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PubMed2004

Reported risk factors are useless in detecting HCV-positive subjects in the general population.

BACKGROUND: Chronic hepatitis C virus infection is mostly asymptomatic, so it will not be identified if specific diagnostic tests are not performed. AIMS: To evaluate the positive predictive value of some risk factors in detecting anti-hepatitis C virus-positive subjects in the general population. SUBJECTS: Two-thousand five hundred and sixty-one subjects randomly selected from the list of the census in three population-based surveys performed in hepatitis C virus endemic areas in Southern Italy. METHODS: The sensitivity, specificity and positive predictive value of blood transfusion, past use of glass syringes and surgical intervention in detecting hepatitis C virus positivity were assessed. Data were collected using a precoded questionnaire administered by an interviewer. RESULTS: All risk factors showed a poor positive predictive value (ranging from 21.0% for surgical intervention to 29.0% for blood transfusion). The positive predictive value was extremely low (ranging from 2.9 to 4.3%) in subjects younger than 46 years of age, who mostly could benefit from antiviral treatment. The combination of the simultaneous presence of more than one risk factor does not improve the detection of hepatitis C virus infection. CONCLUSIONS: Reported risk factors are useless in detecting hepatitis C virus-positive subjects in the general population.

Adolescent↗

PubMed2006

Similar ovulation rates, but different follicular development with highly purified menotrophin compared with recombinant FSH in WHO Group II anovulatory infertility: a randomized controlled study.

BACKGROUND: The contribution of the LH activity in menotrophin preparations for ovulation induction has been investigated in small trials conducted versus FSH preparations. The objective of this study was to demonstrate non-inferiority of highly purified urinary menotrophin (HP-HMG) versus recombinant FSH (rFSH) with respect to the primary outcome measure, ovulation rate. METHODS: This was a randomized, open-label, assessor-blind, multinational study. Women with anovulatory infertility WHO Group II and resistant to clomiphene citrate were randomized (computer-generated list) to stimulation with HP-HMG (n=91) or rFSH (n=93) using a low-dose step-up protocol. RESULTS: The ovulation rate was 85.7% with HP-HMG and 85.5% with rFSH (per-protocol population), and non-inferiority was demonstrated. Significantly fewer intermediate-sized follicles were observed in the HP-HMG group (P<0.05). The singleton live birth rate was comparable between the two groups. The frequency of ovarian hyperstimulation syndrome and/or cancellation due to excessive response was 2.2% with HP-HMG and 9.8% with rFSH (P=0.058). CONCLUSIONS: Stimulation with HP-HMG is associated with ovulation rates at least as good as a rFSH in anovulatory WHO Group II women. LH activity modifies follicular development so that fewer intermediate-sized follicles develop. This could have a positive impact on the safety of ovulation induction protocols.

Adolescent↗

PubMed2004

E-mail or snail mail? Randomized controlled trial on which works better for surveys.

OBJECTIVE: To compare e-mail with regular mail for conducting surveys of physicians. DESIGN: Randomized controlled trial. SETTING: Ontario, Canada. PARTICIPANTS: A random sample of physicians listed in the College of Family Physicians of Canada's membership database. INTERVENTIONS: Survey delivered by e-mail and by post. MAIN OUTCOME MEASURES: Response rates and times, and completeness and characteristics of responses to the survey. RESULTS: Overall response rate was 44.7% (33.6% of e-mail recipients, 52.7% of post recipients who have e-mail, and 47.8% of post recipients without e-mail). While the e-mail rate was significantly lower than for both post groups, e-mail responses were received much faster. There was no significant difference among groups as to completeness of responses, but e-mail responses had more frequent and longer comments. CONCLUSION: E-mail provides faster but fewer responses to surveys. Content of structured-response questions was similar in all groups, but e-mail provided more and longer responses to open-ended questions. Where a quick response to a survey is required, e-mail is superior.

