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PubMed1994

Randomized intervention to increase children's selection of low-fat foods in school lunches.

OBJECTIVE: The purpose of this study was to determine whether children would increase their selection of low-fat foods in school lunches if these foods were labeled on the menu and parents were notified of their availability. METHODS: The 16 elementary schools in the Bellevue (Washington) School District were randomly assigned to intervention and control groups. Participants were the students eating the school lunch--an average of 2445 students per day, of whom one third received free or reduced-price lunches. In all schools, one of the two daily lunch entrees was low in fat (< or = 30% of calories from fat). After a 5-month baseline period, eight schools received a 4-month intervention. The monthly menus carried home by students began to indicate the low-fat entree and to compare the fat content of both entrees. In the first month, parents in the intervention schools (2329 households) received a mailing with a copy of the menu, an informational pamphlet on dietary fat, and a letter that described the menu changes and asked the parents to encourage their children to select low-fat entrees. A follow-up telephone survey was performed in one school 1 month after the intervention mailing to assess the recall and impact of the intervention. The main outcome, based on 249,861 student meal selections, was the proportion of students who selected the low-fat entree, and the unit of analysis was the school. RESULTS: At baseline, there was little difference between intervention and control schools in the percentage of children choosing the low-fat entree (31.5% vs 30.8%). During the intervention, there was an increase in low-fat entree selection in the intervention schools compared with the control schools (35.5% vs 32.2%; p = 0.03). Of 221 parents surveyed, 71% recalled the mailing, 53% remembered that there were now low-fat entrees on the menu, and 10% reported that, after the mailing, they asked their child to choose a low-fat entree.

Child↗
PubMed2001

Neonatal circumcision.

The merits of neonatal circumcision continue to be debated hotly. Some argue that circumcision is a "uniquely American medical enigma." Most of the world's male population remains uncircumcised; however, most boys born in the United States continue to undergo neonatal circumcision. Review of existing literature supports that most children who are uncircumcised do well from a medical standpoint and, thus, the question of whether US health care practitioners are subjecting neonates to an unnecessary surgical procedure remains. The medical benefits of circumcision are multiple, but most are small. The clearest medical benefit of circumcision is the relative reduction in the risk for a UTI, especially in early infancy. Although this risk [figure: see text] is real, the absolute numbers are small (risk ranges from 1 in 100 to 1 in 1000), and one investigator has estimated that it may take approximately 80 neonatal circumcisions to prevent one UTI. In the case of a patient with known urologic abnormalities that predispose to UTI, neonatal circumcision has a clearer role in terms of medical benefit to the patient. Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved. Proper penile hygiene should all but eliminate the risk for foreskin-related medical problems that will require circumcision. Moreover, proper hygiene and access to clean water has been shown to reduce the rate of development of squamous cell carcinoma of the penis in the uncircumcised population. Proper techniques on the care of the foreskin are illustrated in the American Academy of Pediatrics pamphlet titled "How to care for the uncircumcised penis." Regarding the relationship between STDs and circumcision, patient education and the practice of low-risk sexual behavior make a far greater impact than does routine circumcision in hopes of reducing the spread of HIV and other STDs. Nevertheless, in areas where safe sexual practices are poorly adhered to, circumcision can have a relative protective effect against the transmission of HIV and other STDs. The medical harms of circumcision lie mainly in the 1% acute complication rate and the additional patients who require revision of their initial circumcision for cosmetic or medical reasons. Anecdotally, the authors see far fewer complications in the acute and long-term phase when the circumcision has been performed by someone with expertise and experience with the procedure. Thus, the authors routinely recommend to parents that, if they choose to have their newborns circumcised, they should seek out an experienced practitioner. A negative psychologic and sexual impact of circumcision has been argued, but solid, scientific data are lacking. Special interest groups have argued that perhaps the greatest harm of circumcision is in performing an operation without a clear indication. Many of these groups have claimed that performing a routine neonatal circumcision is akin to performing a surgical procedure without a clear medical benefit, and in an infant, that is akin to surgery without informed consent. Although this is an extreme posture, the clinician can understand the emphasis on trying to provide invasive medical services only when a clear medical benefit is expected, especially when treating an infant or child. Deciding whether or not to circumcise an infant continues to challenge many new parents. Clearly, the procedure provides potential medical benefits and potential risks. It is difficult to say whether the benefits outweigh the risks for all male infants. Further complicating the decision for many American parents is that, in some areas of the United States, there exists an unexplained positive cultural connotation with neonatal circumcision. For these reasons, parents who actively choose to keep their sons uncircumcised need to be encouraged to make this decision forthrightly. Parents who choose to have their children circumcised also should be encouraged to actively seek an experienced practitioner who can afford the child adequate local analgesia.

