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PubMed2005

Group consensus in social influence: type of consensus information as a moderator of majority and minority influence.

Three experiments investigated the effect of consensus information on majority and minority influence. Experiment 1 examined the effect of consensus expressed by descriptive adjectives (large vs. small) on social influence. A large source resulted in more influence than a small source, irrespective of source status (majority vs. minority). Experiment 2 showed that large sources affected attitudes heuristically, whereas only a small minority instigated systematic processing of the message. Experiment 3 manipulated the type of consensus information, either in terms of descriptive adjectives (large, small) or percentages (82%, 18%, 52%, 48%). When consensus was expressed in terms of descriptive adjectives, the findings of Experiments 1 and 2 were replicated (large sources were more influential than small sources), but when consensus was expressed in terms of percentages, the majority was more influential than the minority, irrespective of group consensus.

Adolescent↗
PubMed2000

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study.

OBJECTIVE: To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices. METHOD: Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire. RESULTS: Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential. CONCLUSIONS: The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

Adult↗
PubMed2003

Dame Muriel Powell (1914-1978): role model of a hospital matron and leader of nursing.

Muriel Powell was for 22 years matron of St George's Hospital, London, and for a brief period Chief Nursing Officer in the Scottish Home and Health Department in Edinburgh. She was an influential role model, an influential leader of and spokesperson for her profession, and a member of the government committee that recommended the removal of the title "matron" from the National Health Service in 1968. The title is now being reintroduced and one of the purposes of this paper is to highlight the lack of any consideration having been given to the historical background of the title and the reasons why it was removed.

History, 20th Century↗
PubMed1998

The art of nursing.

This article discusses the question of whether, as is often claimed, nursing is properly described as an art. Following critical remarks on the claims of Carper, Chinn and Watson, and Johnson, the account of art provided by RG Collingwood is described, with particular reference to his influential distinction between art and craft. The question of whether nursing is best described as an art or a craft is then discussed. The conclusion is advanced that nursing cannot properly be described as an art, given acceptance of Collingwood's influential definition of art. Moreover, it is shown that, due to difficulties inherent in specifying the 'ends' of nursing, nursing is only problematically described as a craft.

Art↗
PubMed2003

The news on health behavior: coverage of diet, activity, and tobacco in local newspapers.

News media are an important and influential part of the social environment, calling attention to certain issues by the amount and nature of their coverage. To better understand how health behaviors are covered, we examined more than 80,000 stories in 1,354 newspaper issues from four midsize Missouri communities. Health behavior stories were rare. Of 1,373 stories (1.7%) that addressed diet, physical activity, or tobacco, few were prominently located in the paper, and only half had a primary prevention focus. A large majority had no local angle, local quotes, or call to action for individuals or the community, and only 10% were generated by local reporters. Because the local newspaper can be especially influential in smaller communities, strategies are needed to help reporters and editors in these settings provide more and better coverage of health behavior-related stories.

Chi-Square Distribution↗
PubMed1998

The limits of leadership: opinion leaders in general practice.

OBJECTIVE: To explore the importance and characteristics of opinion leaders in general practice, particularly in relationship to the use of laboratory tests. DESIGN: Focus group discussions and a mailed survey. SUBJECTS: Five focus groups (n = 29 participants) in four different municipalities and a random sample of 85 general practitioners (GPs) in Norway. RESULTS: While Norwegian GPs recognised colleagues who were influential in determining how they practised, they found it difficult to identify opinion leaders specifically with respect to the use of laboratory tests. Opinion leaders were thought to be less important in influencing the use of laboratory tests than continuing medical education activities and practice guidelines, but more important than industry, patients or personal financial interests. Norwegian GPs recognised and characterised opinion leaders in much the same way as physicians in the USA. Influential colleagues were characterised as being good conveyers of information and willing to take time, as well as being up-to-date and having a high level of clinical expertise. GPs expressed a negative attitude towards 'superspecialists' who give advice without knowing the epidemiology of general practice, people who are arrogant and people who do not show respect towards GPs. CONCLUSIONS: The potential to identify and use opinion leaders to improve the use of laboratory tests by GPs in Norway appears to be limited.

Attitude of Health Personnel↗
PubMed2002

The public health relevance of air pollution abatement.

