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PubMed2001

Rheumatologists' attitudes toward routine screening for hydroxychloroquine retinopathy.

OBJECTIVE: To examine rheumatologists' attitudes toward routine ophthalmologic screening for hydroxychloroquine (HCQ) retinopathy and to estimate the acceptability of hypothetical guidelines discouraging this practice. METHODS: We E-mailed a random sample of 300 US rheumatologists listed in the American College of Rheumatology (ACR) Directory who treat adults. We asked about current screening practice, reasons for screening, and the effect of hypothetical guidelines discouraging routine screening on future practice. Associations between adherence to guidelines and clinical variables were evaluated using multiple logistic regression. RESULTS: Of 56% who responded, almost all (94%) currently screen their patients at least once per year. Seventy-five percent stated that they would continue to screen because they are unwilling to accept any risk of visual loss among their patients; 74% would continue to screen because of legal liability; and 56% felt their patients would insist on being screened regardless of their physician's opinion. Forty-four percent stated that they would continue to screen regularly, even if the ACR published guidelines discouraging routine screening. Rheumatologists unwilling to accept any risk of retinopathy were less likely to follow guidelines discouraging screening (46 vs 77%, adjusted OR 0.2, 95% CI 0.1-0.6). Patient insistence and fear of legal liability were not significantly associated with predicted adherence to guidelines. CONCLUSION: Our survey indicates that the majority of rheumatologists currently routinely screen their patients for HCQ retinopathy, and that many would not follow ACR guidelines discouraging this practice, at least in part because they are unwilling to accept any risk of visual damage.

Antirheumatic Agents↗

PubMed1975

List organization and rehearsal instructions in recognition memory of retarded adults.

The effects of rehearsal training and categorical list organization on recognition memory of mentally retarded individuals was examined. Retention materials were lists of pictures in four taxonomic categories. During acquisition, subjects saw lists organized according to these categories or lists in which category members were distributed randomly. One-half of the subjects were given cumulative-rehearsal training. The remaining subjects were not given rehearsal training. Subjects who were taught to rehearse made fewer errors on the recognition test than subjects who were not taught to rehearse. List organizations did not affect correct responding. We interpreted the data as support for production-deficiency hypothesis.

Achievement↗

PubMedDate not supplied

Social characteristics, HIV/AIDS knowledge, preventive practices and risk factors elicitation among prisoners in Lagos, Nigeria.

BACKGROUND: Although many behavioral research studies and public enlightenment campaigns have been undertaken by both government and non-governmental organizations in the general public, no such study has been documented on prison inmates in Nigeria. This study aimed at documenting the social characteristics, HIV/AIDS knowledge and preventive practices of selected prisoners in Nigeria. It also elicited risk factors HIV/AIDS transmission in Nigeria prisons. METHODS: A cross-sectional study of prison inmates using an anonymous risk-factors identification questionnaire was undertaken in January 1997. The Kiri-kiri (maximum, medium and female) prisons were selected by balloting. Thereafter, two hundred and fifty two inmates were selected by systematic random sampling method using the full listing of all inmates as at the time of the survey. The study comprised of an interview session using a well structured questionnaire to seek information about their social data, their knowledge about HIV/AIDS including its transmission and preventive social data, and their indulgence in HIV/AIDS risky behaviour. RESULTS: The majority (53.6%) of the respondents were in the age group 20-29 years, 18 (7.1%) were less than 20 years old one of whom was in the maximum-security prison and three were females (table 1). The majority (52%) had secondary education while 9.9% had tertiary education and 7.1% had no formal education. About 97.2% of the study population had heard about AIDS although only 20.6% had known or seen someone with AIDS before and about 34.1% knew the causative agent of AIDS. 60.3% knew the correct mode of transmission of AIDS. 15.5% claimed fidelity and 12.7 % claimed use of condom for casual sexual contact, were measures that could help prevent AIDS but 7.9% did not know any preventive measure. Since hearing about AIDS, 59.5% claimed to have taken steps to protect themselves. 42.7% of the 89 who had not taken any protective steps against AIDS had no knowledge of how to protect themselves. About 56.3% claimed to have used condom before although only 38.7% used it for their last sexual exposure while 28.2% claimed they used it for all casual sexual intercourse. Many (42.8%) said they knew that homosexuality was the most prevalent sexual practice in the prison while 28.6% claimed there was no sexual practice and 13.1% feigned ignorance of any sexual practices in the prisons. Many (53.2%) claimed to have multiple sexual partners although 94.8% denied any sexual practice whilst still in prison. CONCLUSION: This study demonstrated that (i) almost all THE prisoners studied had heard of AIDS although only a few had seen or known a case of AIDS; (ii) despite the fact that many of them knew the correct modes of transmission, many indulged in high risk behaviours for AIDS transmission; (iii) there is a considerable proportion of receptive naïve inmates who stand the risk of being infected due to their high level of ignorance about HIV/AIDS. Well designed information, education and communication (IEC) programmes on AIDS with such formidable support structures as the provision of harm-reduction devices and risk-reduction counselling are urgently recommended for the Nigerian prisoners to effectively combat the imminent HIV/AIDS epidemic among the prison inmates.

