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PubMed2002

Satisfaction of orthognathic surgical patients in a Malaysian population.

Thirty-one patients treated at the Faculty of Dentistry, University of Malaya, were assessed for their satisfaction following orthognathic surgery. The female to male ratio was 22:9 with an age range of 17 to 36. Almost all patients (97%) listed appearance as one of their rationales for surgery. More males (78%) than females (59%) wanted functional improvement, while more females (91%) than males (33%) hoped for improvement in self-confidence. All patients reported esthetic improvement while 68% each reported improvement in mastication and self-confidence. Slightly more than half (52%) chose esthetic improvement as the single most important factor resulting in satisfaction. Almost ninety percent of male patients claimed satisfaction with functional improvement, while 68% of those who found satisfaction in improved self-confidence were females. Eighty-seven percent rated their post-surgical changes as being well accepted by their family. The impact of these findings on the success of the surgery and the need to reinforce verbal communication with printed pamphlets are emphasized.

Adolescent↗
PubMed2002

A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity.

OBJECTIVE: To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase moderate-intensity physical activity (PA). RESEARCH DESIGN AND METHODS: In this randomized controlled trial conducted at seven practices in central North Carolina, 200 African-American women, > or =40 years of age with type 2 diabetes, were randomized to one of three treatment conditions: clinic and community (group A), clinic only (group B), or minimal intervention (group C). The clinic-based intervention (groups A and B) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practices and attitudes; the community-based intervention (group A) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was designed to provide social support and reinforce behavior change goals; and the minimal intervention (group C) consisted of educational pamphlets mailed to participants. The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer, which was worn while awake for 7 days. RESULTS: Totals of 175 (88%) and 167 (84%) participants completed PA assessment at 6 and 12 months, respectively. For comparison of PA, the P value for overall group effect was 0.014. Comparing group A with C, the difference in the average adjusted mean for PA was 44.1 kcal/day (95% CI 13.1-75.1, P = 0.0055). Comparing group B with C, the difference in the average adjusted mean was 33.1 kcal/day (95% CI 3.3-62.8, P = 0.029). The intervention was acceptable to participants: 88% were very satisfied with clinic-based counseling to enhance PA, and 86% indicated that the peer counselor's role in the program was important. CONCLUSIONS: The intervention was associated with a modest enhancement of PA and was acceptable to participants.

Adult↗
PubMed1989

Comprehensibility of patient education literature.

A survey of the mental health information literature available in NSW was made using the Flesch Formula for Reading Ease. It was found that ten out of thirteen were written at a level of complexity unintelligible to up to 60% of the general public. The literature is therefore falling far short of its potential. It is recommended that a serious attempt be made to write pamphlets in Plain English style. This process should include a Reading Ease estimation.

Humans↗
PubMed1996

The early history of the New Zealand Association of Psychotherapists and the related movement for primary prevention in mental health: some recollections.

Following his return to New Zealand from London in 1940, Dr C. M. Bevan-Brown gave lectures leading to the formation of the Mental Health Club. In 1946 this became the Christchurch Psychological Society. The New Zealand Association of Psychotherapists was formed at a conference in 1947 and held annual conferences for many years. In 1948 and 1949 training courses for doctors and medical students were conducted. To combat widespread ignorance, a series of pamphlets on various aspects of emotional health was published, and in 1950 a book on psychotherapy and primary prevention. These inspired the formation of Parents' Centres from 1951, which, as branches increased, led to the New Zealand Federation of Parents' Centres. They later gained official medical recognition and played an historic role in transforming some aspects of New Zealand culture and guiding institutions towards greater sensitivity to the emotional and mental health aspects of pregnancy, childbirth and early parent-child relationships. The influence of this movement continues.

Female↗
PubMed1987

Interdisciplinary andrology. STDs. AIDS research.

