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PubMed1999

Stability study on specimens mailed to a state laboratory and tested with the Gen-Probe PACE 2 assay for chlamydia.

BACKGROUND: Although specimen collection is acknowledged to be a critical factor in the testing of chlamydia, rarely do studies examine the effects of specimen transport on laboratory results. GOAL: To compare the results on specimens shipped in a controlled environment with duplicate specimens exposed to environmental conditions such as heat or extended time in transit. STUDY DESIGN: Duplicate specimens were collected from 1,017 women tested at South Carolina public health clinics. One specimen from each woman was shipped by courier and the other by U.S. mail. The results, swab collected first, method of transport, and temperature during shipment were compared for each set of specimens. Specimens were tested with the Gen-Probe PACE 2 test. RESULTS AND CONCLUSIONS: Mailed specimens were exposed to longer transport times and elevated temperatures; despite this, 99% of the results using courier specimens agreed with the mailed specimen results. Eighty-eight women tested positive and 891 women tested negative for chlamydia on both specimens. When the 11 specimens with discrepant results were retested by polymerase chain reaction, 10 were positive for chlamydia, with 9 concurring with the mailed specimen results. Results of specimens in this study were not adversely affected by heat and extended transit times when transported by U.S. Mail.

Adult↗

PubMed1993

A case-control study of risk factors for industrial low back injury. The utility of preplacement screening in defining high-risk groups.

Using a cohort of 8183 postal workers, this study assesses the efficacy of preplacement medical examinations in defining the risk of occupational low back injuries. From this cohort, 154 subjects with occupational low back injuries between 1983 and 1988 and 942 control subjects who did not have low back injuries were identified. A multivariate logistic regression shows that a history of prior disability, odds ratio 2.90 (95% confidence interval 1.88-4.48), and a heavy lifting job, odds ratio 1.91 (1.32-276) are associated with occupational low back injuries. However, a history of previous back injury on screening examination is not associated with subsequent occupational injury. The association between a history of disability and occupational low back injury has not been previously noted and warrants further research.

Adult↗

PubMed2000

Influence of occupational factors on the relation between socioeconomic status and self-reported back pain in a population-based sample of German adults with back pain.

STUDY DESIGN: Population-based cross-sectional postal survey and interview substudy. OBJECTIVES: To examine the association between socioeconomic status and severe back pain and to determine whether this association can be explained by occupational factors. SUMMARY OF BACKGROUND DATA: Like other disorders, back pain and its consequences are inversely related to indicators of high socioeconomic status. METHODS: The associations between indicators of socioeconomic status and presence or severity of current back pain (no back pain or back pain of low intensity and low disability versus back pain with high intensity and/or high disability) were investigated in a survey among German adults 25 to 74 years of age (n = 2731) and an interview substudy of 770 participants with a recent history of back pain.- RESULTS: In the survey, educational level was inversely associated with back pain and severe current back pain. Similarly, in the interview substudy, educational level, vocational training, occupational class, household income, and health insurance status were inversely related to severe current back pain. Age-adjusted and gender-adjusted odds ratios were 0.36 (95% confidence interval [CI] 0.25-0.52) for immediate educational level and 0.37 (95% CI 0.18-0.73) for high educational level. Recalled work tasks at the onset of back pain were significant risk factors of severe current back pain (heavy physical work: odds ratio [OR] 1.77, 95% CI 1.06-2.93; work in bent position among males: OR 1.89, 95% CI 1.03-3.46). After adjusting for occupational class or work tasks, the association between educational level and severe current back pain remained unchanged.- CONCLUSIONS: The findings support the hypothesis that severe back pain is less prevalent among adults of higher socioeconomic status. The underlying mechanism could not be explained by differences in self-reported occupational factors.