Adult↗

PubMed1999

Determinants of users' satisfaction with primary health care settings and services in Saudi Arabia.

OBJECTIVE: To identify the components of primary health care that cause most concern to service users and to identify socio-demographic and other factors associated with satisfaction among the users of primary health care centres. DESIGN: Interviews conducted by well-trained interviewers with a random sample of heads of households. The questionnaires were composed of questions that measure the extent of satisfaction with settings and services in the primary health care centres using a 5-point rating scale from very satisfied to very dissatisfied. SETTING: The community of Qateef, eastern Saudi Arabia. STUDY PARTICIPANTS: A sample of 802 households representing 838 families was chosen randomly from the housing lists of the primary health care centres in Qateef. There were 40 vacant houses and nine refusals. Thus the number of heads of households actually interviewed was 789. RESULTS: Waiting area structure, confidentiality measures and environmental structure were the areas that caused most concern to service users. The factors that showed the greatest association with satisfaction were the type of the primary health care centre building (purpose-built or rented), literacy status of the household head (literate or illiterate), the extent of the primary health care centre utilization (regular or infrequent). Surprisingly, age showed no association when other characteristics of the respondents were adjusted for, and sex was less important than in other studies. CONCLUSION: How regular the respondent was in using his or her primary health care centre was more predictive in deciding the extent of satisfaction with the various components in the study than the other variables. Socio-demographic factors played minor roles in deciding the extent of satisfaction, although each had a deciding role with one or more, but not all, components.

Adolescent↗

PubMed2000

Prevalence of nocturnal asthma in a general population sample: determinants and effect of aging.

Nocturnal asthma (NA) is important because of clinical and prognostic implications. Previous data on prevalence may be overestimated, because they are derived from selected series. Observations on monitoring of peak expiratory flow in elderly asthmatics suggested that prevalence of NA may increase with age. This study was designed to estimate the prevalence of NA-related symptoms in a sample drawn from a general population and evaluate the role of aging. Subjects (1,100, mean age 41.9, SD 22.8 years) were randomly selected from the lists of seven general practitioners. A questionnaire on nighttime and morning NA-associated symptoms was used and frequency of occurrence was rated as never, sometimes (less than once a week), and often (once a week or more). In the overall sample, symptoms were experienced "sometimes" by 2.3%-4.9% of subjects, whereas the response "often" was given by 0.9%-1.6% of subjects. Among subjects with a diagnosis of asthma, symptoms occurred sometimes in 16.7%-23.7% and often in 5%-15%. Symptoms reported the morning after were significantly more frequent among patients aged 65 years and older (p < 0.005), whereas the difference for nighttime symptoms was not statistically significant in different age groups, confirming an age-related blunted sensitivity. Logistic regression analysis shows that a diagnosis of asthma is the most important correlate of symptoms, with odds ratio (OR) up to 14.78 for cough; advanced age also proved to be an independent risk factor (OR 3.35-4.97). In conclusion, although the prevalence of NA was previously overestimated, our results indicate its importance, particularly among elderly patients who are exposed to a prominent risk of underdiagnosis and undertreatment.

Adult↗

PubMed1994

Corticosteroid prophylaxis for patients with increased risk of adverse reactions to intravascular contrast agents: a survey of current practice in the UK.

There is no definite experimental evidence that prophylactic corticosteroids reduce the frequency or severity of adverse effects from low-osmolar contrast agents in patients at increased risk of reaction. There is no consensus in terms of how prophylaxis should be conducted. We have studied current radiologists' practice in the UK by sending postal questionnaires to 212 radiologists randomly selected from a list of current consultants who are Fellows of the Royal College of Radiologists. One hundred and seventy (80.2%) of the 212 questionnaires were completed. The majority of radiologists routinely use non-ionic low osmolar contrast media for intravenous administration, only 30 (17.6%) routinely using conventional ionic agents and six (3.5%) ionic low osmolar agents. All 170 use low osmolar contrast media for those patients perceived to be at increased risk of adverse reactions. Seventy-six radiologists (44.7%) never use steroid cover. There is no consistent practice amongst the 94 consultants (55.3%) who do use steroid cover. The indications for prophylaxis vary, as do the corticosteroid used and the dose regime employed. The total dose used varied from the equivalent of 7.5 mg to 400 mg of prednisolone, and the duration of prophylaxis varied from a single dose to a 4 day course. One hundred and forty-two radiologists (83.5%) would welcome nationally agreed guidelines for the use of steroid cover. The great variation in the use of steroid cover in the UK reflects the lack of clear evidence of its benefit in combination with low osmolar contrast media.

