protocol application for use by investigators around the world. This article describes the GISSI experience and outlines an appropriate structure for a clinical trial website.

Clinical Trials as Topic↗

PubMed1986

The relationship between the sexual attitudes of parents and their college daughters' or sons' sexual attitudes and sexual behavior.

This study determined if three selected sexual attitudes of parents were related to similar sexual attitudes of their college daughters or sons and to five sexual behaviors. Only never married, college freshmen (N = 83) with both parents participating were utilized. A self-report questionnaire was administered to students at a large midwestern university and distributed to and returned from parents by mail. The Pearson product-moment correlation and the stepwise and multiple regressions were used to test four hypotheses. Mothers' sexual attitudes had a stronger relationship than fathers' attitudes with offspring sexual attitudes and behaviors, particularly for daughters. Generally, mothers with the most positive attitudes toward sexual-self had daughters who were more responsive relative to personal sexual expression (masturbation frequency and orgasmic experience), but who were not any more involved heterosexually (frequency of coitus and number of coital partners). Fathers' sexual attitudes had little relationship to offspring sexual attitudes and behavior. None of the male students' sexual behaviors were related strongly to parent sexual attitudes. Implications for school and parent sexuality education programs are briefly discussed.

Adolescent↗

PubMed2002

Seasonal affective disorders: relevance of Icelandic and Icelandic-Canadian evidence to etiologic hypotheses.

OBJECTIVE: This study tests the suggestion of earlier studies concerning the importance of genetic factors in the etiology of winter seasonal affective disorders (SADs) and subsyndromal winter SAD (S-SAD). METHOD: Two study populations of Winnipeg, Manitoba residents were canvassed: 250 adults of wholly Icelandic descent and 1000 adults of non-Icelandic descent. We distributed the Seasonal Pattern Assessment Questionnaire by mail to these 2 populations, yielding 204 and 449 valid responses, respectively. RESULTS: Rates of SAD and S-SAD proved markedly lower in the Icelandic population than those in the non-Icelandic population. CONCLUSIONS: These differences seem unexplained by differences in ambient light or climate, thus indicating that genetic factors contribute to the expression of SADs. Compared with earlier findings from a group of adults of wholly Icelandic descent living in nearby rural Manitoba, the etiologic importance of as-yet-undetermined environmental factors unrelated to latitude or ambient light is also indicated.

Adolescent↗

PubMed1994

[Current characteristics associated with a history of induced abortion].

For the purpose of analysing the association between selected current socio-demographic characteristics and the history of induced abortion, 138 students of a Brazilian university, who had been pregnant at least once, were studied. These students were identified from among the 937 who returned, by mail, a self-administered, anonymous questionnaire distributed to all the female undergraduates. The subjects were divided into two groups, those who had and those who did not have a history of induced abortion. It was found that the largest percentage of women who had already had an induced abortion were of less than 24 years of age, were not living in marital union, had no religious affiliation and no living children at the time of the study. Analysis by logistic regression showed that having no living children was the only current characteristic associated with having had an induced abortion.

Abortion, Induced↗

PubMedDate not supplied

Partnerships between mothers and professionals in the NICU: caregiving, information exchange, and relationships.

PURPOSE: The purpose of this study was to examine the perspectives of mothers, nurses, and neonatologists on the importance and implementation of NICU practices related to caregiving, information exchange, and relationships within the context of family-centered care. DESIGN: This study design was descriptive. The PARTNERS Questionnaire was developed and implemented, including both quantitative and qualitative items in the three areas (caregiving, information exchange, relationships). For the parent participants, it was a retrospective study. SAMPLE: Two hundred fifteen questionnaires were distributed to professionals and 157 questionnaires were mailed to mothers of NICU graduates. A total of 196 questionnaires (53 percent) was returned (55 mothers, 18 neonatologists, and 123 nurses). RESULTS: Ratings of importance to the respondent and ratings of degree of implementation of items in the three areas were uniformly high. Mothers and nurses had significantly higher ratings than neonatologists in implementation of caregiving. In addition, mothers and nurses rated importance higher than implementation for the areas of information exchange and relationships.