Adult↗

PubMed2001

2001 Volvo Award Winner in Clinical Studies: Effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice.

STUDY DESIGN: Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before and after telephone surveys of the general population and postal surveys of general practitioners was conducted, with an adjacent state used as a control group. OBJECTIVES: To evaluate the effectiveness of a population-based intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and workers' compensation-related costs. SUMMARY OF BACKGROUND DATA: A multimedia campaign begun during 1997 in Victoria, Australia, positively advised patients with back pain to stay active and exercise, not to rest for prolonged periods, and to remain at work. METHODS: The campaign's impact on population beliefs about back pain and fear-avoidance beliefs was measured in telephone surveys, and the effect of the campaign on the potential management of low back pain by general practitioners was assessed by eliciting their likely approach to two hypothetical scenarios in mailed surveys. Demographically identical population groups in Victoria and the control state, New South Wales, were surveyed at three times: before, during, and after intervention in Victoria. RESULTS: The studies were completed by 4730 individuals in the general population and 2556 general practitioners. There were large statistically significant improvements in back pain beliefs over time in Victoria (mean scores on the Back Beliefs Questionnaire, 26.5, 28.4, and 29.7), but not in New South Wales (26.3, 26.2, and 26.3, respectively). Among those who reported back pain during the previous year, fear-avoidance beliefs about physical activity improved significantly in Victoria (mean scores on the Fear-Avoidance Beliefs Questionnaire for physical activity, 14, 12.5, and 11.6), but not in New South Wales (13.3, 13.6, and 12.7, respectively). General practitioners in Victoria reported significant improvements over time in beliefs about back pain management, as compared with their interstate colleagues. There were statistically significant interactions between state and time for 7 of 10 responses on management of acute low back pain, and for 6 of 10 responses on management of subacute low back pain. CONCLUSION: A population-based strategy of providing positive messages about back pain improves the beliefs of the general population and general practitioners about back pain and appears to influence medical management.

Australia↗

PubMed1992

The effectiveness of preemployment drug screening in the prediction of employment outcome.

Studies of adverse employment outcomes associated with positive preemployment drug screens have tracked employees for only about 1 year. Changes in drug use after hire may invalidate the predictions of employment outcome in later years which are essential for cost-benefit analyses. This blinded, prospective cohort study tracks absence, industrial accidents, occupational injuries, discipline, and turnover in 2537 screened employees through an average of 2 years. Marijuana-positive urines predicted increased turnover, accidents, injuries, discipline, and absence, but these risks appeared lower in the second year than the first. Cocaine-positive urines predicted increased turnover, accidents, injuries, discipline, and absence at levels not consistently different than the first year. Cost-benefit analyses of drug screening project employment risks throughout employees' careers. This study raises the possibility that elevated risks may decrease after the first year.

Boston↗

PubMed1999

Managing job strain: a randomized, controlled trial of an intervention conducted by mail and telephone.

A randomized, clinical intervention focused on alleviating job strain was conducted over 6 months by mail and/or telephone with a total of 136 employees of Bank of America. Both the mail and mail plus telephone interventions evidenced positive results, with the mail plus telephone intervention being the more effective. Given the relative low cost of such mediated interventions, the results provide a basis for the further development of interventions that may demonstrate both clinical and cost effectiveness.

Adaptation, Psychological↗

PubMedDate not supplied

Persistence of a mock bio-agent in cross-contaminated mail and mailboxes.

Among the 22 confirmed or suspected cases of anthrax during the bioterrorism incidents in 2001, all but two seemed traceable to spores from threat letters. Although no anthrax spores were found in the environments frequented by two females who died of the disease, a suspicion persists that the deaths were somehow related to the mail. This study assesses the spread and persistence of a mock biological agent from a source-letter to other mail and to a receiving mailbox. Successive placement and removal of letters were found to reduce the number of residual bio-agent particles in a mailbox. This suggests that a sweeping action is taking place that can affect the quantity of bio-agent remaining. The exercise supports the possibility that the two females were exposed to spores on mail that had been in their mailboxes although no trace of spores could later be found in their boxes.

Aged↗

PubMed2006

Incidence of musculoskeletal complaints in a large adult Norwegian county population. The HUNT Study.

STUDY DESIGN: Cross-sectional study. Between 1995 and 1997, all inhabitants aged 20 years and older in the Nord-Trøndelag county in Norway were invited to fill in 2 different questionnaires at different times concerning musculoskeletal complaints. OBJECTIVE: To estimate the incidence of musculoskeletal complaints lasting at least 15 days during the past month at 9 different anatomic sites in relation to age and gender. SUMMARY OF BACKGROUND DATA: Incidence data of musculoskeletal complaints are scarce. METHODS: Individuals who reported no musculoskeletal complaints lasting for at least 3 months during the past year were defined as a population at risk and were subjects for the incidence estimates. RESULTS: Of 49,720 individuals (response rate 53.5%), the overall age-adjusted incidence of musculoskeletal complaints was 7.9% (95% confidence interval 7.5% to 8.2%) (women: 7.1%, men: 8.7%). The highest incidence rate was found for the lower back (women: 2.3%, men: 2.8%). The incidence of spinal complaints declined after age 60 years, whereas the incidence of complaints in lower limbs and distal upper limbs tended to be stable or increase in the older age groups. CONCLUSIONS: In this, to our knowledge, first large-scale population-based study evaluating the incidence of musculoskeletal complaints, nearly 1 in 12 individuals reported musculoskeletal complaints lasting at least 15 days during the past month.

