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PubMed2006

Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence--a long-term follow-up.

BACKGROUND: To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence. METHOD: A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2-8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency. RESULTS: Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p=0.01), parity (2.6 versus 2.3; p=0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population. CONCLUSION: Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence.

Age Factors↗

PubMed2005

Antibiotic prescribing for upper respiratory tract infection: the importance of diagnostic uncertainty.

OBJECTIVES: Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem. We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI. STUDY DESIGN: We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada. The association of patient clinical features, parental pressure, and physician characteristics with antibiotic prescribing was determined through the use of logistic regression analysis. RESULTS: A total of 257 physicians responded (48%). Poor appearance (OR, 6.50; 95% CI, 5.06 to 3.84), fever above 38.5 degrees C (OR, 1.48; 95% CI, 1.21 to 1.82), and age older than 2 years (OR, 2.27; 95% CI, 1.85 to 2.78) were associated with prescribing, whereas parental pressure was not. Physician characteristics associated with antibiotic use were family practitioner (OR, 1.54; 95% CI, 1.22 to 1.96), increasing number of patients seen per week (OR, 1.05; 95% CI, 1.01 to 1.08 for every 20-patient increase), and increasing physician age (OR, 1.17; 95% CI, 1.11 to 1.24, 5-year increments). CONCLUSIONS: Clinical factors, which may lead physicians to be concerned about possible bacterial infection in children, are associated with antibiotic use for pediatric URI.

Anti-Bacterial Agents↗

PubMed1997

Cyberspace 101: taking a ride on the information superhighway.

All you need to explore cyberspace is a computer, a modem, a phone line, and a local "on-ramp" to the infohighway. A litserv is an interactive mailing list that distributes information to a large number of people at the same time. Once you subscribe, you receive copies of all messages sent into listserv and have the opportunity to post questions and comments for other subscribers. Dietetics Online: A Network of Dietetic/Nutrition Professionals offers a range of cutting-edge services. Online marketing can reach a potentially larger audience for a fraction of the cost of traditional means and expand your business geographically.

Computer Communication Networks↗

PubMed1997

The economic impact of psoriasis increases with psoriasis severity.

BACKGROUND: Psoriasis treatments are known to be costly, but little is known about the financial impact of psoriasis and the way in which it relates to the severity of the disease. OBJECTIVE: This study was performed to obtain an estimate of the treatment costs faced by patients with psoriasis. METHODS: A total of 578 anonymous mail surveys were distributed to patients with psoriasis; 318 surveys were returned (55%). Psoriasis severity was assessed with the previously validated Self-Administered Psoriasis Area Severity Index (SAPASI). RESULTS: The total and out-of-pocket expenses to care for psoriasis were correlated with psoriasis severity (r = 0.26, p = 0.0001). There were no sex (p = 0.9) or racial (p = 0.4) differences in total expenditures. Severity was correlated with how bothersome to the patient was the cost of treatment (r = 0.30, p = 0.0001), the time required for treatment (r = 0.38, p = 0.0001), and the time lost from work (r = 0.23, p = 0.0001). Lower quality of life at work and in money matters also correlated with severity of psoriasis. Higher family income was associated with less time spent caring for psoriasis and less interference with work around the home. CONCLUSION: As expected, the expenses caring for psoriasis are greater for patients with more severe disease. These costs and other financial implications are associated with lower quality of life for patients with more severe psoriasis.

Absenteeism↗

PubMed2002

The urologist view of BPH progression: results of an international survey.

OBJECTIVES: To assess the opinion amongst the international urological community on whether benign prostatic hyperplasia (BPH) is a progressive disease. METHODS: A 15-item questionnaire was distributed to the mailing list of the publication European Urology Today as well as being accessed through the website of the European Association of Urology (EAU). The survey included questions on: whether BPH was a progressive disorder; what evidence there was to support this, including clinical parameters that could be identified; risk factors for progression; and prevention of progression. RESULTS: A total of 472 completed questionnaires from 47 countries were evaluated. Overall, the urologists surveyed agreed that BPH was a progressive disease, and that some patients were more prone to this than others. Increased post-void residual urine, reduced flow rate, increased urinary symptoms and urodynamic evidence of obstruction were considered to be the most significant risk factors for progression. Half of the urologists surveyed considered that current medical therapies could prevent progression of BPH, while a significant proportion thought that surgery was an effective preventative measure. CONCLUSIONS: BPH, although a benign disease, has a considerable impact on the patient's quality of life. Its progressive nature and the identification of risk factors for progression warrant further investigation. In the future, there is likely to be a shift in the paradigm from treatment of BPH complications to include the prevention of BPH progression.

