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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 behalf.

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 Clearinghouse.

Escalante, A., Lichtenstein, M.J., Rios, N., and Hazuda, H.P. (1996). "Measuring chronic rheumatic pain in Mexican Americans: Cross-cultural adaptation of the McGill pain questionnaire." (AHCPR grant HS07397). Journal of Clinical Epidemiology 49(12), pp. 1389-1399.

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, January). "Dental 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 Clearinghouse.

Harris, L.E., Weinberger, M., and Tierney, W.M. (1997). "Assessing inner-city patients 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, December). "Stroke prevention in a 75-year-old asymptomatic patient." Hospital Physician, pp. 25-48.

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 initiation of 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 psychotropic medications.

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, pp. 1249-1256.

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.

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AHCPR Publication No. 97-0035
Current as of April 1997

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