Acquired Immunodeficiency Syndrome↗

PubMed2006

[What kind of information do family physicians provide to their patients about possible side effects of contraceptive pills?].

The aim of our survey was to investigate the extent to which family physicians in Lithuanian inform their patients about possible side effects of contraceptive pills. We also aimed to examine the relation between physicians' estimation of the severity and frequency of these side effects and their willingness to inform patients spontaneously. A survey was conducted in Lithuania in 2004 using the methodology and questionnaire developed by the researchers of Department of Medical Philosophy and Clinical Theory, University of Copenhagen. A computerized stratified random sampling was drawn using the list of Territorial Sick Funds. A total of 500 family physicians have been questioned in the survey. Response rate was 64%. Family physicians (83%) informed their patients more frequently when the side effect was regarded as frequent and serious than it was regarded as rare and trivial. Only 2.9% of all the respondents would inform their patients about the all possible side effects. Half of the respondents (51%) would inform about the side effects in order to enable the patients to react appropriately to every side effect. The most common reason (29%) for not informing the patients was an effort to avoid unnecessary patients' anxiety.

Adult↗

PubMed2006

Work-related musculoskeletal symptoms reported by female flight attendants on long-haul flights.

INTRODUCTION: Flight attendants working on long-haul international commercial airline operations exposed to ergonomic stressors are likely to experience work-related musculoskeletal symptoms (WMS). To date, however, no studies investigating the extent of WMS experienced by this specific population have been published. The purpose of this study was to identify the prevalence and severity (frequency, duration, and intensity) of WMS experienced by female flight attendants working on long-haul international flights for one major airline. METHODS: A cross-sectional, mailed survey was conducted with female flight attendants randomly selected from a union membership list. Inclusion criteria were female flight attendants who had worked at least one long-haul international flight in the prior 3 mo and had worked at least 75 flight hours in the prior month. A total of 185 eligible flight attendants returned completed questionnaires (63% response rate). WMS in nine body regions were measured by the Nordic Musculoskeletal Questionnaire and the National Institute for Occupational Safety and Health Symptom Survey. RESULTS: The prevalence of WMS by body region ranged from 50% to 86%. Almost all (97%) of the flight attendants in this study experienced some level of WMS during the past year. The WMS tended to involve more than one body region, and the lower back was the most commonly affected body region. DISCUSSION: Female flight attendants working on long-haul international flights at one major airline showed a high prevalence of WMS, suggesting the need for replication studies with other airlines and the need for investigation into the risk factors associated with this substantial problem.

Adult↗

PubMed1991

Management of weight problems and obesity: knowledge, attitudes and current practice of general practitioners.

