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PubMed2004

[The prevalence of chronic generalized pain and its relationship to demographic characteristics and mental status].

Chronic generalized pain (CGP) as one of the diagnostic criteria of fibromyalgia is a common condition amongst the populations of Western Europe and the USA. The prevalence of CGP in these countries is 10.7-13.2%. The etiology of CGP is unclear; however, several findings suggest that this is a process of somatization that masks affective disorders. There have been no studies of the epidemiology of CGP in Russia. The study was undertaken to determine the prevalence of CGP in the Yekaterinburg adult population and to examine the relationship of CGP to its demographic characteristics and affective disorders. A ostal cross-sectional population survey was conducted. This covered 159 persons (54 males and 105 females) aged 27 to 75 years who had been randomly selected from the election lists of Yekaterinburg residents. A questionnaire was posted to each participant in order to reveal whether a respondent had experienced pain a month before, to define its location, duration, severity, and to evaluate psychoemotional disorders. The response rate was 75.5% (120 replies). The prevalence of CGP was 13.3%. There was no relationship of the sex of a respondent to CGP. The latter was shown to be associated with age. There was also its significant association with psychoemotional disorders. CGP is a common condition in the Yekateringburg population, which occurs in every 8 adult residents, more frequently in those aged above 43 years. The individuals who suffer from CGP exhibit a high level of psychological distress.

Adult↗

PubMed2004

French dentists' restorative treatment decisions.

PURPOSE: Variations in decision-making about restorative treatments have been demonstrated among dentists in several countries. This study sought to assess the restorative treatment philosophies based on a representative sample of French dentists. MATERIALS AND METHODS: A sample (n = 2000) was randomly extracted from a national list (n = 42,000). Each dentist received a questionnaire, illustrations of carious conditions, and a reply-paid envelope. The questionnaire assessed the stage of lesion progression at which the respondents considered restorative treatment appropriate, their choice of restorative technique and dental material. For all questions, an imaginary 20-year-old patient with low caries activity was described. RESULTS: After one reminder, the response rate was 40%. Almost half of the respondents would restore an occlusal lesion confined to enamel and 88% would have prepared a cavity for a proximal lesion at the amelo-dentinal junction. The majority of the respondents would not use the Black concepts for cavity preparation. Their preferred restorative material was composite. CONCLUSIONS: Answers indicated a tendency towards early restorative intervention and showed large variations between the treatment decisions of French dentists.

Adult↗

PubMed1990

[Obesity and arterial hypertension. A cross-sectional study of their prevalence in the population of L'Hospitalet de Llobregat].

A study of the prevalence of arterial hypertension and obesity has been performed in the community of Hospitalet de Llobregat which is an industrial town of 289,000 inhabitants in the vicinity of Barcelona. We have studied a population sample of 801 individuals over the age of 19 years, randomly chosen from the elections lists from 1986, and who were classified according to age and sex. Four hundred and thirty two subjects (54%) had a Quetelet index (QI) of 25 or above. Out of these, 300 (38%) had a QI between 25-30 and 124 (16%) had a QI of 30 or above. Obesity prevalence defined as an QI greater than or = 25 was lower in the youngest group (20-39 years), both in males as in females, with a significant difference p less than 0.05). Arterial hypertension prevalence (SAP greater than 160 and/or DAP greater than 95 mmHg) was 19.8%. When individuals with DAP of 90-94 were included, prevalence was 25.7%. A positive correlation between QI and arterial blood pressure was found in the sample studied as a whole, both for systolic arterial pressure (r = 0.23; p less than 0.001; R2 = 0.053) as for diastolic arterial pressure (r = 0.23; p less than 0.001; R2 = 0.053). Arterial hypertension prevalence (SAP greater than 160 and or DAP greater than 90 mmHg plus those individuals with lower values but were on hypotensive treatment) was higher in obese individuals (QI greater than 25). The difference was statistically significant in males below 60. In females a tendency was observed in women below 40. (p = 0.054).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1990

Renal transplant diet recommendations: results of a survey of renal dietitians in the United States.

