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Personal health records: a scoping review

Archer, N; Fevrier-Thomas, U; Lokker, C; McKibbon, K A; Straus, S E
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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35.7%
Electronic personal health record systems (PHRs) support patient centered healthcare by making medical records and other relevant information accessible to patients, thus assisting patients in health self-management. We reviewed the literature on PHRs including design, functionality, implementation, applications, outcomes, and benefits. We found that, because primary care physicians play a key role in patient health, PHRs are likely to be linked to physician electronic medical record systems, so PHR adoption is dependent on growth in electronic medical record adoption. Many PHR systems are physician-oriented, and do not include patient-oriented functionalities. These must be provided to support self-management and disease prevention if improvements in health outcomes are to be expected. Differences in patient motivation to use PHRs exist, but an overall low adoption rate is to be expected, except for the disabled, chronically ill, or caregivers for the elderly. Finally, trials of PHR effectiveness and sustainability for patient self-management are needed.

A Review on Architectures and Communications Technologies for Wearable Health-Monitoring Systems

Custodio, Víctor; Herrera, Francisco J.; López, Gregorio; Moreno, José Ignacio
Fonte: Molecular Diversity Preservation International (MDPI) Publicador: Molecular Diversity Preservation International (MDPI)
Tipo: Artigo de Revista Científica
Publicado em 16/10/2012 EN
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Nowadays society is demanding more and more smart healthcare services that allow monitoring patient status in a non-invasive way, anywhere and anytime. Thus, healthcare applications are currently facing important challenges guided by the u-health (ubiquitous health) and p-health (pervasive health) paradigms. New emerging technologies can be combined with other widely deployed ones to develop such next-generation healthcare systems. The main objective of this paper is to review and provide more details on the work presented in “LOBIN: E-Textile and Wireless-Sensor-Network-Based Platform for Healthcare Monitoring in Future Hospital Environments”, published in the IEEE Transactions on Information Technology in Biomedicine, as well as to extend and update the comparison with other similar systems. As a result, the paper discusses the main advantages and disadvantages of using different architectures and communications technologies to develop wearable systems for pervasive healthcare applications.

Plastics and Environmental Health: The Road Ahead

North, Emily J.; Halden, Rolf U.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
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Plastics continue to benefit society in innumerable ways, even though recent public focus on plastics has centered mostly on human health and environmental concerns, including endocrine-disrupting properties and long-term pollution. The benefits of plastics are particularly apparent in medicine and public health. Plastics are versatile, cost-effective, require less energy to produce than alternative materials – such as metal or glass – and can be manufactured to have many different properties. Due to these characteristics, polymers are used in diverse health applications, such as disposable syringes and intravenous bags, sterile packaging for medical instruments as well as in joint replacements, tissue engineering, etc. However, not all current uses of plastics are prudent and sustainable, as illustrated by widespread, unwanted human exposure to endocrine-disrupting bisphenol-A (BPA) and di-(2-ethylhexyl)phthalate (DEHP), problems arising from the large quantities of plastic being disposed of, and depletion of non-renewable petroleum resources as a result of ever increasing mass-production of plastic consumer articles. By example of the healthcare sector, this review concentrates on benefits and downsides of plastics and identities opportunities to change the composition and disposal practices of these invaluable polymers for a more sustainable future consumption. It highlights ongoing efforts to phase out DEHP and BPA in the healthcare and food industry...

Validation of the SF-6D Health State Utilities Measure in Lower Extremity Sarcoma

Gundle, Kenneth R.; Cizik, Amy M.; Punt, Stephanie E. W.; Conrad, Ernest U.; Davidson, Darin J.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
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Aim. Health state utilities measures are preference-weighted patient-reported outcome (PRO) instruments that facilitate comparative effectiveness research. One such measure, the SF-6D, is generated from the Short Form 36 (SF-36). This report describes a psychometric evaluation of the SF-6D in a cross-sectional population of lower extremity sarcoma patients. Methods. Patients with lower extremity sarcoma from a prospective database who had completed the SF-36 and Toronto Extremity Salvage Score (TESS) were eligible for inclusion. Computed SF-6D health states were given preference weights based on a prior valuation. The primary outcome was correlation between the SF-6D and TESS. Results. In 63 pairs of surveys in a lower extremity sarcoma population, the mean preference-weighted SF-6D score was 0.59 (95% CI 0.4–0.81). The distribution of SF-6D scores approximated a normal curve (skewness = 0.11). There was a positive correlation between the SF-6D and TESS (r = 0.75, P < 0.01). Respondents who reported walking aid use had lower SF-6D scores (0.53 versus 0.61, P = 0.03). Five respondents underwent amputation, with lower SF-6D scores that approached significance (0.48 versus 0.6, P = 0.06). Conclusions. The SF-6D health state utilities measure demonstrated convergent validity without evidence of ceiling or floor effects. The SF-6D is a health state utilities measure suitable for further research in sarcoma patients.