Multidisciplinary andrology deals with clinical application and modern technology for the evaluation and differential diagnosis of male infertility with emphasis on morphological, anatomical, biochemical, immunological, hereditary, and microbiological parameters. Little is known about the effects of diet, disease, stress, environmental, and drugs on male-related unexplained infertility of couples. Regional, national, and international centers of multidisciplinary andrology should provide (1) extensive and unique clinical services; (2) a computerized "patient referral center," (3) self-learning packages (slides/tape programs) for patients; and (4) a computer link to the National Library of Medicine and the Drug Information Center. Specialized laboratories and clinics can be served by expert consultants, visiting professors, bilingual and well-trained clinicians, nurses, laboratory technologists, computer operators, and related allied health personnel. Patient education pamphlets, updated every few years, can be distributed during training workshops when an extensive network of remote teleprinters can be utilized. Qualified client location may install a printer to allow on-site printing of reports in the shortest possible time. Special mailing containers are provided to clients who wish to mail their laboratory specimens. Other clinical services may include the following: 1. Central source of communication and information in andrology; 2. International roster of multidisciplinary andrology centers; 3. Patient referral to centers and consultations for developing countries; 4. Screening of husbands and wives for in vitro fertilization/embryo transfer (IVF/ET); 5. Screening of couples with unexplained infertility for sexually transmitted diseases (STDs) including AIDS; 6. Exchange of research material and methodology; 7. Coordination of multicenter research; 8. Organizing training workshops for clinicians, nurses, and laboratory technicians; 9. Establishing a repository of films, video tapes, slides, catalogs, instrumentation, books, SEM photos, and atlases; 10. Publication and editorial assistance; 11. Consultation for the appropriate selection, purchase, and quality control of instrumentation (all on one computer system); 12. Evaluation of new diagnostic tools for idiopathic infertility and fertility regulation; 13.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1995

Women's perceptions and experience of menopause: a focus group study.

Focus groups were used to investigate women's perception and experience of menopause, hormone replacement therapy, osteoporosis and doctor-patient relationships. Forty women aged between 45 and 55 years participated in seven focus groups. Most women thought that these topics were not widely or freely discussed in the community. Nevertheless they were able to share their experiences on this occasion. Lack of reliable, accessible and current information on menopause and related topics was identified as a problem. This was compounded by the contradictory nature of the information which was available. Hysterectomy and osteoporosis were identified as specific areas in which information was inadequate and not readily accessible. Solutions suggested by the women included distributing information pamphlets with contact numbers for further information to non-health-related settings such as hairdressing salons. The need to foster open discussion between women and their doctors was highlighted, with contributions required from both parties to develop a more equal partnership. A review of doctors' and women's surveillance practices with regard to hormone replacement therapy may also be warranted. We found focus groups a useful method for accessing women's experiences and perceptions. There was particular benefit in researchers being involved as moderators and scribes, and in an early post-focus group meeting to amplify and clarify records of the discussions. Small group size and an emphasis on confidentiality were, we believe, helpful strategies in encouraging discussion of intimate topics.

Attitude to Health↗
PubMed1995

The Harstad injury prevention study: hospital-based injury recording used for outcome evaluation of community-based prevention of bicyclist and pedestrian injury.

OBJECTIVE: To test the feasibility of a hospital-based injury recording for accident analysis and outcome evaluation of bicyclist and pedestrian injury prevention. DESIGN: Prospective injury recording lasting 7 1/2 years, using a quasi-experimental design. SETTING: The population of Harstad (22,000). INTERVENTION: Injury data were evaluated in an injury prevention group and used in planning a community-based intervention. Promotion of bicyclist helmet use and pedestrian safe behaviour was implemented by activating public and voluntary organizations and media. A traffic safety pamphlet containing local traffic injury data was distributed. Changes were made in the physical traffic environment. MAIN OUTCOME MEASURES: Injury rates for bicyclists and pedestrians. RESULTS: In 275 bicyclists upper extremity and head injuries were predominant 70% were below 16 years. In 137 pedestrians lower extremity injury was most frequent and children below 10 years had the highest injury rates. Significant injury rate reductions were observed after intervention for child bicyclists and pedestrians. CONCLUSION: A hospital-based injury recording is feasible for bicyclists and pedestrian accident analysis, planning injury prevention, and outcome evaluation of the programme. This study indicates that a significant injury rate reduction in children may have been the result of the intervention.

