Where do young adults want opportunistic chlamydia screening services to be located?

BACKGROUND: This study measured the acceptability of urine-based chlamydia screening to young adults, where young adults wanted opportunistic chlamydia screening services to be located, and by whom they wanted to be offered screening. METHODS: A cross-sectional survey of 5685 university students and 400 young adult healthcares setting attendees (age: 18-29 years). RESULTS: Ninety-six percent of males and 93% of females said that they would find it acceptable to be offered chlamydia screening. Seventy-six percent of males and 77% of females wanted to be offered screening by a doctor or nurse. Young women would prefer female staff. Most respondents preferred that screening be located in traditional healthcare settings such as General Practices, and offered by either doctors or nurses. More than 90% of respondents did not want screening services to be located in pharmacies and almost all rejected public non-health care screening settings. CONCLUSIONS: Opportunistic chlamydia screening services should be located in traditional healthcare/medical settings, and screening should be offered by doctors and nurses.

Comparing solutions to the expectancy-value muddle in the theory of planned behaviour.

OBJECTIVES: The authors of the Theories of Reasoned Action (TRA) and Planned Behaviour (TPB) recommended a method for statistically analysing the relationship between the indirect belief-based measures and the direct measures of attitude, subjective norm, and perceived behavioural control (PBC). However, there is a growing awareness that this yields statistically uninterpretable results. This study's objective was to compare two solutions to what has been called the 'expectancy-value muddle'. These solutions were (i) optimal scoring of modal beliefs and (ii) individual beliefs without multiplicative composites. DESIGN: Cross-sectional data were collected by telephone interview. METHODS: Participants were 110 first-degree relatives (FDRs) of patients diagnosed with colorectal cancer (CRC), who were offered CRC screening in the study hospital (83% response rate). Participants were asked to rate the TPB constructs in relation to attending for CRC screening. RESULTS: There was no significant difference in the correlation between behavioural beliefs and attitude for rescaled modal and individual beliefs. This was also the case for control beliefs and PBC. By contrast, there was a large correlation between rescaled modal normative beliefs and subjective norm, whereas individual normative beliefs did not correlate with subjective norm. CONCLUSIONS: Using individual beliefs without multiplicative composites allows for a fairly unproblematic interpretation of the relationship between the indirect and direct TPB constructs (French & Hankins, 2003). Therefore, it is recommended that future studies consider using individual measures of behavioural and control beliefs without multiplicative composites and examine a different way of measuring individual normative beliefs without multiplicative composites to that used in this study.

Readmission rates among cardiology inpatients with echocardiography abnormalities associated with heart failure.

BACKGROUND: Heart failure is a condition associated with significant morbidity. It is caused by structural or functional abnormalities of the heart. Many of these abnormalities if detected and managed early would prevent the onset of heart failure. AIMS: The aim of this study was to to determine the usefulness of echocardiography as a means of predicting readmission rates. A secondary aim was to profile patients with echocardiography abnormalities. METHODS: This was a prospective cohort study that followed patients over 36 months. Data were abstracted from the medical records of 76 cardiology patients in a large urban teaching hospital between 1.6.11 and 31.8.14. The outcome of interest was the number of readmissions occurring up to 48 months after discharge. We also aimed to profile these patients in terms of their co-morbidities and their medication history. RESULTS: Of those patients who had echocardiography (n = 447), 76 were considered to have a cardiac disorder (HHD, VHD, or LVSD) (n = 29). The mean readmission rate for HHD was 0.82, LVSD 0.62, and HHD 0.98. Patients with HHD were associated with a higher readmission rate of 1.8980 and for LVSD-1.24 times more likely. Those with a cardiac disorder were 13 % more likely to have a readmission within the next 36 months than those without a cardiac disorder. CONCLUSIONS: A significant proportion of patients were found to have a cardiac disorder related to HF. Echocardiographic abnormalities were shown to be an independent risk factor for readmission.