DataView: National Health Expenditure Projections, 1994–2005

Burner, Sally T.; Waldo, Daniel R.
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1995 EN
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Using 1993 as a baseline and assuming that current laws and practices continue, the authors project U.S. health expenditures through the year 2005. Annual spending growth has declined since 1990, and, in the scenario reported here, that trend continues in 1994. Growth of health spending increases thereafter, but remains below the average experience of the past decade. Even so, health expenditures grow faster than the gross domestic product (GDP), and by 2005, account for 17.9 percent of the GDP. Unless the system changes, Medicare and Medicaid are projected to pay for an increasing share of total spending during the next decade.

Comparative Value of Four Measures of Retention in Expert Care in Predicting Clinical Outcomes and Health Care Utilization in HIV Patients

Reveles, Kelly R.; Juday, Timothy R.; Labreche, Matthew J.; Mortensen, Eric M.; Koeller, Jim M.; Seekins, Daniel; Oramasionwu, Christine U.; Bollinger, Mary; Copeland, Laurel A.; Jones, Xavier; Frei, Christopher R.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 20/03/2015 EN
Relevância na Pesquisa
35.7%
This study compared the ability of four measures of patient retention in HIV expert care to predict clinical outcomes. This retrospective study examined Veterans Health Administration (VHA) beneficiaries with HIV (ICD-9-CM codes 042 or V08) receiving expert care (defined as HIV-1 RNA viral load and CD4 cell count tests occurring within one week of each other) at VHA facilities from October 1, 2006, to September 30, 2008. Patients were ≥18 years old and continuous VHA users for at least 24 months after entry into expert care. Retention measures included: Annual Appointments (≥2 appointments annually at least 60 days apart), Missed Appointments (missed ≥25% of appointments), Infrequent Appointments (>6 months without an appointment), and Missed or Infrequent Appointments (missed ≥25% of appointments or >6 months without an appointment). Multivariable nominal logistic regression models were used to determine associations between retention measures and outcomes. Overall, 8,845 patients met study criteria. At baseline, 64% of patients were virologically suppressed and 37% had a CD4 cell count >500 cells/mm3. At 24 months, 82% were virologically suppressed and 46% had a CD4 cell count >500 cells/mm3. During follow-up, 13% progressed to AIDS...

The globalization of clinical drug development

Thiers, Fabio Albuquerque
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 58 p.; 3189328 bytes; 3189282 bytes; application/pdf; application/pdf
ENG
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Industry-sponsored clinical research of investigational drugs (also called clinical development) has traditionally been carried out in relatively developed countries in the North American, Western European, and Pacific regions. However, lately it has been widely reported that clinical trials starting now are becoming increasingly diffused globally, with significant growth of activity in so-called emerging economies in Eastern Europe, Latin America, and Southeast Asia. This change in location of clinical development activities has numerous implications for patients, health care providers, pharmaceutical companies, regulatory agencies and governments around the globe. Even though there is much debate about the topic, a public systematic quantitative assessment of the current status of the globalization of clinical drug development phenomenon is lacking. The objective of this thesis research is to provide such objective quantification while addressing some issues that are currently in active discussion. This thesis documents that the participation of emerging countries is still relatively small (13%) and they most commonly participate in very large (involving more than five countries) phase Ilb or III trials.; (cont.) Albeit perceived as small...

BE.104J Chemicals in the Environment: Toxicology and Public Health, Spring 2005; Chemicals in the Environment: Toxicology and Public Health

Sherley, James L.; Tannenbaum, Steven R., 1937-; Green, Laura C.
Fonte: MIT - Massachusetts Institute of Technology Publicador: MIT - Massachusetts Institute of Technology
EN-US
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This course addresses the challenges of defining a relationship between exposure to environmental chemicals and human disease. Course topics include epidemiological approaches to understanding disease causation; biostatistical methods; evaluation of human exposure to chemicals, and their internal distribution, metabolism, reactions with cellular components, and biological effects; and qualitative and quantitative health risk assessment methods used in the U.S. as bases for regulatory decision-making. Throughout the term, students consider case studies of local and national interest.

