The role of the cytopathologist's interpretation in achieving diagnostic adequacy of head and neck fine needle aspirates.

OBJECTIVE: We aimed to assess the potential role of interpretation by cytopathologists on the level of diagnostic adequacy of head and neck fine needle aspirations (FNAs). METHODS: An audit ('first audit') was performed between 1 May 2007 and 30 April 2008 using data from three different hospitals (A, B and C). The specimens were interpreted by two cytopathologists with specific experience in head and neck pathology in hospitals A and B, and by any of the eight cytopathologists (only two of whom were experienced in head and neck cytopathology) in hospital C. Following the analysis of the initial findings, there was a change in practice in hospital C, after which specimens were also read only by two experienced cytopathologists. A new audit ('second audit') was then performed between 20 January 2011 and 20 December 2012 in the same three hospitals. RESULTS: During the first audit, the diagnostic adequacy of FNAs from hospital C was 84.2% compared with 96.6% in hospital A and 97.7% in hospital B (P = 0.000). No significant difference in the diagnostic adequacy rate of the FNAs performed in hospitals A and B was found when comparing the first and second audits. The FNA diagnostic adequacy for hospital C increased significantly in the second relative to the first audit (95.5% versus 84.2%, P = 0.000). CONCLUSIONS: Our study confirms that expert cytology interpretation is important in achieving optimal diagnostic adequacy of head and neck FNAs.

Novel PHEX gene mutation associated with X linked hypophosphatemic rickets.

INTRODUCTION: X-linked hypophosphatemia (XLH) is characterized by renal phosphate wasting with hypophosphatemia, short stature, and rachitic manifestations. CLINICAL PICTURE: We describe a novel nonsense mutation in exon 3 of the PHEX gene (Glu(96)X (c.286G>T) causing XLH in a mother and daughter of Indian ancestry. The mother was noted to have concomitant vitamin D insufficiency. CONCLUSION: Our report identifies a novel nonsense mutation in the PHEX gene causing XLH. It also highlights the fact that the presence of concomitant vitamin D insufficiency should not preclude the diagnosis of familial forms of hypophosphatemic rickets, especially if more than one family member is affected.

A comparison of rural and urban Emergency Medical System (EMS) personnel: a Texas study.

INTRODUCTION: In treating accident victims, actions by the Emergency Medical Personnel (EMP) at the scene may be the difference between life or death, full recovery or permanent disability. Development of selected profiles based on locale of services, tenure, and paramedic certification will provide valuable insight into the diversity within the Emergency Medical Services (EMS) profession. Not only will these profiles enable administrators to improve their recruitment, training, and retention of the emergency medical workforce, it potentially could enhance the quality of health care in the community. POPULATION: Emergency medical personnel attending a statewide conference in Texas in late 1996 (n = 425). HYPOTHESES: 1) There is no difference between the profiles of urban and rural EMP; 2) There is no difference between the profiles of urban EMP with < 9 years of experience and those with > or = 9 years of experience; 3) There is no differences between the profiles of rural EMP with < 9 years of experience and those with > or = 9 years of experience. 4) There is no difference between the profiles of urban EMP with paramedic certification and those without certification; and 5) There is no difference between the profiles of rural EMP with paramedic certification and those without certification. METHODS: EMP attending the conference completed 425 survey instruments measuring five demographic features, five work-related features, and two psychological features. Survey instruments were included in each registrant's conference package. Completed surveys were deposited anonymously in labeled receptacles throughout the statewide conference site. Data collection ceased at the end of the conference. Discriminant analysis identified distinct profiles for the urban and rural EMP. RESULTS: The urban EMP, more than rural subjects, was younger (mean = 36 years), more likely to be compensated 100% for their services, had a higher level of education (mean = 13.8 years), and reported a lower level of burnout. Urban EMP with < 9 years of experience tended to be younger, male, married, and reported less burnout. Urban paramedics were more likely to be compensated 100% for their services, and had achieved a higher level of education. The rural EMP with < 9 years of experience were less likely to be paramedic, reported lower burnout scores, and was younger. The rural EMP without paramedic certification was more likely to be a volunteer, and have had fewer years of service. CONCLUSIONS: In Texas, locale of service (urban or rural), length of tenure as an EMP (> or = 9 years), and paramedic certification appear to be significant factors that define the EMP population in Texas.

