Philip Zazove

Knowledge and attitudes about AIDS among deaf and hard of hearing persons

We investigated whether the public information being dispensed about Acquired Immunodeficiency Syndrome (AIDS) reaches Deaf and Hard of Hearing (D&HH) persons to the same extent as the rest of the American population. Using a self-administered written survey, modified so that D&HH persons whose primary language is American Sign Language (ASL) could understand the questions, we studied 40 D&HH and 37 hearing persons in southeast Michigan. There were no significant demographic differences between the two populations, but there were differences regarding attitudes towards and knowledge about AIDS. D&HH persons were less likely to associate sexual contact with drug users and number of sexual partners as high risk sexual behaviours, were more likely to believe that storing blood for future personal use lowers their chances of contracting AIDS, and believed that using public restrooms, kisses on the cheek and visiting an AIDS patients increased their chance of contracting AIDS. Furthermore, they were more likely to believe they did not need to change their sexual behaviour as a result of the AIDS epidemic. D&HH persons also reported different attitudes towards AIDS patients, such as they were not important to their community, dentists with AIDS should not be allowed to continue working, and landlords should be able to evict people with AIDS. Our findings suggest differences in receiving, trusting, and/or being exposed to current information about AIDS by the Deaf community, consistent with the fact that they are a minority population with distinct knowledge and cultural traditions.

Candida Transmission and Sexual Behaviors as Risks for a Repeat Episode of Candida Vulvovaginitis

OBJECTIVE To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. METHODS A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. RESULTS Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p </= 0.05). Male factors associated with recurrences in the woman included history of the male masturbating with saliva in the previous month (hazard ratio 3.68 [95% CI 1.24-10.87]) and lower age at first intercourse (hazard ratio 0.83 [95% CI 0.71-0.96]). CONCLUSIONS Sexual behaviors, rather than the presence of Candida species at various body locations of the male partner, are associated with recurrences of C. albicans vulvovaginitis.

Cancer Prevention Knowledge of People with Profound Hearing Loss

BACKGROUNDDeaf persons, a documented minority population, have low reading levels and difficulty communicating with physicians. The effect of these on their knowledge of cancer prevention recommendations is unknown.METHODSA cross-sectional study of 222 d/Deaf persons in Michigan, age 18 and older, chose one of four ways (voice, video of a certified American Sign Language interpreter, captions, or printed English) to complete a self-administered computer video questionnaire about demographics, hearing loss, language history, health-care utilization, and health-care information sources, as well as family and social variables. Twelve questions tested their knowledge of cancer prevention recommendations. The outcome measures were the percentage of correct answers to the questions and the association of multiple variables with these responses.RESULTSParticipants averaged 22.9% correct answers with no gender difference. Univariate analysis revealed that smoking history, types of medical problems, last physician visit, and women having previous cancer preventive tests did not affect scores. Improved scores occurred with computer use (p = 0.05), higher education (p < 0.01) and income (p = 0.01), hearing spouses (p < 0.01), speaking English in multiple situations (p < 0.001), and in men with previous prostate cancer testing (p = 0.04). Obtaining health information from books (p = 0.05), physicians (p = 0.008), nurses (p = 0.03) or the internet (p = 0.02), and believing that smoking is bad (p < 0.001) also improved scores. Multivariate analysis revealed that English use (p = 0.01) and believing that smoking was bad (p = 0.05) were associated with improved scores.CONCLUSIONPersons with profound hearing loss have poor knowledge of recommended cancer prevention interventions. English use in multiple settings was strongly associated with increased knowledge.