The effects of cigarette excise taxes on health and wages

RESTREPO, Brandon
Fonte: Instituto Universitário Europeu Publicador: Instituto Universitário Europeu
Tipo: Trabalho em Andamento Formato: application/pdf; digital
EN
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The cigarette excise tax is viewed as an important policy tool to reduce smoking-related health problems and productivity losses. This is based on evidence that higher cigarette taxes reduce cigarette consumption and induce people to quit smoking, but there is also evidence that smokers adopt potentially health-reducing smoking behaviors to compensate for higher cigarette costs. In this paper, I exploit the substantial variation in cigarette taxes across and within U.S. states over time to examine the impact of cigarette taxes on health and wages. The analysis reveals that higher cigarette taxes cause a reduction in wages and a reduction in the number of healthy days in the past month. The negative impact on healthy days is more pronounced among individuals with low incomes and high daily intakes of nicotine and tar. These results indicate that cigarette taxes have unintended negative consequences, which may be driven in part by compensatory smoking behaviors. Alternative mechanisms related to weight gain and alcohol consumption are explored, but the analysis reveals that there is no empirical support for them.

Mental health services in the Marine Corps an exploratory study of stigma and potential benefits of desigmatization training within the OSCAR (Operational Stress Control and Readiness) program

Cooper, Susanna R.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado
Relevância na Pesquisa
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Approved for public release; distribution in unlimited.; This study examines stigma associated with mental health services counseling in the Marine Corps for the purpose of assessing areas of concern where lack of awareness or stigma exists. Marines with longstanding unresolved personal problems or more immediate emotional distress may be less effective, they may also not know where to go for help. Secondly, stigma may be associated with the fear of negative performance evaluations and decreased future promotions, which may reflect an underutilization of the available mental health services. Results of this study reflect: 1)that stigma does exist; 2)that Marines have a poor knowledge of the availability and variety of mental health services; 3)that there is little in the way of destigmatization training within the Marine Corps. By studying civilian models which may have a destigmatization component, this study presents possible methods for incorporating destigmatization training into the OSCAR program. Theoretically, the results of this study, garnered through interviews with practitioners, literature, and an OSCAR program review, can be used to further the efficacy of Marine Corps mental health services by way of education and destigmatization training.

Strategies for the integration of medical and health representation within law enforcement intelligence fusion centers

Morrissey, James F.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado
Relevância na Pesquisa
35.7%
CHDS State/Local; Terrorism-related intelligence gathering, analysis and information dissemination would be improved and enhanced by including a medical and health element in law enforcement intelligence fusion centers. The lack of medical representation and participation in intelligence analysis and information dissemination has been an obstacle to effective terrorism prevention, preparedness and response. Terrorist acts, including weapons of mass destruction, would have a significant and profound impact on the medical and health community. The medical and health community should work more closely with the intelligence community and be privy to terrorism-related information and alerts. The three areas of implementation to be examined include the FBIâ s Joint Terrorism Task Force, state level fusion centers and local (city, county, regional) terrorism early-warning groups. The Terrorism Liaison Officer Program will be examined as an option for medical personnel to become involved in anti-terrorism efforts. Literature on the subject shows overwhelming support for the involvement of non-law enforcement public safety representation, including the medical and health communities, in intelligence fusion centers.

Qualia : a prescription for developing a quality health threat assessment

Pritchett, Beverly A.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado
Relevância na Pesquisa
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CHDS State/Local; The 9/11 Commission Report called for consolidation of intelligence assets in order to unify the knowledge base of the intelligence community agencies. This concept gave rise to the fusion center as a place for the fusion of multiple information sources from local, state, and federal levels of government. Although the need for inclusion of health and medical information in fusion centers has been documented, relatively few have done so, and a product designed specifically toward health and medical intelligence currently does not exist at the state and local level. The purpose of this paper is to document a methodology for development of a health threat assessment as a means for the intelligence community to maintain a decision advantage, particularly at the state and local level where the intelligence developed will provide the most benefit to first responders and the local community. This model demonstrates the need for the public health and medical community to improve collaboration across sectors to produce a more integrated product that enhances the understanding of the entire community, thus developing qualia. This can only be accomplished through trust, complete transparency, and clarification of expectations in order to establish the consummate information sharing community.

