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PubMed2003

Patterns of postmenopausal progestin use with estrogen in relation to endometrial cancer (United States).

OBJECTIVE: To investigate the risk of endometrial cancer associated with various regimens of postmenopausal hormone therapy. METHODS: Data from a population-based case-control study were analysed that included 591 women newly diagnosed with endometrial cancer, aged 40-79, and who were reported to Wisconsin's statewide tumor registry in 1991-1994. Similarly aged population controls (n = 2045) were randomly selected from lists of licensed drivers and Medicare beneficiaries. Information on hormone use and other factors was obtained through telephone interviews. RESULTS: Ever use of estrogen-progestin hormones was associated with increased endometrial cancer compared to women who had never used hormones; the increase per year of use was 7% (95% confidence interval 1-13%). Both cyclic (<10 days per month) and continuous progestin used with estrogen were associated with comparable twofold increases in risk relative to non-users. There was no increased risk associated with progestin used for 10-21 days per month. CONCLUSIONS: Both continuous and cyclic progestin regimens are associated with a much lower risk of endometrial cancer than estrogen alone. However, many women using these regimens remain at significantly increased risk of endometrial cancer.

Adult↗

PubMed1997

Knowledge of oral radiology among Swedish dentists.

OBJECTIVES: To develop a method of measuring Swedish dentists' knowledge of oral radiology and to relate the knowledge measure to a number of characteristics including risk attitude and use of low dose techniques. METHODS: A questionnaire was mailed to 2000 randomly selected dentists listed in the register of the Swedish Dental Society, with a response rate of 69.2%. An index for measuring knowledge was constructed, based on the answers to the questions. The measure was cross-tabulated with a number of demographic variables. RESULTS: Dentists with 5-25 years in practice had a higher level of knowledge than those with either fewer or more years in practice. Dentists working in the Public Dental Health Service had a higher level of knowledge compared with those in private practice. Specialists had a significantly higher level of knowledge compared with dentists who were not. Forty-two per cent of the dentists had not attended any course in oral radiology since graduation. Seventy-nine per cent of the dentists using a 'low' dose technique had a 'high' level of knowledge. The difference between dentists using a 'low-dose' and a 'high-dose' technique was statistically significant (P = 0.000). Dentists' attitude to risk is related to their knowledge. Seventy-one per cent of the dentists in counties with a specialist in oral radiology had a 'high level of knowledge' compared with 57% in those without. CONCLUSIONS: It is possible to study the relationship between knowledge and demographic variables by a survey. Work experience and extended education affect dentists' knowledge. There is an association between knowledge, use of low-dose techniques and risk attitude.

Adult↗

PubMed1999

'Health assessment' at school entry: performance of a system based on school nurse interviews.

OBJECTIVES: To describe the performance of a school entry 'health assessment' based on school nurse interviews. BACKGROUND: Universal medical examination at school entry has largely been replaced by a 'health assessment' led by the school nurse, based on screening tests, a health interview, eliciting parental and professional concern and past history. As a result children with possible problems are selected for school medicals, reviewed in school or referred to a range of health professionals and other agencies. SETTING: Inner city south-east London. SUBJECTS: Children born between 1/3/89 and 31/8/89 who were on the class lists of 21 randomly selected primary schools. DATA COLLECTION: A form for each subject was distributed to the school nurse and completed as children were invited for screening, school health interviews and medical examinations. MAIN OUTCOME MEASURES: Proportion of subjects attending, patterns and proportions of reviews and referrals. RESULTS: 426 children were eligible for inclusion and 419 (98%) forms were returned. 232 children were seen for a health interview and a further 50 were screened for vision, hearing and growth problems only. 124 had no contact with the school nurse or doctor. Following health interview or screening, 180 children were reviewed and/or discussed with other health professionals. 71 external referrals were made. CONCLUSION: Adequate coverage at school entry is difficult to obtain. The objectives of school entry health assessment and the relationship between selection criteria and health needs require clarification.

Child↗

PubMed2002

A prospective study of absence for illness and injury in childcare children.

OBJECTIVES: This population-based study investigated prospectively collected absence episodes to describe patterns and rates of absences for illness and other reasons in two types of formal childcare. DESIGN: Centre day care and family day care homes were selected at random from licensing lists. All centres (n = 11) and 95% of family day care caregivers (n = 130) agreed to participate. The results are based on absence information from carers and on questionnaires to the parents of participating children (n = 846). RESULTS: The major reason for absence was respiratory illness with 48% of all children absent at least once during the year with some form of respiratory illness. Although the absence rate for children in centre care was higher than that in family care (3.34 episodes per 52 child-weeks compared with 2.41), the difference was not statistically significant. CONCLUSION: Investigating patterns of absences from childcare allows a better understanding of needs in childcare. The major reason for absence for illness was respiratory illness.