A survey of dietitians at renal transplant centers in the United States was conducted to identify diet modifications currently used for nondiabetic adults after kidney transplantation. The survey focused on the diet recommended for the first 21 days after successful transplantation. Questionnaires were mailed to 100 centers randomly selected from a comprehensive list obtained through the Organ Transplant Coordinating Office of the Texas Medical Center, Houston. A 66% response rate was obtained. The results of the survey showed that dietitians were most frequently recommending 1.2 to 1.5 gm protein per kg body weight, 40% to 50% of total energy as carbohydrate, a fat intake of less than 30% of total energy, and an energy level consistent with achieving or maintaining desirable body weight. Sodium intake was most commonly restricted to 2 to 4 gm, whereas potassium and phosphorus intakes were individualized according to the patient's serum values. Comments on the returned questionnaires indicated that many institutions were reviewing and updating their transplant diet to include a polyunsaturated fat to saturated fat ratio and restrictions of cholesterol and simple sugars. The findings of the survey indicated that the renal transplant diet should focus on optimal protein and energy intake as well as restriction of simple sugars, total fat, cholesterol, and saturated fat to restore nitrogen balance and minimize clinical symptoms of post-transplant diabetes and hyperlipidemia.

Cholesterol, Dietary↗

PubMed1987

Use and abuse of controlled substances by pharmacists and pharmacy students.

The use of controlled substances by samples of pharmacists and pharmacy students in one New England state was surveyed. A questionnaire was sent in November 1984 to a sample of 510 pharmacists randomly selected from the membership list of the state's pharmaceutical association and to a sample of 470 students from the state's pharmacy schools; 76% and 67% of the eligible pharmacists and students responded, respectively. The questionnaire elicited information about the respondents' use of controlled substances for self-treatment and recreation, as well as the instrumental use of stimulants to enhance performance. Almost half of the pharmacists (46%) and two thirds of the students (62%) reported using a controlled substance at some time without a prescription; 19% and 41%, respectively, used one within the past year. Whereas students used the drugs most often for recreation (57% ever, 36% currently), use by pharmacists was more equally divided among self-treatment (29% ever, 13% currently), recreation (29% ever, 9% currently), and instrumental purposes (21% ever). The drugs most often used were marijuana, stimulants (especially cocaine by students), tranquilizers, and opiates. Drug use was generally limited in amount, but 18% of the pharmacists and 35% of the students who ever used a drug either became dependent or were at risk of drug abuse. Current drug use was most strongly associated with age, non-attendance at religious services, student access, year in school, and citizenship. The findings of this study suggest the need for continued development of impaired pharmacist committees and drug abuse prevention programs for pharmacists and pharmacy students.

Adolescent↗

PubMed1988

Job-related stress experienced by hospital pharmacists and nurses.

Pharmacists' and nurses' perceptions of job-related stress and its relationship to career satisfaction were surveyed. A questionnaire was developed and mailed in 1987 to pharmacists and nurses whose names were randomly selected from national mailing lists. Subjects were asked to rate, on a five-point scale (4 = very often), how often they found 39 situations to be stressful. The first 30 situations composed the Health Professions Stress Inventory (HPSI), which was created for this study; the remaining nine questions were included for validation of the HPSI. Respondents were also asked whether they would choose the same profession again. Usable questionnaires were returned by 107 pharmacists and 263 nurses practicing in hospitals. Of the potentially highest stress score of 120, overall mean scores were significantly higher for nurses (63) than for pharmacists (57). Statistical analysis indicated that the sample size was adequate and the HPSI was valid and reliable. Both pharmacists and nurses found situations that dealt with interruptions, poor opportunities for advancement, inadequate staffing levels, excessive workload, and inadequate pay to be the most stressful. Pharmacists viewed not feeling challenged as a significantly more stressful situation than did nurses. Career satisfaction was significantly related to job stress for both pharmacists and nurses; 45% of the pharmacists and 37% of the nurses said they would not choose the same profession again, and those with the highest scores on the stress scale were least likely to choose the same profession again. These hospital nurses and pharmacists reported moderate job-related stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1987

Functional and structural prerequisites for clinical pharmacy services.

Pharmacy directors and pharmacists in charge of clinical services at 46 medium-sized hospitals were surveyed to identify possible explanations for previously documented inconsistency in the implementation of clinical pharmaceutical services. There were three study objectives: to determine the extent to which basic structural and functional management prerequisites have been implemented at these institutions; to determine whether a relationship exists between the kind and number of clinical services offered and implementation of these prerequisites; and to identify discrepancies between responses of the pharmacy director and the pharmacist in charge of clinical services at the same hospital to the same questions. One hundred hospitals providing clinical pharmaceutical services were randomly selected from a master list of 190 hospitals that had been grouped into nine geographic areas. Of 17 functional and structural prerequisites studied, 4 to 13 of them had been implemented at the hospitals surveyed. Only 24% of the hospitals had implemented the basic functional prerequisites of unit dose drug distribution and decentralized pharmaceutical services. Of nine clinical pharmaceutical services, one to eight were being delivered. A weak correlation between the number of prerequisites implemented and the number of clinical services provided was found. Significant disagreement was found between the directors and their pharmacists about which prerequisites and clinical services were being implemented. This pilot study suggests that pharmacy directors and clinical pharmacists need to assess how effectively basic management prerequisites are being put into practice in the delivery of clinical pharmaceutical services.