Sexual Behaviors and Other Risk Factors for Candida Vulvovaginitis

Sexual behaviors are associated with many genital infections, but the role of sexual variables as risk factors for Candida vulvovaginitis has not been clearly determined. To assess the association between sexual behaviors and other risk factors with the presence of Candida vulvovaginitis, we performed a case-control study comparing these potential risk factors in women with and without culture-documented Candida vulvovaginitis in two Midwestern community-based medical offices. Participants included 156 women with Candida vulvovaginitis and 92 controls, ages 18-60. Risk factors for Candida vulvovaginitis, including sexual and partnership behaviors, demographic data, past genital infections, exposures, and diet, were investigated using logistic regression. The presence of Candida vulvovaginitis was positively associated with recent cunnilingus (odds ratio [OR] = 2.22 for five times a month compared with no times, 95% confidence interval [CI] 1.36, 3.84), but was less likely in women who masturbated with saliva in the previous month (OR = 0.30 if masturbated five times vs. no times, 95% CI 0.09, 0.99). Other independent risk factors included knowing the sexual partner a shorter period of time (OR = 1.56 for 1 year vs. 5 years, 95% CI 1.16, 2.13) and lower milk ingestion (OR = 3.57 for no servings vs. two servings per day, 95% CI 2.00, 6.67). Increased number of sexual partners, early age at first intercourse, and increased frequency of intercourse are not related to risk.

Deafness among physicians and trainees: a national survey.

Purpose To describe the characteristics of and accommodations used by the deaf and hard-of-hearing (DHoH) physician and trainee population and examine whether these individuals are more likely to care for DHoH patients. Method Multipronged snowball sampling identified 86 potential DHoH physician and trainee participants. In July to September 2010, a Web-based survey investigated accommodations used by survey respondents. The authors analyzed participants’ demographics, accommodation and career satisfaction, sense of institutional support, likelihood of recommending medicine as a career, and current/anticipated DHoH patient population size. Results The response rate was 65% (56 respondents; 31 trainees and 25 practicing physicians). Modified stethoscopes were the most frequently used accommodation (n = 50; 89%); other accommodations included auditory equipment, note-taking, computer-assisted real-time captioning, signed interpretation, and oral interpretation. Most respondents reported that their accommodations met their needs well, although 2 spent up to 10 hours weekly arranging accommodations. Of 25 physicians, 17 reported primary care specialties; 7 of 31 trainees planned to enter primary care specialties. Over 20% of trainees anticipated working with DHoH patients, whereas physicians on average spent 10% of their time with DHoH patients. Physicians’ accommodation satisfaction was positively associated with career satisfaction and recommending medicine as a career. Conclusions DHoH physicians and trainees seemed satisfied with frequent, multimodal accommodations from employers and educators. These results may assist organizations in planning accommodation provisions. Because DHoH physicians and trainees seem interested in primary care and serving DHoH patients, recruiting and training DHoH physicians has implications for the care of this underserved population.

Emergency Department utilization among Deaf American Sign Language users

BACKGROUND Deaf American Sign Language (ASL) users comprise a linguistic minority population with poor health care access due to communication barriers and low health literacy. Potentially, these health care barriers could increase Emergency Department (ED) use. OBJECTIVE To compare ED use between deaf and non-deaf patients. METHOD A retrospective cohort from medical records. The sample was derived from 400 randomly selected charts (200 deaf ASL users and 200 hearing English speakers) from an outpatient primary care health center with a high volume of deaf patients. Abstracted data included patient demographics, insurance, health behavior, and ED use in the past 36 months. RESULTS Deaf patients were more likely to be never smokers and be insured through Medicaid. In an adjusted analysis, deaf individuals were significantly more likely to use the ED (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.11-3.51) over the prior 36 months. CONCLUSION Deaf American Sign Language users appear to be at greater odds for elevated ED utilization when compared to the general hearing population. Efforts to further understand the drivers for increased ED utilization among deaf ASL users are much needed.

