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PubMed2005

Effectiveness of a parental educational intervention in reducing antibiotic use in children: a randomized controlled trial.

OBJECTIVE: To determine whether an educational intervention aimed at parents leads to fewer antibiotic prescriptions for their children. DESIGN: Placebo-controlled, randomized controlled trial. SETTING: Offices of primary care pediatricians who are members of a regional practice-based research network. PARTICIPANTS: Healthy children younger than 24 months old enrolled at the time of an office visit. INTERVENTIONS: Parents of study children were randomized to receive either a pamphlet and videotape (featuring one of their child's pediatricians) promoting the judicious use of antibiotics (intervention group) or brochures about injury prevention (control group). A total of 499 eligible children were enrolled, and data on outpatient visits during a 12-month observation period were collected. MAIN OUTCOME MEASURES: We compared the number of visits for upper respiratory tract infections (URIs), number of diagnoses and antibiotic prescriptions for otitis media and/or sinusitis and total number of antibiotics per patient among children in the intervention and control groups using Poisson regression analysis, adjusted for clustering into different practices. RESULTS: : Data on 4924 visits were reviewed; 28.8% of these visits were because of URI symptoms. The mean number of visits per study patient for URI symptoms was 2.8. Including all visits, the mean number of diagnoses of otitis media in study children was 2.1, mean number of diagnoses of otitis media and/or sinusitis was 2.3 and mean number of antibiotic prescriptions was 2.4; there were no significant differences between children in the intervention and control groups for any of these outcomes. Overall physicians prescribed 1 or more antibiotics during 45.9% of visits for a chief complaint of URI symptoms; 92% of antibiotic usage in children presenting with URI symptoms was for a diagnosis of otitis media and/or sinusitis. CONCLUSIONS: An educational intervention aimed at parents did not result in a decrease in the number of antibiotic prescriptions in their children. The use of antibiotics among children with URI symptoms was common; other interventions promoting the judicious use of these medications are needed.

Adult↗
PubMed1989

Superior outcome of females over males after brief treatment for the reduction of heavy drinking.

UNLABELLED: Problem drinkers (52 males, 38 females) recruited through advertisements were randomly assigned to one of three treatments: GUIDELINES: three sessions of advice using a pamphlet outlining basic steps for achieving abstinence or moderate drinking. Manual: three sessions of instruction in the use of a 'self-help' manual presenting a step-by-step approach for attaining abstinence or moderate drinking. Therapist: six or more sessions of instruction in the methods outlined in the 'self-help' manual. At 3, 6 and 12 months follow-up, no significant differences were found among the groups in reduction of heavy drinking days (i.e. days when consumption exceeded four drinks, each containing 13.6 g/ethanol). Overall, the number of heavy days were reduced from an average of 43 at intake, to 20 over the 1-year follow-up period. Females, however, had significantly greater reductions than males (75% versus 35%). Three months after treatment the rate of successful moderate drinkers was significantly higher for females than males in the GUIDELINES (60% versus 33%) and the Manual condition (63% versus 18%), but not in the Therapist condition (25% versus 35%). At 1-year follow-up, females were more successful than males in all conditions. Mean changes in GGT and MCV levels lended support to the change in drinking status (from heavy drinker at intake to moderate drinker at follow-up), based on clients' self-reports.

Adult↗
PubMed1991

Superior outcome of females over males after brief treatment for the reduction of heavy drinking: replication and report of therapist effects.

UNLABELLED: The procedures and findings of a previous study were replicated. Sixty-one men and 35 women were randomized to one of three treatments: Manual: three sessions of instructions in use of a manual describing a step-by-step method for attaining abstinence or moderate drinking. GUIDELINES: three sessions of advice using a pamphlet summarizing the contents of the manual. Therapist: application of the step-by-step method in an indefinite number of sessions. At 3-month follow-up, the number of Moderate drinkers was again significantly higher among women than men in the GUIDELINES (77% versus 24%) and Manual conditions (75% versus 33%), but not in the Therapist condition (50% versus 53%). Again, at 1-year more women than men were Moderate drinkers in all conditions (69% versus 31% overall). Changes from baseline in GGT, MCV, and the Digit Symbol Test corroborated the clients' reports of drinking. In this study the more experienced therapists had significantly lower rates of client dropout than the less experienced. Clinical and research implications of the findings are discussed.