Q fever. A call to heighten our index of suspicion.

The prevalence of Q fever infection is probably underestimated. In Michigan, the first two reported human cases of Q fever occurred in 1984. The case-patients lived in adjacent, rural counties and had multiple exposures to goats. We conducted a serosurvey of goat owners and a reference population to compare the prevalence of Q fever antibodies in the two-county area. Goat owners were almost three times more likely to be seropositive with Q fever antibodies than the reference population (43% vs 15%). Among goat owners, individual and household seropositivity prevalences were positively correlated with the number of goats, the number of positive goats, and the number of goat births on the farm. Q fever should be considered more often in the differential diagnosis of patients with compatible illness, especially those with frequent animal contact.

Information leaflets for venous leg ulcer patients: are they effective?

OBJECTIVE: To validate the usefulness of written information for patients with venous leg ulcers and test the hypothesis that patients who receive written information retain more knowledge than those who receive verbal information alone. METHOD: Twenty patients newly diagnosed with venous leg ulcers were recruited into this prospective trial. Patients were randomised either to the control group (given verbal information on their condition) or the intervention group (same verbal information and an information leaflet). The verbal information was in the same format as in the leaflet. Patients' knowledge of the condition was ascertained at an initial interview and at follow-up four to six weeks later. RESULTS: At follow-up both groups showed an overall improvement in knowledge, with no statistical difference between them. CONCLUSION: The results indicate there is limited value in providing information leaflets to this patient group, who were predominantly older patients with low levels of education. The relatively small sample size may explain the disappointing results. Further research may reveal a benefit of providing these leaflets to carers.

Cardiac rehabilitation services in Ireland: the impact of a coordinated national development strategy.

BACKGROUND: The national Cardiovascular Health Strategy including specific plans for cardiac rehabilitation was launched in Ireland in 1999. A survey of cardiac rehabilitation services was conducted in 2003 to evaluate progress on service provision. AIM: To establish levels of service provision, service formats and geographic distribution of cardiac rehabilitation services in 2003 and compare them with the status pre-Strategy (1998). METHOD: All hospitals in Ireland (n = 39) admitting cardiac patients to a coronary or intensive care unit were surveyed by postal questionnaire. RESULTS: All hospitals provided information and all reported providing Phase I cardiac rehabilitation. Seventy-seven per cent (30 of 39) provided Phase III rehabilitation in 2003 (i.e. outpatient cardiac rehabilitation services) compared with 29% (12 of 41) in 1998. Of those hospitals currently without programmes, 78% (seven of nine) had plans in place for programme establishment. All programmes had trained cardiac rehabilitation coordinators, multidisciplinary teams and multiple components as recommended in the Strategy. In 82% of hospitals, intervention was provided at Phase II (immediate post-discharge period) while 26% of hospitals provided intervention at Phase IV (long-term maintenance period). CONCLUSIONS: There have been substantial achievements towards the Cardiovascular Health Strategy target of providing cardiac rehabilitation services for all relevant hospitals in Ireland over the past five years. Service provision of cardiac rehabilitation can benefit from collective efforts made across centres to encourage the prioritisation of cardiac rehabilitation in national health policy initiatives.

Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes.