Adult↗

PubMed1998

Rationale and design of the International Verapamil SR/Trandolapril Study (INVEST): an Internet-based randomized trial in coronary artery disease patients with hypertension.

OBJECTIVES: The primary objective of the International Verapamil SR/Trandolapril Study (INVEST) is to compare the risk for adverse outcomes (all-cause mortality, nonfatal myocardial infarction [MI] or nonfatal stroke) in hypertensive patients with coronary artery disease (CAD) treated with either a calcium antagonist-based or a noncalcium antagonist-based strategy. BACKGROUND: Treatment recommendations for hypertension include initial therapy with a diuretic or beta-adrenergic blocking agent, for which reductions in morbidity and mortality are documented from randomized trials but are less than expected from epidemiologic data. For this reason, recent attention has focused on calcium antagonists or angiotensin-converting enzyme inhibitors. While these agents reduce blood pressure, outcome data from large randomized trials are lacking, but some case-control data, dominated by short-acting dihydropyridines, suggest an increased risk of cardiovascular events. These studies had methodologic limitations and did not differentiate among calcium antagonist types and formulations. Several studies differentiating among calcium antagonist types and an overview of published randomized trials show no increased risk with verapamil and suggestion for benefit in CAD patients. METHODS: A total of 27,000 CAD patients with hypertension will be randomized at 1,500 primary care sites to receive either a calcium antagonist-based (verapamil) or beta-blocker/diuretic-based (atenolol/hydrochlorothiazide) antihypertensive care strategy. The study uses a novel, electronic "paper-less" system for direct on-screen data entry, randomization and drug distribution from a mail pharmacy linked to the coordination center via the Internet. RESULTS: Contract negotiations with the United States and international sites are ongoing. Patients being enrolled are predominantly elderly (72% aged 60 years or older) men (54%), with either an abnormal coronary angiogram or prior MI (71%). In addition to hypertension, CAD and elderly age, most patients (89%) have one or more associated conditions (diabetes, dyslipidemia, smoking, cerebral or peripheral vascular disease, etc.) contributing to increased risk for adverse outcome. While 26% have diabetes, most of these are noninsulin dependent. Using the protocol strategies, target blood pressures (according to JNC VI) have been reached in 58% at the fourth visit, and as expected most (89%) are requiring multiple antihypertensive drugs. CONCLUSION: The design and baseline characteristics of the initial patients recruited for a prospective, randomized, international, multicenter study comparing two therapeutic strategies to control hypertension in CAD patients are described.

Aged↗

PubMed2001

Fragmented sleep and tiredness in males and females one year after percutaneous transluminal coronary angioplasty (PTCA).

AIM: Reported sleep quality was examined in relation to anxiety, depression, selected psycho-physiological sleep disturbing symptoms, daytime dysfunctions according to poor sleep, and quality of life 1 year after percutaneous transluminal coronary angioplasty (PTCA). Furthermore, females were compared with age-matched males to examine any differences in sleep quality, psycho-physiological symptoms and quality of life. STUDY DESIGN: A descriptive comparative study. SAMPLE: Twenty-two females, mean age 62.7 (SD 5.7) and 70 men, mean age 60.4 (SD 6.7), were consecutively recruited. METHOD: A mailed questionnaire was distributed, including the Uppsala Sleep Inventory, Spielberger State Anxiety scale, Zung's Self-rating Depression Scale and the Nottingham Health Profile instrument. RESULTS: Forty-six per cent of the patients had a history of myocardial infarction and 40.2% hypertension. Seventy-two per cent of the patients were anxious and 30.4% depressed. Difficulty in getting to sleep was related to intrusive thoughts with increased feelings of anxiety and sensitivity. Difficulty in maintaining sleep was the most common sleep complaint (42.4%) and physical tiredness/fatigue was the greatest consequence of disturbed sleep (51.1%). Those with pain, palpitations or respiratory nocturnal sleep-disturbing symptoms were characterised by shorter sleep duration, emotional distress, cognitive dysfunction, tiredness and reduced quality of life. Greater difficulties initiating sleep and worse health related quality of life were revealed in females compared with aged-matched males. CONCLUSION: Fragmented sleep is a problem partly because of psycho-physiological symptoms 1 year after PTCA, with reduced resilience to stress, increasing vulnerability or diminished coping ability and poorer quality of life.

Aged↗

PubMed1999

Medical informatics education in paediatric residency training.