Analgesia↗
PubMed2002

What motivates adolescent smokers to make a quit attempt?

A sample of 120 adolescent smokers (80 males, 40 females), most of whom were referred by school personnel after being caught with cigarettes at school (n=113), reported motivations for making a quit attempt during a smoking cessation project. Most students (n=76) were randomly assigned to a four session cessation program that included discussion of a number of motivational topics, and the remaining students were assigned to a self-help control group that received a pamphlet recommending strategies for quitting. Reported motivations for quitting did not differ significantly across the two treatment conditions. Concern about future health (73%) was the most popular reason given for making a quit attempt, followed by concern about current health (65%). Concerns about physical appearance (59%), the cost of cigarettes (52%), and athletic performance (51%) were also listed as motivators by a majority of the participants. Future health was the most popular choice for the most important motivator to quit (35%). Females and participants with fewer best friends smoking were more likely to report that the prevalence of non-smoking teenagers, the relationship between smoking and weight, and physical appearance concerns were motivators to quit. African Americans were more likely than Whites to list current health concern as the most important motivator.

Adolescent↗
PubMed2002

Appropriate use of antibiotics for common infections in an era of increasing resistance.

In many respects, antibiotics have changed medicine forever. Countless lives have been enhanced and saved with antibiotic use. Unfortunately, the medical community has opened Pandora's box through the casual distribution of outpatient antibiotics. Society will indeed suffer, as well as the medical profession, if antibiotics are not used judiciously. To date, the rate of penicillin resistance has steadily risen in North America and in many other areas of the world. Much of the increase in resistance has been caused by the distribution of antibiotics for viral infections (e.g., bronchitis, colds, or purulent nasal discharge) as well as nonstreptococcal throat infections. Parental pressure for physicians to prescribe antibiotics also has contributed to the rise in antibiotic resistance. The authors have discussed many common pediatric ED infections and have illustrated the key points for making the diagnosis of each. In addition, the authors also recommend the appropriate choice of antibiotics for each disease process, with an emphasis on narrow-spectrum, first-line antimicrobials. Physicians, as the "holders of the prescription pad," should be aware of the problems with increasing bacterial resistance especially ED practitioners who work on the front line. In addition, families and patients should be educated about the harm of inappropriate antibiotic use. The AAP publishes pamphlets for parents that discuss these issues. It is believed, as was seen in Finland and Japan, that judicious use of antibiotics leads to a decrease in resistant bacteria and prolong antibiotic usefulness. This is an issue of great importance to the long-term health of patients. What Benjamin Rush stated in 1789 is true today: "Do not condemn, or oppose, unnecessarily, the simple, prescriptions of your patients. Yield to them in matters of little consequence but maintain an inflexible authority over matters that are essential to life."

Adolescent↗
PubMed2003

Early use of glycoprotein IIb/IIIa inhibitors in the ED treatment of non-ST-segment elevation acute coronary syndromes: a local quality improvement initiative.

A prospective observational study was conducted in 2,007 patients experiencing chest pain to determine impact of local quality improvement (QI) measures on the use of glycoprotein (GP) IIb/IIIa inhibitors in the ED treatment of high-risk patients with non-ST-segment elevation acute coronary syndromes (ACS). Patients with injury on the initial ECG or new sustained injury on continuous ECG were excluded. QI interventions were as follows: control (0-4 mo): no interventions (standardized protocols and prewritten orders in place 4 months prior); phase I (5-8 mo): simple education/awareness program with posted drug information pamphlets and eligibility criteria; phase II (9-12 mo): mandated QI form with real-time feedback and focused one-on-one physician education championed by an ED physician QI advocate. A total of 179 (8.9%) of the study patients met predefined high-risk criteria. Of these, a total of 41 (23.0%) patients had GP IIb/IIIa inhibitor therapy initiated in the ED. Percent of high-risk patients receiving therapy increased from 6.0% during the control phase to 16.1% during phase I and 50.9% during phase II. After controlling for patient demographics, patients treated during phase I had a 2.8 times increased odds (95% confidence interval CI: 0.8-10.3; P =.11 [not significant]) of receiving GP IIb/IIIa inhibitor relative to the control phase, and patients treated during phase II had a 20.2 times increased odds (95% CI: 6.1-66.9; P <.0001) of treatment. In conclusion, local QI measures incorporating standardized protocols, preprinted orders, physician education, and interactive feedback championed by an ED QI physician advocate can increase early use of GP IIb/IIIa inhibitors in the ED treatment of high-risk patients presenting with chest pain.