A postal questionnaire was used to assess general practitioners' knowledge, attitudes and current practice of treatment regarding obesity and weight problems. Overall, 299 responses (75%) were received from general practitioners randomly selected from family practitioner committee lists in Portsmouth and Norwich. Currently 27% of the doctors were overweight and a further 3% obese. Many doctors (69%) had tried to lose weight at some time and 40% had been overweight and a further 12% obese in the past. The most popular methods used to educate overweight and obese patients were one to one counselling and giving out diet sheets and leaflets on healthy eating. The treatment advice to patients from the majority of doctors was to eat less in general (78%) (specifically to eat fewer calories 75%); to exercise (77%); or to attend a slimmers group (54%). Doctors thought that they were less effective than the media or the family in persuading overweight patients to lose weight. Doctors said they were prepared to counsel on weight reduction but felt they had little success in achieving weight loss in patients. Experience was ranked as the most important contributor to knowledge about managing obesity, and medical school was rated as least important. Further study is needed to discover how different practices and attitudes affect patient management and which ones are associated with greatest success. Medical schools and postgraduate centres could play a more important role in educating doctors about nutrition.

Adult↗

PubMed1986

General practitioner workload with 2,000 patients.

This study was designed to investigate the relationship between general practice workload, the number of partners in the practice, and the use of health centre premises. Thirty general practitioners in twelve randomly selected practices (each with a list size of 2,000 patients per doctor) agreed to record a week's work on pre-printed forms. Information was gathered on content of care in the surgery, number of non-surgery and indirect contacts and time spent on work activities. Content of care was influenced by whether or not the doctors were based in a health centre, rather on how many partners they had. Conversely the numbers of non-surgery and indirect contacts and the time spent on all work activities were more affected by the number of partners. Two factors - consultation rate and the rate at which doctors initiate consultations - were found to be independent of either of the two variables considered.

Community Health Centers↗

PubMed1986

Nutrition support service: role of the clinical dietitian.

A study was undertaken to determine: the qualifications necessary to function on a nutrition support team as perceived by clinical dietitians working in this capacity, the actual role of the clinical dietitian on a nutrition support team, the ideal role of the clinical dietitian on a nutrition support team, and the extent to which clinical dietitians perceive differences between the ideal role expectation and actual performance. A questionnaire was developed and sent to a random sample of 300 clinical dietitians listed as members of a nutrition support service. The respondents indicated that the clinical dietitian should have at least a B.S., R.D., and 2 years' prior work experience before assuming responsibility on a nutrition support team. The dietitians indicated that they consistently take and evaluate diet histories and assess energy and protein needs. Moreover, they viewed these tasks as appropriate. They rarely administer or interpret antigen skin tests and do not perceive this as a function of the dietitian. For all other tasks, dietitians indicated that they should perform the duty or responsibility more often. Over half reported that they did not have adequate educational preparation to assume all of the responsibilities of the clinical dietitian on a nutrition support team.

Adult↗

PubMed1982

Low back pain comprehensive rehabilitation program: a follow-up study.

The outcome of the management of chronic low back pain in 42 men and 36 women by a comprehensive rehabilitation program consisting of biofeedback training, counseling in self-control techniques, self-regulated medication reduction, physical therapy, vocational rehabilitation services and education conducted in a therapeutic milieu was examined at 6 months and 12 months after discharge. The mean age of the subjects was 43.4 years: the mean highest school grade completed, 12.6; and the mean full scale WAIS IQ, 106.7. On admission 72 were unemployed and had been disabled and unemployed for a median time for 3 years. Almost two-thirds were involved in litigation. Thirty-three were working or accepted for employment t 6 months after discharge and 35 at 12 months (p less than 0.001). Success rates are higher when only those who stayed in the program for more than 4 weeks are considered. The employed patients rated their pain lower, used less medication and relied less on attention from physicians. They did not seem to differ in their use of relaxation skills or exercise. A similar study has been initiated of patients randomly assigned to treatment and waiting list control groups.