OBJECTIVE: It is unclear whether the demands of good metabolic control or the consequences of poor control have a greater influence on quality of life (QOL) for adolescents with diabetes. This study aimed to assess these relations in a large international cohort of adolescents with diabetes and their families. RESEARCH DESIGN AND METHODS: The study involved 2,101 adolescents, aged 10-18 years, from 21 centers in 17 countries in Europe, Japan, and North America. Clinical and demographic data were collected from March through August 1998. HbA(1c) was analyzed centrally (normal range 4.4-6.3%; mean 5.4%). Adolescent QOL was assessed by a previously developed Diabetes Quality of Life (DQOL) questionnaire for adolescents, measuring the impact of diabetes, worries about diabetes, satisfaction with life, and health perception. Parents and health professionals assessed family burden using newly constructed questionnaires. RESULTS: Mean HbA(1c) was 8.7% (range 4.8-17.4). Lower HbA(1c) was associated with lower impact (P < 0.0001), fewer worries (P < 0.05), greater satisfaction (P < 0.0001), and better health perception (P < 0.0001) for adolescents. Girls showed increased worries (P < 0.01), less satisfaction, and poorer health perception (P < 0.01) earlier than boys. Parent and health professional perceptions of burden decreased with age of adolescent (P < 0.0001). Patients from ethnic minorities had poorer scores for impact (P < 0.0001), worries (P < 0.05), and health perception (P < 0.01). There was no correlation between adolescent and parent or between adolescent and professional scores. CONCLUSIONS: In a multiple regression model, lower HbA(1c) was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.

Decreasing trends in Reye syndrome and aspirin use in Michigan, 1979 to 1984.

The incidence of Reye syndrome has been decreasing in Michigan, perhaps as a result of decreased aspirin use among children. To evaluate possible changes in the frequency of aspirin use, 199 families in Tecumseh, MI, with children younger than 18 years of age were interviewed by telephone in February 1981 and again in February 1983. Based on the reported use of medications for colds or influenza between 1981 and 1983, fewer parents gave aspirin (56% v 25%), but acetaminophen use did not change (59% v 55%). Younger parents and parents who had heard of the association between aspirin and Reye syndrome were more likely to stop giving aspirin. More parents chose to use either no medication or medications containing neither aspirin nor acetaminophen (6% v 32%) for the treatment of colds or influenza. Approximately 90% of parents who chose not to give aspirin for fever also gave medications for colds or influenza that did not contain aspirin. These results suggest that fewer children are receiving aspirin during illnesses that may precede Reye syndrome. The associated decrease in the incidence of Reye syndrome tends to support the hypothesis that the use of aspirin increases the risk for the development of Reye syndrome.

Hepatitis B vaccination programs for hospital workers: results of a statewide survey.

To assess the implementation of hepatitis B virus (HBV) vaccination programs for hospital workers, we mailed questionnaires to all 229 licensed Michigan hospitals. The response rate was 96% (221/229); of these, 68% (150/221) had vaccination programs. Although multiple hospital characteristics were associated with the presence of a vaccination program, characteristics that independently predicted the presence of a program were medical school affiliation, nonpsychiatric specialty, and the existence of a hepatitis B immune globulin protocol. The most common reason given (56%, 40/71) for the absence of a program was insufficient worker risk of hepatitis B infection; this response was frequent in psychiatric (91%, 10/11) and rural hospitals (61%, 11/18). Among high-risk workers, attending physicians were less likely than other high-risk workers to be included in vaccination programs (68% vs. 95%, respectively). Fear of vaccine-associated acquired immunodeficiency syndrome was most frequently cited as the primary reason for vaccine refusal. We conclude that unwarranted fears about the vaccine's safety need to be dispelled, that high-risk physicians should be included in vaccination programs, and that rural and psychiatric hospital policies reflect their perceived risk of occupational HBV infection.

Psychosocial issues for cardiac rehabilitation with older individuals.

Psychological management of older people undergoing cardiac rehabilitation should be delivered, in the main, as it is to younger people with the heterogeneity of patient characteristics taken as standard. General considerations in delivering a service to older people include societal definitions of ageing, the profile of older cardiac patient groups, ageism as practised by both health professionals and patients, psychological issues of particular relevance to ageing and evidence from scientific studies with older individuals. These topics are considered in this review. The challenge is to develop a system which includes and is responsive to this growing subgroup of patients who can benefit from cardiac rehabilitation.

Psychosocial outcome assessments for use in cardiac rehabilitation service evaluation: a 10-year systematic review.

