Health care seeking behavior and perceptions of the medical profession among pre- and post-retirement age Dutch dancers.

A cross-sectional, descriptive survey and a medical chart review of 154 pre- and post-retirement age injured Dutch dancers were performed. The purpose was to examine dancers' health care seeking behavior and perceptions of the medical profession in context of the current health care system in The Netherlands, which includes both universal access and expertise in performing arts medicine. No logistical or perceptual restrictions to health care were reported by the dancers in this study. Only three younger dancers (< 35 years) lacked a primary care physician. No dancer reported monetary or insurance hindrances to acquiring an appointment or fear of going to the doctor. A small percentage of the younger group (18%), but none of the older dancers, reported that they felt the doctor would not understand them (chi(2) = 2.2, df = 1, p = 0.14). Dancers in both age groups most often sought first treatment from either a physiotherapist (36% to 40%) or a medical doctor (38.8% to 40.8%). When a physician was not consulted first, the primary reason was that dancers had already seen a physiotherapist and thought this treatment was sufficient. Approximately one-third of dancers expected their medical problem to go away on its own. Dutch dancers were additionally found to have a positive relationship with the medical profession, including high satisfaction and confidence. The majority of dancers were satisfied or very satisfied with their medical treatment prior to presenting to the dance medicine specialist (67% older dancers, 52% younger, chi(2) = 1.19, df = 1, p = 0.2). Nearly every dancer was satisfied or very satisfied after treatment by the specialist (100% older dancers, 93% younger dancers, chi(2) = 1.46, df = 1, p = 0.2), and moderately or completely confident of full recovery (80%, each group). Differences in older and younger dancers' perceptions and behaviors were nevertheless found. Older dancers were significantly more likely to continue to dance when injured than younger dancers (100% versus 82%, chi(2) = 5.14, df = 1, p = 0.02), although pain and perceived level of artistic hindrance were similar between the groups at first presentation to a dance medicine clinic (pain: 32.6 versus 34.0 mm, respectively, p = 0.83; artistic hindrance: 49.3 versus 58.0 mm, p = 0.29, respectively). Older dancers were more likely to wait and see for themselves whether an injury would get better by itself (14% versus 4%, chi(2) = 4.1, df = 1, p = 0.05). Average time to seek treatment from a medical doctor was four times longer among older than younger dancers (8.4 versus 2.1 months, respectively, p = 0.004), and older dancers had less confidence in full recovery at first visit (40% versus 61%, chi(2) = 3.8, df = 1, p = 0.05). Thus, the medical system of The Netherlands is one that confers improved health care access and perceptions of the medical profession among dancers, yet there remain areas to be addressed in terms of equalization of health care delivery.

The management of thyroid nodules in patients with primary hyperparathyroidism.

BACKGROUND: Thyroid nodules are found in 12-52% of patients with primary hyperparathyroidism (pHPT). With the increasing use of minimally invasive parathyroidectomy (MIP), there is no standard approach for the management of incidental thyroid nodules in pHPT patients. METHODS: A survey was conducted of the American Association of Endocrine Surgeons. Information was obtained regarding parathyroidectomy practice patterns, including surgical technique, preoperative localization procedures, and algorithms used in the diagnosis/treatment of incidental thyroid nodules. RESULTS: The survey response rate was 74%. Sixty-seven percent were high-volume parathyroid surgeons (>5/mo); the majority performed MIP. High-volume surgeons were more likely to use Sestamibi/single photon emitted computed tomography for preoperative localization (40% versus 24%; P = 0.011) and to disregard incidentally discovered thyroid nodules <1 cm (41% versus 22%; P = 0.023). They were less likely to evaluate nodules discovered intraoperatively by frozen section (28% versus 41%; P = 0.081), fine-needle aspiration (13% versus 24%; P = 0.078), or thyroidectomy (24% versus 40%; P = 0.03). Surgeons performing open parathyroidectomy were more likely than those who use MIP to biopsy nodules intraoperatively (32% versus 20%; P < 0.05) and perform simultaneous thyroidectomy (30% versus 10%; P < 0.001). CONCLUSIONS: Experienced endocrine surgeons disagree about the optimal management of incidental thyroid nodules encountered during parathyroidectomy. Our data suggest that high-volume parathyroid surgeons are less aggressive in their evaluation of thyroid pathology in patients with pHPT. Variation in practice among this experienced group implies even greater variation in the broader surgical community, and in the quality and cost of care for patients with pHPT.