Anticoagulants↗
PubMed1998

Advice on exercise from a family physician can help sedentary patients to become active.

OBJECTIVES: To test the effectiveness, in the setting of primary health care, of verbal advice on exercise from a family physician (FP) combined with supporting written information. DESIGN: A controlled trial with subjects allocated to a control group or one of two intervention groups using a balanced design based on day of the week. SETTING: Ten general practices in Perth, Western Australia. SUBJECTS: All sedentary patients consulting an FP. INTERVENTION: Verbal advice on exercise from the FP and a pamphlet on exercise mailed to the patient's home address within 2 days of his/her visit to the doctor. MAIN OUTCOME MEASURE: Level of physical activity at follow-up. RESULTS: 6,351 adult patients attending an FP practice completed a screening questionnaire, and 763 sedentary adults were recruited to the project. The response to follow-up, via a postal survey at 1, 6, and 12 months after the index consultation was 70%, 60%, and 57%, respectively. At 1 month a subsample of the control and intervention subjects were contacted for a telephone interview to verify self-reported levels of activity (n = 136). Treating all nonresponders as sedentary, at 1 month significantly more subjects in the combined intervention groups reported doing some physical activity (40%) compared with the control group (31%). Similarly, at 6 months, 30% of the control group and 38% of the combined intervention groups were "now active." There was very little change at follow-up at 12 months (31% control and 36% intervention groups, respectively). CONCLUSION: A simple intervention aimed at the promotion of physical activity to sedentary patients in general practice can help reduce inactivity.

Adult↗
PubMed2003

[Evaluation of the effectiveness of an injury prevention kit delivery for toddlers in four French cities].

BACKGROUND: The home delivery of counseling and devices intended to prevent child injuries could help parents to adopt safe behavior more efficiently. The aim of the present study was to adapt and test in France a safety kit designed and used in Quebec (Canada). The intervention program (kit delivery and counseling) was assessed by measuring 6 to 8 weeks after a first home visit the percentage of safety changes adopted by the families included in the survey, compared with the pre-intervention situation; and by evaluating the satisfaction of families with their participation in the survey, and the satisfaction of nurses with the use of this new tool. POPULATION AND METHOD: One hundred families from 4 towns in the Hauts-de-Seine department in the Paris suburbs (Boulogne, Chaville, Sèvres, Ville d'Avray) were selected by the social services for home visits by nurses or doctors, when their child reached the age of 6 to 9 months. Selection criteria were usually primipara, medical problem, psychological and/or socio-economic difficulties. During the first visit, 49 families (group 1) (1 family lost for follow-up) received the usual informative and preventive counseling, and a kit including preventive devices and pamphlets about indoor injuries and ways of avoiding them. The other 50 families (group 2) received counseling but not the kit. Between 6 and 8 weeks later, a second home visit was paid to all selected families. RESULTS: Between the first and the second visits, the percentage of safety improvement was significantly higher in group 1 (with the kit) than in group 2 (without the kit). This improvement mainly related to the risk of fall (P < 0.02), fire and burns (P < 0.001), poisoning (P < 0.01) and suffocation (P < 0.001). When the analysis was focused on safety improvement related to devices provided in the kit, the difference between the 2 groups was significant: 67.8% of safety improvement in group 1 vs 38.1% in group 2 (P < 0.001). The relative risk (RR) was 1,78 (95% confidence interval (CI): 1,18-2,68). Even for items not related to the devices provided, the difference remained significant: 48.6% in group 1 vs 28.8% in group 2 (P < 0.001); RR =1,31 (95% CI: 1,23-1,40). The perceived usefulness of the kit was discussed in a focus group with all nurses and doctors. On the whole, the judgment was very positive, mainly because the kit facilitated the introduction of the notion of accident prevention in the discussion at home. CONCLUSION: As in the canadian survey, our results indicate that routine home visits by the social services offer a good opportunity to introduce the subject of child injury prevention. Free delivery of prevention kit and simple counseling allow often deprived families to modify their behavior and to arrange their apartments so as to reduce risks.