Adult↗
PubMed1994

Assisting problem drinkers to change on their own: effect of specific and non-specific advice.

Problem drinkers (99 males, 41 females) wishing to quit or cut down without professional help received a 60-minute session during which they were assessed and given at random one of these materials: Guidelines, a two-page pamphlet outlining specific methods for achieving abstinence or moderate drinking; Manual, a 30-page booklet describing the methods in the Guidelines; or General Information, a package about alcohol effects. At 12 months follow-up, subjects in the Guidelines and Manual conditions showed significantly greater reductions of heavy days (of 5+ drinks) than subjects in General Information (70% vs. 24%); in addition, significantly fewer subjects in the Guidelines and the Manual conditions expressed need for professional assistance with their drinking (25% vs. 46% in General Information). No main effect of condition or gender was observed on rates of moderate drinkers. At 12 months follow-up, 31% of the men and 43% of the women were rated as moderate drinkers. It was concluded that drinkers intending to cut down on their own derive greater benefit (in terms of their alcohol use) from materials containing specific instructions to develop moderate drinking than from those providing general information on alcohol effects. Clinical and research implications of the findings are discussed.

Adult↗
PubMed1988

A survey of the social and psychological effects of psoriasis.

One hundred and four consecutive patients with psoriasis who were being treated in two Dublin dermatology hospital units answered a questionnaire. Social and emotional morbidity was present for many patients despite access to modern treatment facilities. Fifty five percent of patients had never experienced a complete remission from their psoriasis. A large percentage of patients avoided common social activities, for example swimming and sports; 50% felt that psoriasis had inhibited their sexual relationships and 11% of patients said they would avoid having children in case their offspring should develop the condition. Thirty-six per cent felt the hospital doctor spent most of the consultation time writing prescriptions and 59% of patients had never been given an explanatory pamphlet or book about psoriasis. To help patients to come to terms with what is for many a lifelong condition, greater efforts should be made to improve the communication at consultation, and provide more patient education.

Adolescent↗
PubMed1993

Melanoma and skin cancer: evaluation of a health education programme for secondary schools.

The effectiveness of an education package for secondary schools about the sun and skin cancer was assessed using questionnaires. A variety of teaching methods was used, including pamphlets, workbooks, and a video. The effect of this material was assessed by asking pupils to complete questionnaires immediately after receiving the package (July), and after the summer holiday (September). Five-hundred and forty-three children from seven schools were recruited into the study. Results of the questionnaire demonstrated a significant difference in knowledge (P < 0.001) and reported attitude (P < 0.001) compared with a control group. There was no significant difference in behaviour of the taught groups compared with the control group. The only significant activity associated with increased knowledge was wearing a sunscreen (P < 0.005). In contrast, in terms of attitude, those who covered up in the sun (P < 0.0001), wore a sunscreen (P < 0.004), and sat in the shade (P < 0.02), had significantly better attitudes than those who did not behave in this way. This project is a first attempt to assess health education in schools, and reports changes in knowledge, attitudes, and some aspects of behaviour. Adolescents are a group who are difficult to influence, but our study has produced some useful information about how these children respond to such teaching measures.

Adolescent↗
PubMedDate not supplied

Health education needs of primigravidae.

Forty-eight primigravidae were interviewed when 3-4 months pregnant about their knowledge of fetal development, awareness of hazards to development and sources of information. Although there was reasonable knowledge about normal fetal development, the women were not generally aware of the repercussions of maternal rubella or rationale for many routine tests at antenatal clinics. Fourteen of the women were smoking and only four of these intended to change during pregnancy. The general practitioner was perceived as a vital source of information, in marked contrast to the midwife. Few women reported learning about child development or care at school, but most used pamphlets or books as a source of information.

Adult↗
PubMed2004

Is dietary counselling effective in increasing dietary calcium, protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial.