Accidents, Traffic↗
PubMed2000

The archives of the Canadian Dermatology Association.

This article describes some details of the archival material of the Canadian Dermatology Association (CDA). Covering its 75 years of existence, these archives consist of seven items: (1) 38 volumes of bound archives; (2) tri-annual issues since 1975 of the CDA Journal/Bulletin (a socio-political historical newsletter); (3) members' files containing extensive biographical material; (4) a collection of 150 books and other pamphlets; (5) since 1995, the scientific peer-reviewed official journal of the CDA (Journal of Cutaneous Medicine and Surgery); (6) a sporadic collection of photographs, meeting tape recordings, and protocols of patient presentations at the annual meetings; and (7) a miscellany of historical articles on Canadian dermatologists, dermatology published in older medical Journals, and two books published separately.

Archives↗
PubMed1987

Dairy animal welfare: current and needed research.

Of 25 milestones in dairy animal welfare, 10 were linked to laws and regulations, 9 to research, education, and development, 4 to books and publications, and 2 to human error (accidents). Animal rightists have attacked the dairy industry because of farm conditions, bovine somatotropin, overproduction of milk, dairy lobbies, and advertising of milk products. Evidence from Europe suggests that animal welfare has been largely promoted as a sociopolitical issue by nonagriculturalists. Codes, guidelines, and recommendations are well-established for northern Europe. The American Veterinary Medical Association Animal Welfare Committee has prepared the pamphlet on food animal welfare and addressed specific bovine welfare issues in its guide for veal calf care and production. From 1978 to 1986, only four US experiment station projects were concerned with dairy animal welfare. Needed research includes studying learned helplessness; analysis and economics of alternative husbandry systems for veal calves (and cows) freestall design and surfaces; and shade, cooling, and misting of mangers and holding pens prior to entering the parlor. Alert caretakers are encouraged to read behavior signals of cattle. Increased standing of cattle is often taken now as a sign of discomfort or discontent in studies of cow and calf confinement. Criteria that should be considered in assessing welfare or well-being are behavior, health, musculoskeletal soundness, productivity, physiological and biochemical characteristics, and reproduction.

Animal Welfare↗
PubMed2005

Impact of statewide program to promote appropriate antimicrobial drug use.

The Wisconsin Antibiotic Resistance Network (WARN) was launched in 1999 to educate physicians and the public about judicious antimicrobial drug use. Public education included radio and television advertisements, posters, pamphlets, and presentations at childcare centers. Physician education included mailings, susceptibility reports, practice guidelines, satellite conferences, and presentations. We analyzed antimicrobial prescribing data for primary care physicians in Wisconsin and Minnesota (control state). Antimicrobial prescribing declined 19.8% in Minnesota and 20.4% in Wisconsin from 1998 to 2003. Prescribing by internists declined significantly more in Wisconsin than Minnesota, but the opposite was true for pediatricians. We conclude that the secular trend of declining antimicrobial drug use continued through 2003, but a large-scale educational program did not generate greater reductions in Wisconsin despite improved knowledge. State and local organizations should consider a balanced approach that includes limited statewide educational activities with increasing emphasis on local, provider-level interventions and policy development to promote careful antimicrobial drug use.

Anti-Bacterial Agents↗
PubMed2004

Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups.