Absenteeism↗

PubMed1993

Assertiveness among professional nurses.

Assertiveness is considered healthy behaviour for all people that, when present, mitigates against personal powerlessness and results in personal empowerment. Nursing has determined that assertive behaviour among its practitioners is an invaluable component for successful professional practice. The purpose of this descriptive study was to determine assertiveness levels of a population of professional nurses and to determine if assertiveness levels are related to selected demographic factors including age, gender, years of nursing experience, basic nursing education, clinical nursing specialty, type of employer, highest educational level and prior assertiveness training. The sample was composed of 500 registered nurses (64% response rate), chosen randomly from the list of active licensees registered with the Minnesota (USA) State Board of Nursing, who completed and returned an assertiveness questionnaire. The questionnaire consisted of the Rathus Assertiveness Schedule (RAS) and a personal/professional data form. Data analysis included descriptive as well as inferential statistics. The results revealed that this group of nurses was more assertive than any other group of nurses or non-nurses reported in the literature using the RAS. The oldest group of nurses (60-76 years) was significantly less assertive than any of the younger groups of nurses. Nurses practising with a diploma as the highest level of education were significantly less assertive than nurses having a baccalaureate or above. And there was a significant difference in assertiveness between groups of nurses practising in different clinical specialties based on the ANOVA. It appears that the majority of nurses in this study are assertive. They believe in themselves and their abilities. It is hoped that the self-assertion generated by this belief will eventually lead to further personal and professional empowerment.

Adult↗

PubMed2001

Autoclave performance and operator knowledge of autoclave use in primary care: a survey of UK practices.

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice. This has increased the risk of cross-infection with blood-borne viruses and the demand for sterile instruments. The aim of this study was to investigate the knowledge and training of medical personnel in England and Wales on aspects of autoclave use, and to test the effectiveness of their practice autoclaves. An anonymous postal questionnaire and autoclave performance survey using biological indicators was made of 700 general medical practitioners selected at random from FHSA lists from 12 Health Authorities in England and Wales. The overall response rate was 53.1% (N= 372) comprising 10% general practitioners and 90% practice nurses. Eighty-two percent of respondents used autoclaves with a mean age of 2.5 years, of which 91% had been serviced in the past year. While 35% of respondents made daily observation of gauges, 19% did not routinely monitor autoclave effectiveness. Six autoclaves failed to sterilize the spore test ampoules. Fourteen percent of respondents did not autoclave instruments after every patient. Only 33.1% reported wearing gloves during minor operations. Fifty five percent had training in cross-infection prevention. It was concluded that although there has been improvement in instrument decontamination procedures in general practice compared with previous surveys, further education of medical practitioners and practice nurses in the use of autoclaves and infection prevention and control is indicated. The failure of 2% of the autoclaves to kill spores suggests the need for increased monitoring of autoclave performance. Two-thirds of practitioners exposed themselves to increased risk of infection by carrying out minor surgery without the protection of gloves.

Cross Infection↗

PubMed1998

A logistic regression model for analyzing the relation between dentists' attitudes, behavior, and knowledge in oral radiology.

The aim was to study the relation between risk attitude and knowledge in technical, patient-oriented, and organizationally related behavior within oral radiology. A questionnaire was mailed to 2000 randomly selected dentists listed in the register of the Swedish Dental Society, with a response rate of 69.3%. Regression analysis was used for analyzing the effects of the independent variables knowledge, risk attitude, continuing education in oral radiology, counties with specialists in oral radiology, type of practice, work experience, and sex on three categories of dependent variables: 1) technical behaviors: type of film, type of collimator, dose level, frequency of change of chemicals; 2) patient-oriented behaviors: use of patient protection barriers, strict indications for performing full-mouth X-ray examinations and bitewing radiography on new patients and recall patients; and 3) organizationally related behaviors: delegation of X-ray examinations to dental auxiliaries, influence on choice of collimator, influence on choice of film. Knowledge and education had strong direct effects for most of the dependent variables. The technical behaviors were mainly influenced by knowledge, education, and risk attitude, while organizationally related behaviors were influenced by type of practice and sex. The patient-oriented behaviors were influenced by a number of independent variables, such as education, type of practice, work experience, and sex. The present results indicate that both knowledge and the organizational context of dentists influence work.