Assuming a causal relationship between current levels of air pollution and morbidity/mortality, it is crucial to estimate the public health relevance of the problem. The derivation of air pollution attributable cases faces inherent uncertainties and requires influential assumptions. Based on the results of the trinational impact assessment study of Austria, France, and Switzerland, where prudent estimates of the air pollution attributable cases (mortality, chronic bronchitis incidence, hospital admissions, acute bronchitis among children, restricted activity days, asthma attacks) have been made, influential uncertainties are quantified in this review. The public health impact of smoking, environmental tobacco smoke, and air pollution on the prevalence of chronic cough/phlegm are outlined. Despite all methodological caveats, impact assessment studies clearly suggest that public health largely benefits from better air quality. The studies are selective underestimates as they are strongly driven by mortality, but do not include full quantification of the impact on morbidity and their consequences on quality of life among the diseased and the caregivers. Air pollution abatement strategies are usually political in nature, targeting at polities, regulation and technology in mobile or stationary sources rather than at individuals. It is of note that key clean air strategies converge into abatement of climate change. In general, energy consumption is very closely related to both air pollution and greenhouse gases. The dominant causes of both problems are the excessive and inefficient combustion of fossil fuel. Thus, for many policy options, the benefit of air pollution abatement will go far beyond what prudent health-impact assessments may derive. From a climate change and air pollution perspective, improved energy efficiency and a strong and decisive departure from the "fossil fuel" combustion society is a science-based must. Health professionals must raise their voices in the political decision process to give strong support for clean air policies, both on a national and international level.

Air Pollution↗
PubMed2001

Reporting of conflicts of interest in guidelines of preventive and therapeutic interventions.

BACKGROUND: Guidelines published in major medical journals are very influential in determining clinical practice. It would be essential to evaluate whether conflicts of interests are disclosed in these publications. We evaluated the reporting of conflicts of interest and the factors that may affect such disclosure in a sample of 191 guidelines on therapeutic and/or preventive measures published in 6 major clinical journals (Annals of Internal Medicine, BMJ, JAMA, Lancet, New England Journal of Medicine, Pediatrics) in 1979, 1984, 1989, 1994 and 1999. RESULTS: Only 7 guidelines (3.7%) mentioned conflicts of interest and all were published in 1999 (17.5% (7/40) of guidelines published in 1999 alone). Reporting of conflicts of interest differed significantly by journal (p=0.026), availability of disclosure policy by the journal (p=0.043), source of funding (p < 0.001) and number of authors (p=0.004). In the entire database of 191 guidelines, a mere 18 authors disclosed a total of 24 potential conflicts of interest and most pertained to minor issues. CONCLUSIONS: Despite some recent improvement, reporting of conflicts of interest in clinical guidelines published in influential journals is largely neglected.

Clinical Trials as Topic↗
PubMed2005

Structural equation model testing and the quality of natural killer cell activity measurements.

BACKGROUND: Browne et al. [Browne, MacCallum, Kim, Andersen, Glaser: When fit indices and residuals are incompatible. Psychol Methods 2002] employed a structural equation model of measurements of target cell lysing by natural killer cells as an example purportedly demonstrating that small but statistically significant ill model fit can be dismissed as "negligible from a practical point of view". METHODS: Reanalysis of the natural killer cell data reveals that the supposedly negligible ill fit obscured important, systematic, and substantial causal misspecifications. RESULTS: A clean-fitting structural equation model indicates that measurements employing higher natural-killer-cell to target-cell ratios are more strongly influenced by a progressively intrusive factor, whether or not the natural killer cell activity is activated by recombinant interferon gamma (rIFN gamma). The progressive influence may reflect independent rate limiting steps in cell recognition and attachment, spatial competition for cell attachment points, or the simultaneous lysings of single target cells by multiple natural killer cells. CONCLUSIONS: If the progressively influential factor is ultimately identified as a mere procedural impediment, the substantive conclusion will be that measurements of natural killer cell activity made at lower effector to target ratios are more valid. Alternatively, if the individual variations in the progressively influential factor are modifiable, this may presage a new therapeutic route to enhancing natural killer cell activity. The methodological conclusion is that, when using structural equation models, researchers should attend to significant model ill fit even if the degree of covariance ill fit is small, because small covariance residuals do not imply that the underlying model misspecifications are correspondingly small or inconsequential.

Child↗
PubMed2006

Health-seeking behaviors and self-care practices of Dominican women with lymphoedema of the leg: implications for lymphoedema management programs.