Accident Prevention↗
PubMed1995

Psycho-educational interventions in the treatment of arthritis.

Patient education has a long history as an integral part of clinical practice; however, controlled clinical trials of psycho-educational interventions for the rheumatic disorders emerged in significant numbers over the last 15 to 20 years. In this chapter, the efficacy of these interventions was reviewed in 34 reports (54 separate treatment arms) published in the last 10 years. Psycho-educational interventions included both traditional educational or teaching activities and psychological interventions. The most common types of intervention were self-management programmes ((21 treatment arms) and cognitive-behavioral therapy (10 treatment arms). Both approaches emphasize learning new skills helpful in managing one's disease. Self-management programmes are broadly focused on using information, problem-solving and coping skills for symptom management. Cognitive-behavioural therapy usually emphasizes control of pain by understanding the interaction of emotions and cognition with the physical and behavioral aspects of pain. Other interventions, tested either individually or as comparisons for self-management or cognitive-behavioural therapy interventions, included traditional classroom-type programmes (four treatment arms), 'materials' including pamphlets, books and computerized instruction (seven treatment arms), individualized instruction (five treatment arms), psychotherapy (one), and support groups (three treatment arms). Sixty per cent of studies used clinic samples, 52% rheumatoid arthritis and 8% with osteoarthritis. The remaining studies recruited from community samples where the exact diagnosis was not always clear, though most had either RA or OA. The majority of self-management interventions used community samples. The average effect size for treatment compared to non-intervention controls (weighted for sample size) for RA patient pain, functional ability and depression at post intervention was 0.13, -0.16 and 0.01 compared with 0.44, 0.28 and 0.56 for OA patients and 0.21, 0.08 and 0.12 for community samples. At 3 months follow-up, self-management programmes demonstrated improvement compared to controls for self-efficacy (effect sizes 0.22 to 0.29) with community patients while cognitive-behavioural therapy interventions demonstrated similar improvements in active coping skills (effect sizes 0.09 to 0.18) with RA patients. Effect sizes ranged from 0.6 to 1.1 for exercise compliance following self-management interventions. In the few studies with follow-up evaluations extending beyond 3 months post-intervention, effects generally weaken. As expected, psycho-educational interventions do not alter physical functioning with functional abilities continuing to decline over time. Lorig and colleagues have demonstrated in 4-year outcome studies important reductions in the use of health care services for participants in self-management programmes despite the progression of functional disability. Psycho-educational interventions are difficult to evaluate because of the differences in interventions, methods of assessment and varying follow-up times. Studies of these interventions differ in quality, patient population, etc., precluding a useful meta analysis. Overall, there is improvement in pain, depressive symptoms, self-efficacy, coping abilities, and self-management behaviours such as exercise compliance following psycho-educational interventions, with a trend to greater improvement for OA than RA patients. Utilization of health care services may be reduced following educational interventions. Although the overall improvement is small, it is probably of the order of that seen with therapy with NSAIDs and is independent of medical treatment. Psycho-educational interventions are a useful additional modality in the management of rheumatic diseases and may improve treatment effects and patient quality of life.

Arthritis↗
PubMed1999

Using practical quality improvement approaches and tools in reproductive health services in east Africa.

