Knowledge of and attitudes toward the pill: results of a national survey in Japan.

CONTEXT: After decades of debate, the oral contraceptive pill was legalized in Japan in June 1999. Because the pill had been unavailable up until then, little is known about the public's knowledge about, attitudes toward and intentions to use the pill. METHODS: In a nationwide probability sample, 630 women and men were interviewed in their homes in March 1999. Respondents were asked a range of questions to gauge their knowledge about and attitudes toward the pill. RESULTS: Most respondents (79%) could identify both the name and purpose of the birth control pill. Roughly the same proportion of respondents held an overall positive impression (44%) as held a negative impression (42%) of the pill, and 14% were undecided about the method. The pill's high level of effectiveness in pregnancy prevention was the most common reason for having a favorable impression of it (47%). Women were more concerned about side effects than were men, and they also knew more about the pill's potential side effects than did men. Only 12% of respondents said they intended to use the pill if it were approved. Roughly one-quarter (23-26%) did not correctly identify the pill's inability to protect against HIV and other sexually transmitted diseases (STDs). CONCLUSIONS: Legalization of oral contraceptives in Japan has led to an urgent need to educate both men and women on the inability of the pill to protect against STDs, including HIV Policymakers and providers need to recognize the importance of encouraging dual method use in Japan.

Rehabilitation exercises for common sports injuries.

Residual weakness after joint injury is a risk factor for recurrent injury. A rehabilitation program helps patients recover strength and helps prevent further injuries. Orthopedic injuries account for 10 percent of visits to family physicians, yet many primary care physicians do not routinely prescribe rehabilitation exercises for injured patients. Illustrations of exercises for the hip, knee, ankle and shoulder are included as a reference for family physicians to use when prescribing rehabilitation exercises.

Shoulder rotator torques in female tennis and nontennis players.

The purposes of this study were to compare internal and external rotation torque measurements of the dominant arm during concentric and eccentric muscle actions, to determine the relationship between peak and average torques, and to compare shoulder rotator capabilities of tennis and nontennis playing women. Twenty healthy nontennis players and 20 healthy intercollegiate tennis players performed concentric-eccentric cycles at 60 degrees /sec angular velocity while seated with the glenohumeral joint at 45 degrees abduction and in the scapular plane (30 degrees horizontal flexion). No significant differences were observed between the two groups on peak or average torques within 115 degrees range of motion, on average torques within +/- 30 degrees of neutral, or on peak/average torque ratios (p > 0.05). Regardless of muscle action, the internal rotators produced significantly greater peak and average torques during eccentric actions than the external rotators (p < 0.01). Eccentric muscle actions produced significantly greater torques than concentric actions (p < 0.01). Peak torques were highly related to average torques within 115 degrees range of motion (r = 0.85-0.93) and less related within +/- 30 degrees of neutral (r = 0.76-0.91). This study provides comparative data for a test position and protocol that may be applicable early in rehabilitation. J Orthop Sports Phys Ther 1991;13(1):40-46.

A comparison of the treatment of rheumatoid arthritis in health maintenance organizations and fee-for-service practices.

This study compares the use of health care services (hospital and ambulatory) by patients with rheumatoid arthritis who were under the care of rheumatologists in prepaid and fee-for-service arrangements. Participating physicians from a random sample of half the rheumatologists in northern California maintained a log of all their patients with well-established diagnoses of rheumatoid arthritis. We interviewed 822 of their patients, using a structured, validated phone survey to obtain information about health care use. Patients in prepaid plans had about the same number and type of hospitalizations and the same rate of surgery as those receiving fee-for-service care. However, fee-for-service patients made more ambulatory visits. We conclude that the use of expensive services (hospital admissions and surgery) for the care of patients with rheumatoid arthritis is not different in fee-for-service and prepaid settings.

Social and economic impacts of four musculoskeletal conditions. A study using national community-based data.

The present study uses data from a national, community-based survey to compare the social impact of and medical care use due to 4 musculoskeletal conditions: rheumatoid arthritis, osteoarthritis, lower back pain, and tendinitis. The study also compares the impacts experienced by persons with these conditions with those experienced by a sample of persons having a broader range of musculoskeletal conditions, and by an age-adjusted sample representing the entire U.S. population. Rheumatoid arthritis leads to the most frequent use of physician services; lower back pain results in the most hospitalizations and surgery. Rheumatoid arthritis also causes the most restriction in activity. We found that as a broad group, persons with musculoskeletal disease experience about the same amount of restriction in activity and use about the same amount of medical care as U.S. citizens as a whole. This study demonstrates that health planning on the basis of specific musculoskeletal conditions is necessary to serve the disparate needs of persons with particular, discrete conditions.

Is health care use equivalent across social groups? A diagnosis-based study.

Previous studies of medical care utilization have controlled for medical need by signs or symptoms or broad disease classifications. The present study uses both symptoms and discrete diagnoses to control for medical need in order to determine if the use of ambulatory and hospital care differs by race, income, education, insurance coverage, or region. Using data from the 1976 National Health Interview Survey, we found that there were no consistent differences in the number of physician visits made in a year by these characteristics, medical need held constant. Lack of insurance coverage was associated with fewer hospitalizations in a year for five of nine chronic diseases under review. Race was associated with fewer hospitalizations for two conditions prevalent among minorities. These effects were not evident when medical need was controlled solely by signs or symptoms.