To determine the feasibility of increasing the calcium, protein and calorie intake of osteoporotic fracture patients by repeated dietary counselling delivered by a dietitian, a randomized controlled trial was conducted. Among 189 patients presenting with osteoporotic fractures to an Orthopaedics and Traumatology Department of a large regional hospital, 98 patients were randomized to the intervention group and 91 were randomized to the control group (with usual care). Intervention group received three sessions of dietary counselling with tailored made recommendations over a period of 4 months, while the control group only received dietary assessment and pamphlets on the prevention of osteoporosis. Almost all subjects in both intervention and control groups had calcium intake below the recommended level of 1000 mg at baseline. Half and 60% of subjects in both groups had total energy and protein intake below recommended levels respectively. The mean weights of control and intervention groups at baseline were 51.5 and 50.9 kg respectively, while the body mass index (BMI) were 22.6 (kg m(-2)) and 22.6 (kg m(-2)) respectively. After dietary intervention, significant increase of intake was seen in calcium intake (P = 0.0095 by t-test) in the intervention group. No significant increase was seen in protein or calorie intake. No significant change was observed in the body weight or BMI although there was a positive trend in the intervention group for all these parameters. We concluded that there was general malnutrition in Chinese elderly who presented with osteoporotic fractures. Dietary calcium could be increased by repeated professional dietary counselling. Future studies with longer duration and more objective clinical outcomes will be helpful to further demonstrate the long-term effects of dietary intervention on osteoporosis and other chronic diseases.

Aged↗
PubMed1991

'Mrs L.'s case': a celebrated South Australian surgical case.

This paper concerns a dispute at the Adelaide Hospital in September 1896 between Professor Archibald Watson, Pathologist, Honorary Consulting Surgeon and sole remaining University teacher at the hospital, and Alexander Disney Leith Napier, who had arrived from England to fill the place of the honorary surgeons who had resigned from the hospital. Watson accused Napier of incompetence in his management of 'Mrs L.', who died after a femoral hernia operation. Mrs L had a form of internal hernia causing intestinal obstruction, whereas all the medical attendants, including Watson, originally thought an old femoral hernia was the cause of her illness. By fortuitous coincidence the operation on the femoral hernia could have cured the internal hernia if the band of omentum attached to the femoral hernia had been divided. Watson became aware of the band at the post-mortem and then asserted that the operation should have taken it into account. Napier complained to the Board of the Hospital, alleging that Watson had misrepresented the facts when he conducted the post-mortem on the patient and that he was disloyal to the hospital. The Board found the complaint proved and invited Watson to resign; he declined and was dismissed. Undaunted, Watson circulated a privately printed pamphlet (entitled 'Mrs L.'s case'), which re-stated the events of the case and graphically described his post-mortem findings. It was submitted to the Chairman of a Select Committee of the Legislative Council of South Australia established to review the running of the hospital. The Committee recommended the setting up of a Royal Commission but the Government let the matter lapse.(ABSTRACT TRUNCATED AT 250 WORDS)

General Surgery↗
PubMedDate not supplied

Receiving a hepatitis C-positive diagnosis.

BACKGROUND: There is a paucity of academic literature that describes patients' experiences of receiving a hepatitis C-positive diagnosis, doctors' explanations of the infection and referral to support services. AIM: The aim of the present study was to report findings on receiving a positive diagnosis from a study of people with hepatitis C infection. METHOD: A cross-sectional study of people with hepatitis C infection living in New South Wales, Australia, was carried out (n=504). RESULTS: Of participants diagnosed with hepatitis C infection from 1989 to 2001 (n= 17), just under one-third (29.5%, n=123) reported that they had received 'no explanation' about their infection from their doctor at diagnosis. Women and those diagnosed from 1989 to 1996 were significantly more likely to report receiving no explanation than men and those diagnosed later (35.4 vs 23.7% and 37.5 vs 23.0%, respectively). Similarly, current injecting drug users and those diagnosed from 1989 to 1996 were significantly more likely to report receiving no post-test counselling than those who were not currently injecting and those diagnosed later (42.9 vs 30.2% and 37.6 vs 25.9%, respectively). Participants diagnosed from 1997 to 2001 were significantly more likely to report receiving pamphlets about hepatitis C infection (39.2 vs 23.7%), information about treatments (24.5 vs 16.2%) and advice regarding natural therapies (9.1 vs 3.8%) than those diagnosed earlier. CONCLUSIONS: These data provide evidence of an increase in the dissemination of hepatitis C information by doctors at diagnosis during the late 1990s. Continued effort is needed to improve doctors' provision of information and referral to specialists and support agencies for people newly diagnosed with hepatitis C.

