Reliability of random digit dialing calls to enumerate an adult female population

Challenges to random digit dialing have been documented, but the reliability of random digit dialing outcomes from telephone number calling, household identification, and enumeration has never been addressed, despite its potential to bias population representativeness by affecting completeness of coverage. The authors explored interobserver reliability of calls to numbers generated by random digit dialing for a 1990-1996 population-based case-control study in San Francisco, California, area women, using data from a quality control effort in which 122 of 4,890 random digit dialing numbers were assigned to a second interviewer for recontacting within 4 months. The 34 numbers discrepant between the first and second calls did not differ from the 88 unchanged outcomes, and reliability was good (kappa = 0.65, 95% confidence interval: 0.55, 0.75). Eligibility (an adult woman in the household) was confirmed for nine of 11 eligible households. However, six of 29 households originally ineligible because of gender were eligible on recontact, and eligible residences rose from 24% to 39% between the two calls, although the two groups of eligible women did not differ in age or race. This underenumeration of women by random digit dialing confirms prior observations, although interviewer differences or changes in respondents or household composition between the first and second calls may have contributed. Recontact of gender-ineligible households may improve completeness of random digit dialing coverage for female populations.     

Inaccurate communications in telephone calls to an antimicrobial stewardship program.

BACKGROUND: Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system--that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used--depends on the accuracy of the patient data communicated from the primary service. OBJECTIVES: To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication. DESIGN: We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard. SETTING: A tertiary care medical center that has a prior approval system for restricted antimicrobials. PATIENTS: Inpatients discussed in telephone ASP interactions. INTERVENTION: Observational study. RESULTS: Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]). CONCLUSIONS: A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.     

An analysis of telephone calls to an inner-city accident and emergency department.

The general public in the UK often telephone accident and emergency (A&E) departments for medical advice. Such calls are usually dealt with by nursing staff in an informal manner (often with no written record of the call being made). The specific questions addressed in this study are who was calling for advice, when did they call, what were their presenting complaints, and what was the outcome of the call? In addition, the study provided an opportunity to test the implementation of a new system of record-keeping for telephone consultation. A telephone consultation record (TCR) was developed and used to record details of each call made to the A&E department for medical/health advice. An analysis of 597 consecutive documented calls is presented in this paper. The majority of calls were dealt with by 'E' grade nursing staff (42.7%); only four calls (0.7%) were recorded by medical staff. Two hundred and six (43.5%) calls related to patients aged up to 15 years. In 57% of the cases the call was made by a third party. In all, 149 different presenting complaints were recorded on the TCRs. The three most common presenting complaints were dental problems (7.4%), fever (4.3%), and concerns about drug reactions (23%). Seventy-three per cent of callers were advised that a visit to the A&E department was not immediately necessary. The study identifies several important issues for development of a more formal and effective system of telephone advice. The majority of calls made to the A&E department appeared to be of a primary care nature but the extent to which nurses are trained to assess and advise on these problems needs to be questioned. A reluctance to document the calls to A&E was identified, one reason being a concern about accountability. Training and support are clearly required.     

Alternative strategies for selecting population controls: comparison of random digit dialing and targeted telephone calls

PURPOSE: This project was carried out to identify a valid framework for selecting controls to be used in a population-based case-control study of breast cancer, and to compare participation rates and characteristics between women contacted using a standard random digit dialing (RDD) strategy and those who were sent a letter of presentation prior to telephone contact (targeted telephone calls, TTC). METHODS: Twelve hundred women, ages 20-74, were sampled from the Department of Motor Vehicles (DMV) and Health Care Financing Administration (HCFA) records. Women for whom telephone numbers were obtained (N = 771) were randomly assigned to RDD or TTC. The respondents participated in a brief telephone interview. Odd ratios (OR) and their 95% confidence intervals (CI) were used to estimate differences in characteristics of the respondents between the two contact strategies. RESULTS: Telephone numbers were obtained for 79% of women aged > or = 55 years and for only 38% of women aged < 55 years. Interviews were obtained for 48% of women for whom we obtained telephone numbers, and for 77% of women for whom eligibility was confirmed via telephone contact. Participation of target women appeared to be higher for the TTC than the RDD group (42% vs. 35%, p = 0.054). Among respondents who were > or = 55 years old, those in the TTC group were 80% more likely (OR = 1.8, 95% CI: 0.9-3.4) to report a serious medical condition than women in the RDD group, 60% less likely (OR = 0.4, 95% CI: 0.2-1.0) to report having used oral contraceptives, and 80% less likely (OR = 0.2, 95% CI: 0.1-0.5) to report having had breast surgery. CONCLUSIONS: Characteristics of respondents differed according to method of contact. These differences, along with the sampling frame used, should be considered when interpreting findings of case-control studies.     