Adult↗

PubMed2003

Post office box addresses: a challenge for geographic information system-based studies.

BACKGROUND: Geographic information system (GIS)-based health studies require information on the physical location of data points, such as subject addresses. In a study of California women diagnosed with breast cancer between 1988 and 1997, we needed to locate the residential addresses of 4,537 women with post office boxes (POBs). METHODS: We investigated the feasibility of tracing street addresses for the POBs and examined potential selection biases and case attribute misclassifications introduced by different methods of handling POBs in GIS-based health studies. RESULTS: Our tracing method yielded street addresses for only 34% of POBs in our study. Examination of subjects' case characteristics revealed that boxholders were not representative of the full population. Geocoding using a POB's delivery-weighted five-digit zip code centroid, as a proxy for street address, resulted in case attribute misclassification for 81% of boxholders. CONCLUSIONS: Disease registries should modernize their infrastructure to complement GIS technologies. Epidemiologists should understand GIS data limitations and consider potential biases introduced by incomplete or inaccurate geocoding.

Adult↗

PubMed2005

Web-based and mailed questionnaires: a comparison of response rates and compliance.

BACKGROUND: We assessed response rates and compliance for a printed questionnaire and a Web questionnaire in a Swedish population-based study and explored the influence of adding personalized feedback to the Web questionnaire. METHODS: We assigned 875 subjects to 1 of 3 groups: printed questionnaire, plain Web questionnaire, or Web questionnaire with personalized feedback. The questionnaire had 2 parts, first a general section and then a dietary section. RESULTS: The response rate for the general section was 64% for the printed questionnaire, compared with 50% for the Web questionnaire with feedback. For the dietary questionnaire, the rates were reversed, resulting in a total response rate for the dietary questionnaire that did not differ between printed and web questionnaire with feedback. CONCLUSIONS: Interactivity in the Web questionnaire increased compliance in completion of the second section of the questionnaire. Web questionnaires can be useful for research purposes in settings in which Internet access is high.

Adult↗

PubMed2005

Alternative modes for health surveillance surveys: an experiment with web, mail, and telephone.

BACKGROUND: Web and mail surveys as complements to telephone surveys may help resolve concerns about declining participation in telephone surveys for public health surveillance. Little is known, however, about how responses obtained in Web surveys compare with those from mail or telephone surveys. METHODS: The Behavioral Risk Factor Surveillance System 2003 core interview was conducted in 3 survey modes: Web (n = 1143), mail (n = 836), and telephone (n = 2072). All 3 samples were drawn randomly. We compared respondent demographics and responses to 8 key questions on health conditions and risk behaviors (including asthma, diabetes, obesity, and HIV testing) across the 3 survey modes. RESULTS: Demographic characteristics of mail and Web respondents varied considerably from those interviewed by telephone. The unadjusted prevalence of outcomes varied by survey mode. After adjustment for respondent demographic characteristics, there were still differences among survey modes in several of the health conditions and risk behaviors, although for some of these, the pattern was different for the unadjusted and adjusted results. CONCLUSIONS: As health surveys take advantage of new technologies and moved towards mixed-mode designs, researchers need to test for and, if necessary, account for the effect of mode in the estimates they produce.

Health Surveys↗

PubMed2004

Feasibility and reliability of a mailed questionnaire to obtain visual analogue scale valuations for health states defined by the Health Utilities Index Mark 3.