A variety of measures are currently used to assess psychosocial outcome (quality of life) in cardiac rehabilitation programmes. However, there is no consensus on the most appropriate instruments to use. Instruments that are not sufficiently responsive to change in cardiac populations are unsuitable as audit tools as they underrepresent the benefits of programme attendance. To identify the most responsive instruments in cardiac rehabilitation populations a systematic overview of studies for the 10-year period 1986-1995 was conducted. The following databases were searched: Medline, Psychlit, Cinahl and Sociofile and 32 relevant studies were identified. The effect size statistic (a comparison of the magnitude of change to the variability in baseline scores) was used to determine those instruments most responsive to change. The following instruments were identified as being responsive in more than one study: Beck Depression Inventory, Global Mood Scale, Health Complaints Checklist, Heart Patients Psychological Questionnaire and Speilberger State Anxiety Inventory. There is little consensus on psychosocial evaluation instrument use in the cardiac rehabilitation literature. A number of measures show significant potential for routine outcome assessment. Formal assessment of these instruments is recommended to inform final recommendations about instrument selection for audit and evaluation purposes in cardiac rehabilitation.

Assessing adherence to dietary recommendations for hemodialysis patients: the Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ).

This article describes preliminary investigations into the psychometric properties of two scales for hemodialysis patients (N=35): the Renal Adherence Attitudes Questionnaire (RAAQ), a 26-item scale measuring attitudes toward adherence: and the Renal Adherence Behaviour Questionnaire (RABQ), a 25-item scale measuring self-reported dietary (diet and fluid) adherence. Factor analysis of the RAAQ yielded a four-factor structure. These factors were attitudes to social restrictions, well-being, self-care/support, and acceptance. The scale demonstrated high internal and test-retest reliability. Factor analysis of the RABQ gave a five-factor structure: adherence to fluid restrictions; adherence regarding potassium and phosphate restrictions, adherence regarding self-care; adherence regarding sodium intake; and adherence in times of particular difficulty. This scale had moderately high internal reliability and high test-retest reliability. Validity for the RABQ was tested with independent measures of adherence; biochemical (serum potassium, serum phosphate, and interdialytic weight gain) and dietician-rated (potassium and fluid). There was little association among the differing measures of adherence. These scales facilitate empirical evaluation of dietary adherence for hemodialysis patients.

Nutritional, respiratory, and psychological effects of recombinant human growth hormone in patients undergoing abdominal aortic aneurysm repair.

BACKGROUND: Recombinant human growth hormone (rhGH) has been shown to have powerful anabolic effects and to reduce or even prevent nitrogen catabolism in stressed patients. The effects of rhGH on functional parameters are less clearly defined. The aim of this study was to assess the effects of perioperative rhGH on nutritional markers, skeletal muscle function, and psychological well-being in patients undergoing infrarenal, abdominal aortic aneurysm repair. METHODS: Thirty-three patients undergoing elective infrarenal abdominal aortic aneurysm repair were randomized to one of three groups: (1) control (n = 12): placebo for 6 days before and after surgery; (2) preop + postop (n = 10): rhGH (Genotropin; Pharmacia Ltd, Uppsala, Sweden) 0.3 IU/kg/d for 6 days before and after surgery; and (3) postop (n = 11): placebo for 6 days before and rhGH 0.3 IU/kg/d for 6 days after surgery. Patients were assessed on days -7 and -1 before surgery and days 7, 14, and 60 after surgery. RESULTS: Administration of rhGH resulted in increased insulin-like growth factor 1 levels, the increase being significantly more marked in the group given rhGH preoperatively. Preoperative and postoperative rhGH reduced the postoperative decrease in both serum transferrin and grip strength at day 7 by 30% and 70%, respectively. Postoperative respiratory function and arterial oxygenation also were improved, with significant differences in arterial oxygenation between rhGH-treated and untreated groups. No difference in mood was seen between groups after surgery, nor was there any difference between subjective assessment of fatigue scores between groups. CONCLUSIONS: This pilot study indicates that rhGH administered preoperatively has beneficial effects on skeletal muscle and respiratory function and may be more useful than postoperative rhGH administration alone.