Medication Systems, Hospital↗

PubMed1986

Parental preferences regarding sex education topics for sixth graders.

The purpose of this study was to ascertain which sex education topics parents of preadolescents regarded as appropriate for their children. The sample was comprised of 146 respondents randomly selected from a class list of sixth graders in a suburban school district. A mailed, self-administered questionnaire listing 48 possible topics was used to elicit parental response. Pretesting found the questionnaire to be highly reliable (Cronbach's alpha = .95). Overall, parents strongly supported the inclusion of a broad range of sex education topics regardless of parental age, sex, marital status, income, education, or child's sex. Moreover, parents were largely in agreement with the inclusion of sensitive topics in addition to those which were more physiological or behavioral. Catholics more often than Protestants agreed with the inclusion of birth control, abortion, and sterilization even after controlling for income and education. Thus, the findings suggest that parents of sixth graders find a broad sex education program in the school appropriate. To this end, school officials and sex educators should not overlook the needs of preadolescents for sex education solely on the basis of perceived parental opposition.

Adolescent↗

PubMed1995

[Utilization of visits and analysis of the impact of programmed visits].

OBJECTIVES: To discover the characteristics of the use of consultations with regards to frequency of, and reasons for, attendance. To measure the repercussion on on-demand attendance of including patients with chronic pathologies in the appointments system. PATIENTS: Two samples of clinical histories were extracted at random from two general medical lists; one sample of 125 histories in order to determine the characteristics of the previous year's consultations; another of 44 histories where the patient had used the appointments system, in order to quantify the attendances for one year before and one after their inclusion in the system. DESIGN: A descriptive retrospective study. SETTING: Fuentes Norte Health Centre (Zaragoza). MEASUREMENTS AND MAIN RESULTS: The average of consultations per inhabitant per year was 3.7.4.8% attended_11 times. Women attended more than men (4.8 times as against 2.6; p < 0.0005), as did those over 65 (6.9 times; p < 0.0005). The main reasons for an on-demand consultation were bureaucratic (20%) and acute respiratory infections (16.3%); and for consultation with appointment, Hypertension (35.3%) and Obesity (32.8%). The average of on-demand consultations went down from 6.3 to 3.5 (p < 0.0001) on introducing the patients into the appointments system; but the overall number of consultations for these patients went up from 6.3 to 10.5 (p < 0.0001) because of the general medical and nursing appointments. CONCLUSIONS: We must limit unnecessary bureaucratic requests and encourage self-care. The efficacy of scheduled consultations must be analysed; and those attending must be identified and dealt with.

Adolescent↗

PubMed1994

[Diagnostic and therapeutic strategies in acute pneumopathies in urban practice].

The consensus conference of the French Language Society of Infectious Disease convened at Lille in 1991 stressed the fact that "in the management of pneumonia, neither the clinical features nor the bacteriological information would enable a prediction of the responsible and effective agent with sufficient accuracy" and that antibiotic therapy should be empirical, based on the probabilities linked to the epidemiology and locality. The object of this study was to ascertain the diagnosis and therapeutic attitude of the general practitioner (GP) dealing with an acute infectious pneumonia in a 40 year old adult, previously well without any critical signs, which was the model taken for the consensus conference. One hundred GPs were selected at random from the general medical list in the city of Bordeaux and registered with the local medical council in Gironde. They were invited to answer a questionnaire containing 69 questions. The results were analysed for the two phases of the enquiry. The strategy of first intention and the method of re-evaluating for treatment instituted. Secondly the strategy used when faced with a patient who did not improve with the initial treatment. Eighty eight GPs answered the questionnaire and thus we are able to give the following information: the differential diagnosis was not clearly made between bronchial and pulmonary pathology when faced with a lower respiratory tract infection; two thirds of the GPs had a diagnostic and therapeutic approach which was in agreement with the recommendations of the consensus.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMedDate not supplied

Exercise, education, and quality of life in lung transplant candidates.