Adrenal Cortex Hormones↗

PubMed2002

Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials.

OBJECTIVE: To carry out a systematic review of the literature examining the efficacy of psychological interventions (e.g., relaxation, biofeedback, cognitive-behavioral therapy) in the treatment of rheumatoid arthritis (RA). METHODS: Studies that met the following criteria were included: random assignment, wait-list or usual care control condition; publication in peer-reviewed journals; treatment that included some psychological component beyond simply providing education information; and separate data provided for patients with RA if subjects with conditions other than RA were included. Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control, direction and nature of the outcome(s). RESULTS: Twenty-five trials met the inclusion criteria. Methodologic quality was assessed, and effect sizes were calculated for 6 outcomes. Significant pooled effect sizes were found postintervention for pain (0.22), functional disability (0.27), psychological status (0.15), coping (0.46), and self efficacy (0.35). At followup (averaging 8.5 months), significant pooled effect sizes were observed for tender joints (0.33), psychological status (0.30), and coping (0.52). No clear or consistent patterns emerged when effect sizes for different types of treatment and control conditions were compared, or when higher quality trials were compared to lower quality ones. Findings do, however, suggest that these psychological interventions may be more effective for patients who have had the illness for shorter duration. CONCLUSIONS: Despite some methodologic flaws in the literature, psychological interventions may be important adjunctive therapies in the medical management of RA.

Arthritis, Rheumatoid↗

PubMed1996

[Appropriate use and effectiveness of chronic domiciliary oxygen therapy in Catalonia].

BACKGROUND: The aim of this study was to study the pattern of the use of chronic domiciliary oxigenotherapy (CDO) in Catalonia, Spain. METHODS: A transversal study including 110 patients randomly selected from a list of all the subjects with CDO (n = 3,585) was made. A domiciliary survey on the characteristics of the indication for CDO and its fulfillment was carried out. Two pulsioximetries were also performed one breathing room air and another with oxigen. RESULTS: Of the 70 eligible patients the following factors were simultaneously observed in only 14 (20% of the total): adequate indication for CDO, use of oxigen at a flow which corrected the hypoxemia, and prescription fulfillment. The most important cause of inadequate usage of CDO was inappropriate indication since only 19 patients (27%) presented SaO2 less than or equal to 88%. Hypoxemia was not corrected in four of these 19 patients. Thirty-seven percent of the total admitted bad fulfillment, bot only one of the 15 patients with SaO2 less than or equal to 88% and in whom hypoxemia was corrected, recognized bad fulfillment. Sixty-nine percent of the patients had a document explaining the way and length of time they should receive the oxigen. CONCLUSIONS: The inappropriate indication of CDO is the main factor influencing the low effectiveness of chronic domiciliary oxigenotherapy in Catalonia.

Aged↗

PubMed1991

A double-blind, randomized trial of 0.5% podofilox and placebo for the treatment of genital warts in women.