Proportionate mortality study of Vietnam-era veterans of Michigan.

This study examines the proportion of deaths from major diseases among Michigan Vietnam veterans. The distribution of deaths among Michigan Vietnam veterans was compared to deaths among veterans serving elsewhere for 1974-1989 to generate a proportionate mortality ratio (PMR). PMRs were estimated overall and for Black versus non-Black veterans. Overall, Vietnam veterans had significantly elevated PMRs for infectious and parasitic diseases and endocrine disease and lower PMRs for all malignant neoplasms combined. Vietnam veterans overall and non-Black specifically had elevated PMRs for non-Hodgkin's lymphoma. Black Vietnam veterans had elevated PMRs for cancer of the digestive organs, peritoneum, and pancreas. The elevated PMR for non-Hodgkin's lymphoma is consistent with results of individuals exposed to phenoxy herbicides. Results suggest that future studies should examine risks among racial groups separately.

Validity of a household gun question in a telephone survey.

The validity of self-reported data on the presence of guns in the home obtained in a telephone survey was assessed in samples of households where a hunting license had been purchased or a handgun registered. The survey was conducted among a random sample of Ingham County, MI, residents who had purchased a hunting license between April 1990 and March 1991 and among those registering a handgun during 1990. A third study sample was selected from the county's general adult population using a random digit dialing method. The interviews were conducted between November 1991 and January 1992. The proportion of respondents who reported that at least one gun was kept in their household was 87.3 percent among handgun registration households and 89.7 percent among hunting license households. In the survey of the general population of the county, approximately one-third of the respondents reported keeping a gun in the household, 67 percent of them for hunting and 23 percent for safety. Despite some limitations, the data indicate that a question on gun presence in a household can be used in a in a telephone survey.

Imaging of intramedullary tumour spread in osteosarcoma. A comparison of techniques.

The level of bone resection for osteosarcoma depends on the pre-operative evaluation of the extent of intramedullary tumour. We compared the accuracy of magnetic resonance imaging (MRI), computerised tomography (CT), and isotope bone scanning with the actual extent of the tumour in the resected specimens from 34 patients with primary osteosarcoma of a long bone. The extent of medullary tumour was defined accurately in 23 of 24 MRI scans (96%) and 24 of 32 CT scans (75%). A flexion contracture of a joint close to the tumour was an important cause for inaccurate measurements from both MRI and CT scans. Isotope bone scanning was inaccurate: its role is now confined to detecting skeletal metastases and skip lesions.

The effect size statistic: useful in health outcomes research ?

An increasing array of health status instruments provides challenges to the researcher in selecting the most appropriate measure in health outcomes studies. The responsiveness of a measure is its ability to identify small but important changes over time or following interventions. For health outcomes studies, responsiveness is an important psychometric requirement to guide instrument selection and it can be evaluated using the effect size statistic. The calculation and meaning of effect sizes are described here. Effect size considerations can also contribute to other topics of importance to health researchers. Issues of power and statistical and clinical significance are discussed.

Complex dislocation of the metacarpo-phalangeal joint of the index finger: a comparison of the surgical approaches.

Complex dislocation of the index metacarpo-phalangeal joint almost always requires surgical intervention. Controversy exists as to the most suitable surgical approach to reduction: palmar or dorsal. We reviewed four cases and carried out dissections in eight cadaver hands to compare the surgical approaches. The interposed volar plate was found to be the most important obstacle to reduction. Both approaches were successful in obtaining reduction. The dorsal approach was simple and safe, but necessitated longitudinal division of the volar plate and may carry a theoretical risk of late instability. The palmar approach allows restoration of normal anatomy but the radial neurovascular bundle is always vulnerable.