Common fraud experienced by the elderly: findings from a 1998 survey in Houston, Texas.

This study investigated the types and frequency of frauds experienced by seniors of different ethnic groups attending senior centers in 1998. Two hundred seniors aged 65 years or older were surveyed at 6 selected senior centers in Houston, Texas, and were asked to report the occurrence of frauds over the past year. Forty-three seniors (27%) responded that they had been victims of frauds, such as fake free prizes, work around the house, products to improve health and beauty, false insurance coverage, fees paid to attorneys and accountants, appliance repairs, credit restoration, investment participation, magazine subscriptions, and training courses.

Vaginal infections in human immunodeficiency virus-infected women.

Objective: This study was undertaken to compare the frequencies of vaginal infections among human immunodeficiency virus-infected women with those among human immunodeficiency virus-seronegative women.

Study Design: Human immunodeficiency virus-seropositive women attending a comprehensive care center for human immunodeficiency virus disease at the outpatient department of an inner-city hospital in Houston underwent rigorous gynecologic evaluation for sexually transmitted diseases, including evidence of vaginal infections such as bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. Demographic information was collected, as was information regarding disease classification and degree of immunosuppression.

Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative.

Background: Despite extensive progress in the scientific understanding of pain in humans, serious mismanagement and undermedication in treating acute and chronic pain is a continuing problem. This study was designed to examine the barriers to adequate pain management, especially as they might be associated with community size and medical discipline.

Methods: A 59-item survey was used to measure physicians' attitudes, knowledge, and psychologic factors that contribute to pain management practices.

Medical students' attitudes toward pain and the use of opioid analgesics: implications for changing medical school curriculum.

Background: Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics.

Methods: We tested a medical school class during their freshman and senior years.

Measuring medical students' reluctance to prescribe opioids for cancer pain.

Among 644 senior medical students a 14-item scale which was internally consistent indicated no change over the 6 years of testing in intent to reserve opioids for terminally ill.

Caring for terminally ill persons: comparative analysis of attitudes (thanatophobia) of practicing physicians, student nurses, and medical students.

To investigate why some caregivers desire to avoid patients with terminal illnesses, a thanatophobia scale assessing caregivers' uncomfortable feelings and sense of helplessness was developed and evaluated among practicing physicians and student nurses and medical students. As a group, student nurses scored lower on the thanatophobia scale than practicing physicians and medical students. Higher scores on intolerance to clinical uncertainty were associated with higher thanatophobia scores in all groups.

Medical manners: medical students' perceptions of their own.

Background: Because good interpersonal skills are essential for successful careers in primary care, we investigated senior medical students' (SMS) perceptions of the impression they leave with patients.

Methods: To assess the key elements that define the impression we make on others, we developed measures for self monitoring/social desirability, sensitivity, and Machiavellianism. These scales were used to predict SMS' attitudes toward various patient problems and their residency choices.

Reliance on high technology among senior medical students.

To gain a better understanding of senior medical students who perceive high-technology medicine as the desirable form of medical practice, we developed and evaluated a structural equation model. Intolerance to clinical uncertainty, Machiavellianism, and authoritarianism characterized students who scored higher on reliance on high-technology medicine. High scorers also tended to have a negative orientation toward patients' psychological problems and were unlikely to choose careers in primary care medicine.

Terminally ill cancer patients. Their most important concerns.

Purpose: When the goal of treatment is palliative, the most important outcome is improving patient quality of life. The authors describe the major concerns of terminally ill cancer patients with a prognosis of 6 months of less.

Overview: In phase I of this three-part study, 74 terminally ill patients were interviewed to identify their major concerns.

Self-esteem and caregivers' attitudes toward elderly persons.

A scale identifying 141 medical students who responded positively to geriatric patients was based on Rosenberg's Self-esteem Scale modified by adding a phrase about geriatric care. Personal and professional role traits that predicted a positive therapeutic attitude were high scores on social desirability or self-monitoring and low scores on thanatophobia and depression. Senior medical students who expressed the highest self-esteem toward caring for elderly people indicated family medicine as their first choice of residency.

Participants' perceptions of a phase I colon cancer chemoprevention trial.

To assess participants' perceptions of a phase I colon cancer chemoprevention trial using a calcium intervention, questionnaires were mailed to trial participants at the conclusion of the study. Responses to questionnaire items reported here include (1) perceived benefits and barriers of participation, (2) interest in participating in future trials, (3) willingness to pay trial expenses out of pocket, and (4) posttrial continuation of the calcium regimen. The study found that the most highly rated trial benefit was the perception of potential colon cancer prevention; the trial barrier reported to be the most troublesome was inappropriate or mistaken billing for study visits.