To act or not to act: responses to electronic health record prompts by family medicine clinicians

Objective: A major focus of health care today is a strong emphasis on improving the health and quality of care for entire patient populations. One common approach utilizes electronic clinical alerts to prompt clinicians when certain interventions are due for individual patients being seen. However, these alerts have not been consistently effective, particularly for less visible (though important) conditions such as hearing loss (HL) screening. Materials and Methods: We conducted hour-long cognitive task analysis interviews to explore how family medicine clinicians view, perceive, and use electronic clinical alerts, and to utilize this information to design a more effective alert using HL identification and referral as a model diagnosis. Results: Four key direct barriers were identified that impeded alert use: poor standardization and formatting, time pressures in primary care, clinic workflow variations, and mental models of the condition being prompted (in this case, HL). One indirect barrier was identified: electronic health record and institution/government regulations. We identified that clinicians’ mental model of the condition being prompted was probably the major barrier, though this was often expressed as time pressure. We discuss solutions to each of the 5 identified barriers, such as addressing physicians’ mental models, by focusing on physicians’ expertise rather than knowledge to improve their comfort when caring for patients with the conditions being prompted. Conclusions: To unleash the potential of electronic clinical alerts, electronic health record and health care institutions need to address some key barriers. We outline these barriers and propose solutions.

Developing a CQI program in a family medicine department.

BACKGROUND Efforts to implement continuous quality improvement (CQI) principles in ambulatory or primary care settings still lag behind efforts in the hospital setting. Many physicians view the concept of CQI with unconcealed skepticism; the process of ambulatory care is very different from that of hospital-based care; and the data necessary to guide CQI efforts are often either missing or inaccurate in the outpatient setting. Since fall 1995, the Department of Family Medicine (DFM) at the University of Michigan (Ann Arbor), including approximately 35 faculty members at seven family practice sites, has been engaged in CQI projects. PLANNING AND IMPLEMENTATION The CQI committee had a six-month deadline to lay out a plan for educating all faculty and staff in the importance of the CQI approach to problems; design methods for all faculty and staff to buy in to the concepts; and develop a plan to address basic clinical CQI activities, administrative systems change and work environment improvement, and larger ad hoc projects in clinical care, educational programs, and research programs. IMPLEMENTATION CQI activities were incorporated into the routine monthly business agendas at each clinical site, each of which had a functioning local committee and had begun development of at least one CQI project. PROJECTING INTO THE FUTURE AND CONCLUSIONS Cost cutting has further moved CQI from the sideline to center stage in the DFMs activities. An effective CQI program can be a major asset in the current competitive health care market, but designing and implementing an outpatient CQI program is a difficult and complex process. Three major problems--the ongoing resistance to change, the slow pace of adding CQI projects to already overburdened work schedules, and the need to conduct the program with ever-decreasing resources available-persist.

Deep venous thrombosis after office vasectomy: a case report

IntroductionPostoperative pulmonary embolism is considered a complication of major surgery. However, thromboembolism can also occur following minor procedures. We report a case of a major embolic event following a straightforward office vasectomy.Case presentationA healthy 35-year-old Asian man underwent an uncomplicated office vasectomy. Soon after, he noticed vague chest pain and dyspnea. Lower extremity Doppler ultrasound revealed acute venous thrombosis. A computer-assisted tomography angiogram revealed extensive bilateral pulmonary emboli. Extensive laboratory work-up failed to identify thrombophilia. He has not had any recurrences in the eight years since the initial presentation.ConclusionThis case highlights that major embolic events can follow minor office procedures. Patients with suggestive findings should be investigated aggressively.

A Breast Cancer Education Program for D/deaf Women

Abstract:Barriers to obtaining breast cancer prevention knowledge and breast cancer screening have been noted among D/deaf women. A randomized controlled trial (RCT) is described that tested a culturally and linguistically tailored breast cancer education program conducted among a racially/ethnically diverse sample of 209 D/deaf women age 40 years or older. The study focused on D/deaf women with no more than a secondary education, a population at relatively high risk for incomplete breast health knowledge and services. This population’s inadequate breast cancer knowledge and screening practices and the value of the education program were confirmed. Knowledge increased from –baseline to 12-month follow-up in the intervention group, and in some instances the control group; increased intention to get a mammogram was observed in the intervention group. Possible reasons for the few significant intervention/control group differences at 12 months were examined. Materials from the RCT are available online.