Adult↗

PubMed1996

Cigarette smoking: an independent risk factor in alcoholic pancreatitis.

It is not known whether cigarette smoking plays a role as a risk factor in alcoholic pancreatitis. The aim of this study was to compare drinking and smoking habits in three groups of male subjects with an alcohol intake in excess of 40 g/day: (i) 67 patients with acute alcoholic pancreatitis, without other known potential causative agents; (ii) 396 patients with chronic alcoholic pancreatitis; and (iii) 265 control subjects randomly selected from the Verona polling lists and submitted to a complete medical checkup. The variables considered were age at onset of disease, years of drinking and smoking, daily alcohol intake in grams, number of cigarettes smoked daily, and body mass index (BMI). Cases differed from controls in daily grams of alcohol, number of cigarettes smoked and BMI (Mann-Whitney U test, p < 0.00001 for each comparison). Multivariate logistic regression analysis, comparing acute and chronic cases, respectively, versus controls, revealed an increased relative risk of pancreatitis in the two comparisons, associated in both cases with a higher alcohol intake (p < 0.00001) and cigarette smoking (p < 0.00001). No significant interaction between alcohol and smoking was noted, indicating that the two risks are independent. In conclusion, in males a higher number of cigarettes smoked daily seems to be a distinct risk factor in acute and chronic alcoholic pancreatitis.

Adult↗

PubMed1997

Parental age in relation to risk of breast cancer.

Data from a population-based case-control study were analyzed to evaluate risk of breast cancer among women according to parental age at the time of subject birth. Between 1988-91, breast cancer cases (n = 1,253) were obtained from the statewide tumor registry in Wisconsin. Concurrently, population controls (n = 1,121) were randomly selected from driver's license lists (if under age 65) and Medicare beneficiary files (if 65-74 years). Information regarding parents' ages and breast cancer risk factors was obtained by telephone interview. Relative risk estimates were very slightly elevated with increasing maternal age, although no consistent trend of increasing risk was observed (P for trend = 0.38). No association between paternal age and breast cancer risk was observed (P for trend = 0.98). Older maternal or paternal age was not associated with risk among any of the subgroups examined, except for daughters who had late age at first birth. These findings are consistent with the majority of studies that have found little or no association between parental age and breast cancer risk.

Adult↗

PubMed1996

Cigarette smoking and breast cancer.

A priori hypotheses suggest that cigarette smoking could either increase or decrease breast cancer incidence. To clarify these competing hypotheses, we used data from a very large population-based breast cancer case-control study to investigate the impact of smoking on breast cancer risk. Breast cancer patients less than 75 years old were identified from statewide tumor registries in Wisconsin, Massachusetts, Maine, and New Hampshire; controls were randomly selected from driver's license lists (age less than 65) or lists of Medicare beneficiaries (age 65-74). Information on reproductive history, medical history, and personal habits including cigarette smoking was obtained by telephone interview. A total of 6,888 cases and 9,529 controls were interviewed. There was virtually no relationship between current smoking and breast cancer risk (multivariate odds ratio, 1.00; 95% confidence interval, 0.92-1.09), and former smokers had a barely increased risk (odds ratio, 1.10; 95% confidence interval, 1.01-1.19). Similar results were observed among both premenopausal and postmenopausal women. There was no suggestion that heavy or long-term smoking increased or decreased risk, nor were there indications that women who began smoking at an early age were at increased risk, as has been hypothesized. The results of this large population-based study indicate that smoking does not influence the risk of breast cancer, even among heavy smokers who began smoking at an early age.

Age Factors↗

PubMed1997

Evaluation of a practice-based ambulatory program in food animal medicine, surgery, and herd health management.