On the comparative costing of military vs. civilian modes of health care delivery

Whipple, David R.; Terasawa, Katsuaki
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Relatório
EN_US
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The views expressed are not necessarily those of BUMED or the Navy.; The military services of the United States maintain an extensive health care delivery system in order to ensure the appropriate level and availability of care to the active duty forces. If only the active duty personnel were to use these facilities they would operate at only a fraction of that possible given the necessity to staff for the military contingency plans. Thus, given the expansion of the health care fringe benefit package of the active duty and retired personnel, the non-active duty population for whose care the military become responsible in one form or another have been allowed, and sometimes urged to utilize at least a portion of this excess system capacity. The end of the draft and the resulting need to compete in the marketplace for medical personnel, as well as the general inflation in the health care sector, has spotlighted the increasing cost of caring for these dependent groups. The question has arisen of whether it might not be cheaper to shift some of this demand for health care to the civilian sector. In this paper we examine analytically the appropriate considerations and elements to be compared in this research point out the crucial empirical work necessary to estimate such a model...

La gestión por competencias, un modelo para la gestión de recursos humanos en las organizaciones sanitarias.; Management by area: a model for the management of human resources in health organizations.

Villa Andrada, J. M.; Garví García, M.; García Retamar, S.; Galindo Casero, A.; Merchán Felipe, M.N.; Rojo Durán, R.M.
Fonte: Murcia : Servicio de Publicaciones de la Universidad de Murcia Publicador: Murcia : Servicio de Publicaciones de la Universidad de Murcia
Tipo: Artigo de Revista Científica Formato: application/pdf
SPA
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La gestión por competencias constituye un modelo de participación y estímulo adaptable a la carrera profesional del profesional sanitario. Es un modelo integral de gestión de los recursos humanos que contribuye a tal fin, detectando, adquiriendo, potenciando y desarrollando las competencias que dan valor añadido a la organización y que le diferencia en su sector. Propone un estilo de dirección donde prima el factor humano, en el que cada persona debe aportar sus mejores cualidades a la organización. Extender un nuevo modelo de dirección en la organización sanitaria, sensibilizar a los lectores sobre la importancia y la repercusión de la gestión por competencias y aportar una visión global e integral conociendo las herramientas específicas de la gestión de recursos humanos por competencias, son los objetivos que nos hemos planteado. El modelo que presentamos, se viene posicionando como uno de los más adecuados para los nuevos tiempos. Se trata de una manera de lidiar con lo cotidiano, de tal manera que posibilita la formación del capital intelectual de una institución u organización. La mayoría de las empresas en general y de las organizaciones sanitarias en particular, invierten de forma muy tímida en el desarrollo de sus equipos...

TRICARE: an organizational change study in the military health services system

Nerio, Guillermo.; O'Connor, Richard B.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado Formato: 116 p.
EN_US
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Approved for public release; distribution is unlimited.; Approved for public release; distribution is unlimited.; This thesis is a qualitative analysis of the managed care approach to delivering health care in the Tidewater area of Virginia. The thesis begins with the development of civilian health care as well as the history of Navy and military medicine. This is followed by the development of managed care within the Department of Defense. A sociotechnical systems approach is then used to analyze the central function of accessing health care through the TRICARE service Center in the Tidewater area. The analysis disclosed some key deviations from providing the patient quick, dependable access into the military health care system. To control these variances, the establishment of horizontal coordination and communication linkages are recommended.; Captain, United States Marine Corps; Captain, United States Army

Organizational Innovation in Health Care

Haque, Rezwan
Fonte: Harvard University Publicador: Harvard University
Tipo: Thesis or Dissertation; text Formato: application/pdf
EN
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This dissertation investigates whether differences in organizational innovation amongst health care providers can explain the huge variation in costs and outcomes. I specifically consider two facets of organizational innovation: the deployment of information technology and the relationships between hospitals and physicians. In the first chapter, I investigate IT adoption in a service setting by considering the impact of electronic medical records (EMRs) on the length of stay and clinical outcomes of patients in US hospitals. To uncover the distinct impacts of EMRs on operational efficiency and care coordination, I present evidence of heterogeneous effects by patient complexity. I find that EMRs have the largest impact for relatively less complex patients. Admission to a hospital with an EMR is associated with a 2\% reduction in length of stay and a 9\% reduction in thirty-day mortality for such patients. In contrast, there is no statistically significant benefit for more complex patients. However, I present three additional results for complex cases. First, patients returning to the same hospital benefit relative to those who previously went to a different hospital, which could be due to easier access to past electronic records. Second...