Adult↗
PubMed1998

Improving smoking cessation advice in Australian general practice: what do GPs suggest is needed?

Smoking cessation advice from a general practitioner (GP) significantly increases quit rates among patients who smoke. However, smoking is not discussed during most routine consultations with smokers. This study describes GPs' own views about strategies to support their cessation advice. In 1997, a random sample of 311 GPs in NSW (73% response rate) completed a self-administered questionnaire about smoking cessation. Most respondents were 'very confident' about discussing the health effects of smoking (81.7%). Fewer were as confident about negotiating a quit date (21.5%) or using evidence-based smoking cessation techniques (19.3%). The top three preferred strategies to support smoking cessation advice were all resources for patients: subsidised nicotine replacement therapy (rated as 'quite useful' by 60.5%), pamphlets (55.0%) and free access to smoking cessation clinics (50.8%). Skills training (39.7%) was the preferred resource to improve practitioner effectiveness. Interventions combining skills training with patient resources are likely to be well received by GPs.

Adult↗
PubMed1999

Barriers to Pacific women's use of cervical screening services.

OBJECTIVE: The present study explored barriers to the use of cervical screening information and services from the perspective of Pacific women. METHOD: Qualitative, face-to-face interviews based on a snowball sampling approach were used in Palmerston North, New Zealand, in 1997, to assess attitudes among 20 Pacific women. RESULTS: The study found a high level of awareness of a local cervical screening program. Specific barriers determined were: a resistance to being defined as socially problematic, embarrassment, belief in the sacred nature of human sexuality, an anxiety about lack of confidentiality within small community groups, and a perceived relationship between cervical smears and sexual activity. CONCLUSIONS: Participants strongly preferred that information on cervical screening should be transmitted by interpersonal means, though pamphlets on screening services were also sought. The women agreed that the preferable role of a Pacific Island health professional would be in disseminating information, rather than actually serving as a smear-taker. IMPLICATIONS: The need for smear-taking should not be stereotyped as a 'Pacific problem'. Multi-racial images of women should be used in advertising to demonstrate that cervical smears are necessary regardless of ethnicity. Information providers need to show great sensitivity when providing information relevant to human reproduction or sexuality.

Adult↗
PubMed2001

Fluoridation--what the public know and what they want.

OBJECTIVE: To describe the knowledge and beliefs on fluoridation of a community served by an unfluoridated water supply prior to consultation on implementing fluoridation. METHODS: Telephone survey of a sample of residents and businesses utilising semi-structured questionnaires. Comparisons were made among responses of ethnic and age groups. RESULTS: Residents were more conversant concerning fluoridation than business users. Knowledge and beliefs among ethnic groups differed significantly. Younger persons and those who had never been married were less knowledgeable. Pamphlets supplied by water-provider organisations or health professionals were the preferred methods of acquiring fluoridation information. The majority of respondents wished the opportunity to express their views via a referendum. Health authorities were the favoured decision-makers. CONCLUSIONS AND IMPLICATIONS: Gaps were identified in this community's knowledge on fluoridation with important differences based on ethnicity and age. Strategies to inform the public on water fluoridation need to address these subgroup differences.

Adolescent↗
PubMed2003

The four Ds deconstructed.

For decades, pamphlets provided by credible government authorities have reproduced tips for quitting smoking, recommended with certainly, but with no basis in facts, findings or substantiated outcomes. The 'four Ds' are an example of a universally accepted set of instructions to quit smoking that has little basis in science. This anomaly is at odds with the era of evidence-based medical interventions and should be addressed.

