Kin and elderly amenity migration.
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Aged↗
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Results for “Knowledge Sources”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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A method in search of a theory: peer education and health promotion.
Peer education has grown in popularity and practice in recent years in the field of health promotion. However, advocates of peer education rarely make reference to theories in their rationale for particular projects. In this paper the authors review a selection of commonly cited theories, and examine to what extent they have value and relevance to peer education in health promotion. Beginning from an identification of 10 claims made for peer education, each theory is examined in terms of the scope of the theory and evidence to support it in practice. The authors conclude that, whilst most theories have something to offer towards an explanation of why peer education might be effective, most theories are limited in scope and there is little empirical evidence in health promotion practice to support them. Peer education would seem to be a method in search of a theory rather than the application of theory to practice.
Adolescent↗
Pregnancy and motherhood among Mexican American adolescents.
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Acculturation↗
Comparison of key informant and survey methods for ascertainment of childhood epilepsy in West Bengal, India.
BACKGROUND: This study aimed to compare efficacy and cost of key informants and survey for ascertainment of childhood epilepsy within a treatment context in rural India. METHODS: The study was set in a non-governmental, community programme for the functional and socioeconomic rehabilitation of children with disabilities in rural West Bengal, India. Ascertainment was by two methods: house-to-house survey of 15000 households and also by 430 key informants including village leaders, health workers and 670 schoolchildren. Methods were compared for positive predictive value, and sensitivity by capture-recapture technique. Ninety four children were enrolled into treatment. Predictors of treatment success were determined by multiple logistic regression analysis, giving adjusted odds ratios for remission. The costs of identifying one case and one treatment success were measured by costing personnel, materials and overheads. RESULTS: The survey was four times as sensitive as key informants although the positive predictive values were similar (36%, 40%). The survey had an absolute sensitivity of only 59%. Identification by key informants strongly predicted successful treatment outcome (odds ratio [OR] = 4.74, 95% confidence interval [CI] : 1.19-18.85). The cost of finding one case was US$11 and US$14, and of finding one successful treatment outcome US$35 and US$67 for informants and survey respectively. Key informants were essential in attaining longer term programme objectives. CONCLUSIONS: In the context of a treatment programme, key informants were the more cost-effective method, but community involvement was traded against low sensitivity in the short term. Overall ascertainment costs were significant in the context of primary health care in India.
Child↗
The home birth movement in the United States.
The home birth movement in the United States is an alternative health belief system that promotes a model of pregnancy and childbirth contradictory to the conventional biomedical model. The alternative model stresses normalcy and non-intervention and is informed by an ideology that promotes individual authority and responsibility for health and health care. It is founded in an epistemological system that assigns primacy and goodness to the Natural, fuses moral and practical injunctions in the arena of health behavior, and valorizes subjective as well as objective sources of knowledge. (Natural = as found in nature without technical intervention). Differences of opinion with the conventional medical model of childbirth do not spring from misunderstanding of this model, but from disagreement with it. Members of this movement are typically educated, middle class, and white.
Delivery of Health Care↗
What kind of expert should a system be?
Human experts are the source of knowledge required to develop computer systems that perform at an expert level. Human beings are not, however, able to reliably express what they know. As a result, experts often develop non-authentic accounts of their own expertise. These accounts, here termed reconstructed methods of reasoning, lead to computer systems that perform at a high level of proficiency but have the disadvantage that they often do not reflect the heuristics and processing constraints of a system user. Reconstructed methods of reasoning are compared with authentic methods derived from the study of expert human behavior. Tests are proposed to establish the authenticity of reasoning methods and examples from medical diagnosis are used to illustrate how authentic methods of reasoning can be incorporated into an expert computer system.
Clinical Competence↗
Beyond 'knock-out' mice: new perspectives for the programmed modification of the mammalian genome.
The emergence of gene inactivation by homologous recombination methodology in embryonic stem cells has revolutionized the field of mouse genetics. Indeed, the availability of a rapidly growing number of mouse null mutants has represented an invaluable source of knowledge on mammalian development, cellular biology and physiology and has provided many models for human inherited diseases. In recent years, improvements of the original 'knock-out' strategy, as well as the exploitation of exogenous enzymatic systems that are active in the recombination process, have considerably extended the range of genetic manipulations that can be produced. For example, it is now possible to create a mouse bearing a targeted point mutation as the unique change in its entire genome therefore allowing very fine dissection of gene function in vivo. Chromosome alterations such as large deletions, inversions or translocations can also be designed and will facilitate the global functional analysis of the mouse genome. This will extend the possibilities of creating models of human pathologies that frequently originate from various chromosomal disorders. Finally, the advent of methods allowing conditional gene targeting will open the way for the analysis of the consequence of a particular mutation in a defined organ and at a specific time during the life of a mouse.