BACKGROUND: A nonprofit, nongovernment organization, AVSC International provides technical assistance worldwide, including a range of reproductive health services and quality improvement (QI) approaches and tools. Current activities in East Africa involve several hundred sites, including referral hospitals, district-level hospitals, and individual family planning clinics. THE QI PACKAGE: AVSC and its local partners developed Client-Oriented, Provider-Efficient Services (COPE), a problem-solving process and set of tools to involve all levels of site staff members in assessing and improving the services. The COPE tools--self-assessment guides, client interview guides, client flow analyses, and action plans--promote involvement, ownership, and commitment to the QI process. Facilitative supervision and whole-site training complemented AVSC's traditional approaches of medical monitoring and informed choice. Facilitative supervision encourages supervisors and managers to consider staff members as internal customers, whose needs they must meet for staff to be able to meet the needs of external customers (clients). Whole-site training was developed to meet the needs of staff members and providers, who needed to function as a team responsible for providing high-quality services. CASE STUDY: A government hospital that has adopted the entire package of QI approaches, has used the Quality Improvement Quotient self-assessment surveys to track its progress in several elements of high-quality care, including management and supervision, safety, and information and client--provider interactions. For example, maternity ward staff learned how to pass on to their clients information about clients' rights and family planning methods through posters, pamphlets, sample contraceptives, and health talks. LESSONS LEARNED: AVSC's work with local organizations suggests a number of lessons learned, including the following: easy-to-use tools that promote staff involvement and ownership are essential in the QI process, QI requires considerable staff development and capacity building at all levels, and although the QI approaches were initially introduced for a relatively narrow field of services, they are applicable to and have increasingly been used in other departments and wards. (It is difficult, may be impossible, and certainly undesirable, to limit QI activities to one ward or service.) CONCLUSION: Activities in East Africa have shown that QI is possible even in very resource-poor settings. The same principles have guided the process in all the different programs, with some adaptation of the tools used. AVSC program activities are to continue to disseminate the experiences of sites implementing the package of tools and approaches, to advocate for investment in supervision and management capacity building as a means to support continuous quality improvement, and to further study the impact of the QI approaches on service quality.

Adult↗
PubMed2000

Thomas Hodgkin: social activist.

Thomas Hodgkin's discovery of a lymph gland disorder is merely one event in a life of unusually varied public activities in the social reform and humanitarian movements of the mid-19th century. He wrote pamphlets on medical care for the working-class poor, public health, housing, sanitation, and the relief of cold, hunger, and unemployment. Hodgkin wrote about the problems arising from urban renewal and suburban development. His contributions to geographic explorations, anthropology, ethnology, and foreign affairs are virtually unknown today. Hodgkin's opposition to slavery and the slave trade involved him in the development of settlements in Africa for freed slaves and disputes with the abolitionists in America. He fought for social justice and human rights for native populations being oppressed by British foreign policy in South Africa and New Zealand. His criticism of the exploitation of Indians by the Hudson's Bay Company's fur trade contributed to a professional conflict in the highly politicized environment of Guy's Hospital and blocked advancement of his medical career. Closer to home he advocated reform of medical education and practice and sponsored adult education programs. As a member of its Senate, he helped in establishing London University, the first nonsectarian institution of higher learning in England. He lectured to working people on the means of preserving and promoting health and advocated prepaid medical care for the working poor. Concerned about unequal distribution of medical care, he opposed medical contracts to the lowest bidder and price-determined government plans for health care. He consistently maintained that the basic problems of the poor were not medical but socioeconomic. Since charity leaves nothing behind in exchange, Hodgkin was certain that greater benefits would result if charitable money was used to provide jobs. He denounced the evils of tobacco, practices of trade unions, and barbarous prize fights. On a trip to Jerusalem with Sir Moses Montefiore in 1866, Hodgkin contracted dysentery and died. He is buried in a protestant cemetery in Jaffa. His epitaph is fitting: "Nothing human was alien to him."

England↗
PubMed2003

Whatever happened to Dorothy Reed?

Born in 1874, Dorothy Reed entered the fourth medical school class at Johns Hopkins Medical School. After internship, she spent a year as University Fellow in Pathology, during which time she wrote and illustrated her well-known paper, "On the Pathological Changes in Hodgkin's Disease, With Especial Reference to Its Relationship to Tuberculosis." She left pathology at Hopkins after 1 year because, as a woman, she was told she could not be appointed to the faculty and because of an unhappy love affair. She took training in pediatrics, married a long-time friend, and moved to Madison, WI. Her first two children died tragically; subsequently, she gave birth to two fine boys. She developed a new career as a pioneer in maternal and child health. She established infant welfare clinics in Madison, wrote pamphlets for the United States Children's Bureau, and taught college students child development and sexual hygiene. For the first time, the identity of her lover and his role in establishing her fame is revealed.

History, 19th Century↗
PubMedDate not supplied

Casting health messages in terms of responsibility for dietary change: increasing fruit and vegetable consumption.