Adult↗

PubMed1997

Frequency of eating and risk of colorectal cancer in women.

Numerous dietary constituents have been extensively studied with regard to colorectal cancer risk, but food intake patterns have been studied less frequently. The purpose of these analyses was to describe associations between frequency of eating and colorectal cancer risk in women. Female Wisconsin residents aged 30-74 years with a diagnosis of colorectal cancer within two years were identified through the statewide tumor registry. Control subjects were randomly selected from lists of licensed drivers (< 65 yrs old) and Medicare beneficiaries (65-74 yrs old). Meal and snack frequency was obtained on a subset of case (n = 189) and control (n = 322) subjects. Odds ratios and 95% confidence intervals (CIs) obtained from conditional logistic regression models were used to estimate multivariate-adjusted relative risks. Compared with women consuming three or four meals daily, women consuming one to two meals daily had an adjusted relative risk of 0.57 (95% CI = 0.34-0.94). Snacking frequency and frequency of meals + snacks were not associated with cancer risk. These results are consistent with other reports and suggest that meal frequency is associated with colorectal cancer risk.

Adult↗

PubMed2003

Prevalence of cardiovascular disorders among the elderly in primary care in Estonia.

OBJECTIVE: To assess the prevalence of diagnoses of cardiovascular disorders among the elderly in family practice. DESIGN: Cross-sectional study. SETTING: Estonia, population aged 65 years or older (206,915 persons). SUBJECTS: 811 elderly persons selected randomly from the lists of family practitioners. MAIN OUTCOME MEASURES: Prevalence of hypertension, hypotension, coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) and cardiac arrhythmias; differences between the genders and age groups. RESULTS: The prevalence of cardiovascular disorders was as follows: hypertension 63.2%, hypotension 11.1%, CHD 56.5%, MI 9.8%, HF 41.4% and arrhythmias 37.5%. Women had a significantly higher prevalence of hypertension and men of MI. The prevalence of CHD and hypotension was significantly higher in the oldest elderly persons. CONCLUSION: Among the older population in Estonia, cardiovascular disorders that have broader diagnostic criteria and need expensive methods for verifying (CHD, HF) have a high prevalence and are most likely over-diagnosed. The need for strict and simple diagnostic methods for these disorders in primary care practice continues to be serious.

Aged↗

PubMed2006

Traditional healers' perceptions of smokeless tobacco use and health in the Limpopo Province of South Africa.

Traditional healers (THs) exert a significant influence in indigenous South African communities, where smokeless tobacco (SLT) use and dependence is common among women. This study was conducted during 2002. It sought to explore THs' beliefs about SLT use and its health effects. In-depth interviews were conducted with 28--mostly female (68%)--registered THs, with a mean age of 55 years and with an average of 17 years of practice experience. These listed THs were randomly selected from two culturally diverse regions of the (largely rural) Limpopo Province in South Africa. The THs perceive the ritual (external) use of SLT as an absolute necessity in divination, but 32% have also prescribed its 'internal' use to their clients, usually following a "directive from the ancestors." Almost all the THs who themselves regularly consume SLT condemned the recreational use of SLT and believe that SLT is addictive. However, 39% of them claimed to be able to treat addiction resulting from tobacco use not sanctioned by the ancestors. This study has identified opportunities for enlisting THs' collaboration in future community-based tobacco dependence interventions.

Adult↗

PubMed2004

Tobacco use and acculturation among Californians of Korean descent: a behavioral epidemiological analysis.

This study presents population estimates of cigarette use among adults of Korean descent residing in California. Data were drawn from telephone interviews with adults (N=2,830) developed from a random sampling of listed persons in California with Korean surnames. A total of 86% of attempted interviews were completed, and 85% of the interviews were conducted in Korean. Less acculturated men and more acculturated women reported higher present and predicted future rates of smoking after multivariate statistical controls were applied. Sharply divergent rates of cigarette use were found between the genders. Although men did not smoke their first cigarette or smoke cigarettes regularly earlier than women, both groups began smoking later than adults born in the United States. To be effective, tobacco intervention efforts must be tailored specifically to cultures of each minority. Results suggest that acculturation processes influence tobacco use differentially by gender, and future research is needed to identify the implications of processes in tobacco initiation and cessation.

Adult↗

PubMed1985

Medically useful criteria for analytic performance of laboratory tests.

