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Cohen, S.S., Mason, D.J., Kovner, C., and others (1996, November). "Stages of nursing's political development: Where we've been and where we ought to go." Nursing Outlook 44, pp. 259-266.
This editorial examines the development of political activism within the nursing profession.
The author identify four stages of nursing's political development based on a review of
the literature and analysis of political involvement by nurses. Stage 1 is the political awakening of nursing, which includes a recognition of the importance of health policy in
nursing curricula. During stage 2, the profession moves beyond heightened awareness to
political activism. In stage 3, nurses gain expertise in areas such as campaign
financing laws, election strategies, and public relations techniques. In stage 4, nurses
become the initiators of crucial health policy ideas and innovations. The authors
conclude that the further the profession is able to move into stage 4, the more the public
will benefit from nursing's expertise and the advocacy that nurses can provide on their
Reprints (AHCPR Publication No. 97-R042) are available from the AHCPR Publications Clearinghouse.
Cohen, S.B., and Potter, D.E.B. (1996). "An estimation strategy for the combined population represented by the NMES household and nursing home surveys." Journal of Economic and Social Measurement 22, pp. 161-179.
The National Medical Expenditure Survey (NMES) Household Survey was designed to produce
national estimates of health care utilization, expenditures, insurance coverage, and sources of
payments for the civilian noninstitutional population in 1987. The NMES Nursing Home
component was designed to produce comparable estimates for the residents of nursing and
personal care homes in 1987. However, individuals who were admitted to nursing and personal
care homes from the community in 1987 were represented in both components of the survey. This
paper presents the estimation strategy adopted in NMES to allow for population estimates of the
combined population represented by these component surveys. Investigators at the Agency for
Health Care Policy and Research who authored the paper detail the derivation of per capita and
total health care expenditure estimates that characterize the population in the community and in
institutions over the course of 1987. They also discuss limitations with respect to the estimation
strategy as a consequence of the NMES survey design.
Reprints (AHCPR Publication No.
97-R041) are available from the AHCPR Publications
Escalante, A., Lichtenstein, M.J., Rios, N., and Hazuda, H.P. (1996).
rheumatic pain in Mexican Americans: Cross-cultural adaptation of the McGill pain
questionnaire." (AHCPR grant HS07397). Journal of Clinical Epidemiology 49(12), pp.
More than 17 million people aged 5 years and older in the United States speak Spanish at home,
and 44 percent of these people speak English less than "very well." Thus, tools used to assess
their health must be in Spanish. This study shows that the McGill Pain Questionnaire (MPQ),
when translated into Spanish, is cross-culturally equivalent to the original English version and has
similar validity and reliability. As a result, the McGill questionnaire is suitable for cross-cultural
studies of pain comparing Spanish-speaking Mexican Americans with English-speaking members
of the same and other ethnic groups. The questionnaire consists of 78 single-word pain
descriptors, which were translated into Spanish. The researchers rated the pain-intensity content
(PIC) of the words in each language and found a strong correlation. They then compared the
Spanish version to the original English version in a group of 50 bilingual Mexican-American
patients with musculoskeletal pain who completed the MPQ in both languages. The agreement
between the two language versions was almost perfect.
Fleishman, J.A., Schneider, D.A., Garcia, I., and Hardwick, K. (1997,
service use among adults with human immunodeficiency virus infection." Medical Care 35(1), pp. 77-85, 1997.
Dental care is important for persons infected with the human immunodeficiency virus (HIV)
because it allows early detection and treatment of HIV-related oral infections that can seriously
threaten the health of immunocompromised patients. Researchers at the Agency for Health Care
Policy and Research and the Health Resources and Services Administration interviewed nearly
2,000 HIV-infected patients who were part of the AIDS Cost and Services Utilization Survey
(ACSUS) to examine use of dental services during an 18-month period in 1991 and 1992. Results
showed that about half (51 percent) of patients visited the dentist, oral surgeon, or other dental
care provider during that time. Only 9 percent said they needed but did not receive dental care.
About 61 percent of the general population aged 18 to 34 years had one or more annual dental
visits compared with 67 percent of those aged 35 to 44 years and 63 percent of those aged 45 to
54 years. The corresponding figures of ACSUS patients making a dental visit were 49 percent, 56
percent, and 49 percent, measured over a longer time period (18 months). The number of dental
visits per year in the 18 to 34, 35 to 44, and 45 to 54 age groups in the National Health Interview
Survey (NHIS) of the overall population were 1.8 (vs. 1.3 for ACSUS persons), 2.2 (vs. 1.8), and
2.3 (vs. 1.6). This is not a large difference according to the researchers, who note that the
ACSUS respondents were more socioeconomically disadvantaged than the NHIS respondents.
Reprints (AHCPR Publication No. 97-R040) are available from the AHCPR Publications
Harris, L.E., Weinberger, M., and Tierney, W.M. (1997). "Assessing
hospital experiences: A controlled trial of telephone interviews versus mailed surveys."
(AHCPR grant HS07763). Medical Care 35(1), pp. 70-76.