Accuracy of the estimated prevalence of obesity from self reported height and weight in an adult Scottish population

STUDY OBJECTIVE: To determine whether self reported heights and weights from Scottish adults can provide an accurate assessment of obesity prevalence in the population. DESIGN: Standardised clinic measurements of weight and height were compared against self reported values on a postal questionnaire in the fourth Scottish MONICA cross sectional study. SETTING: A sex and five year age band stratified random population sample drawn from general practitioner registers in north Glasgow in 1995. Response rate 63% for men and 62% for women. PARTICIPANTS: A total of 865 men and 971 women aged between 25 and 64 years. RESULTS: Men and women under-reported their weight by a mean (SD) of 0.63 (3.45) kg and 0.95 (2.64) kg respectively, and their height by a mean (SD) of 1.3 (2.50) cm and 1.7 (2.37) cm respectively. Estimated body mass index, BMI (kg/m2) varied from true (measured) BMI by +0.19 (1.40) for men and by +0.17 (1.34) for women. The only age/sex group in which BMI was under-estimated from self reports (mean 0.2) was the 55-64 year old women. Prediction equations that explained 90% (men) and 88% (women) of the difference between self reported and measured height included age and self reported weight. The equivalent prediction equations for weight explained 93% of the difference between self reported and measured weight for men and included smoking and diabetic status, while for women 96% of the variance was explained with no further variables being significant. Sensitivity and specificity for determining clinical obesity (BMI > or = 30) were 83% and 96% respectively for men, and 89% and 97% for women. CONCLUSIONS: This Scottish population was unique in the under-reporting of height as well as weight, which resulted in BMI estimates with low error. These data suggest that self reported weights and heights would be satisfactory for the monitoring of obesity prevalence in Scotland.     

Comparing patients' telephone calls after medical and surgical abortions

OBJECTIVE: The purpose of this study is to monitor the content, timing of and response to telephone calls from medical and surgical abortion patients in order to improve the counseling and nursing care and allay patient's concerns. METHODS: There were 43 calls from a possible 626 surgical patients and 100 calls from a possible 671 medical patients. Calls were considered preventable in 67% of the medical patients and 46.5% of the surgical patients. Women who were having their first abortion were more likely to place preventable calls. CONCLUSIONS: Calls could be reduced by explaining variations in normal bleeding and how to use analgesics and providing this information in diagrammatic form on an information sheet.     

不同身体测量指标预测中国城市成人血脂异常差异及截断值筛选

目的探讨身体测量指标预测中国城市成人血脂异常的差异,寻找合适的截断值。方法采用多阶段分层抽样法,于2016年3—7月在中国8个城市共获得1615名有效调查对象,调查社会人口学特征(年龄、性别、民族、受教育程度、收入)和疾病健康状况,测量身高、体重、腰围(WC)、臀围、体脂率(%Fat)及空腹血脂水平。使用受试者工作曲线(ROC)比较不同身体指标预测血脂异常的差异。结果腰高比(WHtR)预测女性血脂异常具有最大的受试者工作曲线下面积(AUC=0.744),与WC(P=0.008)、体质指数(BMI,P=0.004)、腰臀比(P=0.005)、%Fat(P0.001)的差异有统计学意义。WHtR预测城市成年女性血脂异常的截断值为0.50。BMI在男性中具有最大的AUC值(0.677),与其他指标差异均无统计学意义(P0.05),BMI预测城市成年男性血脂异常的截断值为24.1 kg/m2。结论在中国城市成人中,WHtR和BMI可能分别是预测成年女性和男性血脂异常的良好指标,在选择指标时应同时注意地域及性别差异。     

The nature and content of physician telephone calls in a private practice

Telephone encounters received by two physicians in a private rural family practice setting were examined over a 61-day sampling period. A total of 1,264 calls were received during the study period, with 905 (71.6 percent) being received in the office setting. An average of 10.4 calls per physician were received each day, and a mean of 16.2 minutes per physician was spent each day with telephone encounters. Each call was brief, lasting 1.6 minutes (standard deviation 1.5 minutes); administrative and personal calls each lasted significantly longer than other call categories (F = 20.8, P = .0001). More chronic disease diagnoses tended to be handled during office when compared with nonoffice telephone encounters. The majority of calls (932, or 83.1 percent) did not require a face-to-face visit as judged by the physician. Of the office calls, 58.2 percent were handled by the physicians through a message system rather than a direct physician telephone call. It is estimated that uncharged care over the telephone saved patients in this practice up to $150,000 per year.     

