Incoming and outgoing hospital CEOs: what kind of help do they want?

CEO turnover, although common, is expensive and disruptive for everyone involved. Both incoming and outgoing CEOs would welcome help in making the transition a painless experience. Through a 2005 nationwide survey of 805 current hospital CEOs, the authors obtained comments and suggestions in response to three open-ended questions about specific activities or processes that would help incoming and outgoing CEOs. Mostly, CEOs felt the need for a structured orientation process, succession planning, concrete peer and organizational support, training on recruitment and retention for the board, and an adequate separation package including continued healthcare coverage.     

Desktop study of occupational exposure judgments: do education and experience influence accuracy?

This study examines the impact of several experience and education determinants on exposure judgment accuracy. The study used desktop assessments performed on several different tasks with different exposure profiles to identify correlations between determinants and judgment accuracy using logistic regression models. The exposure judgments were elicited from industrial hygienists with varying levels of experience, education, and training. Videos and written and oral information about the exposure tasks were presented to all participants as they documented a series of qualitative and quantitative exposure judgment probabilities in four exposure categories. Participants (n = 77) first documented their qualitative and then their quantitative exposure assessments after receiving the series of sampling data points. Data interpretation tests and training in simple rules-of-thumb for data interpretation were also given to each participant to investigate the impact of data interpretation skills on exposure judgment accuracy. Logistic regression analysis indicated "years of exposure assessment experience" (p < 0.05), "highest EHS degree" (p < 0.05), and a participant's "data interpretation test score" (p < 0.05) directly impacted qualitative exposure judgment accuracy. Logistic regression models of quantitative judgment accuracy showed positive correlation with "greater than 10 years of exposure assessment experience" (p < 0.05), "highest EHS degree" (p < 0.05), a participant's "data interpretation test score" (p < 0.001), rules-of-thumb data interpretation training (p < 0.001), and the number of sample data points available for a judgment (p < 0.005). Analyzing judgments in subsets for participants with less or more than 10 years' experience indicated additional correlations with Certified Industrial Hygienist and Certified Safety Professional certifications, total number of task exposure assessments, and career number of air surveys. The correlation of qualitative and quantitative exposure judgment accuracy with "greater than 10 years experience" supports similar research findings from other fields. The results of this study indicate that several determinants of experience, education, and training, in addition to the availability of sampling data, significantly impact the accuracy of exposure assessments. The findings also suggest methods for enhancing exposure judgment accuracy through statistical tools, mathematical exposure modeling, and specific training.     

Allium vegetables and organosulfur compounds: do they help prevent cancer?

Allium vegetables have been shown to have beneficial effects against several diseases, including cancer. Garlic, onions, leeks, and chives have been reported to protect against stomach and colorectal cancers, although evidence for a protective effect against cancer at other sites, including the breast, is still insufficient. The protective effect appears to be related to the presence of organosulfur compounds and mainly allyl derivatives, which inhibit carcinogenesis in the forestomach, esophagus, colon, mammary gland, and lung of experimental animals. The exact mechanisms of the cancer-preventive effects are not clear, although several hypotheses have been proposed. Organosulfur compounds modulate the activity of several metabolizing enzymes that activate (cytochrome P450s) or detoxify (glutathione S-transferases) carcinogens and inhibit the formation of DNA adducts in several target tissues. Antiproliferative activity has been described in several tumor cell lines, which is possibly mediated by induction of apoptosis and alterations of the cell cycle. Allium vegetables and organosulfur compounds are thus possible cancer-preventive agents. Clinical trials will be required to define the effective dose that has no toxicity in humans.     

Adolescent clients of primary health care services. How do they live? Why do they seek help, and how do they express themselves?

The objective of this study was to characterize adolescent clients of community-based primary health care services in order to understand: 1) how they express themselves when they seek medical help; 2) the health care they receive; and 3) key social and family factors. Among 35 urban primary care services belonging to the municipal public health department in Pelotas, Rio Grande do Sul State, Brazil, 10 were randomly selected, and all individuals between 13 and 19 years of age who had previously had an appointment with a non-psychiatric physician were interviewed during a three-month period (n = 463). Use of the services has more of a more curative than preventive focus. Males seek medical help less frequently and mainly due to physical complaints. Females tend to express themselves on the basis of sexual problems. Few adolescents expressed their emotional problems, although some mentioned family and school problems as well as stressful situations.     