Ethnic identity, gay identity, sexual sensation seeking and HIV risk taking among multiethnic men who have sex with men.

Data (N = 302) were collected from gay bars, bathhouses, community events and programs targeting gay men of color, and male participants of the National Minority AIDS Council Conference of AIDS in Dallas, 1998. More than half of the sample reported at least one incident of unprotected anal sex in the past month. Logistic regression analysis identified sexual sensation seeking (odds ratio [OR] = 4.22, p = .0001, confidence interval [CII = 2.39, 7.45); not having a defined gay identity (OR = 3.63, p = .0007, CI = 1.73, 7.65); being in a sexually exclusive relationship (OR = 2.94, p = .0016, CI = 1.51, 5.73); and, for those born overseas, length of stay in the United States (OR = .94, p = .0436, CI = .86, .98) as significant predictors of unprotected anal sex among the sample.

Sensation seeking as it relates to burnout among emergency medical personnel: a Texas study.

INTRODUCTION: Burnout among emergency medical personnel (EMP) is suspected, but largely unsupported in the literature. An investigation of the phenomenon of burnout and factors contributing to its existence are essential steps in designing effective interventions. RESEARCH QUESTIONS: Three research questions were proposed: 1) Are EMP sensation seekers as measured by Arnett's Inventory of Sensation Seeking? 2) Are EMP burnt out as measured by Revicki's Work-Related Strain Inventory? 3) Is there a relationship between sensation seeking and burnout among EMP? METHODS: Emergency medical personnel attending a statewide conference in Texas, USA in late 1996 completed 425 survey instruments measuring sensation seeking and burnout as well as demographic items. Survey instruments were included in each registrant's conference package. Completed surveys were deposited anonymously in labeled receptacles throughout the statewide conference site. Data collection ceased at the end of the conference. RESULTS: EMP had significantly higher sensation-seeking total and intensity subscale scores than the general public. Full-time employees reported more sensation-seeking than volunteers or part-time employees. The younger the EMP, the greater were their reported sensation seeking tendencies. EMP reported more burnout in 1996 than in 1991. The older the EMP, the lower was the reported level of burnout. EMP who sought counseling for a work-related event reported more burnout than those who did not. Paid full-time EMP reported higher burnout than did volunteers. There was a weak but positive correlation between sensation seeking and burnout, suggesting that these two dimensions may be unrelated. CONCLUSIONS: The field of emergency medical services attracts sensation seekers, and EMP today report more burnout than their counterparts did in 1991. Although EMP appear to be high in sensation seeking, this dimension alone does not protect them from the effects of burnout.

Epidemiology of HIV and AIDS among Asian and Pacific Islander Americans.

As of June 1997 the Centers for Disease Control and Prevention reported 4,370 AIDS cases among Asian and Pacific Islander Americans (APIs) in the U.S. It also reported that the rate of new AIDS cases among APIs men who have sex with men (MSM) per 100,000 population increased by 55% from 1989 (4.0) to 1995 (6.2). Focusing on the relatively low numbers of APIs with AIDS in the U.S. has resulted in complacency among API communities and government officials, despite reports of increased seroprevalence and exponential growth in diagnosed AIDS cases. However, because of the geographic and social isolation of many Asian and Pacific Islander American communities, the effect of HIV is magnified once it takes hold. The low numbers of reported AIDS cases among API and the perception of them as the "model minority" has reinforced their denial of AIDS as a threat. Data collection and surveillance tools must be modified to accurately capture the range of HIV-related and social issues that affect Asian/Pacific Islander communities in the United States. Notwithstanding sample limitations, ethnic-specific data are needed to identify HIV trends in each of the Asian Pacific Islander American communities, which can inform prevention and intervention programs.

HIV seroprevalence, risk behaviors, and cognitive factors among Asian and Pacific Islander American men who have sex with men: a summary and critique of empirical studies and methodological issues.