Differences between adolescent and adult mothers of infants

Samples of adolescent and adult mothers of 6-month-old infants were compared on parenting knowledge, quality of stimulation in the home, and family involvement with the infant. Adolescents perceived that care-giving had less influence on infant outcome and they provided a lower quality of stimulation in the home environment than did adults. For both groups, greater knowledge was associated with higher quality of stimulation in the home. Adolescents were more likely to live with their own mother/grandmother, less likely to live with the infant's father, and more likely to live in larger households. The adolescent's infant was more likely to have daily involvement with the maternal grandmother. Approximately 50% of the fathers in both groups were involved on a daily basis. The fathers were involved to a greater extent if the mother of the infant was an adult. Services to adolescents with infants should include an assessment of family participation in infant care and provide support to the mother.     

Associations between overall physical activity level and cardiovascular risk factors in an adult population

Background It is well established that physical activity level is inversely associated with cardiovascular morbidity and mortality, and with all-cause mortality. However, the dose–response relationship between physical activity and other cardiovascular disease risk factors is not fully understood. The aim of the present study was to explore the dose–response relationship between daily physical activity, as measured by a metabolic equivalent score, and BMI, waist circumference, waist hip ratio, total cholesterol, HDL, LDL, triglycerides, systolic and diastolic blood pressure. Methods A total of 1693 men and women, 33–64 years of age, from the 3 year follow-up of a population-based intervention study, were included in this cross-sectional study. Information on physical activity and other lifestyle factors was obtained by self-report questionnaire. Associations between activity level and biological variables were explored by general linear regression. Results Data from 835 (51%) men and 805 (49%) women were included. Mean age was 50.8 years (33–64). A significant inverse association between average 24-hour physical activity level ≤45 METs and waist circumference (men p = 0.012, women p = 0.011), BMI (p = 0.0004), waist-hip-ratio (p = 0.002) and triglycerides (p = 0.0001) was found as well as a positive association with HDL (p = <0.0001). In those with an activity level above 45 METs there were no associations. No association was found with total cholesterol, LDL, systolic or diastolic blood pressure. Conclusion This study suggests a linear dose–response relationship between activity level and certain biological cardiovascular risk factors up to a threshold of a daily 24 h MET-score of 45, which corresponds to a moderate physical activity level. Electronic Supplementary Material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Computerized telephone nurse triage. An evaluation of service quality and cost

The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients.     

Dietary fiber consumption in an adult population

OBJECTIVE: The dietary fiber has emerged as a leading dietary factor in the prevention and treatment of chronic diseases. I was estimated the average consumption of total dietary fiber (DF), insoluble fiber (IF) and soluble fiber (SF) in the meals of both sex adults from the town of Cotia, a metropolitan area in S. Paulo State, Brazil. METHODS: A population sample of Cotia country, S. Paulo (Brazil), consisted of 559 adults older than 20 years old, was studied. Food consumption was assessed by the dietary history habits. The amount of dietary fiber in each meal (breakfast, lunch and dinner) was estimated by the serving size. The foods were classified according to their fiber content in Very High (7 g or more), High (4.5 to 6.9), Moderate (2.4 to 4.4) and Low (<2.4). RESULTS: The average population's consumption of dietary fiber was of 24 g/day, with an average consumption of insoluble fiber of 17 g/day and soluble of 7 g/day. Among women, the average consumption was 20 g/day and among men 29 g/day (p<0.01). Most of the foods in their diet were classified as having a low content of dietary fiber. Beans were the most important dietary fiber source in the population diet. Lunch and dinner were the meal with a higher content of dietary fiber. CONCLUSIONS: A low consumption of dietary fiber in the population sample could be detected. Their usual sources of dietary fiber were poor.