OBJECTIVE: To assess the educational value of a practice-based ambulatory program used at a school of veterinary medicine. DESIGN: Retrospective cohort study. SAMPLE POPULATION: Graduates of US veterinary medical schools between 1987 and 1994. PROCEDURE: Phase I involved use of interviews and focus groups to assist in development of the questionnaire used in phase II, a retrospective cohort study. The pretested questionnaire was sent to a study population consisting of all graduates of the University of Wisconsin-Madison, School of Veterinary Medicine, between 1987 and 1994 as well as a control group who were randomly selected from the 1994 AVMA list of veterinarians. Control-group veterinarians were matched on the basis of professional activity, region, and year of graduation. RESULTS: 728 of 1,067 veterinarians completed the questionnaire in phase II of the study (response rate, 68%). The practice-based ambulatory program at the University of Wisconsin-Madison compared favorably with university-based ambulatory programs in volume of experiences and perceived educational quality. Regardless of rotation type, female students were significantly less likely to observe or perform 12 specific clinical procedures and were significantly less likely to rate instructional quality as excellent or very good, compared with male students. CLINICAL IMPLICATIONS: Practice-based ambulatory rotations can be a good alternative to existing university-based ambulatory rotations. Implementation of these programs should emphasize performance of procedures while striving to ensure participation of female students.

Animal Husbandry↗

PubMed1997

[Estimation of the prevalence of cognitive impairment according to the test used].

OBJECTIVES: The aim of the study was to compare the findings of Folstein's Mini Mental Test (MMT), Lobo's Cognitive Mini Exam (CME) and the Isaacs Set test, in their detection of cognitive deficit in over-64 year olds; and to analyse the factors associated with variability in the scores obtained with these tests. DESIGN: An observational crossover study. SETTING: An urban Primary Care center. PATIENTS: Among the total of 1096 patients aged over 64 registered on 5 lists and with medical records, a random sample of 329 was chosen. INTERVENTIONS: The MMT, CME and Set test were administered to each patient in the same interview. Information on associated morbidity and social and demographic variables was gathered. MAIN RESULTS: 211 women (64%) and 118 men (36%) completed the tests. Women were older (73.0 +/- 6 against 71.2 +/- 6; p = 0.02) and had had less schooling (3.2 +/- 3.6 years against 4.2 +/- 3.7; p = 0.019). A higher percentage of women were illiterate (47.1% against 24.3%; p = 0.008). The MMT showed CD at 60.8%, the CME at 28% and the Set test at 11.3%. CONCLUSIONS: Estimated prevalence of CD varies depending on the test used. Variability in the MMT and CME is basically due to years of schooling, whereas in the Set test it is because of age.

Age Factors↗

PubMed1995

Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis.

OBJECTIVE: To use a meta-analysis of all published randomized trials to determine whether the use of continuous electronic fetal heart rate monitoring (EFM) as the main method of intrapartum fetal surveillance is associated with improved pregnancy outcome compared to intermittent auscultation. DATA SOURCES: We used the MEDLINE data base and reference lists of articles to identify all published randomized trials of EFM versus intermittent auscultation. METHODS OF STUDY SELECTION: A total of nine randomized trials published in peer-review journals were identified. The selection criterion was the use of EFM or intermittent auscultation as the main intrapartum fetal surveillance technique. DATA EXTRACTION AND SYNTHESIS: A total of 18,561 patients were included in the nine published randomized trials, 9398 in the EFM group and 9163 in the auscultation group. Measures of pregnancy outcome included cesarean delivery, cesarean for suspected fetal distress, overall use of forceps or vacuum, use of forceps or vacuum for suspected fetal distress, overall perinatal mortality, and perinatal mortality due to fetal hypoxia (intrapartum or early neonatal death) attributable to the method of intrapartum monitoring. The meta-analysis showed that the patients monitored electronically had a significantly higher overall cesarean rate (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.17-2.01), higher cesarean rate for fetal distress (OR 2.55, 95% CI 1.81-3.53), overall increased use of forceps or vacuum (OR 1.23, 95% CI 1.02-1.49), increased use of forceps or vacuum for suspected fetal distress (OR 2.50, 95% CI 1.97-3.18), and decreased perinatal mortality due to fetal hypoxia (OR 0.41, 95% CI 0.17-0.98). CONCLUSION: Electronic fetal monitoring is associated with increased rates of surgical intervention and decreased perinatal mortality due to fetal hypoxia.