Filling a void: thyroid cancer surgery information on the internet.

BACKGROUND: Thyroid cancer incidence is increasing, making it an important public health issue. Many patients use the Internet for health-related decisions. Our purposes were to measure the quality of thyroid cancer surgery information on the Internet, and to identify quality predictors. METHODS: The 50 most popular thyroid cancer websites from Google, Yahoo, and MSN were identified. A novel 55-point instrument based on current clinical practice guidelines was designed and used by a Delphi panel of 5 "blinded" endocrine surgeons to assess website information. Each website was independently evaluated by two surgeons. Quality was related to website demographic data using the Student's t-test, chi-square, and ANOVA analyses. RESULTS: Inter-rater reliability for quality scores was excellent (kappa = 0.81). Mean (% of overall quality) score was 21 (38%), and mean score for surgical content was low at 3.5 (29%). Only 50% of sites discussed indications for surgery; 8% length of surgery/anesthesia; 42% the role of lymphadenectomy; 44% recurrent laryngeal nerve injury/hoarseness and 42% hypoparathyroidism as potential complications; 16% recovery; and 20% recommendations for choosing a thyroid surgeon. Only 38% were updated within 2 years. On univariate analysis, no significant associations were found between surgical quality score and website country of origin, currency, sponsorship, authorship, oversight, or references. CONCLUSIONS: Thyroid cancer surgery websites on the Internet are incomplete and outdated. No predictors of quality were identified. Significant improvement is needed in regulating information about thyroid cancer surgery on the Internet, and surgeons may contribute to this effort.

Outdated and incomplete: a review of thyroid cancer on the World Wide Web.

OBJECTIVE: To evaluate the most frequently searched thyroid cancer websites for completeness, accuracy, and consumer friendliness. DESIGN: The 50 most popular thyroid cancer websites were evaluated using a novel instrument developed by a Delphi panel of endocrine experts and based on practice guidelines. Each website received independent scores for disease-specific information and a final quality score. Quality was related to website demographics using the Student t test, chi-square, and ANOVA analyses. MAIN OUTCOMES: Interrater reliability was excellent (kappa = 0.81). Most websites were not specific to thyroid cancer alone (72%), contained advertisements (72%), lacked references (66%), and were privately sponsored (50%). Only 38% had been updated within 2 years. "Government" and "Non-Profit" websites were the most consumer friendly. Mean quality score of medical content was 38%, with websites receiving the highest score in "Anatomy/Physiology" (55%) and lowest in "Surgery" (29%). Low quality score was attributed to information deficiency rather than inaccuracy. On univariate analysis, no significant associations were found between quality score and country of origin, currency, sponsorship, authorship, administration, advertisements, or references. CONCLUSIONS: Thyroid cancer websites are out of date and incomplete, lacking important information sought by patients, particularly surgical information. An accurate, comprehensive, easily available, and patient-oriented thyroid cancer Internet resource is needed for patients.

SAFB2, a new scaffold attachment factor homolog and estrogen receptor corepressor.

We have characterized previously the nuclear matrix protein/scaffold attachment factor (SAFB) as an estrogen receptor corepressor and as a potential tumor suppressor gene in breast cancer. A search of the human genome for other potential SAFB family members revealed that KIAA00138 (now designated as SAFB2) has high homology to SAFB (now designated as SAFB1). SAFB1 and SAFB2 are mapped adjacent to each other on chromosome 19p13.3 and are arranged in a bidirectional divergent configuration (head to head), being separated by a short (<500 bp) GC-rich intergenic region that can function as a bidirectional promoter. SAFB1 and SAFB2 share common functions but also have unique properties. As shown previously for SAFB1, SAFB2 functions as an estrogen receptor corepressor, and its overexpression results in inhibition of proliferation. SAFB1 and SAFB2 interact directly through a C-terminal domain, resulting in additive repression activity. They are coexpressed in a number of tissues, but unlike SAFB1, which is exclusively nuclear, SAFB2 is found in the cytoplasm as well as the nucleus. Consistent with its cytoplasmic localization, we detected an interaction between SAFB2 and vinexin, a protein involved in linking signaling to the cytoskeleton. Our findings suggest that evolutionary duplication of the SAFB gene has allowed it to retain crucial functions, but also to gain novel functions in the cytoplasm and/or nucleus.