Stress reduction at the worksite: an evaluation of two methods.

Abstract Stress is estimated to cost industry between 75 and 100 billion dollars annually as a result of absenteeism, medical claims and diminished productivity. Two types of stress management programs were studied to evaluate their effectiveness at the worksite. The Time-Life Stress Management Program and a Myers-Briggs Personality Type approach were used. The Time-Life program was given to 113 participants, and 35 participated in the Myers-Briggs program. Baseline stress (strain) scores were obtained using a standardized strain survey instrument. Follow-up strain scores were obtained six to eight months after baseline for 62 percent of the individuals. Both groups showed significant reductions in follow-up strain scores when compared to baseline. Reductions in strain were greater in the group with higher baseline strain scores (Time-Life). Worksite stress management programs have the potential to reduce strain among employees for at least six to eight months.

Physicians' responses to diagnostic test guidelines.

Internists (IM), subspecialty internists (SS), and family practitioners (FP) were surveyed regarding their opinions of ten of the Blue Cross Blue Shield Association/American College of Physicians diagnostic test use guidelines applied to the asymptomatic periodic health exam. The majority of 390 respondents agreed with the guidelines (59% of all responses). There was at least 40% disagreement with seven of ten guidelines. Board certification was associated with agreement. Internists and family practitioners were more likely to agree than subspecialty internists. The number of years in practice had a negative correlation with agreement for five guidelines. HMO physicians tended to agree with guidelines that discouraged test ordering. Results indicate that these guidelines for test use, based on research data and developed cooperatively by physicians, are a starting point for guidelines to testing during the periodic health examination.

Clinical AIDS update.

In summary, although progress against AIDS is being made, tremendous hurdles still exist. More effective prevention methods such as widely disseminated education programs and an effective vaccine are essential. Effective treatment methods are critical. Coordinated ambulatory care AIDS programs are needed to reduce costs and enhance the quality of life of AIDS patients.

Evaluation of olfactory dysfunction in the Connecticut Chemosensory Clinical Research Center.

The olfactory test administered to patients at the Connecticut Chemosensory Clinical Research Center combines stability of outcome with sensitivity to variables known to affect olfaction (age, sex). The test, which pairs an odor threshold component with an odor identification component, readily resolves differences in function between patients and controls. It reveals differences in the distribution of functioning for various probable causes (nasal/sinus disease, postupper respiratory infection, and head trauma), proves sensitive to improvements in function caused by therapeutic intervention (ethmoidectomy, steroid administration for nasal/sinus disease), and correlates with objective signs of nasal/sinus disease (visual exam, x-ray). The two components of the test agree well, though the odor identification component seems somewhat more sensitive than the threshold component as currently designed.

Compliance with mammography recommendations at the work site.

Mammography was recommended to 212 women, according to American Cancer Society guidelines, at the time of a work site-offered periodic health exam (PHE). Sixteen weeks later telephone follow-up determined compliance. A total of 56 (26%) had complied. A second phone contact to 82 noncompliers identified 18 additional women who complied after the first phone contact. Overall compliance (36%) was associated with the presence of physical findings upon breast examination (fibrocystic disease). Compliers did not differ from noncompliers with regard to age, time between PHE and follow-up, or insurance coverage. There was no association between compliance and age greater than or equal to 50 years or previous mammography.

Medical subspecialty training and interest in cost containment education.

To investigate academic physicians' interest in learning methods to reduce health care costs, we asked the faculty and housestaff of a university-based department of internal medicine to rate their interest in 30 potential topics for medical grand rounds, a traditional forum for continuing medical education. The 30 topics were equally divided among clinical, research and cost-containment categories. The 29 housestaff and the 41 subspecialty faculty members clearly favored clinical and research topics over cost-containment topics (p less than 0.001). On the other hand, the nine general internists considered the cost-containment topics as attractive as the clinical and research topics and ranked them higher than did both the subspecialists (p less than 0.001) and the house-staff (p less than 0.05). Efforts to alter costs in academic medical centers may be hampered by the relative disinterest in cost-containment education among house officers and subspecialists, who are responsible for most of the health care delivery in this setting.

Taste and smell problems: validation of questions for the clinical history.

Complaints of taste and smell dysfunction unaccompanied by symptoms of neurological or nasal problems are not uncommon. However, "I can't taste" is not necessarily an accurate symptom description. Complaints tend to reflect the common confusion between taste sensations (that is, salt, sour, sweet, bitter) and flavor sensations (including taste, smell, temperature, and texture). A number of questions have been identified that help classify symptoms according to the type of dysfunction (taste, smell, or both): whether the problem is quantitative (reduced or absent sensation) or qualitative (distorted sensations); and what might have caused the dysfunction. Directed questioning can yield a clinical history that predicts chemosensory function and identifies the most likely cause of the problem. Questions were assessed by comparing the self-reports of taste and smell symptoms to the clinical evaluation of chemosensory function for 101 new patients seen in the Taste and Smell Center at the University of Connecticut Health Center in 1983.

Chemosensory dysfunction. Clinical evaluation results from a taste and smell clinic.

Findings from 441 patient evaluations performed at the Taste and Smell Clinic of the Connecticut Chemosensory Clinical Research Center are presented. Taste and smell dysfunction was the chief complaint in all patients. The diagnostic approach included tests of taste and smell function; history taking; physical, neurologic, otorhinolaryngologic, and nutritional examinations; and clinical laboratory screening tests. Results indicate that the most common chemosensory dysfunction is probably olfactory: 86% of patients in this series had measurable loss of smell function. The most common cause of olfactory deficit was nasal and/or sinus disease (30% of patients), followed by idiopathic conditions (26%) and prior upper respiratory infection (19%). Assessment of individual components of the evaluation suggests that a total circulating eosinophil count may be useful as a screening test for nasal and/or sinus disease among patients whose chief complaint is chemosensory dysfunction.

Clinical evaluation of taste.

Partial loss of taste function can take a variety of forms. Losses can be specific to one taste quality or to one tongue locus. In addition, the shapes of psychophysical functions can be altered so that taste intensity no longer grows normally with concentration. Magnitude matching, an efficient psychophysical scaling method (based on magnitude estimation of stimuli from two sensory continua), can provide a relatively quick assessment of a patient's ability to taste the four taste qualities--sweet, salty, sour, and bitter. When taste intensity and loudness are scaled in the same session, a person with normal hearing who has taste loss will match taste intensities to abnormally weak sounds. Spatial losses are detected by placing pieces of filter paper soaked in taste solutions on specific tongue loci. Dysgeusia, the presence of a chronic taste in the mouth, can result from abnormal substances in the mouth (e.g., via saliva or from poor oral hygiene) or can reflect disorders of the central nervous system.

Clinical evaluation of olfaction.

An odor identification test and an odor threshold test offered satisfactory quantitative information on olfactory function in patients with chemosensory complaints. The threshold test used various concentrations of butanol presented in an ascending sequence. On each trial, the participant had to choose between stimulus and blank (two-alternative forced-choice procedure). The identification test used common odorous items (e.g., baby powder and ground coffee) and pungent items (e.g., ammonia) to test trigeminal function. A list of odor names and use of corrective feedback during testing overcame word-finding difficulty in odor identification. Each test readily distinguished between patients and control subjects. At present, a score that reflects the combined outcome of the tests is used to indicate five categories of functioning: normal osmesis, mild hyposmia, moderate hyposmia, severe hyposmia, and anosmia.