OBJECTIVES: The objective of this study was to determine whether Medical Informatics education among house staff is included in the current residency curriculum, and to present ways in which this type of education may be improved. DESIGN: During autumn 1996 a mailed survey was distributed to chief residents of American paediatric residency programmes. Questions included the resident's use of computers, the influence of Informatics-trained faculty members on programme education and plans for curriculum expansion. SETTING: Division of General Paediatrics, University of Alabama, United States. SUBJECTS: Paediatric chief residents. RESULTS: Eighty programmes (63%) returned a survey. An average of 97% of residents use the computer for looking up patient laboratory results, while 70% use it for Medline searches. Less than half of all residents use the Internet or computer-based learning programmes. Thirty-seven per cent of programmes provided formal lectures on computer topics, and 22% of programmes provided hands-on Internet training. There was no association between the presence if Informatics faculty and current programmes; however, programmes with Informatics faculty were more likely to have future curriculum plans (P=0.04). Some of the programmes' future plans are described. CONCLUSIONS: We felt that an overall description of what is currently being done with computers would be helpful as a baseline for other programmes considering new curricula changes. Residents use the computer often to check patient laboratory results but not as much for self-education. Many programmes are expanding their Informatics curriculum. Faculty without formal Informatics training can take part in basic computer education for residents. A self-study approach by the residents has been received positively.

Computer-Assisted Instruction↗

PubMed2002

Increasing proportions of Australian gay and homosexually active men engage in unprotected anal intercourse with regular and with casual partners.

We examined trends in sexual practice among gay and homosexually active men in Australia. Self-complete questionnaires were distributed with mail-order sex video catalogues in 2000 and returned anonymously through a reply-paid facility. The data were compared with those from men who responded to promotional material sent out with the same catalogues and who participated in national telephone surveys of men who have sex with men conducted in 1992 and 1996. A key independent variable was gay community attached (GCA) versus non-GCA (NGCA) derived from two items about number of gay friends and amount of free time spent with gay men. Responses came from 1,832 men ranging in age from 16 to 80 (median = 39) years. HIV status was 73% negative, 5% positive, 22% untested; 1,181 men were GCA and 651 men were NGCA. Overall, from 1992 to 2000 there was a significant upward trend in the proportion of men reporting any unprotected anal intercourse (UAI) in the previous six months with regular partners: 21.5%, 24.7%, 46.4% of the total sample (p < 0.001). And similarly for UAI with casual partners: 12.4%, 16.2%, 25.5% (p < 0.001). The upward trends in UAI-regular and UAI-casual were similar and significant (p < 0.001) for both GCA and NGCA men. These nationwide Australian data provide evidence of continuing increases in unprotected anal intercourse with regular and with casual partners. Whereas the majority of men do not engage in any unprotected anal intercourse during a defined interval, ever increasing proportions of them do.

Adolescent↗

PubMedDate not supplied

Self-reported headgear use and concussions among collegiate men's rugby union players.

The perceived effectiveness of rugby union headgear in reducing concussions in American male collegiate rugby union athletes was assessed. Data collection was conducted by survey method distributed using electronic mail. One hundred and thirty-one men's club rugby union participants from eight university teams in the United States were surveyed. Demographic data were assessed using frequencies, means, and standard deviations. An ANOVA was used to assess differences in the frequencies of responses between players with concussions and their perception of headgear, with an increase in positive perception of headgear with increased concussions. Player position and years of experience played a role in the number of concussions and use of protective headgear. Seventy-six different athletes reported a concussion while playing, with the majority (51%) not wearing headgear. Athletes who wore headgear experienced 24% of the concussions, compared to 76% of those who did not wear headgear. The incidence of concussions and severity of concussions were perceived as less severe among the group wearing headgear. The general perception of those individuals polled as to the effectiveness of headgear in reducing head injuries was positive.

Adult↗

PubMed1996

The BRMD thyroid-neck phantom: design and construction.

The Human Monitoring Laboratory, which acts as the Canadian National Calibration Reference Center for In Vivo monitoring, has constructed a robust neck-thyroid phantom for use in the Canadian Thyroid Intercomparison Program. The phantom is rugged and capable of being distributed through the mail with no expectation of a leak of radioactive materials; it is anthropomorphic; the thyroid inserts simulate 125I and 131I; the phantom can be used to mimic different layers of adipose tissue over the thyroid insert; and it is cost effective. This paper describes the design criteria and the manufacturing process; the performance characteristics have been described in an earlier publication.

Canada↗

PubMed2005

Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta.