OBJECTIVE: To compare the effectiveness of messages emphasizing the importance of either personal or social responsibility for dietary behavior change in increasing fruit and vegetable intake. DESIGN/SETTING: Randomly assigned individually or socially oriented messages were delivered at baseline, 1 week, and 2 and 3 months later. Telephone surveys were conducted at baseline and 1 and 4 months later. PARTICIPANTS: 528 callers to a cancer information hotline who were not meeting the "5 A Day" dietary recommendation. INTERVENTIONS: A brief telephone-delivered message and 3 mailings of pamphlets and promotional items encouraging fruit and vegetable intake that emphasized either personal or social responsibility. MAIN OUTCOME MEASURES: Fruit and vegetable intake 1 and 4 months post baseline. ANALYSIS: Chi-square, t tests, and analyses of variance and covariance. RESULTS: Both types of messages increased intake substantially (P =.01). To some extent, the social responsibility message continued to motivate increased intake over time compared with the personal responsibility message. CONCLUSIONS AND IMPLICATIONS: These minimal interventions had a substantial impact on fruit and vegetable intake. Health messages might be more effective over the longer term if they are designed to emphasize the importance of social responsibility, although further study is needed to confirm the robustness of these findings.

Female↗
PubMed2003

How health care organizations can establish and conduct a program for a latex-safe environment.

BACKGROUND: The advent of universal precautions brought about a dramatic increase in the use of natural rubber latex gloves, and reports of rubber latex allergies began appearing in the literature. In 1997 the Johns Hopkins Hospital created the interdisciplinary Latex Task Force to address the issue of creating, implementing, and evaluating a latex-safe environment. CONVERSION TO NONLATEX PRODUCTS AND EXAMINATION GLOVES: When suitable alternatives were available, all medical products that contained latex were to be removed from the hospital and nonlatex alternatives substituted. Latex medical gloves, especially powdered latex examination gloves, which were used in all patient care areas, were replaced by vinyl gloves. Yet because of the ongoing concern about strike-through and the minimal level of acceptance of fit with the vinyl gloves, the search for alternatives to the vinyl gloves continued. The task force recommended switching to nitrile examination gloves throughout the hospital. To facilitate the transition to another examination glove, new educational pamphlets about the nitrile gloves were developed. POSTSCRIPT: The switch to nitrile examination gloves was successfully completed, but conversion to nonlatex surgical gloves was less successful, with costs being the overwhelming impediment. Monitoring of latex-containing products and ongoing evaluations of alternatives are crucial in ensuring patient and health care worker safety.

Advisory Committees↗
PubMedDate not supplied

Communication and health protection issues arising from a flooding emergency.

OBJECTIVE: To identify and describe the key communication and health protection issues surrounding a flooding emergency. METHODS: A telephone questionnaire was used to assess health and safety information sources, information recalled, and behavioral responses among residents of the town of Feilding, New Zealand following a major flood in February 2004. This was supplemented by key informant interviews and a newspaper content analysis. RESULTS: A total of 154 adult residents were surveyed (76% of those successfully contacted and eligible). Of the respondents, 79% recalled being provided with health and safety information from authorities. The major sources were: radio (41%), pamphlets (23%), and newspapers (20%). The regional newspaper had extensive coverage of this flooding emergency but "health" only was mentioned in 46 (7%) of the 664 flood-related articles. Of those who recalled receiving information from authorities, most (89%) perceived that it was adequate. Nevertheless, 18% actively sought out information (mainly about water safety and availability). In the post-flood period, 73% of all respondents boiled water; however, only 4% maintained boiling water or bottled water use for the necessary nine-week period. Some forms of emergency preparations did not change substantially from before the flood, compared to four months afterwards (e.g., having a radio with batteries increased from 62% to 68%). Perceived health concerns around the flooding were low, though 59% were concerned about the risk of water contamination. Actual self-reported, health consequences from the flood were rare, as only two (1%) people out of 154 reported flood-related health problems. CONCLUSIONS: Health and safety information generally was communicated successfully and was regarded as appropriate by the population of this flood-affected town. Nevertheless, there are further improvements needed in the emergency response by both residents and authorities.

Adult↗
PubMed1996

Increasing clients' knowledge of community pharmacists' roles.