Enabling the nation's schools to help prevent heart disease, stroke, cancer, COPD, diabetes, and other serious health problems.

Kolbe, Lloyd; Kann, Laura; Patterson, Beth; Wechsler, Howell; Osorio, Jenny; Collins, Janet
Fonte: Association of Schools of Public Health Publicador: Association of Schools of Public Health
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
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In the United States, more than 53 million young people attend nearly 120,000 schools, usually for 13 of their most formative years. Modern school health programs--if appropriately designed and implemented--could become one of the most efficient means the nation might employ to reduce the establishment of four main chronic disease risks: tobacco use, unhealthy eating patterns, inadequate physical activity, and obesity. The U.S. Centers for Disease Control and Prevention and its partners have developed four integrated strategies to help the nation's schools reduce these risks. Participating national, state, and local agencies (1) monitor critical health risks among students, and monitor school policies and programs to reduce those risks; (2) synthesize and apply research to identify, and to provide information about, effective school policies and programs; (3) enable state, large city, and national education and health agencies to jointly help local schools implement effective policies and programs; and (4) evaluate implemented policies and programs to iteratively assess and improve their effectiveness.

Medical care employment in the United States, 1968 to 1993: The importance of health sector jobs for African Americans and women.

Himmelstein, D U; Lewontin, J P; Woolhandler, S
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1996 EN
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35.7%
OBJECTIVES: The purpose of this study was to elucidate the social and economic impact of health sector employment. METHODS: US medical care employment was analyzed for each year between 1968 and 1993, with data from the March Current Population Survey. RESULTS: Between 1968 and 1993, medical care employment grew from 4.32 million to 11.40 million persons, accounting for 5.7% of all jobs in 1968 and 8.4% in 1993. Today, one seventh of employed women work in medical care; they hold 78% of medical care jobs. One fifth of all employed African-American women work in medical care. African-Americans hold 15.5% of jobs in the health sector: they hold 24.1% of the jobs in nursing homes, 15.9% of the jobs in hospitals, but only 5.6% of the jobs in practitioners' offices. Hispanics constitute 6.4% of medical care employees. Real wages rose 25% to 50% between 1968 and 1993 for most health occupations. Wages of registered nurses rose 86%; physicians' incomes rose 22%. Wages of nursing home workers were far lower than those of comparable hospital workers, and the gap has widened. In 1993, 11.7% of all medical care workers lacked health insurance and 597 000 lived in poverty. CONCLUSIONS: Hospital cuts and the continuing neglect of long-term care exacerbate unemployment and poverty among women and African Americans.

The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.

O'Donnell, L; Stueve, A; San Doval, A; Duran, R; Haber, D; Atnafou, R; Johnson, N; Grant, U; Murray, H; Juhn, G; Tang, J; Piessens, P
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/1999 EN
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35.7%
OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.

Common colds. Reported patterns of self-care and health care use.

Vingilis, E.; Brown, U.; Hennen, B.
Fonte: College of Family Physicians of Canada Publicador: College of Family Physicians of Canada
Tipo: Artigo de Revista Científica
Publicado em /11/1999 EN
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OBJECTIVE: To describe the self-reported prevalence and patterns of self-care and health care use for colds and flu. DESIGN: Using the expert panel method, a questionnaire was developed to explore self-care practices, attitudes, pharmaceutical use, and health care use for a range of cold and flu symptoms. SETTING: London and Windsor, Ont. PARTICIPANTS: Using a random-digit-dialing survey method, 210 residents were interviewed between November and December 1993. Of 1484 telephone numbers called, 1179 calls were ineligible. Two hundred ten questionnaires were completed for 305 eligible respondents. MAIN OUTCOME MEASURES: Demographic data, typical self-care practices, actual practice during respondents' last cold, opinions on appropriate practices, and knowledge of how to treat colds. RESULTS: Self-care was respondents' treatment of choice, and most respondents use over-the-counter drugs. Prescription drug use was low. Only 1% reported seeing a physician for their last cold. As the number of symptoms increased, however, reported use of over-the-counter drugs and calls or visits to doctors increased. CONCLUSIONS: Results are congruent with other studies showing that the health care practices of most respondents are consistent with low use of the health care system and high levels of self-care for colds and flu.