BACKGROUND: Despite the critical importance of well-being during residency training, only a few Canadian studies have examined stress in residency and none have examined well-being resources. No recent studies have reported any significant concerns with respect to perceived stress levels in residency. We investigated the level of perceived stress, mental health and understanding and need for well-being resources among resident physicians in training programs in Alberta, Canada. METHODS: A mail questionnaire was distributed to the entire resident membership of PARA during 2003 academic year. PARA represents each of the two medical schools in the province of Alberta. RESULTS: In total 415 (51 %) residents participated in the study. Thirty-four percent of residents who responded to the survey reported their life as being stressful. Females reported stress more frequently than males (40% vs. 27%, p < 0.02). Time pressure was reported as the number one factor contributing to stress (44% of males and 57% of females). A considerable proportion of residents would change their specialty program (14%) and even more would not pursue medicine (22%) if given the opportunity to relive their career. Up to 55% of residents reported experiencing intimidation and harassment. Intimidation and harassment was strongly related to gender (12% of males and 38% of females). Many residents (17%) rated their mental health as fair or poor. This was more than double the amount reported in the Canadian Community Health Survey from the province (8%) or the country (7%). Residents highly valued their colleagues (67%), program directors (60%) and external psychiatrist/psychologist (49%) as well-being resources. Over one third of residents wished to have a career counselor (39%) and financial counselor (38%). CONCLUSION: Many Albertan residents experience significant stressors and emotional and mental health problems. Some of which differ among genders. This study can serve as a basis for future resource application, research and advocacy for overall improvements to well-being during residency training.

Adult↗

PubMed2006

Utilization of noninvasive ventilation in acute care hospitals: a regional survey.

PURPOSES: Little information is available on the utilization of noninvasive positive-pressure ventilation (NPPV) in the United States. Accordingly, we performed a survey on the use of NPPV at acute care hospitals in a region of the United States to determine variations in utilization and between hospitals, the reasons for lower rates of utilization, and the techniques used for application. METHODS: Using survey methodology, we developed a questionnaire consisting of 19 questions and distributed it by mail to directors of respiratory care at all 82 acute care hospitals in Massachusetts and Rhode Island. Nonresponders were contacted by phone to complete the survey. Responses were analyzed using standard statistics, including t tests and Mann-Whitney U tests where appropriate. RESULTS: We obtained responses from 71 of the 82 hospitals (88%). The overall utilization rate for NPPV was 20% of ventilator starts, but we found enormous variation in the estimated utilization rates among different hospitals, from none to > 50%. The top two reasons given for lower utilization rates were a lack of physician knowledge and inadequate equipment. In the 19 hospitals that provided detailed information, COPD and congestive heart failure constituted 82% of the diagnoses of patients receiving NPPV, but NPPV was still used in only 33% of patients with these diagnoses receiving any form of mechanical ventilation. CONCLUSIONS: The utilization rates for NPPV vary enormously among different acute care hospitals within the same region. The perceived reasons for lower utilization rates include lack of physician knowledge, insufficient respiratory therapist training, and inadequate equipment. Educational programs directed at individual institutions may be useful to enhance utilization rates.

Emergency Service, Hospital↗

PubMed1992

New approaches to social and economic research on schistosomiasis in TDR (Special Programme for Research and Training in Tropical Diseases).

This paper describes new approaches to social and economic research being developed by the Social and Economic Research component of the Special Programme for Research and Training in Tropical Diseases of the World Health Organization. One of these is a study to assess the possibility of identifying high risk communities for urinary schistosomiasis through a "mailed" questionnaire approach distributed through an existing administrative system, thereby eliminating the need for face-to-face interviews by the research or disease control team. This approach, developed by the Swiss Tropical Institute in Ifakara, Tanzania, is currently being tested in seven other African countries. The paper also describes a change of emphasis of economic research on schistosomiasis, focusing on the intra-household effects of the disease on rural households, rather than, as previously done, studying the impact of the disease on the productivity of individual wage labourers. Other priorities involve the identification of epidemiological information needed for improved decision-making regarding acceptable treatment strategies in endemic areas with limited financial capacity, as well as research on how the adverse effects of economic development projects can be alleviated.

Child↗

PubMed2001

Neonatal thermal care, part I: Survey of temperature probe practices.