Adolescents and genetic testing: what do they think about it?

PURPOSE: To examine adolescents' attitudes toward screening for hereditary disorders. METHODS: A survey was distributed among 672 students in grades 10 to 12 attending a public suburban high school. The first part of the survey consisted of information about three diseases: familial breast cancer, Tay-Sachs disease, and hypercholesterolemia. The second part was a questionnaire developed by the authors, which explored students' attitudes toward testing for these diseases. Comparisons between and within groups were performed using X2 analysis. RESULTS: Out of the 672 surveys distributed, 361 were returned (54% response rate). Mean age of participants was 17 +/- 1 years. Most girls (67%) wanted to be tested for familial breast cancer. Girls were significantly more willing than boys to be tested for Tay-Sachs disease (23% vs. 13%, p <.002) and for hypercholesterolemia (54% vs. 39%, p <.001). Girls who had a relative with breast cancer were significantly more willing to be tested than other girls (p <.05). Individuals in the ethnic risk groups for Tay-Sachs disease were significantly more willing to be tested than those not in the ethnic risk groups (p <.001). However, only 33% of those in the ethnic risk groups for Tay-Sachs disease stated that they would either "definitely" or "probably" wish to be tested. Students who had a family history of high cholesterol were significantly more willing to be tested than those without a family history (70% vs. 34%, p <.0001). About 81% of the students with a family history of high cholesterol had never been referred for cholesterol testing. Only about 25% of participants stated that their attitude toward genetic testing was affected by concerns that genetic information might be misused by insurance companies/employers. CONCLUSIONS: The main motivator for genetic testing is having someone in the family affected by the disease in question. Adolescent girls are more willing to be tested for genetic diseases than are boys.     

The veil of experience: do consumers prefer what they know best?

There is growing interest from health policy makers in eliciting consumer preferences for health care services. This is particularly the case when assessing the likely impact of innovations. Some people may be wary of innovations because they prefer the service they have previously experienced. Consumer preferences for an existing and a hypothetical new bowel cancer testing programme were measured using a discrete choice experiment questionnaire. The results showed that consumers had a statistically significant preference for the existing service (status quo) when all other factors remained constant. It suggested that consumers make decisions under a 'veil of experience'. Possible explanations for this result include the endowment effect, status quo bias and loss aversion. Future evaluations of health service innovation should be aware of this tendency to favour the status quo.     

Household smoking bans: which households have them and do they work?

BACKGROUND: This study characterized Oregon households according to type and degree of restrictions on smoking and explored whether smoking restrictions are associated with decreased environmental tobacco smoke (ETS) exposure. METHODS: A population-based, random-digit-dialed cross-sectional telephone survey of 6,199 adult Oregonians was performed in 1997 to provide baseline data on tobacco use in Oregon. RESULTS: Seventy percent of Oregon households were composed of nonsmokers only, and 85% of those had a full ban on smoking inside the home. Of the households containing one or more smokers, 38% had a full household ban on smoking. Among respondents with a full ban in place, 99% of nonsmoker-only households reported that no one smoked in the home in the previous month, compared with 91% of households with at least one smoker. In both nonsmoker-only households and those with at least one smoker, full bans were strongly associated with awareness of the harm of ETS (OR = 12.8, 95% CI 7.3-22.3, and OR = 6.6, 95% CI 3.6-12.3, respectively). The presence of children in the household was also closely associated with full bans in the two types of households (OR = 4.6, 95% CI 2.8-7.6, and OR = 3.0, 95% CI 2.1-4.4, respectively). Nevertheless, 50% of households with children and a smoker present did not have a full ban in place. CONCLUSIONS: While the prevalence of household smoking restrictions is high in Oregon, there remains room for improvement, since 50% of households with a smoker and a child present do not have a full ban on indoor smoking. Public health messages that focus on household smoking restrictions may help protect nonsmokers from exposure to ETS.     

Facing the facelessness of public health: what's the public got to do with it?

Despite compelling statistics that show we could eliminate 80%of all heart disease and strokes, 90% of all diabetes, and 60% of all cancers with basic lifestyle changes, we have failed to motivate the public to make these changes and failed to motivate policy makers to make healthy choices the easiest choice. Dr. Katz suggests we have failed because we have focused too much on statistics and too little on passion. He implores all of us to tap into people's passion by connecting each of these statistics with a human story.     