In addition to improved functional ability, patients who complete rehabilitation programs typically have positive psychologic changes, including increased motivation and an enhanced quality of life. Potentially, patients with end-stage lung disease awaiting a lung transplant can have similar benefits. However, no studies were identified that examined the impact of an exercise program on quality of life in patients awaiting lung transplantation. This pilot study was an initial step toward evaluating outcomes of a health maintenance program on exercise tolerance and quality of life. Subjects were nine lung transplant candidates who met lung transplant listing criteria and who were randomized to participate in a 6-week health maintenance program consisting of education alone or education plus exercise. Subjects completed cardiopulmonary exercise testing, a 6-minute walk, and the Quality of Well-being scale, Quality of Life Index, and Symptom Frequency/Symptom Distress scale before and after completion of the program. No significant between-group changes were seen. Quality of Well-being scores (p < 0.005) and 6-minute walk distance (p < 0.03) improved over time in both groups. Findings suggest that patients awaiting lung transplantation perceived improved quality of well-being and increased walk distance after participation in a health maintenance program. Education plus exercise conferred no benefits beyond those achieved by education alone. However, the number of subjects studied was small and duration of follow-up was limited.

Activities of Daily Living↗

PubMed1994

[Use of alternative treatments by patients with multiple sclerosis].

OBJECTIVE: Survey on the use of alternative treatments by patients with multiple sclerosis (MS). SETTING: Vrije Universiteit Amsterdam. DESIGN: Descriptive. METHOD: A structured telephone interview was conducted with 100 MS patients randomly selected from the membership list of the Dutch Multiple Sclerosis Society. RESULTS: At the time of the survey 26% of the 88 respondents reported current use of alternative treatments. An additional 42% reported use of alternative treatments in the past, but had ceased to take them. The currently most frequently used treatment was homeopathy followed by vitamin treatments, paranormal treatments and phytotherapy. The treatments most used in the past were paranormal treatments, homeopathic remedies and enzyme therapy. Recommendations by friends and relatives were strong incentives to start alternative treatment. Patients ceased using these treatments when the treatments proved ineffective. In general, the current users of alternative treatments had a favourable impression of their alternative therapist. CONCLUSION: When compared with patients with other chronic diseases, the use of alternative treatments by MS patients is high.

Adult↗

PubMedDate not supplied

Helmets and horseback riders.

To determine patterns of helmet use and attitudes toward helmets among horseback riders, we analyzed a subset of data (n = 1,834) from a cross-sectional mail survey of horseback riders conducted from July to December 1991. Riders were randomly selected from the mailing list of a national mail-order company that sells horseback-riding equipment. Of 900 English-style riders, 517 (57.5%) wore helmets on their last ride, compared with only 81 of 684 (11.8%) Western-style riders. Among 546 riders who did not own helmets, their most commonly cited reasons included believing that helmets were unnecessary (43.8%) or uncomfortable (29.9%). Of the 1,263 helmet owners, nearly 62% had one or more complaints about helmets, but 41.1% of owners reported that their helmet had prevented at least one head injury. Increasing helmet use will require major educational efforts with horseback riders and design changes by manufacturers.

Adolescent↗

PubMed1995

Comparison of the Jamar dynamometer and the Martin vigorimeter for grip strength measurements in a healthy elderly population.

Grip strength is considered to be a good indicator of upper limb strength. The Jamar dynamometer and the Martin vigorimeter are two instruments frequently used to assess grip strength in clinical and research settings. The purpose of this study was to compare these instruments for assessing grip strength in 360 people aged 60 to 94 years, randomly selected from the electoral list. Anthropometric data were also collected. Data analyses were done using the maximum value on 3 trials with each instrument. Although the Martin vigorimeter is a pressure measure implying a dynamic movement as opposed to the static strength measure of the Jamar dynamometer, results indicate a very high correlation between the two measures. Grip strength measured by the Jamar dynamometer is even more dependent on hand anthropometry than measurements with the Martin vigorimeter.

Aged↗

PubMed1997

Use of the Trendelenburg position by critical care nurses: Trendelenburg survey.

BACKGROUND: Little evidence indicates that changing a patient's body position to the Trendelenburg (head lower than feet) or the modified Trendelenburg (only the legs elevated) position significantly improves blood pressure or low cardiac output. This intervention is still used and is often the first measure implemented for treatment of hypotension. OBJECTIVES: The purpose of this research was to assess the degree of use of Trendelenburg positions by critical care nurses, the clinical uses of these positions, and the sources of knowledge and beliefs of nurses about the efficacy of the positions. METHOD: A survey was mailed to 1000 nurses whose names were randomly selected from the membership list of the American Association of Critical-Care Nurses. RESULTS: The return rate was 49.4%. Ninety-nine percent of the respondents had used the Trendelenburg position, and 80% had used the modified Trendelenburg position, mostly for treatment of hypotension. Most used this intervention as an independent nursing action, and most learned about these positions from their nursing education, nurse colleagues, supervisors, and physicians. The Trendelenburg position was used for many nonemergent reasons; the most frequent use was for insertion of central IV catheters. Although 80% of the respondents believed that use of the Trendelenburg position improves hypotension almost always or sometimes, many respondents recognized several adverse effects associated with use of this position. DISCUSSION AND CONCLUSIONS: The results provide evidence that tradition-based therapy still underlies some interventions used in the care of critically ill patients and that some nurses may be relying on an outdated knowledge base that is not supported by the current literature.