Initiation of prenatal care by low-income Hispanic women in Houston.

Objective: To understand why many Hispanic women begin prenatal care in the later stages of pregnancy.

Methods: The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care.

Results: A perception of many barriers to care was associated with later initiation of care and non-use of care.

Measuring social desirability among senior medical students.

The purpose of the study was to assess the role of medical students' social desirability scores on influencing their attitudes toward either a geriatric or hypochondriac patient. To carry out this investigation, we developed a social desirability scale that was domain-specific for medicine. Students' medical social desirability scores predicted negative attitudes and beliefs toward the geriatric but not the hypochondriac patient.

Is obstetrics-gynecology a primary care specialty?

Suddenly everyone wants more primary care physicians. For several years, we collected data from senior medical students to relate their attitudes and beliefs about several clinical problems common to primary care to their choices of residencies. Because the Texas Medical Association's Special Committee on Primary Care included obstetrics-gynecology as a primary care specialty, we reviewed our data to see if the personal traits and professional role characteristics of seniors choosing obstetrics-gynecology differed materially from those of seniors choosing family medicine, internal medicine, or pediatrics.

How children spend their time: a sample survey for use in exposure and risk assessments.

Children are becoming an increasingly important focus for exposure and risk assessments because they are more sensitive than adults to environmental contaminants. A necessary step in measuring the extent of children's exposure and in calculating risk assessments is to document how and where children spend their time. This 1990-1991 survey of 1000 households was designed for this purpose, targeting children between 5 and 12 years of age, in six states in varied geographic regions.

Uncertainties and ambiguities: measuring how medical students cope.

To develop psychometric measures specific to the ambiguities encountered in medicine and determine their value in predicting medical students' attitudes towards patients and their choice of residency, we administered to senior and first-year medical students a 25-item Likert-type questionnaire to assess their intolerance of ambiguity (ITA). Factor analysis yielded two dimensions that were converted to scales: 'Aversion to uncertainties in clinical medicine' (ITA1) and 'Preference for highly structured training environs' (ITA2). First-year students scored higher on ITA1 and lower on ITA2 than seniors.

Screening for diabetic retinopathy. The wide-angle retinal camera.

Objective: To define the test characteristics of four methods of screening for diabetic retinopathy.

Research Design And Methods: Four screening methods (an exam by an ophthalmologist through dilated pupils using direct and indirect ophthalmoscopy, an exam by a physician's assistant through dilated pupils using direct ophthalmoscopy, a single 45 degrees retinal photograph without pharmacological dilation, and a set of three dilated 45 degrees retinal photographs) were compared with a reference standard of stereoscopic 30 degrees retinal photographs of seven standard fields read by a central reading center. Sensitivity, specificity, and positive and negative likelihood ratios were calculated after dichotomizing the retinopathy levels into none and mild nonproliferative versus moderate to severe nonproliferative and proliferative.

Cost-effectiveness of alternative methods for diabetic retinopathy screening.

Objective: To assess from the perspectives of a government delivery system and patients, the cost-effectiveness of the 45-degrees retinal camera compared to the standard ophthalmologist's exam and an ophthalmic exam by a physician's assistant or nurse practitioner technician, for detecting nonproliferative and proliferative diabetic retinopathy.

Research Design And Methods: Comparison of 45-degrees fundus photographs with and without pharmacological pupil dilation taken by technicians and interpreted by experts, direct and indirect ophthalmoscopy by ophthalmologists, and direct ophthalmoscopy by technicians with seven-field stereoscopic fundus photography (reference standard). Costs were estimated from market prices and actual resource use.

Self-derogation and adjustment in the community: a longitudinal study of psychiatric patients.

The authors assessed the symptoms and role performance of a group of psychiatric inpatients 1 year after their discharge to determine their level of adjustment in the community. Level of self-derogation at the time of discharge was consistently found to predict the level of adjustment. The occurrence of stressful life events was also predictive of symptoms but was not found to be significantly related to role performance.

The independent contributions of socioeconomic status and health practices to health status.

The objective of this study was to determine whether the much-repeated finding of a relationship between socioeconomic status and health status is explained by individuals' health practices. The investigation was carried out using data tapes from the 1977 Health Interview Survey in which a one-third subsample of adults was asked a series of questions related to the seven nonmedical health practices identified in the Alameda County Study. The group selected for analysis comprised 15,892 white, responding adults.