To establish medically useful guidelines for analytic precision of commonly used clinical laboratory procedures, the authors conducted a mail survey of physicians selected randomly from national lists of specialists. They were asked to review, briefly, outlined clinical problems and select the change in test results that would alter their diagnosis or treatment or prompt further assessment of the patient's condition. The responses were used to calculate goals for laboratory precision that are sufficient to meet the present requirements of the average physician. The medically useful limits were compared with existing performance of laboratories as reported in national proficiency surveys and regional quality control programs. Almost all the common laboratory procedures they studied are being assayed at a precision level adequate for the perceived needs. The authors suggest that, for the more common constituents, further progress in clinical laboratory testing will depend on factors other than the improvement of analytic precision.

Attitude of Health Personnel↗

PubMed2005

MAVisto: a tool for the exploration of network motifs.

UNLABELLED: MAVisto is a tool for the exploration of motifs in biological networks. It provides a flexible motif search algorithm and different views for the analysis and visualization of network motifs. These views help to explore interesting motifs: the frequency of motif occurrences can be compared with randomized networks, a list of motifs along with information about structure and number of occurrences depending on the reuse of network elements shows potentially interesting motifs, a motif fingerprint reveals the overall distribution of motifs of a given size and the distribution of a particular motif in the network can be visualized using an advanced layout algorithm. AVAILABILITY: MAVisto is platform independent and available free of charge as a Java webstart application at http://mavisto.ipk-gatersleben.de/ CONTACT: schwoebb@ipk-gatersleben.de SUPPLEMENTARY INFORMATION: Can be found at http://mavisto.ipk-gatersleben.de/

Computer Simulation↗

PubMed2002

Graduates' evaluation of a postgraduate diploma course in family medicine.

BACKGROUND: Postgraduate programmes offer an opportunity to learn family medicine for physicians in practice who were unable to obtain formal training in the immediate postgraduate phase of their career. Since 1985, the Chinese University of Hong Kong has provided a part-time 1-year diploma course at hours convenient for private practitioners. The curriculum has evolved, reducing public health components and increasing family medicine concepts. Between six and 16 students took the course each year until 1999, when formal recognition led to increased popularity. OBJECTIVE: The aim of this study was to evaluate the components and outcomes of the course as a prelude to further development. METHODS: Evaluation comprised a structured telephone interview conducted with two enrollees from each year of the course (total 28), selected randomly from class lists. RESULTS: Participants were mostly young doctors, with an average of 5 years in general practice. Many graduates are now prominent in training and development of family medicine in Hong Kong. Graduates rated most components favourably, but found the original research components too demanding, and not useful subsequently for most. Counselling, family dynamics, consultation and practice organization skills were valued. Conventional continuing education components, such as lectures by specialists, were evaluated poorly. CONCLUSIONS: This course has proved useful in the Hong Kong context, being practical for physicians, and allowing them to study ideas they would not otherwise encounter. Critical appraisal and evidence-based medicine exercises now replace the former research components.

Adult↗

PubMed1995

Postmenopausal hormone use and risk of large-bowel cancer.

BACKGROUND: The epidemiology of large-bowel cancer suggests a role for endocrine factors in its development. Although analytic studies have not consistently provided evidence for an association between reproductive history and large-bowel cancer, some relatively small studies have observed a reduced risk among women using postmenopausal hormone replacement therapy (HRT). PURPOSE: This study was planned to evaluate more precisely the relationship between HRT and the risk of colon and rectal cancers. METHODS: Female residents of Wisconsin aged 30-74 years with a diagnosis of colon or rectal cancer within 2 years were identified through a statewide tumor registry. Control subjects were randomly selected from lists of licensed drivers if the case subjects were less than 65 years old and from lists of Medicare beneficiaries if they were 65-74 years old. Information on post-menopausal hormone replacement use, medical history, and family history was obtained in telephone interviews. After premenopausal women were excluded, 694 case subjects and 1622 control subjects remained for analysis. The odds ratios and 95% confidence intervals (CIs) obtained from conditional logistic regression models were used to estimate relative risks (RRs). All RRs were adjusted for age, family history of large-bowel cancer, use of screening sigmoidoscopy, and recent alcohol consumption. RESULTS: Compared with postmenopausal women who never used HRT, recent users had an RR of 0.54 (95% CI = 0.36-0.81) for colon cancer and an RR of 0.91 (95% CI = 0.54-1.55) for rectal cancer. This inverse association was observed among users of both estrogen only and combined estrogen and progestin preparations. Decreasing time since last use was inversely associated with colon cancer risk (P for trend < .001). The effect of HRT appeared to be stronger among women at lower absolute risk of colon cancer, particularly among women with lean body mass. CONCLUSIONS: Use of HRT was associated with a statistically significant reduced risk of colon cancer. In contrast, no statistically significant relationship was observed for rectal cancer. Given the widespread use of postmenopausal hormones and the morbidity and mortality from adenocarcinoma of the bowel in women, these findings may have potentially important public health implications.