Assumptions about the usefulness of mailed surveys versus telephone interviews may not hold for
the urban poor, many of whom are illiterate, move often, and don't have phones. For this study,
the researchers surveyed patients discharged from the inpatient medicine service of an urban
teaching hospital about their experiences with hospital care via a 116-item satisfaction survey
using one of two methods: mail-first (mailed surveys with followup of nonrespondents by
telephone) or telephone-first (telephone interviews with followup of nonrespondents by mail). The
researchers randomized 130 patients to the mail-first and 122 to the telephone-first survey
method. Response rates were higher with the telephone-first compared with the mail-first method
(73 percent vs. 50 percent). Surveys obtained by the telephone-first method had fewer missing
data compared with the mail-first method and were 42 percent less expensive per completed
survey ($26.32 vs. $37.35).
Oddone, E.Z., Matchar, D.B., Goldstein, L.B., and Pritchett, E.L. (1996,
"Stroke prevention in a 75-year-old asymptomatic patient." Hospital Physician, pp.
In this commentary, the authors draw out critical areas of stroke prevention by using a case study
of stroke prevention in a 75-year old asymptomatic patient with high blood pressure. They assert
that stroke is fundamentally preventable if physicians and patients know the warning signs. For
example, about half of all patients who ultimately develop a stroke will first have a transient
ischemic attack (TIA), a short episode of brain dysfunction that lasts between 2 to 15 minutes.
In this case, the physician should do further work-up to determine the etiology of the TIA,
including computed tomography, clotting factor assessment, electrocardiogram, and Doppler
ultrasound to assess the carotid arteries and cardiac valve status. Although narrowed carotid
arteries are the most common cause of stroke, noninvasive ultrasound to screen for carotid
stenosis in the general population (vs. symptomatic patients) is not cost effective.
Sleath, B., Svarstad, B., and Roter, D. (1997). "Physician vs. patient
psychotropic prescribing in primary care settings: A content analysis of audiotapes."
(AHCPR grant HS07499). Social Science and Medicine 44(4), pp. 541-548.
Researchers at the University of North Carolina, Chapel Hill, the University of Wisconsin, and
Johns Hopkins University, found that 42 percent of psychotropic prescriptions were initiated by
patients rather than their primary care physicians. These patients had one or more chronic
conditions, had seen their physicians at least twice before, and in many cases, had received the
psychotropic medication before. The study involved audiotapes of physician-patient interactions
for 508 patients who were seen in 11 different outpatient settings. The researchers found that 17
percent of these primary care patients received prescriptions for one or more psychotropic
medications; 47 percent of repeat psychotropic prescriptions and 20 percent of new ones were
initiated by patients. But 69 percent of prescriptions for low-income patients were
physician-initiated, while nearly 90 percent of psychotropic prescriptions for high-income patients
were patient-initiated. Fifty percent of patients who had been to see their physician seven or more
times initiated psychotropic prescribing, compared with 29 percent of patients who had seen their
physician two to six times previously. The patients sex, race, age, and rating of physical and
emotional health were not significantly related to whether physicians or patients initiated
psychotropic prescribing. The findings of this study are consistent with survey research which has
found that higher income patients tend to be more actively involved in decisionmaking than lower
income patients. The researchers call for additional studies to determine whether patient initiation
of prescribing is important with regard to other types of medications such as antiulcer or
antiinflammatory agents. Also, research is needed to determine whether physician vs. patient
initiation of psychotropic prescribing is related to increased or decreased appropriateness of use of
Starfield, B., Forrest, C.B., Ryan, S.A., and others (1996). "Health status
of well vs. ill
adolescents." (AHCPR grant HS07045). Archives of Pediatric and Adolescent Medicine 150,
This study was conducted to determine whether the Child Health and Illness Profile-Adolescent
Edition (CHIP-AE)—an instrument used to measure the health status of adolescents—could
discriminate between teenagers in schools and those attending three specialty clinics for chronic
disease (cystic fibrosis, rheumatoid arthritis, and inflammatory bowel disease) and an adolescent
primary care clinic. The CHIP-AE covers six aspects of health: discomfort, satisfaction with
health, disorders, achievement of social expectations, risks, and resilience. The researchers
administered the CHIP-AE questionnaire to teenagers (aged 11 to 17 years) visiting the primary
care and specialty clinics and to teens in nearby schools. Acutely ill teenagers reported more
physical discomfort, minor illnesses, and lower physical fitness; chronically ill teens reported more
limitations of activity, long-term medical disorders, dissatisfaction with their health, lower
self-esteem, and less physical fitness than teenagers in the school samples. Nevertheless, a
substantial portion of chronically ill children did not show limited functioning. These findings held,
even after researchers made adjustments for the teens socioeconomic status, age, and sex. The
authors conclude that by being person-focused rather than disease-focused, the CHIP-AE can
indicate which aspects of health need particular attention and identify points of strength that can
sustain health as chronically ill teens mature.
A new toll-free TDD number, 888-586-6340, is now available at the AHCPR Publications Clearinghouse to support the telecommunication needs of the hearing impaired. TDD callers can
communicate with Clearinghouse staff from 9 a.m. to 5 p.m., Monday through Friday (excluding
holidays). After 5 p.m., callers may leave a message using the TDD recording device.
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AHCPR Publication No. 97-0035
Current as of April 1997