OBJECTIVES: To estimate UK need for outpatient cardiac rehabilitation, current provision and identification of patient groups not receiving services. To conduct a systematic review of literature on methods to improve uptake and adherence to cardiac rehabilitation. To estimate cost implications of increasing uptake of cardiac rehabilitation. DATA SOURCES: Hospital Episode Statistics (England). Hospital Inpatient Systems (Northern Ireland). Patients Episode Database for Wales. British Association for Cardiac Rehabilitation/British Heart Foundation surveys. Cardiac rehabilitation centres. Patients from general hospitals. Electronic databases. REVIEW METHODS: The study analysed hospital discharge statistics to ascertain the population need for outpatient cardiac rehabilitation in the UK. Surveys of cardiac rehabilitation programmes were conducted to determine UK provision, uptake and audit activity, and to identify local interventions to improve uptake. Data were also examined from a trial estimating eligibility for cardiac rehabilitation and non-attendance. A systematic review of interventions to improve patient uptake, adherence and professional compliance in cardiac rehabilitation was conducted. Estimated costs of improving uptake were identified from national survey, systematic review and sampled cardiac rehabilitation programmes. RESULTS: In England, Wales and Northern Ireland nearly 146,000 patients discharged from hospital with primary diagnosis of acute myocardial infarction, unstable angina or following revascularisation were potentially eligible for cardiac rehabilitation. In England in 2000, 45-67% of these patients were referred, with 27-41% attending outpatient cardiac rehabilitation. If all discharge diagnoses of ischaemic heart disease were considered, nearly 299,000 patients would be potentially eligible and in England rates of attendance and referral would be 22-33% and 13-20% respectively. Rates of referral and attendance were similar in Wales, but somewhat lower in Northern Ireland. It was found that referral and attendance of older people and women at cardiac rehabilitation tended to be low. It was also suggested that patients from ethnic minorities and those with angina or heart failure were less likely to be referred to or join programmes. A wide range of local interventions suggested awareness of the problem of uptake. In an NHS-funded randomised controlled trial, possibly representing more optimal protocol-led care, medical and nursing staff identified 73-81% of patients with acute myocardial infarction as eligible for cardiac rehabilitation. Excluded patients tended to be older with more severe presentation of cardiac disease. Experiences of patients suggested that uptake may be improved by addressing issues of motivation and relevance of rehabilitation to future well-being, co-morbidities, site and time of programme, transport and care for dependents. Systematic review of studies supported the use of letters, pamphlets or home visits to motivate patients and the use of trained lay visitors. Self-management techniques showed some value in promoting adherence to lifestyle changes. Studies examining professional compliance found that professional support for practice nurses may have value in the coordination of postdischarge care. Average costs in 2001 of cardiac rehabilitation to the health service per patient completing a cardiac rehabilitation programme were about GBP350 (staff only) and GBP490 (total). If services were modelled on an intermediate multidisciplinary configuration with three to five key staff, approximately 13% more patients could be treated with the same budget. Depending on staffing configuration an approximate 200-790% budget increase would be required to provide cardiac rehabilitation to all potentially eligible patients. CONCLUSIONS: Provision of outpatient cardiac rehabilitation in the UK is low and little is known about the capacity of cardiac rehabilitation centres to increase this provision. There is an uncoordinated approach to audit data collection and few interventions aimed at improving the situation have been formally evaluated. Motivational communications and trained lay volunteers may improve uptake of cardiac rehabilitation, as may self-management techniques. Experience of low-cost interventions and good practice exists within rehabilitation centres, although cost information frequently is not reported. Increased provision of outpatient cardiac rehabilitation will require extra resources. Further trials are required to compare the cost-effectiveness of comprehensive multidisciplinary rehabilitation with simpler outpatient programmes, also research is needed into economic and patient preference studies of the effects of different methods of using increased funding for cardiac rehabilitation. An evaluation of a range of interventions to promote attendance in all patients and under-represented groups would also be useful. The development of standards is suggested for audit methods and for eligibility criteria, as well as regular and comprehensive data collection to estimate the need for and provision of cardiac rehabilitation. Further areas for intervention could be identified through qualitative studies, and the extension of low-cost interventions and good practice within rehabilitation centres. Regularly updated systematic reviews of relevant literature would also be useful.

Cost-Benefit Analysis↗
PubMed2004

[Cardiac rehabilitation and resuming sexual activity].