Attitude of Health Personnel↗

PubMed2000

Comparative anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices. A two-year caries clinical trial on children in New Jersey and Puerto Rico.

PURPOSE: To provide a head-to-head comparison of the anticaries efficacy associated with two commercially-available and American Dental Association-accepted dentifrices: Crest Cavity Fighting Toothpaste with Fluoristat, containing 0.243% sodium fluoride in a silica base, and Colgate Great Regular Flavor Fluoride Toothpaste, containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward this purpose. MATERIALS AND METHODS: The study employed a double-blind, parallel-groups, multi-center two-treatment design, and involved third, fourth, and fifth grade schoolchildren from Newark, New Jersey, and from the Cidra and Lares areas of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by the presentation of educational films and lectures at school, by semi-annual mailings to parents, and through the periodic distribution of small novelty gifts along with the dentifrice deliveries, in order to enhance the interest and enthusiasm of study participants. Post-baseline examinations were performed after 1 and after 2 yrs of product use. Two thousand four hundred seventy-nine (2,479) subjects completed this 2-yr study. For these subjects, the mean (S.D.) DFS scores at baseline were 2.77 (3.35) for the Crest group, and 2.66 (3.18) for the Colgate group. For caries increment after 1 yr, the respective means were 1.68 (2.53) and 1.70 (2.57). After 2 yrs, the mean caries increments were 3.56 (4.11) for the Crest group, and 3.56 (4.05) for the Colgate group. RESULTS: The analysis of the 2-yr caries increment scores support the conclusion that the anticaries efficacy associated with Colgate Great Regular Flavor Fluoride Toothpaste is equivalent to that associated with Crest Cavity Fighting Toothpaste with Fluoristat, in accordance with the procedures and standards provided by the published guidelines of the American Dental Association. Further, consistent with those same standards, the results of this study serve to lend additional support to the conclusion that dentifrices formulated with sodium monofluorophosphate provide an equivalent level of anticaries efficacy as to those formulated with sodium fluoride.

Calcium Phosphates↗

PubMed2005

Recruitment of Medicaid and dual-enrolled Medicare beneficiaries with diabetes mellitus into a randomized controlled trial.

OBJECTIVE: To document the recruitment of Medicaid and dual-enrolled Medicare beneficiaries with diabetes mellitus into a randomized clinical trial. STUDY DESIGN: Randomized controlled trial with 1-year follow-up. METHODS: A total of 2242 Medicaid or dual-enrolled Medicare beneficiaries with diabetes residing in King County, Washington, were recruited by direct mail for a clinical trial of diabetes self-care management. Washington State Medicaid program databases were used to identify the target population who received recruitment packets from the program director. Individuals who did not return a participation refusal letter were telephoned to determine study eligibility. Subjects were screened during a study visit, and written informed consent was obtained. Enrolled subjects were randomized to a self-care intervention group or a usual care group. RESULTS: Of 2242 recruitment packets sent, we were unable to contact 40% of the target population, despite the fact that packets were sent to the same mailing addresses used for monthly Medicaid check distributions. The primary recruitment challenges were missing telephone contact information and a lack of interpreters speaking needed dialects. Of the 146 subjects enrolled, 71% were nonwhite, 28% were non-English speaking, 69% were women, and the mean age was 59.8 years. CONCLUSIONS: Research in Medicaid and Medicare populations is possible but requires additional time, energy, and resources. The finding that 40% of the Medicaid population could not be contacted suggests that Medicaid may want to revisit their contact information procedures to facilitate case management and other programs.

Aged↗

PubMed2005

Chest X-ray ordering related to varied clinical scenarios: a survey of Saskatchewan physicians.