Aged↗

PubMed2004

Absence from childcare for respiratory illness.

BACKGROUND: This population-based study investigated prospectively collected absence for respiratory illness data in two types of formal childcare (centre day care and family day care) in Perth, Western Australia, and factors associated with such absence. METHODS: All centres (n = 11) and 95% of family day care caregivers (n = 130) selected at random from licensing lists agreed to participate. Demographic details were obtained from a parental questionnaire and absences were recorded prospectively. Characteristics of the child and family were described using univariate odds ratios (OR) with 95% confidence intervals (CI). Multivariable analysis including generalized estimating equations was used to investigate having at least one absence for respiratory illness, having two or more absences, and having six or more absences. RESULTS: No statistically significant difference between care types for having had at least one absence episode for respiratory illness (OR 1.37, 95% CI 0.92-2.04) was found. Children who attended care for more days per week (OR 1.40, 95% CI 1.26-1.56) and those in the study for more weeks (OR 1.03, 95% CI 1.01-1.05) were more likely to be absent for respiratory illness. Those children in care for a greater number of hours per day were less likely to be absent (OR 0.88, 95% CI 0.80-0.97). Family history of bronchitis was also associated with absence for respiratory illness (OR 1.86, 95% CI 1.32-2.63). CONCLUSIONS: Statistically significant factors which had an impact on absence for respiratory illness were primarily those relating to the time spent in childcare and to family history of bronchitis.

Absenteeism↗

PubMed2005

Household pit latrines as a potential source of the fly Musca sorbens--a one year longitudinal study from The Gambia.

OBJECTIVES: To assess whether the trachoma vector Musca sorbens was breeding in household latrines in a trachoma-endemic part of The Gambia. METHODS: Longitudinal study of flies emerging from 16 sentinel household latrines selected at random from a list of all latrines present in four Gambian villages. Latrines were surveyed and fly traps were set over the drop hole for 24 h once per month for a year. RESULTS: All the sentinel latrines were of the 'Gambian improved household latrine' design, which has a cement slab but is not ventilated or fly-proofed. The latrines were all in regular use by a family, mean number of users per latrine 14.8 (SD 8.0, range 2-29). Of 55 351 flies caught in 192 catches 54 130 (97.8%) were Chrysomya albiceps, 690 (1.2%) Musca domestica, 466 (0.8%) Chrysomya regalis and 65 (0.1%) M. sorbens. Of the M. sorbens caught 61 (93.8%) were female. CONCLUSIONS: Gambian improved household pit latrines cannot be considered a source of the trachoma vector M. sorbens, and the promotion of pit latrines as a method to reduce M. sorbens is warranted. A large number of C. albiceps were caught emerging from the latrines, but this species is not considered to be of medical importance.

Animals↗

PubMed2005

Prevalence of chronic kidney disease in an urban Mexican population.

BACKGROUND: The present study was primarily designed to assess the prevalence of chronic kidney disease in a Mexican urban population residing in Mexico and to evaluate certain biologic and socioeconomic conditions as risk factors for the development of renal disease. METHODS: A population-based cross-sectional survey was conducted, which included 3564 patients of either gender aged >18 years, who were randomly selected from lists of patients assigned to primary care facilities in the city of Morelia. A questionnaire about personal current health status, kidney disease, diabetes, hypertension, or heart disease in close relatives, anthropometric and blood pressure measurements, and blood and urine samples to measure glucose, blood urea nitrogen, and creatinine was obtained for each patient. Creatinine clearance (Ccr) was calculated by the Cockcroft-Gault formula. Patients were classified in 1 of the 5 Ccr categories established by the Kidney Disease Outcomes Quality Initiative guidelines. RESULTS: The prevalence rate of Ccr < 15 mL/min was 1142 per million population, and that of Ccr <60 mL/min 80,788 per million population. Alcohol and tobacco consumption, female gender, age >65 years, educational level < primary school, and income < US $4.00/day were significantly associated with reduced Ccr. CONCLUSION: Chronic kidney disease prevalence in this population is similar to that seen in industrialized countries. If these figures are similar to those of the entire Mexican population, only l out of 4 patients requiring renal replacement therapy in the country currently has access to it.

Adult↗