Sexual function is an important component of cardiac patients' quality of life and subjective well being. Patients, however, are often uninformed regarding the question of resuming sexual activity after a cardiac event. Recent epidemiologic data reveal that sexual problems are widespread and adversely affect mood, well-being, and interpersonal functioning Erectile dysfunction (ED) is the most commonly recognized and treated sexual dysfunction. It affects > 30% of men 40 to 70 years of age and its prevalence in patients with cardiovascular disease is higher than in the general population. International Guidelines has faced the problem of resuming sexual activity after a cardiac event and of the eventual suitability to the use of sildenafil or other selective inhibitor of cGMP-specific phosphodiesterase type 5 (5-PDE) for the therapy of ED in these patients. The clinical judgment should be based on the integration of clinical and instrumental data, on the evaluation of the compatibility with the foreseen energetic cost of the effort connected to sexual activity and, in case of prescription of 5-PDE inhibitors, on the eventual incompatibility with the therapy undertaken (in particular with nitrates). In the review the main reference points of literature are supplied in order to have the chance of giving motivated technical advice. Finally it is extremely important to face the problem of resuming sexual activity systematically within the cardiac rehabilitation program, with educational sessions, individual or couple conversations, and with the aid of information pamphlets.

Erectile Dysfunction↗
PubMed1999

The use of reproductive health information material in the rural clinics of Umtata district.

Though it appears that there has been a long history of development, distribution and dissemination of reproductive health information materials, impediments still exist in the health information, communication and education systems in South Africa. The aim of the study was to contribute towards improvement of the development, distribution and utility of reproductive health information material both in the Eastern Cape province and nationally. In-depth understanding of complexities surrounding development, distribution and utility of educational material is key to the provision of information to communities. The objectives were to describe the availability and examine the content, target groups, language and utility of reproductive health information materials. Qualitative study using non probability sampling was done. Ten rural clinics were conveniently selected. In-depth interviews, focus groups and a checklist were used to collect data. Reproductive health information materials found were mostly posters, there were no pamphlets, material on some reproductive health aspects was not available, inconsistently distributed and not updated. It was concluded that posters are available in the rural clinics of Umtata district judging from the results there is a need to improve the quality of reproductive health information material.

Ambulatory Care Facilities↗
PubMed1975

Rocky Mountain spotted fever (tick-borne typhus) in South Carolina: an educational program and tick/rickettsial survey in 1973 and 1974.

Because the incidence of spotted fever is increasing in South Carolina, campaigns were carried out in 1973 and 1974 to provide the public and medical practitioners, through pamphlets and news media, with information about spotted fever and the ticks which transmit the causative agent, Rickettsia rickettsii. People were also invited to save and submit live ticks removed from vegetation, animals and humans, for examination by the hemolymph test. A total of 1,186 ticks consisting of 987 Dermacentor variabilis, 103 Rhipicephalus sanguineus, and 96 Amblyomma americanum were examined. Rickettsiae identified by direct immunofluorescence as members of the spotted fever group were detected in 49 (4.9%) of the D. variabilis, and 16 (16.6%) of the A. americanum ticks. Two hundred and twenty (199 D. variabilis, 17 A. americanum, and 4 R. sanguineus) were recorded as having been attached to 199 persons. Nine of these ticks (8 D. variabilis, and 1 A. americanum) were hemolymph test-positive for spotted fever-group rickettsiae. Infected ticks originated from each of the three major South Carolina biogeographic regions, namely Piedmont, Sandhill, and Coastal Plain. Since education is the first and most important step in preventing spotted fever, educational programs and tick examination services similar to those decribed, are suggested for other states with high spotted fever incidence.

Animals↗
PubMed1997

Educational techniques used in occupational therapy treatment of cumulative trauma disorders of the elbow, wrist, and hand.