Patient-applied formulations of 0.5% podofilox (podophyllotoxin) were evaluated for the treatment of external genital warts in a double-blind, placebo-controlled study. Seventy-two women were enrolled and, using a randomized, computer-generated list, assigned to receive either active drug or placebo in a 2:1 ratio. Patients were instructed to apply the medication to their external warts twice each day for 3 consecutive days, followed by 4 days without treatment. This cycle was repeated at weekly intervals for a maximum of 4 weeks (and a minimum of 2 weeks). Patients were evaluated weekly for the first month and then at weeks 6 and 10. The number of warts present was recorded and the overall improvement was assessed. The treated area was examined, the patients were questioned about any adverse effects, and standard hematologic/biochemical studies were conducted. The final results showed that podofilox cleared 74% of the total wart count, compared with an 18% regression in the placebo group (P less than .001). The investigators' assessments of improvement correctly distinguished active drug from placebo at every observation point. Local untoward effects were minor and transient. There was no evidence of systemic effects. It is concluded that patient-applied podofilox is a safe and effective therapy for genital condylomata in women. When available, this drug will simplify the treatment of genital warts by providing a patient-applied alternative therapy.

Adolescent↗

PubMed1989

Characteristics of women with hysterectomy.

Socio-demographic and health information, including history of hysterectomy/oophorectomy, was obtained in a telephone survey of 2137 women aged 40-52. Subjects were randomly selected from a list of all women with a driver's license in Pittsburgh, Pennsylvania. Results showed that 27.3% of women surveyed reported having had a hysterectomy. Women who had undergone hysterectomy were more often black, less educated, older and heavier; and reported less frequent alcohol consumption, younger age at birth of first child and earlier menarche than women who did not report hysterectomy. Forty-seven percent of blacks reported hysterectomy compared with 24% of whites (P less than 0.01) and blacks were significantly younger at surgery than whites (mean age 38.5 vs. 39.6 yr, P less than 0.05). Results of multivariate analyses showed age, black race, less than a college education, menarche before age 12 and having no children to be associated with an increased risk of hysterectomy (P less than 0.01). Additional multivariate analyses conducted separately for blacks and whites showed that, for whites but not blacks, the higher a woman's educational attainment the less likely she was to report having had a hysterectomy (P less than 0.01). Black women with no children more often reported hysterectomy than those with children (P less than 0.01), but this relationship was not found among whites. These findings show the distribution of hysterectomy in the population to vary by race, education and parity.

Adult↗

PubMed2003

Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial.

BACKGROUND: Diagnostic hysteroscopy has not yet been generally accepted as a well-tolerated office procedure. The aim of our study was to verify compliance, side-effects and haemodynamic variations when a mini-hysteroscope is used. METHODS: A prospective randomized trial on office hysteroscopy was performed by comparing the use of a traditional 5 mm hysteroscope (group A) and of a 3.3 mm mini-hysteroscope (group B). Two patient groups (A and B), each comprising 100 cases, were formed on the basis of a randomized computer-generated list. RESULTS: A marked reduction in the mean (+/- SD) pelvic pain score during office hysteroscopy was seen in group B (2.3 +/- 2.1) as compared with group A (4.6 +/- 2.2) (P < 0.0001, Mann-Whitney test). This result was also confirmed when using an alternative approach: four classes of pelvic pain at the visual analogue score (VAS). A significant reduction was observed in the incidence of moderate and severe pelvic pain in group B at the end of the examination (P = 0.001) and 5-10 min later (P < 0.05). CONCLUSIONS: The use of mini-hysteroscopes (3.3 mm with diagnostic sheath) lowers considerably the level of pelvic pain the patients feel: it is halved in comparison with traditional calibre hysteroscopes (2.3 +/- 2.1, on a 0-10 VAS). Furthermore the outpatient hysteroscopy failure rate is less than half (2%) with the mini-hysteroscope compared with the traditional 5 mm hysteroscope (5%). As for side-effects and haemodynamic parameters, no differences were observed except for an increase (P < 0.05) in bradycardia in group B. The advantage of this technique is self-evident, if the patients' compliance is taken into account: in many cases the introduction or withdrawal of the vaginal speculum was reported as the greatest discomfort.