To establish the generalizability (external validity) of the Health Utilities Index Mark 3 (HUI3) as a single-summary score generic outcome measure in numerous countries/subgroups (including children), repeated studies of community preferences should be performed in various settings. In performing multiple HUI3 studies, a mailed questionnaire approach, if feasible and reliable, might be substituted for oral interviews. In the present study, we assessed the feasibility and reliability of a mailed questionnaire approach originally developed for the EQ-5D, for the purpose of collecting Visual Analogue Scale (VAS) valuations from parents as surrogate responders for 65 pediatric HUI3 health states and for the state of being dead. Untransformed mean VAS scores of the health states and scores converted into preliminary Standard Gamble (SG)-utilities were compared with Canadian and French multiattribute utility estimates. A random sample of 1920 parents of schoolchildren (aged 4 to 13) received a mailed questionnaire. Each parent was asked to rate 6 HUI3 health states on a 0 to 100 VAS. Response was 70%. Mean completion time was 20 minutes (SD 9). The questionnaire was rated difficult by only 9%. The current format was, however, inappropriate for valuing the state of being dead. Interrater reliability of health state valuations was.87. Spearman's rank correlations, Pearson-R correlations and intra class correlation coefficients (ICCs) between untransformed VAS valuations and Canadian/French utility estimates were > or =.87. However, preliminary SG-utilities showed diminished ICCs (.71 to.72). The data support the feasibility and reliability of mailed HUI3 valuation questionnaires to a considerable extent, but further methodological studies regarding other formats and different populations are recommended.

Activities of Daily Living↗

PubMed2004

Why do people report better health by phone than by mail?

CONTEXT: Past research shows that fewer health symptoms are reported by phone than by mail. OBJECTIVES: We sought to examine whether interview mode-dependent differences in health symptom reporting are the result of socially desirable responding or to expending less cognitive effort when formulating responses, a behavior known as satisficing. DESIGN: Participants were randomly assigned to telephone interview only or to mail interview followed 2 weeks later by telephone interview. SETTING & PARTICIPANTS: Participants were American veterans from the Gulf War Registry (n=719). MAIN OUTCOME MEASURES: Our main outcome measure was the number of mild, moderate, or severe symptoms reported (of 48 possible). RESULTS: Veterans reported an average of 5 more symptoms via mail than via telephone, F (1, 709) = 32.50, P < 0.001. The difference was mainly the result of symptoms reported by mail as mild but not reported at all by phone. Veterans with higher social desirability scores reported fewer symptoms by phone and mail, F (1, 709) = 10.11, P = 0.001, but social desirability scores did not interact with interview mode. Furthermore, embarrassing symptoms such as genital complaints were no less likely to be reported by phone. CONCLUSIONS: Reporting of better health in phone surveys is the result of fewer mild symptoms reports but not of socially desirable responding. The findings are consistent with phone interviews encouraging satisficing by limiting the recall of less severe health states. Researchers should handle mild symptom reports with some skepticism.

Adult↗

PubMed2005

Increasing response rates in a survey of Medicaid enrollees: the effect of a prepaid monetary incentive and mixed modes (mail and telephone).

OBJECTIVES: We sought to evaluate the effect of pairing a mixed-mode mail and telephone methodology with a prepaid US 2.00 dollars cash incentive on response rates in a survey of Medicaid enrollees stratified by race and ethnicity. RESEARCH DESIGN: Sampling was conducted in 2 stages. The first stage consisted of a simple random sample (SRS) of Medicaid enrollees. In the second stage, American Indian, African American, Latino, Hmong, and Somali enrollees were randomly sampled. A total of 8412 enrollees were assigned randomly to receive a mail survey with no incentive or a US 2.00 dollars bill. RESULTS: The response rate within the SRS after the mail portion was 54% in the incentive group and 45% in the nonincentive group. Response rates increased considerably with telephone follow-ups. The incentive SRS response rate increased to 69%, and the nonincentive response rate increased to 64%. Differences between incentive conditions are more pronounced after the first mailing (P < 0.01); almost all differences remained significant (P < 0.05) after the completion of the mail mode. The inclusion of the US 2.00 dollars incentive had similar effects on response rates and cost across the different racial and ethnic strata, except for Latino enrollees. CONCLUSIONS: A mixed-mode mail and telephone methodology is effective for increasing response rates in a Medicaid population overall and within different racial and ethnic groupings. The effectiveness of this strategy can be enhanced, in terms of response rate and cost, by including a US 2.00 dollars prepaid incentive.

Ethnicity↗

PubMed2006

Evaluating patients' experiences with individual physicians: a randomized trial of mail, internet, and interactive voice response telephone administration of surveys.