PURPOSE: The pharmaceutical care framework requires an active client-pharmacist partnership, particularly with respect to consultation about medications. With low client expectations for pharmacist consultation documented by several studies, this research sought to identify: 1) what information clients want from pharmacists, 2) what barriers prevent clients from asking pharmacists their questions, and 3) whether an inexpensive intervention could increase client short-term knowledge of pharmacist roles related to patient consultation and monitoring prescription appropriateness. Role theory provides a framework for this study. METHODS: Nineteen community pharmacies and 355 pharmacy clients participated in the study. Each client completed a survey on their needs for information and knowledge of pharmacist roles, with clients in the experimental arm receiving a short brochure on pharmacist roles while a control group did not. RESULTS: Sixty percent wanted information about side effects; 51% wanted directions for how to take the medication correctly. Most frequently listed barriers to asking pharmacists questions were client embarrassment and ignorance that it was appropriate to seek information from pharmacists. Significantly more experimental group clients than control group clients correctly answered survey questions about pharmacist roles and training. Only 52% of the control group believed the pharmacist always checks for possible drug interactions. Only 55% believed pharmacists were required to provide appropriate patient consultation for prescriptions under state law. CONCLUSIONS: Brief exposure to a short pamphlet about pharmacists' activities increased knowledge of pharmacist roles and training, suggesting that inexpensive interventions can impact on client short term knowledge of pharmacist roles.

Community Pharmacy Services↗
PubMed2003

Peer education for HIV prevention in the Socialist Republic of Vietnam: a national assessment.

In 2000, the government of Vietnam conducted the first assessment of its national peer education program for HIV prevention. Twenty (32%) of Vietnam's 61 provinces and urban areas had functioning peer education programs, and program coordinators of all 20 were interviewed regarding their programs. In addition, on-site reviews were done for 10 of the 20 programs, including interviews of peer educators and high-risk persons in each program. The assessment found that a total of 500 peer educators were functioning either independently or as part of one of 79 teams. In the 20 provinces, the peer educators made an estimated 7,000 total contacts per month with high risk persons, but many persons were likely contacted repeatedly. Despite this, coverage was limited: some provinces with high numbers of persons reported with HIV/AIDS had few peer educators. Although most provinces targeted IDU and many targeted CSW, few provinces targeted sex partners of IDU or CSW. The definition of peer education and composition of teams varied substantially by province; only one province included persons living with HIV/AIDS as peer educators. The services provided by peer educators were primarily distributional: delivering information either through word of mouth, pamphlets, or brochures, providing condoms, and sometimes providing clean syringes and needles. Skills building or goal setting interventions aimed at HIV risk reduction were rarely provided. Most provinces had concerns about ongoing funding and sustainability of the programs. Based on the assessment, specific recommendations were provided for strengthening and expanding Vietnam's peer education programs.

Adolescent↗
PubMed1996

Involving parents in cancer risk reduction: a program for Hispanic American families.

The authors explored changes in dietary behavior, nutrition knowledge, and parental support among inner-city, low-income, Hispanic American families. Thirty-eight families were randomly assigned to receive a 12-week, culture-specific dietary intervention or be in a control group. Results showed that parental support was related to changes in diet, nutrition knowledge, and attendance for both mothers and children. Dietary behavior changes (e.g., reduction in dietary fat) were seen only in the treatment group. Distribution of health-related pamphlets to the control group may have promoted cognitive changes (e.g., increased nutrition knowledge) seen in this low-literacy sample. Further research is needed to document behavioral changes after ethnic-specific interventions and the maintenance of those changes over time.

Adult↗
PubMed1996

Emotional support for cancer patients: what do patients really want?

For many cancer patients and their families the experience of cancer is an intensely stressful one. Emotional support is important for most cancer patients during their illness and can be gained from different people and services. This study evaluates patients' attitudes to different sources of support and rates their satisfaction with sources already used. A total of 431 patients completed a questionnaire covering the use of different sources, including individuals, support groups and information sources. The questionnaire also incorporated validated measurements of anxiety, depression and locus of control. The results revealed that the three most important sources of emotional support were senior registrars (73%) and family (73%), followed by consultants (63%). Patients would prefer doctor- and nurse-led support groups to patient only-led groups (26% vs 12%). Pamphlets, such as the BACUP booklets, proved the most important of the informational sources sought (50%). A total of 86% of patients were satisfied or very satisfied with the emotional support received. Patients who expressed dissatisfaction with their emotional support were significantly more likely to be anxious and depressed (P < 0.001). Patients who used information sources were more likely to have a higher locus of control over the course of their disease. These results show how important the doctor's role is in the provision of emotional support.

Adolescent↗