Mothers' attitudes and concerns about their children smoking: do they influence kids?

BACKGROUND: The effects of mothers' attitudes and concerns about tobacco use on whether their children take up smoking are largely unknown. This study examined the predictive effects of mothers' attitudes about tobacco and concerns about their children smoking. METHODS: Self-reported data from a large number of 12th-grade students (2,736) and their mothers were used. Mothers' attitudes and concerns were assessed when their children were 3rd graders (age 8), at the start of the smoking acquisition period; their children were then followed prospectively (with attrition of only 5%) for 9 years to the end of the period (12th grade) for the assessment of smoking behavior. RESULTS: In households in which both parents are nonsmokers, strong maternal antismoking attitudes are associated with a statistically significant approximately 50% reduction (P < 0.05) in the prevalence of smoking by adolescent children. In contrast, in households in which one or both parents are current smokers, there was no reduction in adolescent smoking associated with mothers' antismoking attitudes. CONCLUSIONS: Maternal antismoking attitudes when their children are young predict adolescents' adoption of smoking at 12th grade, but only when parental behavior is consistent with these attitudes.     

Diagnostics for assumptions in moderate to large simple clinical trials: do they really help?

In this article, primarily we look at a case study, where prior to conducting the major efficacy analysis, one performs a diagnostic test for assumptions, and acts upon the result if the diagnostic test rejects the assumptions. Specifically, we show by an example that a hybrid approach of using a diagnostic test for equality of variance in a two-sample t-test situation can adversely affect, rather than protect, the operating characteristics of the study. If this kind of hybrid approach fails in such a simple setting, analysts should be very cautious about using hybrid approaches in more complex analyses of efficacy. Secondarily, we present rationale as to why the classical tests (or slightly modified versions) can be viewed as asymptotically non-parametric, and can actually be more robust against failure of assumptions than rank tests. Readers are cautioned that this illustration is limited to efficacy analysis, and is not meant as a criticism of other analyses, such as modelling or exploratory ones.     

Do preschool children understand what it means to “diet,” and do they do it?

OBJECTIVE: The current study determined what preschool children understand about dieting and the extent to which they report engaging in dieting behaviors. METHOD: Forty-two children (mean age = 5.2 years) were interviewed about their understanding of the word "diet" and about food restraint behaviors. Children's height and weight were recorded. RESULTS: Only 17% of the children provided an accurate definition of the word diet (i.e., an answer having to do with the foods a person eats). None of the children mentioned weight loss in their definition. Children reported occasional use of restraint behaviors. Girls and heavier children reported more use of restraint. DISCUSSION: Children did not have a clear understanding of the word diet. Thus, the use of the word diet should be avoided when assessing eating behaviors in preschool children. Individual differences in reported dieting behaviors were in the expected directions, suggesting validity in these reports and early emerging social pressures to diet.     

Older and wiser? Men’s and women’s accounts of drinking in early mid‐life

Most qualitative research on alcohol focuses on younger rather than older adults. To explore older people's relationship with alcohol, we conducted eight focus groups with 36 men and women aged 35 to 50 years in Scotland, UK. Initially, respondents suggested that older drinkers consume less alcohol, no longer drink to become drunk and are sociable drinkers more interested in the taste than the effects of alcohol. However, as discussions progressed, respondents collectively recounted recent drunken escapades, challenged accounts of moderate drinking, and suggested there was still peer pressure to drink. Some described how their drinking had increased in mid-life but worked hard discursively to emphasise that it was age and stage appropriate (i.e. they still met their responsibilities as workers and parents). Women presented themselves as staying in control of their drinking while men described going out with the intention of getting drunk (although still claiming to meet their responsibilities). While women experienced peer pressure to drink, they seemed to have more options for socialising without alcohol than did men. Choosing not to drink alcohol is a behaviour that still requires explanation in early mid-life. Harm reduction strategies should pay more attention to drinking in this age group.     

Readiness, action, and resolve for change: do health care leaders have what it takes?

Careful assessment and planning are not enough to lead organizational change. Success depends on deliberate action by leaders and the resolve to stay the course.