INTRODUCTION: The chest X-ray (CXR) is one of the most commonly requested diagnostic imaging examinations. It is estimated that over 250,000 CXRs are ordered in Saskatchewan annually. Judicious use of the CXR is valuable in patient care, while unnecessary use increases costs, adds to patient irradiation, and may be in conflict with standards of patient care. In 1993, the Saskatchewan Health Services Utilization and Research Commission (HSURC) developed clinical practice guidelines (CPGs) for the CXR. These guidelines were based on a metaanalysis of validated literature. We were uncertain about whether Saskatchewan physicians were ordering CXRs based on the HSURC CXR CPGs. MATERIALS AND METHODS: A survey, based on recommendations from the HSURC CXR CPGs, was developed and distributed to 363 physicians in Saskatchewan by mail (30/363) and by email (333/363). The survey asked physicians if they would order, or not order, a CXR for 5 basic clinical scenarios. The question of whether to order a CXR was then repeated when the basic scenario was altered one variable at a time, to determine if the physicians would change their CXR orders. RESULTS: According to our assessment of physician responses to the initial clinical scenarios, the surveyed physicians correctly followed the HSURC CXR CPGs in the following frequencies: 100% scenario 1, 91.9% scenario 2, 35.4% scenario 3, 100% scenario 4, and 61.2% scenario 5. Alteration of the basic clinical scenarios resulted in very unpredictable ordering of CXRs by the survey participants. CONCLUSION: The Saskatchewan physicians we surveyed are not ordering CXRs on the basis of HSURC CXR CPGs. They order too many nonindicated CXRs. Further communication with, and education of, the physician population about the HSRUC CXR CPGs may be warranted.

Adult↗

PubMed1995

Clinical profile, comorbidity, and treatment history in 123 hair pullers: a survey study.

BACKGROUND: Trichotillomania, characterized by an irresistible urge to pull one's hair, may be more prevalent than previously believed. Despite increasing attention devoted to this topic in the recent literature, there are few studies based on large samples that are potentially generalizable to a community population. METHOD: Surveys addressing clinical profile, comorbidity, and treatment history were mailed to all responders to a nationally distributed magazine article on trichotillomania. Out of 772 surveys sent, 123 completed surveys were returned. RESULTS: While there was a predominance of females in the whole sample, female-to-male prevalence was lower in children than adults. Onset was predominantly in childhood (mean age = 11 years), most frequently in middle childhood and least frequently before age 6. Subjects pulled hair from a variety of sites, including scalp, eyelashes, eyebrows, pubic region, face, and body, but the highest incidence and severity involved scalp hair. Children under 6 were more likely than other age groups to pull scalp hair and possibly less likely to pull other hair. In adults, symptom profile was not associated with age at onset. While subjects reported high rates of comorbid conditions in both self and family, trichotillomania was reportedly formally diagnosed in only 40% of the subjects. Although subjects reported a range of treatments, the majority (58%) reported no treatment history. Finally, only minimal improvement was reported for all modalities, with no significant difference in response to psychotherapy, behavior therapy, clomipramine, or fluoxetine. CONCLUSION: Trichotillomania is a chronic illness that may be difficult to treat. Controlled studies on comorbidity, epidemiology, treatment-seeking patterns, and long-term treatment response are needed.

Adolescent↗

PubMed1997

[Response rates and non-response bias in a health-related mailed survey].

A health-related mailed survey was conducted to investigate the effect of follow-up mailings to response rates. In addition, the answer distributions among early and late respondents were compared to check non-response bias. Approximately 3,000 persons aged 40-64 were randomized into two groups; a questionnaire with four pages (twenty-two questions) was assigned to the first group, and a questionnaire with eight pages (thirty-five questions) to the second group. Both questionnaires contained questions of current health status, health-related practice, smoking status, etc. Follow-up mailings were sent twice to non-respondents. Response rates were increased from 38% to 62% by the first follow-up mail, and to 71% by the second follow-up mail. Although the length of the questionnaire did not affect response rates, response rates among the older subjects was higher than the younger subjects. Positive response to current smoking status was 10% lower among early respondents than late respondents, collected after the second follow-up mailing, and response to regular participation in physical/medical checkup was 15% higher among early respondents, whereas there were few differences for answers to other questions. Odds ratios between current health status and several health-related questions may not be biased by late response. However, increased response rates are needed to prevent non-response bias, because there were some differences in responses from follow-up mailings.

Adult↗

PubMed1995

Service directories: reinvigorating a community resource for self-care.

This article reviews the development, distribution, and effectiveness of a free, comprehensive mass-mailed community service directory designed for older people. While only half of a pre/post-distribution sample remembered receiving it, recipients of the directory indicate it increased service awareness and prompted various types of use. Alternatives for design and distribution of community directories are discussed.