BACKGROUND: In the Dominican Republic, a Latin American country with filariasis-endemic areas, more than 63,000 people have lymphatic filariasis and more than 400,000 people are at risk of future infection. In this paper, we explore the health beliefs, health-seeking behaviors and self-care practices of women with lymphoedema in filariasis-endemic areas to better understand the needs of women when developing lymphoedema morbidity control programs. METHODS: Qualitative data were collected through semi-structured interviews of 28 women, 3 focus group discussions with 28 women, field notes and photographs. RESULTS: Women described exhaustive and expensive attempts at seeking a cure for their lymphoedema. Family members were influential in providing women with initial care seeking referrals to indigenous healers credited with influence over physical, mental, spiritual and supernatural properties of illness. When indigenous treatments proved to be ineffectual, the women sought care from trained healthcare providers. Most healthcare providers incorrectly diagnosed the edema, failed to adequately treat and meet the needs of women and were viewed as expensive. Most women resorted to self-prescribing injectable, oral, or topical antibiotics along with oral analgesics as a standard practice of self-care. CONCLUSION: Healthcare providers must understand a woman's cultural perspectives of illness, her natural networks of support and referral, her behavioural practices of care-seeking and self-care and the financial burden of seeking care. In the culture of the Dominican Republic family members and traditional healthcare providers are influential advisors on initial health-seeking behaviors and self-care practices. For this reason family-oriented interventions, support groups for women and their families, community education and training on simple, low cost lymphoedema management techniques for indigenous healers are viable ways to influence the early detection, diagnosis and treatment of women with lymphoedema. The extensive use of injectable, oral and topical antibiotics by indigenous healers and women without medical supervision suggests a need for health education messages related to the risks of such practices.

Journal Article↗
PubMed1991

Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung.

To determine if chemotherapy dose intensity (DI) influences treatment outcome, 60 published studies in limited- and extensive-stage small-cell carcinoma of the lung (SCCL) were retrospectively analyzed for relationship between intended DI and response (complete response [CR] or partial response [PR]) or median survival (MS). Agents used in the regimens included cyclophosphamide (C), doxorubicin (A), vincristine (V), etoposide (E), and cisplatin (P). Relative DI (RDI) of each study regimen was calculated against a reference regimen, and weighted regression analysis was used. Additionally, analysis of individual drug RDI within combinations was performed. For CAV, increasing RDI of the regimen showed no correlation with outcome. For the individual drugs, C RDI correlated positively, while A RDI correlated negatively with attainment of CR in limited disease, but both only after unduly influential observations were eliminated. In extensive-stage disease, A RDI correlated positively with CR+, PR but only in randomized trials, and this correlation lost statistical significance after unduly influential observations were eliminated. For CAE and CAVE, the RDI of the regimens correlated positively with MS in extensive-stage disease as did the C RDI. In limited disease, the C RDI correlated negatively with MS. For EP, no significant correlations were seen. We conclude that DI-outcome correlations are not consistent for these chemotherapy regimens in SCCL. Meta-analysis of retrospective data can generate hypotheses for testing in prospective clinical trials, but study sample and method of analysis can appreciably affect conclusions.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Discontinuities, side steps, and finding a proper place: an autobiographical account.

In this invited autobiography, I present an account of some influential events and experiences in my life that led me eventually, after some false starts, to a career in personality assessment psychology. The psychological research and applied areas (self-report personality assessment and cross-cultural research) with which I have been identified for over 40 years can, however, be seen in early interests, although their impact and their direction were not always apparent at the time of occurrence. Several people who were influential in my career development are noted and a number of important collaborators who helped sustain my efforts in personality assessment research and practice over the years are highlighted.

Career Mobility↗
PubMed1989

Smoking habits and smoking cessation among North Carolina nurses.

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.

Cross-Sectional Studies↗
PubMed2005

Stability of attachment-related anxiety and avoidance and their relationships with the five-factor model and the psychobiological model of personality.

OBJECTIVES: The stability of attachment-related anxiety and avoidance and their relationship with influential personality models are issues worth further investigation. Studying discriminant validity with respect to aspects of personality deemed as prevalently heritable, such as temperament, is particularly important. Our aims were to examine the stability of attachment dimensions and to study their relationship with psychological distress, the Big Five factors, and temperament and character dimensions. METHODS: The Experiences in Close Relationships (ECR) questionnaire, the State-Trait Anxiety Inventory (STAI), the Zung depression scale (ZDS), the Temperament and Character Inventory (TCI-125), and the Big Five Questionnaire (BFQ) were administered to 222 undergraduate and graduate students. After 1 month, 115 participants completed again the ECR, the STAI, and the ZDS. RESULTS: Attachment-related anxiety was modestly correlated with depression and anxiety, while attachment-related avoidance was modestly correlated with depression. The test-retest reliability of ECR scores was high. Changes in attachment-related anxiety were not related to changes in depression or anxiety, and changes in attachment-related avoidance were modestly correlated with changes in depression. In separate multiple regression models also including gender and age, attachment-related anxiety was correlated with harm avoidance, reward dependence, low novelty seeking, low self-directedness and low cooperativeness; low energy/extraversion and low emotional stability; attachment-related avoidance was correlated with low reward dependence and tended to be correlated with low self-directedness. CONCLUSIONS: These findings corroborate the reliability and the convergent and discriminant validity of the ECR, and support the notion that the attachment dimensions are only modestly related to psychological distress and are not redundant with constructs developed within influential personality models such as the five-factor model and the psychobiological model.

Adolescent↗
PubMed1992

Political contributions from the health and insurance industries.