BACKGROUND: There is increasing interest in measuring patients' experiences with individual physicians, and empirical evidence supports this area of measurement. However, the high cost of data collection remains a significant barrier. Survey modes with the potential to lower costs, such as Internet and interactive voice response (IVR) telephone, are attractive alternatives to mail, but their comparative response rates and data quality have not been tested. METHODS: We randomly assigned adult patients from the panels of 62 primary care physicians in California to complete a brief, validated patient questionnaire by mail, Internet (web), or IVR. After 2 invitations, web and IVR nonrespondents were mailed a paper copy of the survey ("crossover" to mail). We analyzed and compared (n = 9126) the response rates, respondent characteristics, substantive responses, and costs by mode (mail, web and IVR) and evaluated the impact of "crossover" respondents. RESULTS: Response rates were higher by mail (50.8%) than web (18.4%) or IVR (34.7%), but after crossover mailings, response rates in each arm were approximately 50%. Mail and web produced identical scores for individual physicians, but IVR scores were significantly lower even after adjusting for respondent characteristics. There were no significant physician-mode interactions, indicating that statistical adjustment for mode resolves the IVR effect. Web and IVR costs were higher than mail. CONCLUSIONS: The equivalence of individual physician results in mail and web modes is noteworthy, as is evidence that IVR results are comparable after adjustment for mode. However, the higher overall cost of web and IVR, as the result of the need for mailings to support these modes, suggests that they do not presently solve cost concerns related to obtaining physician-specific information from patients.

Adult↗

PubMed2005

Management of asymptomatic anthracycline-induced cardiac damage after treatment for childhood cancer: a postal survey among Dutch adult and pediatric cardiologists.

Asymptomatic anthracycline-induced cardiac damage (A-CD) is a serious problem among young childhood cancer survivors. The aim of this survey was to assess the current treatment policy in these patients in the Netherlands. A questionnaire was sent to all 136 departments of adult or pediatric cardiology in the Netherlands. It was returned by 61% of the departments. Sixty-six percent of the respondents started medical treatment (ie, an ACE inhibitor and/or a beta-blocker) in childhood cancer survivors with asymptomatic A-CD. Fifty-eight percent of the respondents indicated that their treatment decision was based on published findings in the literature, but none of them referred to studies evaluating the treatment of asymptomatic A-CD. A majority of adult and pediatric cardiologists started medical treatment in childhood cancer survivors with asymptomatic A-CD without knowledge of the benefits and risks of treatment in this patient group. Before ACE inhibitors and/or beta-blockers can be recommended as routine practice in childhood cancer survivors with asymptomatic A-CD, randomized controlled trials should be performed. Until then, the authors recommend centralizing the treatment of childhood cancer survivors with asymptomatic A-CD in a specialized center to cluster the available knowledge and experience.

Adult↗

PubMed2004

Comparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinics.

BACKGROUND: Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended. GOAL: We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea. STUDY: In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus $20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1, 5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder. RESULTS: Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6-2.5) and 2.6 (95% CI, 1.3-5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7-193.5) and 4.6 (95% CI, 0.4-58.0). CONCLUSIONS: A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.

Adolescent↗

PubMed2006

Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs.

BACKGROUND: Testing for Chlamydia trachomatis by nucleic acid amplification tests (NAATs) using self-collected vaginal swabs (VS) is acceptable and accurate. The objectives were to implement an educational Internet-based program for women to facilitate home screening, to determine whether women would request and use self-collected VS kits, to determine associated risk factors for infection, and to determine satisfaction with the process. METHODS: The website, www.iwantthekit.org, was designed to encourage women > or =14 years to obtain home-sampling kits. Kits could be obtained in the community, requested by Internet/e-mail, or telephone. Users mailed the self-collected VS to the laboratory. Swabs were tested by 3 NAAT assays. Respondents called for results. RESULTS: Forty-one of 400 (10.3%) women were chlamydia positive; 95.1% were treated. Questionnaires indicated 89.5% preferred self-collection, 93.5% rated collection easy/very easy, and 86.3% would use the Internet program again. Black race and age <25 years were associated independently with being chlamydia positive, while use of birth control and non-consensual sex were protective. Thirty-six of 41 (87.8%) positive samples were positive by all 3 NAATs, 5/41 (12.2%) were positive by only 2 NAATs, and none were positive by only 1 NAAT. The Internet/e-mail request method was better than the community pick-up approach because 97.2% of kit requests were e-mailed and 87.5% of kits returned for testing were e-mail requested. CONCLUSIONS: Women will use the Internet to request and use home-sampling kits for chlamydia. NAAT testing performed well on dry-transported VS. High prevalence was detected and questionnaires indicated high-risk sexual behavior.

Adolescent↗