PURPOSE: To determine nurses' practices regarding skin temperature probes. DESIGN: Data were collected using an anonymous questionnaire, which was returned by mail. Questionnaires were distributed by volunteer neonatal nurses. Items included frequency of probe change, position of probe, use of probes in skin and air servocontrolled incubators and radiant warmers, as well as demographic data. SAMPLE: Eighty-three neonatal nurses. RESULTS: Nurses reported that skin servocontrolled incubators are used widely, but generally only for infants less than 28 weeks gestational age; a high proportion of respondents reported using continuous monitoring of skin temperature in air servocontrol incubators. Although most nurses reported positioning infants to prevent their lying on the probe, 21 percent reported using the same probe site regardless of infant position. Routine changing of the probe cover was reported by a number of nurses. Practices were influenced by individual knowledge, beliefs, and experience as well as by unit protocols, which varied widely.

Attitude of Health Personnel↗

PubMedDate not supplied

Do blue-collar workers perceive the worksite health climate differently than white-collar workers?

A mail survey was distributed to a random sample of 497 both blue- and white-collar workers employed at a large manufacturing company to measure dimensions of worksite health climate: organizational and interpersonal support, and health norms. Statistically significant differences were observed for nearly all aspects of the dimensions with white-collar workers having more positive perceptions than blue-collar workers. The study suggests that future research explore how these perceptions may be enhanced and what role they may play in promoting worker health.

Adult↗

PubMed2004

Research training during medical residency (MIR). Satisfaction questionnaire.

INTRODUCTION: It is during Medical Residency Training (MIR) that knowledge, abilities and habits are acquired, which will shape professional activity in the future. It is therefore very likely that residents who do not acquire the necessary habits and knowledge for research activities will eventually not carry out these activities in the future. The aim of this study was to analyze the level of satisfaction of residents with his or her scientific and research training, and to determine any deficiencies with respect to this training. MATERIALS AND METHODS: The aim of the questionnaire used was to determine the level of satisfaction of residents regarding their scientific and research training during their residency period. Questionnaires were usually distributed via internal mail to all residents (MIR physicians) registered at a third level teaching hospital, with a completion rate of 78% (n = 178). RESULTS: As far as the evaluation of scientific training is concerned, 68% of residents were dissatisfied or very dissatisfied. With respect to scientific studies carried out, 49% of residents had not taken part in any, but the number of studies carried out increases as the residency progresses. On the other hand, 22% of residents reported not having started their doctoral thesis, 50% having attended doctorate courses, 24% having a title for their thesis, and only 4% having written a thesis. Doctorate courses, thesis topics, and written theses increase with the year of residency, and a greater activity may be seen in this respect in surgical departments. If we analyze help available to residents for their carrying out scientific activities, 55% reported that only selected assistant doctors would offer help, and 21% reported that no doctors would offer help. Dissatisfaction with research training increases with the year of residency. With regard to main specialist fields, it can be seen that residents in surgical fields carry out more theses, whereas central fields report less facilities. Finally, if we evaluate the influence that these variables may have on the general satisfaction of residents with his or her residency, these variables are seen to be significant factors of dissatisfaction. CONCLUSIONS: Most residents are dissatisfied with their scientific training and have relatively few facilities for developing such skills, which in turn results in a scarce number of scientific studies and doctoral theses.

Adult↗

PubMed1998

Prevalence of insomnia: a survey of the enrollees at five managed care organizations.

The purpose of the study was to assess the prevalence of and factors associated with insomnia among enrollees of managed care organizations (MCOs). A survey was distributed either by mail or during a clinic visit to 7,500 enrollees of five MCOs in the United States. The survey included a sleep questionnaire, demographic questions, and questions about medical encounters and prescription drug use. Three levels of insomnia (none; level I--difficulty initiating or maintaining sleep; level II--insomnia with daytime dysfunction) were defined from the responses. Comorbidities were determined by proxy from prescription drug use reported by respondents. A total of 3,447 survey responses were received, yielding a response rate of 46%. Level I and level II insomnia was reported by 13.5% and 32.5% of the respondents, respectively. Level II insomnia increased with decreasing education, income, and age and was more prevalent in women and non-Caucasians. Insomnia was significantly correlated with all daytime sleepiness and most nighttime disturbances factors. Fifty-two percent of all respondents reported at least one comorbid condition. Respondents with multiple comorbidities reported level II insomnia more frequently than those with no comorbidities. Only 0.9% of clinic visitors were seeing a physician specifically for sleep problems. Of those with level I and level II insomnia, only 5.5% and 11.6%, respectively, were taking prescription medications specifically for sleep problems; 11.2% and 21.4%, respectively, were taking over-the-counter medications for sleep. Insomnia occurs in MCO enrollees at rates comparable to those found in the general population. However, few patients with insomnia are actually being treated for their condition. Proper evaluation, diagnosis, and treatment of insomnia are warranted.

Adult↗