Cardiotocography↗

PubMed1993

Evidence for cigarette smoking as a major risk factor for periodontitis.

The role of smoking as a risk factor for periodontitis was assessed separately in diabetic and nondiabetic study groups. Subject listings stratified for age (19 to 40 years) and sex were obtained for subjects with insulin-dependent diabetes mellitus (IDDM) and nondiabetic subjects. For both the IDDM group (n = 132) and the nondiabetic group (n = 95), age and sex stratified samples were constructed by random selection of subjects from each subject listing. Patients were recruited by phone, examined, and their medical and dental histories obtained. Among nondiabetic subjects, the prevalence of periodontitis was markedly higher among current smokers compared with never smokers (P < or = 0.005) in both the 19 to 30 year-old (46% vs. 12%) and 31 to 40 year-old groups (88% vs. 33%). The subject mean percent of sites with gingival pocket depth > or = 4 mm was higher among current smokers than never smokers (P = 0.001) in the 19 to 30 (8.2% vs. 3.4%) and 31 to 40 (14.3% vs. 4.3%) age groups. The effects of smoking among IDDM subjects were similar to that observed in the nondiabetic population. There were no differences between current and never smokers in the proportion of sites positive for plaque. Attributable risk percents from prevalence data suggest that among nondiabetic subjects, a large proportion, perhaps as much as 51% of the periodontitis in the 19 to 30 year old group and 32% of the periodontitis in the 31 to 40 year old group, is associated with smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Responses to telephone inquiries made to craniofacial treatment teams.

This report is a follow-up to an earlier research project concerning composition and function of self-identified teams listed in the ACP-CFA 1990 Membership-Team Directory. We address the types of responses provided by personnel answering telephones for teams listed in a recent Directory. Sixty of the 228 teams listed in the continental United States were randomly selected and divided into 2 groups of 30 each. One group was telephoned by an ACP-CFA member who is the parent of a patient with cleft palate; the other group was telephoned by a graduate student in speech-language pathology. Data indicate that Directory listing does not assure access to information pertinent to cleft lip, palate, and craniofacial anomalies; different type and manner of responses were made to the 2 callers; and inadequate information was often provided by the personnel who answer the telephones. Implications include the need for more training of personnel in responding to telephone inquiry and cautious use of the directory listings as a resource for referral.

Chi-Square Distribution↗

PubMed2005

[Legal competence problems among general practitioners].

BACKGROUND: We wanted to investigate to what extent Norwegian general practitioners (GPs) working within a patient list system have patients who they are legally incompetent to treat, what services they offer these patients, and what attitudes a representative sample of the GPs has towards situations where one is asked to offer services to such patients. MATERIAL AND METHODS: A questionnaire was sent to 622 randomly chosen GPs. We registered sex, age, list size, size of the local community and health region for every practice. For eight hypothetical situations, we recorded whether the doctor clearly, probably or hardly would offer services. RESULTS: About one quarter of the doctors had their spouses and own children below 18 on their list. Many had secretaries or colleagues on the list. From 18% to 31% of the doctors confirmed that they have prescribed reimbursable prescription drugs to one such patient. There were great variations in views on legal competence to treat in these hypothetical situations. INTERPRETATION: GPs encounter problems of legal competence to treat. Many were of the view that a pragmatic approach is needed in day-to-day general practice. GPs should be aware of their own practice and aware of both legal competence problems and other challenges induced by having family, close friends and co-workers on the list.

Family Practice↗