The goals of this article are to (a) summarize and discuss published empirical studies addressing HIV seroprevalence rates and HIV-related behaviors and cognitive factors among Asian and Pacific Islander American (API) men who have sex with men (MSM) in the United States, (b) examine existing population-based research methodologies for studying HIV and AIDS prevention, (c) describe a conceptual framework to facilitate the identification of ecologically sound or culturally appropriate and competent methodologies for studying HIV prevention among API MSM, and (d) discuss methodological issues and recommend alternative methodologies to better understand this population in HIV prevention. A total of eight published empirical studies reported the HIV seroprevalence rates, HIV-risk behaviors, and attitudes toward HIV and AIDS among API MSM. Specifically, seven studies reported HIV seroprevalence rates that were based on either self-disclosure of HIV status or HIV test results among the study participants. Four studies also reported findings about the relationships between HIV-related behaviors and cognitive factors. There are five population-based databases on HIV and AIDS epidemiology and surveillance which have been managed by the Centers for Disease Control and Prevention. Findings from the seven studies indicate that API MSM are as likely to engage in HIV-risk behaviors as other groups. The present analysis reveals that conventional surveillance or epidemiological techniques (e.g., random digit telephone dialing), based on a singular model of populations, are not appropriate to address culturally, linguistically and racially/ethnically diverse groups of API MSM. To address the diversity of this group, ecologically sound or culturally appropriate and competent research methodologies are needed. Thus, a conceptual framework for such methodologies with examples was reviewed. Two alternative methodologies, network analysis and venue-based sampling, were briefly discussed.

PIP: This article presents a summary of HIV seroprevalence rate and HIV-related behavior empirical studies. Results of population-based HIV and AIDS prevention programs are analyzed. Furthermore, this paper describes a conceptual framework for HIV prevention and discusses methodological issues and alternative HIV prevention programs among Asian and Pacific Islander (API) American men who have sex with men (MSM). This study analyzed 8 published studies on HIV seroprevalence rates, HIV risk behaviors, and HIV/AIDS attitudes among API MSM, particularly 7 studies on HIV seroprevalence rates which were based on HIV status self-disclosure and HIV test results. Of the 8 studies, 4 were able to focus on API MSM. The Center for Disease Control, which controls the surveillance of population-based HIV/AIDS epidemiology, utilizes 5 databases. These studies indicate that API MSM were likely to practice unsafe behaviors compared with other risk groups. The use of conventional surveillance or epidemiological techniques based on a singular model of populations is inadequate in response to the culturally, linguistically, and racially/ethnically diverse groups of API MSM. It was suggested that the use of ecologically sound or culturally appropriate and competent research methodologies is necessary to address the diversity of this group. Finally, a discussion on the use of two alternative methodologies, particularly network analysis and venue-based sampling within a conceptual framework, is presented.

Asian and Pacific Islander American HIV community-based organizations: a nationwide survey.

A national survey was conducted to (a) ascertain the status of HIV prevention among community-based organizations targeting APIs in the United States, (b) define technical assistance needs among these organizations, and (c) determine their involvement in the HIV community planning process. Of the 80 surveys sent out, 49 (61%) completed responses were received. Filipinos, Chinese, Vietnamese, Cambodians, and multiracials were the subpopulations targeted the most often, and, not surprising, Tagalog, Cantonese, Mandarin, Vietnamese, Cambodian, Korean and Japanese were the Asian languages most widely in use. Gay men, bisexual men, and youth were targeted most frequently by HIV prevention efforts. Of all the largest ethnic subpopulations, Asian Indian is the only group with no community-based organization that exclusively targets them for HIV prevention. More than 95% of respondents reported conducting some type of evaluation; the size of the budget and organization often determined the evaluation strategies used. Program development, staff development, and program evaluation were the most frequently reported areas of technical assistance requested. A majority of the respondents (79%) reported being involved with the HIV prevention community planning process where APIs were represented on state/local community planning groups, they did not rate the performance of the community planning process highly. We recommend providing technical assistance in fund-raising, program evaluation, and participation in the HIV community planning process.

A profile of six community-based HIV prevention programs targeting Asian and Pacific Islander Americans.