Adult↗

PubMed2002

Effectiveness of metronidazole gel on cyclosporine-induced gingival overgrowth in heart transplant patients.

To evaluate the efficacy of metronidazole on cyclosporine-induced gingival overgrowth (GO), a prospective intra-subject double-blind longitudinal study was performed on six heart transplant patients with GO. All patients underwent scaling and root planing before any treatment. Metronidazole gel (Elyzol, Cabon) was then applied in two of the four anterior hemi-sextants of each subject, following a balanced random pre-programmed list, with a placebo gel being applied to the remaining two hemi-sextants. Plaque index (PI), bleeding on probing (BP) and probing depth (PD) were recorded for all teeth of the four anterior hemi-sextants before and at 1, 2, 3, and 4 months after gel application. A general linear model was fitted and ANOVA for repeated measurements with split-plot design and Chi-square analysis were used for statistical analysis. PD significantly decreased after 1 month following both treatments. Analogous results were obtained as regards PI and BP. No statistically significant difference was detected between results obtained with metronidazole and placebo. However, PD in the group of teeth treated with placebo significantly increased after 4 months, while PD values obtained from teeth treated with metronidazole remained statistically unchanged with respect to the 1st month. In conclusion, short-term results suggest that metronidazole and placebo are equally effective in reducing periodontal parameters and GO when associated with scaling and root planing. Long-term results, however, showed greater efficacy of metronidazole with respect to placebo in controlling cyclosporine-induced GO.

Analysis of Variance↗

PubMedDate not supplied

Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial.

OBJECTIVE: This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease. METHODS: Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months. RESULTS: At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome. CONCLUSIONS: Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.

Culture↗

PubMed1996

The effects of list-making on recall in young and elderly adults.

This study examined the effects of list-making, and specific aspects of list-making such as intent (whether one expects to refer back to one's list at the time of recall) and organization, on memory performance in young and old adults. Young and old adults were randomly assigned to a list-making or a non-list-making condition. In both conditions, subjects performed two memory tasks in which they were presented with a word list followed by written recall and recognition tests. On one task, subjects were informed that they would not be allowed to refer to the list at the time of testing (internal-intent). On the other task, subjects were informed that they would be allowed to refer back to the list (external-intent), but actually were not allowed to. Planned comparisons found that list-making significantly improved older adults' performance on the recall tasks. Additionally, while the old performed significantly worse than the young in the non-list-making internal-intent recall task (the traditional memory test condition), these significant differences were not found on either of the list-making recall tasks. Both young and old list-makers who spontaneously organized their lists while studying the words recalled more items than subjects who did not organize their lists. These findings suggest future directions for both theoretical and applied research in the area of memory and aging.

Adolescent↗

PubMed1994

The deliberate misdiagnosis of major depression in primary care.

OBJECTIVE: Because the correct diagnosis of a psychiatric condition can jeopardize reimbursement and other benefits, physicians deliberately substitute alternative diagnoses. We estimated the prevalence of alternative coding for major depression by primary care physicians and the reasons for its occurrence. DESIGN: Cross-sectional mail survey with telephone follow-up of nonresponders. SETTING: Primary care practices in communities across the nation. PARTICIPANTS: Physicians were eligible to participate if they were randomly selected from membership lists of two professional organizations of primary care clinicians. Four hundred forty-four physicians (70.0% of eligible physicians and 89.5% of eligible physicians we could locate) completed the survey by mail or telephone. MAIN OUTCOME MEASURE: Substitution of an alternative code for major depression within a 2-week period. RESULTS: Of our respondents, 50.3% (SE, +/- 2.5%) reported that they had substituted another diagnostic code during a 2-week period for one or more patients whom they recognized met the criteria for major depression in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Thirty-one percent of depressed patients received alternative codes. The most common reasons for these substitutions involved physician uncertainty about the diagnosis and problems with reimbursement for services if a diagnosis of major depression was coded. CONCLUSION: The practice of deliberately substituting another diagnostic code for major depression is widespread among primary care providers. Physicians who employ deliberate misdiagnosis circumvent inequitable policies for particular patients, but the impact of substitution on the health care system as a whole deserves more careful consideration.