OBJECTIVE: This study examined patient education techniques used by occupational therapists when treating cumulative trauma disorders (CTDs) of the elbow, wrist, and hand. METHOD: A self-administered survey was sent to 232 registered occupational therapists whose primary area of practice was hand therapy. The questionnaire sought information about specific content areas and methods (i.e., media, format) used to educate patients about preventing the recurrence of CTDs in the elbow, wrist, and hand. RESULTS: One hundred twenty-eight therapists responded to the survey. A majority of respondents (n = 116) reported that patient education content area consisted of anatomy of the joint, the CTD disease process, and job modification. Verbal instruction, illustrations, and pamphlets and handouts were the most frequently used forms of educational media. A majority of respondents (n = 111) also reported that individual interaction was the most common format of patient education. CONCLUSION: The findings indicate that a majority of therapists use the same patient education techniques with regard to content areas, media, and format, regardless of the area being treated (i.e., elbow, wrist, hand). Furthermore, it appears that therapists with specialty training in CTDs more frequently include anatomy of the elbow, job modification, and proper body mechanics in the content of their patient education about the elbow.

Adult↗
PubMed1978

Counselling the hysterectomy patient.

The problem of psychosexual disorders following hysterectomy is reviewed. A search of the current literature suggests that a large number of women who have post-hysterectomy depression, loss of libido, or other neuroses have a previous history of depression and neurosis, that they have a generally poor knowledge of their own anatomy and physiology, or that they have received poor counselling and explanation from their own doctor. The fact that the decision to perform a hysterectomy may have been incorrect has also been suggested as a possible cause for regret for the loss of their uterus in some women, whilst in others it is often related to the concept that the uterus is the source of a woman's femininity and the loss of this organ makes her less than a woman. A regime of counselling and the use of an explanatory pamphlet is proposed for all women who are to have a hysterectomy.

Adult↗
PubMed1990

Increasing cervical screening in women of more than 40 years of age: an intervention in general practice.

An intervention that was aimed at increasing cervical screening in women of more than 40 years of age was undertaken, with general practitioners as the primary point of contact. The intervention consisted of the practice receptionist giving female patients pamphlets about Papanicolaou smear-tests and the general practitioner offering a Papanicolaou smear-test. Nineteen general practitioners and their female patients (n = 466) of more than 40 years of age who presented for consultation over a 10-day period were involved in this study. Each woman in the study was asked when she had last undergone a Papanicolaou smear-test. All women who were found to be "at risk", that is, who had not undergone a Papanicolaou smear-test in the previous two years (57% of those women who were asked) were offered cervical screening. Over-all about 50% of the women who were found to be "at risk" underwent a Papanicolaou smear-test at the general practitioner initiated request, either at the same consultation (26% of those "at risk") or on their return at a later date (23% of those "at risk"). Therefore, the intervention appears to have been effective in encouraging a relatively high-risk group of patients to undergo Papanicolaou smear-tests. However, the strategy was differentially effective depending on age: more women of less than 65 years of age underwent a Papanicolaou smear-test than did women of more than 65 years of age. The feasibility of using the intervention in everyday general practice depends on the willingness of medical practitioners to ask female patients to undergo a Papanicolaou smear-test, the ability to take a Papanicolaou smear during the consultation or soon after, and the acceptance of the invitation by women as based on an understanding of the need.

Adult↗
PubMed2001

Evaluation of a breast self-examination (BSE) program in a breast diagnostic clinic.

The purpose of this study was to evaluate the short-term effectiveness of a breast self-examination (BSE) teaching program on women's knowledge about BSE, proficiency in performing BSE, and motivation to perform BSE. The program was developed for delivery by nurses in a breast diagnostic clinic, a clinic designed to meet the need for expeditious management of breast disease, current information about breast cancer risk, surveillance, and counselling. A convenience sample of 68 women attending the clinic in a regional cancer centre participated in a pre- and five month post-teaching program evaluation. The Toronto Breast Self Examination Instrument was used as the evaluation tool. There were statistically significant changes following the teaching program in the areas of knowledge about the correct technique for performing BSE, proficiency performing BSE, and confidence about finding changes when performing BSE. No significant changes were observed in motivation to practise BSE, although group scores did improve following the education. Participants found the video presentation and the review of BSE information pamphlets by the nurse to be the most helpful components of the BSE teaching program.

Adult↗