Based on a framework (i.e., research and evaluation, prevention and services, and advocacy and policy), the goal of this article is to profile six community-based HIV prevention programs targeting Asian and Pacific Islander (API) Americans, especially among men who have sex with men. These six programs were chosen based on one or more of the following three criteria: (a) epidemiological profiles of AIDS cases among Asian and Pacific Islander Americans, (b) ethnic diversity, and (b) community development among Asian and Pacific Islander Americans in the fight against HIV. The six programs are (a) the Kokua Kalih Valley Health Center, Honolulu; (b) the Asian and Pacific Islander Wellness Center, San Francisco; (c) the Asian Pacific AIDS Intervention Team, Los Angeles; (d) the Asian and Pacific Islander Coalition on HIV and AIDS, New York City; (e) the AIDS Services in Asian Communities, Philadelphia; and (f) the Massachusetts Asian AIDS Prevention Project, Boston. The present analysis reveals that five programs have their roots in the gay or bisexual communities. Two programs have existed for about 3 years (the epidemic is going into its 17th year). Major financial support for the six programs are federal, state, or county sources; private support is generally minimal. All six programs offer a wide range of culturally competent and linguistically appropriate prevention activities and services (including two national projects) targeting a diverse API population. However, gaps in services exist in the younger programs. In addition to a paucity of epidemiological, surveillance, and empirical data, most reported that barriers fall into one or two interrelated categories: (a) structural (e.g., lack of governmental or private funding) or (b) cultural (e.g., denial of risk, homophobia, fear of confidentiality). These findings suggest that HIV prevention activities and services for Asian and Pacific Islander Americans should be based on empirical and cultural data, and that API Americans should become more actively involved in social and political activities. Asian and Pacific Islander American agencies are challenged to integrate HIV with other health and social issues pertinent to the communities.

Physician and consumer attitudes and behaviors regarding self-help health support groups as an adjunct to traditional medical care.

This study assessed the creditability of self-help health support groups as an adjunct to traditional medical care among a sampling of physicians (N = 120) and group members (N = 73) located in the Dallas/Ft. Worth Metropolitan area. Findings suggest a general lack of awareness of local groups among physicians, referral to only a few select groups, as well as little communication between health care professionals and their patients. Physicians in group practice, surgical specialties, and having never referred patients to support groups responded less favorably. Several benefits were reported by the group members, although for a majority their patient-physician relationship remained relatively unchanged.

HIV antibody testing: who benefits and who loses?

From a public health perspective, a significant milestone in the AIDS crisis so far has been the development of serologic tests to detect exposure to the HIV. With AIDS now reported in more than 124 countries and in every state of the Union, with the possibility that in excess of two million Americans have been infected and in the absence of a cure or vaccine, the issue of testing cannot be ignored anymore. Unfortunately, the testing debate has generated more heat than light. This paper examines the proposed "benefit" to public health in testing certain target groups deemed "at risk", and also discusses socio-ethical implications of such testing. The whole question of HIV antibody testing essentially raises the need for a balance between voluntary and mandatory testing; and society's commitment to protect public health as well as safeguard individual civil rights.

Vietnamese in America: a case study in cross-cultural health education.

The rescue of the "boat people" from Vietnam is not over when they reach American shores . Adjustment problems abound . Health professionals are in a good position to help immigrants, but because of the language barrier and unfamiliarity with foreign cultures, there has been little success, despite the best of intentions. This paper attempts to highlight the importance of understanding culture in health education, using the Vietnamese as a case study.

The male role in contraception: implications for health education.

Today most contraceptive efforts are focused on the female. The resultant diminished male role may have inadvertently undermined the many societal efforts at birth control. Many men, young and old, still perceive contraception as primarily a woman's responsibility, for after all, she suffers most directly from contraceptive failure. This attitude is unfortunate. Since decisions about pregnancy affect both partners, both should share the contraceptive burden equitably. More specifically, the two-fold purpose of the paper is: (1) to examine the available male contraceptives; and (2) to draw implications of the changing male role in contraception for health professionals in the school and community. The paper argues that while the involvement of men in contraception will not automatically solve the problem of unwanted pregnancy among the young, it can certainly make a difference--an important difference.

PIP: This study examines method of male contraception available in the United States and suggests ways in which health professionals in the schools and in the community can teach men, especially teenage men, how to take a more active role in contraception. 4 methods of male contraception, the condom, coitus interruptis, vasectomy, and the male pill are discussed in terms of advantages and disadvantages. How the diminishing male role in contraception since the advent of oral contraceptives has changed because of the women's movement is noted. A comparison between Japanese and American methods of selling condoms is made. The authors say that Japanese methods are much better, and suggestions are made on how to better promote condom use in the United States are made. Suggestions are also given on how to involve men at family planning clinics and how to teach sex education in the schools to promote more active participation in contraception.