Aged↗

PubMedDate not supplied

"Understanding AIDS"--the national AIDS mailer.

The Centers for Disease Control (CDC) of the Public Health Service made public health history in 1988 by mailing the pamphlet, "Understanding AIDS," to every household in the United States. Approximately 126 million copies were distributed, reaching at least 60 percent of the population according to several national polls. The pamphlet was produced and mailed at a cost of about 20 cents per copy. The impact of "Understanding AIDS" by itself on AIDS-related behavior was not fully assessed. Extensive message pretesting and other commercial marketing techniques to improve the effectiveness of the brochure, however, helped "Understanding AIDS" achieve an increase in awareness and concern about AIDS. A number of lessons were learned during the process. They included the importance in such an enterprise of setting a deadline, doing formative research, receiving active support from senior management, achieving a consensus on scientific knowledge, using communications experts, centralizing the final decision-making function, maximizing publicity surrounding the mailing, building a base of support among constituency groups, planning distribution logistics from the very start, and designing evaluation into the process from the beginning.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Postal surveys versus electronic mail surveys. The tortoise and the hare revisited.

The advent of computer-based technology has led to a consideration of change in research methods that exploit the advantages of computer-mediated communications. In survey research, electronic mail (e-mail) has anecdotally shown particular promise as a data collection tool. This article compares traditional postal and nontraditional e-mail surveys within the context of a larger listserv evaluation project in terms of overall return rate, distribution of survey returns over time, response to initial and follow-up mailings, representativeness of respondent groups, thoroughness of survey completion, and the likelihood of respondents to include additional written comments. In summary, whereas postal surveys were shown to be superior to e-mail surveys with regard to response rate, all things being equal, the decision of which to use may be situation-specific, dependent on issues such as survey cost, desire for convenience and timeliness in data collection, and need for higher response rates, among others.

Attitude of Health Personnel↗

PubMed1999

An assessment of issues related to clinical skill remediation in dental hygiene education.

PURPOSE: Within the confines of a lock-step dental hygiene education curriculum, the remediation of clinical skills poses a challenge for both the faculty responsible for assuring clinical competence and for the students expected to meet the stringent clinical performance criteria. To gain an understanding of how dental hygiene programs meet remediation challenges, a survey of U.S. dental hygiene programs was conducted. METHODS: A questionnaire designed to elicit information on specific remediation protocols, the type of instructional methods used in clinical remediation, and the management of faculty work load and compensation when the need for remediation was identified was developed. The questionnaire was pretested by dental hygiene program administrators and then distributed to 227 U.S. dental hygiene programs via mail and Internet services with a follow-up mailing to non-respondents. Data were analyzed and reported as descriptive statistics using the Statistical Package for Social Science (SPSS). RESULTS: An 80 percent (n = 181) response rate was obtained. A chi-square analysis of goodness of fit demonstrated no statistically significant difference between the respondents and the survey population in relationship to type of degree granted, educational setting, or geographic location. Results revealed an average student to clinical faculty ratio of five to one regardless of year of curriculum, educational setting, or geographic location. Just over half (53.6%, n = 97), reported having a written policy on clinical remediation with a clinical course syllabus being the most frequently cited mode of distribution. Ninety-eight percent (n = 177) indicated that clinical faculty met regularly to discuss student clinical progress. Issuing an incomplete grade, requiring the student to attend additional clinical sessions, and allowing the student to continue with his or her peers was the most frequent action taken when clinical remediation was needed at the end of the academic term (32.6%, n = 59). The most frequent remediation intervention strategy employed was one-on-one faculty instruction (87.3%, n = 158). Typodont practice and extra clinical time under one-on-one supervision were also identified by over half of the programs as clinical remediation methods. The majority reported that faculty responsible for managing remediation activities received no financial compensation for the remedial instruction (83%, n = 150). CONCLUSIONS: The study demonstrates that dental hygiene programs do engage in student clinical skill remediation. Educators are encouraged to apply principles of psychomotor skill acquisition to increase remediation effectiveness.

Competency-Based Education↗