Animals↗
Problem-based learning as a training modality in the occupational medicine curriculum.
Problem-based learning has been used as a curricular modality in the academic year of the Occupational Medicine Residency Program. The method was applied to the resolution of problems presented by patients referred to a university clinic specifically for the determination of possible work-relatedness of the syndrome or symptoms presented. Following the usual development of the occupational and medical histories, physical examination, and determination of certain clinical laboratory values, the resident would then have to seek assistance through consultation with related specialists, a perusal of the pertinent toxicology, epidemiology, or other discipline literature, and ultimately prepare a university-level report, following case conferences with fellow residents and faculty members. No formal direction was given the student, the problems of diagnosis, occupational etiology and medicolegal acceptance of the resulting report having to be resolved through self-perusal of informational sources. The knowledge gained from the exercise would be longer-lasting than that attained strictly from lecture attendance.
Curriculum↗
Cancer registries--future development and uses in Britain.
Cancer registries are a vital source of information on cancer epidemiology and cancer services. Their role has changed dramatically over the past 15 years. A number of factors will affect their future role, including health service changes, information technology, development of clinical datasets and greater demand for both health service and public information. The potential of cancer registration needs to be realized by clinicians and health authorities: how they can use the data, its limitations, and how they can support and influence it through this period of change. A strategic direction is needed so that cancer registries develop into a dynamic, interactive source of knowledge for the twenty-first century.
Confidentiality↗
Reading the body: dissection and the 'murder' of Sarah Stout, Hertfordshire, 1699.
This article is concerned with forensic medical evidence and the several forms in which it was supplied to courts in early modern England. A specific trial is described and interpreted in detail, with particular attention being given to the kinds of information derived from the decomposed body of a young Quaker woman, believed either to have drowned or been murdered. The role of medical and lay evidence is evaluated and attention directed towards the ways in which the proceedings were recounted and recycled in post-trial publications. Major themes include popular attitudes towards dissection, the roles of lay and professional witnesses and the role of women as traditional sources of knowledge about the body.
Dissection↗
Substance use by fourth-year students at 13 U.S. medical schools.
Fourth-year medical students at 13 medical schools in different regions of the United States received an anonymous questionnaire designed to examine their current and prior use of 11 substances and their attitudes toward substance use among physicians. Of 1,427 questionnaires distributed, 41 percent were returned. The questionnaire and distribution method were derived from an ongoing survey on drug use in order to permit comparison of the medical students with a national sample of age- and sex-matched cohorts. The rates of substance use during the 30 days preceding receipt of the questionnaire were: alcohol, 87.8 percent; marijuana, 17.3 percent; cigarettes, 9.0 percent; cocaine, 5.6 percent; heroin, 0.0 percent; other opiates, 0.9 percent; LSD, 0.2 percent; other psychedelics, 0.5 percent; barbiturates, 0.5 percent; tranquilizers, 2.2 percent; and amphetamines, 1.2 percent. Compared with their age and sex cohorts nationally, the medical students reported less use of marijuana, cocaine, cigarettes, LSD, barbiturates, and amphetamines. However, their use of other opiates was approximately the same and their use of tranquilizers and alcohol was slightly higher than that of the other cohorts. Data on their sources of knowledge about drug abuse indicate the need for greater attention to this issue in the medical curriculum.
Adult↗
Evaluation of a targeted AIDS prevention intervention to increase condom use among prostitutes in Ghana.