Australia↗
PubMed2006

Embodiment and ethics: constructing medicine's two bodies.

The first 'modern' presentation of medical ethics is generally acknowledged to be Percival's text of 1803. The main theme of this influential pamphlet was the way in which medical practitioners should relate to one another. Two centuries later, clinical practice has very different moral underpinnings: bioethics, which first emerged in the middle of the 20(th) century, is not concerned with how doctors should interact with each other but with the responsibilities of medical practitioners to their patients. The shift from an ethics based on the relationship between practitioners to one based on the relationship with their patients is viewed as a major advance brought about by a more enlightened society engaging with the consequences of new technologies. But rather than addressing the changing picture of medical ethics in its own terms (which over the last few decades has been from the perspective of bioethics) I examine the history of medical ethics in its close relationship to the form and nature of the medical profession. Further, in a parallel thread I describe contemporary developments in public health and explore the similarities and connections between the two.

Codes of Ethics↗
PubMed1984

Communicating with sick and hospitalised children.

This paper is concerned with preparing paediatric patients for hospitalisation. It is concluded that most work has focused on children requiring short-stay hospitalisation for minor surgery. All of the main techniques in use (pamphlets, video or pre-admission nursing contact) appear more beneficial to the patient and family than routine care, but no method is superior. Little attempt has been made to modify the technique according to the age of the child. It is suggested that greater benefits to the child might occur where information about illness is made appropriate to the child's cognitive level. The implications of developmental changes in children's beliefs about health and illness for such education are discussed.

Adenoidectomy↗
PubMed1997

Changes in folate supplementation, and in serum and red cell folate levels in antenatal patients over the course of a health promotion project for the prevention of neural tube defects.

We assessed the use of folic acid supplements and changes in serum and red cell folate levels in pregnancy over the course of a health promotion project in Western Australia by 4 cross-sectional studies of women attending a public antenatal outpatient clinic in 1992 (before the launch of the health promotion project), 1993, 1994, and 1995. A short questionnaire was completed and blood taken for estimation of serum and red cell folate. There was an increase in the proportion of women taking folic acid supplements in the first trimester (51.9% in the final phase) and before pregnancy (15% in the final phase of the study), and no change in the proportion taking other vitamin supplements. Serum and red cell folate levels increased significantly over the study period in both women taking and not taking folic acid supplements. The proportion of women who had seen the pamphlet used in the health promotion project rose to 35.4% in the third phase, and fell to 27.8% in the final phase. Coincident with the health promotion project, there was an increase in folate status in early pregnancy. However, most women were not taking folic acid supplements before they became pregnant and, hence may not have had sufficient folate at the time of normal neural tube closure.

Erythrocytes↗
PubMed2004

People who influence women's decisions and preferred sources of information about prenatal testing for birth defects.

BACKGROUND: More than half of Victorian pregnant women are undergoing prenatal testing for birth defects, although little is known about the factors that are influencing their decisions. AIMS: To examine whom women perceived as influencing their decision about prenatal testing for birth defects, with whom they would have liked to talk more, and what sources of information they preferred. METHODS: A total of 737 pregnant women aged 37 years and over, who either had or had not undergone prenatal testing (screening and/or diagnosis) completed a questionnaire in 18 hospitals throughout Victoria. RESULTS: Over 90% reported that they themselves had a strong influence on their decision, and 70% reported their partner as strongly influencing their decision. Approximately 30% of women who had both screening and diagnosis and more than 20% of women who had no prenatal testing, would like to have discussed prenatal testing with women who had previously had testing. Face-to-face counselling with a doctor or counsellor was the preferred source of information, followed by a pamphlet as the second choice. CONCLUSIONS: Given that both tested and untested women felt so strongly that they were responsible for their own decisions about prenatal testing, it is unlikely that universal acceptance and uptake will occur, even in this group of women of advanced maternal age. A support network of women who have already had testing could supplement existing sources of support. However, there continues to be a need for face-to-face sessions with a doctor or counsellor in combination with printed material.

Adult↗