During a major election year, interest surges in discovering the sources of campaign funds for influential members of Congress and presidential candidates. This study traces the contributors from the health and insurance industries during the 1990 campaign and presents preliminary figures for the 1992 campaign. Health interests contributed $16.3 million to congressional candidates in 1990, many of whom sit on influential committees and subcommittees. The insurance industry gave $10.9 million that same year. In either case, more than half of the funds came from political action committees (PACs); the rest, from individuals. As of 30 June 1992 health industry PACs had given more than $8.3 million to candidates for federal office in the 1992 campaign; insurance PACs had contributed $6.4 million.

Data Collection↗
PubMed1995

Influence of meal composition on the postprandial response of the pituitary-thyroid axis.

Ingestion of food can result in an acute decline of serum thyrotropin (TSH) concentrations, but it is not known whether meal composition and/or stomach distension are influential. Normal men and women were given a normocaloric or hypocaloric, isobulk meal at lunch and at dinner in a randomized design. The normocaloric, but not the isobulk, meal resulted in a significant decline in serum TSH at both lunch and dinner; thyroid hormones and cortisol were not affected significantly. These findings suggest that meal composition is influential in the acute postprandial decline of serum TSH in man. A possible mechanism is food-induced elevation of somatostatin and consequent suppression of TSH secretion.

Adult↗
PubMed2006

Qualitative analysis of mothers' decision-making about vaccines for infants: the importance of trust.

BACKGROUND: The high visibility of controversies regarding vaccination makes it increasingly important to understand how parents decide whether to vaccinate their infants. OBJECTIVE: The purpose of this research was to investigate decision-making about vaccinations for infants. DESIGN: We conducted qualitative, open-ended interviews. PARTICIPANTS: Subjects included mothers 1 to 3 days postpartum and again at 3 to 6 months. RESULTS: We addressed 3 topics: attitudes to vaccination, knowledge about vaccination, and decision-making. Mothers who intended to have their infants vaccinated ("vaccinators," n = 25) either agreed with or did not question vaccination or they accepted vaccination but had significant concerns. Mothers who did not intend to vaccinate ("nonvaccinators," n = 8) either completely rejected vaccination or they purposely delayed vaccinating/chose only some vaccines. Knowledge about which vaccines are recommended for children was poor among both vaccinators and nonvaccinators. The theme of trust in the medical profession was the central concept that underpinned all of the themes about decision-making. Promoters of vaccination included trusting the pediatrician, feeling satisfied by the pediatrician's discussion about vaccines, not wanting to diverge from the cultural norm, and wanting to adhere to the social contact. Inhibitors included feeling alienated by or unable to trust the pediatrician, having a trusting relationship with an influential homeopath/naturopath or other person who did not believe in vaccinating, worry about permanent side effects, beliefs that vaccine-preventable diseases are not serious, and feeling that since other children are vaccinated their child is not at risk. CONCLUSION: Trust or lack of trust and a relationship with a pediatrician or another influential person were pivotal for decision-making of new mothers about vaccinating their children. Attempts to work with mothers who are concerned about vaccinating their infants should focus not only on providing facts about vaccines but also on developing trusting and positive relationships.

Adult↗
PubMed2006

Association between health care providers' influence on parents who have concerns about vaccine safety and vaccination coverage.

OBJECTIVES: Parents who have concerns about vaccine safety may be reluctant to have their children vaccinated. The purpose of this study was to explore how vaccination coverage among children 19 to 35 months of age is associated with health care providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety. METHODS: Parents of 7695 children 19 to 35 months of age sampled by the National Immunization Survey were administered the National Immunization Survey Parental Knowledge Module between the third quarter of 2001 and the fourth quarter of 2002. Health care providers were defined as a physician, nurse, or any other type of health care professional. Parents provided responses that summarized the degree to which they believed vaccines were safe, and the influence providers had on their decisions to vaccinate their children. Children were determined to be up-to-date if their vaccination providers reported administering > or = 4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, > or = 3 doses of polio vaccine, > or = 1 dose of measles-mumps-rubella vaccine, > or = 3 doses of Haemophilus influenzae type b vaccine, and > or = 3 doses of hepatitis B vaccine. RESULTS: Of all of the parents, 5.7% thought that vaccines were not safe, and 21.5% said that their decision to vaccinate their children was not influenced by a health care provider. Compared with parents who responded that providers were not influential in their decision to vaccinate their children, parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a health care provider had an estimated vaccination coverage rate that was significantly higher than the estimated coverage rate among children whose parents' decision was not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%). CONCLUSIONS: Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe. Physicians, nurses, and other health care professionals should increase their efforts to build honest and respectful relationships with parents, especially when parents express concerns about vaccine safety or have misconceptions about the benefits and risks of vaccinations.

Child, Preschool↗