Adult↗

PubMed1977

Nutritional benefits from federal food assistance: a survey of preschool black children from low-income families in Memphis.

Approximately 4,000 preschool black children from low-income families in South Memphis participated for three years in a supplementary food program sponsored by the US Department of Agriculture. Part of this group received additional benefit from food stamps, day-care centers, and an infant-feeding program. We evaluated the effects of this participation in 250 children selected randomly from the enrollment list of the supplemetary program. Each child was examined for height, weight, head circumference, and levels of hemoglobin, serum iron, and vitamins A and C. The data were then compared with those from a similar survey in the same area conducted three years before. The results of this comparison indicate considerable improvements in height and weight and a reduction in the incidence of anemia and in the numbers of children with low plasma vitamin A levels. In the absence of other recognizable intervening factors, we conclude that federal food assistance programs were primarily responsible for the observed nutritional improvements.

Body Height↗

PubMed2004

An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment.

CONTEXT: Pulsatile lavage is a high-pressure irrigation treatment used increasingly in a variety of health care settings to debride wounds. Infection control precautions are not routinely used during the procedure and are not included in pulsatile lavage equipment package labeling. OBJECTIVES: To investigate an outbreak of multidrug-resistant Acinetobacter baumannii and to test the hypothesis that pulsatile lavage wound treatment was the mode of transmission for the organism. DESIGN: Outbreak case-control investigation including case identification, review of medical records, environmental cultures, and pulsed-field gel electrophoresis. SETTING: A 1000-bed tertiary care hospital in Baltimore, Md, during September and October 2003. PATIENTS: The investigation included 11 patients infected or colonized with multidrug-resistant A baumannii. Seven of these patients met the case definition for the case-control study and were compared with 28 controls randomly selected from a list of inpatients without multidrug-resistant A baumannii who had a wound care consultation. MAIN OUTCOME MEASURE: Infection or colonization with multidrug-resistant A baumannii. RESULTS: Eleven patients had cultures that grew multidrug-resistant A baumannii during the outbreak period. Of the 10 health care-associated cases, 8 had received pulsatile lavage treatment. One strain of multidrug-resistant A baumannii was recovered from all 6 pulsatile lavage patients who had isolates available for pulsed-field gel electrophoresis analysis and from multiple surfaces in the wound care area. Six of 7 cases (86%) were treated with pulsatile lavage vs 4 of 28 controls (14%) (odds ratio, 36; 95% confidence interval, 2.8-1721; P<.001). These results confirm that pulsatile lavage was a significant risk factor for acquisition of multidrug-resistant A baumannii. CONCLUSIONS: Transmission was apparently caused by dissemination of multidrug-resistant A baumannii during the pulsatile lavage procedure, resulting in environmental contamination. Appropriate infection control precautions should be used during pulsatile lavage therapy and should be included in pulsatile lavage equipment labeling.

Acinetobacter Infections↗

PubMed1996

Estimating population size when duplicates are present.

Each of K mental health programmes reports the number of patients served in a year. The sum of these numbers, y, is an overcount because some patients are seen in more than one programme. Health care planners need to know the unduplicated number served by the mental health system. Thus, there is an unknown number, M, of distinct individuals who appear on one or more of K lists; some appear on multiple lists and the duplicates are not readily identifiable. Let X be the number of lists on which a randomly selected individual appears. When E(X) is known, y/E(X) is the natural estimator of M. We assume that we know the number of programmes, Xi, used by the ith individual in a random sample of recipients of service. Here, the intuitive estimator, Y/X has desirable statistical properties. We give confidence interval estimators for M. We apply the method to estimate the number of individuals served in 1991 by the mental health programmes in New York State.

Confidence Intervals↗