OBJECTIVE: To assess the short- and long-term impact of a 6-month pilot intervention program on condom use among prostitutes in Accra, Ghana. DESIGN: The 4-year prospective study follows-up cohorts enrolled in the intervention in 1987 and 1988, comparing condom use in 1991 with that among a comparison group not enrolled in the intervention. SETTING: The community-based intervention was initiated in Accra, Ghana in 1987. PARTICIPANTS: Self-identified female prostitutes who volunteered participation. INTERVENTION: The educational intervention used local health workers to train and support selected prostitutes to be health educators and condom distributors to their peers. OUTCOME MEASURES: Self-reported condom use with clients. RESULTS: Reported condom use increased dramatically between 1987 and 1988 during the first 6 months of the intervention. In 1991, after 3 years of program relapse, 107 (43%) of the 248 women who had enrolled in 1987 or 1988 were still in prostitution and located for interview. Their level of condom use in 1991 was higher than pre-enrollment but similar to use among prostitutes never enrolled. Sixty-four per cent of those followed-up reported always using condoms with clients in 1991. These 'always users' were more likely to have maintained informal contact with project staff, know that HIV can be transmitted by healthy clients, and report that clients frequently initiate condom use. CONCLUSIONS: Findings support the development of long-range educational strategies that recognize the career longevity of prostitutes, available channels for informal program diffusion, individual changes in condom use over time, and the role of clients in condom negotiation.
Acquired Immunodeficiency Syndrome↗
Pregnancy risk among the younger sisters of pregnant and childbearing adolescents.
There is increasing evidence that younger sisters of childbearing teenagers are at increased risk for adolescent childbearing. We critically review this research and discuss three plausible theoretical explanations (social modeling, shared parenting influences, and shared societal risk) why the younger sisters of childbearing adolescents would themselves be at risk for teenage pregnancy. Considerations for preventive interventions aimed at the younger sisters of pregnant teenagers and directions for future research are discussed.
Adolescent↗
Giving birth. Perceptions of Finnish childbearing women.
PURPOSE: To describe the lived experience of childbirth with women giving birth in Finland. DESIGN: Phenomenology. METHODS: Twenty Finnish women who had recently given birth were interviewed within 2 weeks following childbirth, sharing their perceptions of meaning of their childbirth experiences. Culturally appropriate strategies for qualitative data collection were employed. Trustworthiness of the data was ensured. RESULTS: The richness and diversity of the childbirth experience emerged from the data. One theme identified was a sense of awe at the creation of a new life within the context of birth as a bittersweet paradox. A strong sense of maternal confidence or self-efficacy was identified, which influenced the women's perception of and management of childbirth pain. Feelings of self-actualization were articulated as Finnish women successfully negotiated a challenging life event. CLINICAL IMPLICATIONS: Perinatal nurses should increase their sensitivity to the socio-cultural context of giving birth by acknowledging women's experiences as legitimate sources of knowledge.
Adult↗
U.S. women's perceptions of and attitudes about the IUD.
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Adolescent↗
Social marketing: dimensions of power and politics.
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Black or African American↗
Adolescent identity--a qualitative approach: self-concept, existential questions and adult contacts.
In-depth interviews were performed with 12 adolescents (Swedish students, 16-19 years). Three questions were probed; what do adolescents say on the subjects of (a) themselves, (b) their existential questions, and (c) their adult contacts. The first two questions were aimed at elucidating the process of identity development, the last one at factors that may be influencing this process. The results showed that (a) balancing and controlling one's own needs and wishes in relation to others' was a central issue, (b) existential questions mainly concerned the personal future, (c) adult contacts outside the family were scarce and (d) all respondents expressed a need for adult contacts as sources of knowledge and experience. The conclusions are that identity formation during late adolescence consists of integrative issues where adults play a specific and important role.
Adolescent↗
Mixture models for estimating the size of a closed population when capture rates vary among individuals.
We develop a parameterization of the beta-binomial mixture that provides sensible inferences about the size of a closed population when probabilities of capture or detection vary among individuals. Three classes of mixture models (beta-binomial, logistic-normal, and latent-class) are fitted to recaptures of snowshoe hares for estimating abundance and to counts of bird species for estimating species richness. In both sets of data, rates of detection appear to vary more among individuals (animals or species) than among sampling occasions or locations. The estimates of population size and species richness are sensitive to model-specific assumptions about the latent distribution of individual rates of detection. We demonstrate using simulation experiments that conventional diagnostics for assessing model adequacy, such as deviance, cannot be relied on for selecting classes of mixture models that produce valid inferences about population size. Prior knowledge about sources of individual heterogeneity in detection rates, if available, should be used to help select among classes of mixture models that are to be used for inference.
Animal Identification Systems↗