Adult↗

PubMed1997

Where do children go? Comparing the after-hours availability of family physicians and primary care pediatricians in four Canadian cities.

OBJECTIVE: To describe and compare family physicians' and pediatricians' after-hours availability for pediatric care in four Canadian cities. DESIGN: Cross-sectional telephone survey. SETTING: Winnipeg, Toronto, Ottawa, and Montreal pediatric and family practices. PARTICIPANTS: All primary care pediatricians and an equal number of family physicians randomly selected from the membership list of the College of Family Physicians of Canada were matched by postal code. Sixty-four (10%) of 282 family physicians and 296 primary care pediatricians were excluded, most because no office telephone number was found. MAIN OUTCOME MEASURES: "After hours" was defined as between 1800 and 0700 hours on weekdays and 0900 to 2400 hours on weekend days. Outcomes included demographics, year of graduation, day of call, time of call, and availability of physician. RESULTS: Availability varied markedly by city rather than by physicians were available after hours: 92.4% in Winnipeg, 56.0% in Toronto, 65.5% in Ottawa, and 26.9% in Montreal. Winnipeg, Toronto, and Montreal showed no significant differences between specialties in availability. Only Ottawa pediatricians were significantly more available than family physicians when age was taken into account (adjusted relative risk = 2.17, 95% confidence interval = 1.51 to 3.12). Stratified analysis showed no differences by day of call, time of call, or physicians' sex. Physicians graduating before 1975 in both groups tended to be more available in all cities than younger physicians. CONCLUSIONS: Regional differences appear to influence after-hours availability more than specialty. Older physicians from both groups were more available than younger physicians.

Child↗

PubMed1997

Alcohol consumption in relation to endometrial cancer risk.

We analyzed data from a population-based case-control study of Wisconsin women to evaluate the relationship of alcohol consumption to endometrial cancer risk. Cases (n = 739) were identified from a statewide tumor registry; controls (n = 2313) were selected randomly from driver's license lists and Medicare beneficiary files. Alcohol consumption and other factors were ascertained by telephone interview. Compared with abstainers, the multivariable relative risk for recent consumption of two or more drinks per day was 1.27 [95% confidence interval (CI) 0.78-2.07]; increasing consumption was not associated with risk of disease (P for trend, 0.82). The relative risk for early adulthood consumption of two or more drinks per day was 1.00 (95% CI, 0.58-1.73), with no suggestion of a trend (P = 0.26). Although the sample size was limited, a significant inverse association was suggested in premenopausal women consuming one drink per day or more (0.20, 95% CI 0.06-0.71). Beverage-specific consumption was not associated with risk. This study suggests that, unlike breast cancer, endometrial cancer is not positively associated with alcohol intake.

Adult↗

PubMed1998

Prevalence and presentation of dizziness in a general practice community sample of working age people.

BACKGROUND: Dizziness is known to be a common, handicapping condition in the elderly, and a strong association between dizziness and anxiety disorders has been observed in hospital samples. However, little is known about the prevalence of dizziness among people of working age in the community and its implications for psychosocial functioning and general practice consultation and treatment. AIM: To determine the prevalence of dizziness, giddiness, vertigo, and unsteadiness, and associations with disability and handicap, symptoms of panic and agoraphobia, and general practice consultation and treatment. METHOD: Postal questionnaires were completed by 2064 people aged 18-64 years randomly sampled from the patient lists of four London practices. Validated survey items were used to assess symptoms, panic and agoraphobia, levels of occupational disability and handicap, and general practice consultation and treatment. RESULTS: More than one in five responders (n = 480) had experienced dizziness during the past month; nearly half of these (n = 225) reported some degree of handicap and 30% had been dizzy for more than five years. Almost half (n = 221) of those with dizziness also reported anxiety and/or avoidance behaviour. Multiple physical and psychological symptoms were associated with higher levels of handicap. Only one in four of the 225 dizzy responders reporting some degree of handicap had received any form of treatment. CONCLUSION: Dizziness is a common, chronic, and often untreated symptom in people aged 18-65 years, associated with extensive handicap and psychological morbidity.

Adult↗