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PubMed2005

The childbirth expectations of a self-selected cohort of Western Australian women.

OBJECTIVES: to explore and describe the labour and birth expectations of a cohort of Western Australian women, and to identify the factors that influence these expectations. DESIGN: a qualitative study using an explorative descriptive design and techniques associated with constant comparison. Data were collected from tape-recorded telephone interviews. SETTING: : Perth, Western Australia. PARTICIPANTS: two hundred and two women who were pregnant or who had birthed within the last 12 months. FINDINGS: five major themes were identified. Three of the five themes reflected a positive outlook on birth. These were labelled, 'owning and believing in birth as a natural event', 'satisfaction with the birth process and outcome' and 'involvement and participation in the birthing experience'. The remaining two themes 'birth is a negative event' and 'birth is a medical event' encapsulated the women's statements that described childbirth as a potential negative and unaffirming experience. Particularly influential on the formation of childbirth expectations were the public and private discourses of childbirth, especially those related to books and magazines, and the stories of mothers and sisters. Professional discourses, women's own history, and factors such as age and life-style choices also influenced decisions and contributed to how women perceived their experiences. IMPLICATIONS FOR PRACTICE: the findings of the study challenge the anecdotal evidence that many contemporary western women willingly and knowingly choose or expect birth to be a medicalised event. Although midwives and other maternity healthcare providers need to help women develop realistic expectations, there is also a need to examine the influence of healthcare professionals in perpetuating a technical approach to birth. The findings do, however, confirm that some women are anxious, scared and frightened of the childbirth experience. It is essential that research continues to focus on developing strategies to assist women confront and deal with these fears.

Attitude to Health↗
PubMed2006

Instrumental learning in hyperdopaminergic mice.

In two experiments we investigated the effects of elevated dopaminergic tone on instrumental learning and performance using dopamine transporter knockdown (DAT KD) mice. In Experiment 1, we showed that both DAT KD mice and wild-type controls were similarly sensitive to outcome devaluation induced by sensory specific satiety, indicating normal action-outcome learning in both groups. In Experiment 2, we used a Pavlovian-to-instrumental transfer procedure to assess the potentiation of instrumental responding by Pavlovian conditional stimuli (CS). Although during the Pavlovian training phase the DAT KD mice entered the food magazine more frequently in the absence of the CS, when tested later both groups showed outcome-selective PIT. These results suggest that the elevated dopaminergic tone reduced the selectivity of stimulus control over conditioned behavior, but did not affect instrumental learning.

Animals↗
PubMed2005

Women's experiences of information, psychological distress and worry after treatment for gynaecological cancer.

Sensitive, appropriate patient information is considered to be an important element in the psychological support of patients. Specialist nurses are seen to have a key responsibility for this work. With regard to gynaecological cancer, evidence suggests that women do not get optimum psychological care. This study set out to explore women's experiences of information, psychological distress and worry after treatment for gynaecological cancer. The study was a survey (not an RCT) and 70 patients from two specialist gynaecological oncology centres were interviewed at the time of diagnosis/initial treatment and again at 6 months. The semi-structured schedule included recognised instruments to assess; sources of information, concerns, and psychological distress. Both initially and at 6 months there was evidence of a considerable burden of worry; over half the women had four or more significant concerns related to their illness experience. However, women who had initial support from a clinical nurse specialist at the time of diagnosis experienced a clinically significant reduction in their level of psychological distress 6 months from diagnosis. Hospital linked professional sources of information were well used at the time of diagnosis, but by 6 months many patients were using non-professional sources such as television, magazines and newspapers. This study suggests that support from a clinical nurse specialist may be able to assist psychological recovery. However, to be effective in this area nurses should be skilled and willing to assess the individual's need for help with information, and managing their worry.

Adaptation, Psychological↗
PubMed2006

Knowledge and attitudes towards attention deficit hyperactivity disorder among elementary school teachers.

OBJECTIVE: Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in child and adolescent psychiatry. ADHD children are at risk for academic and psychological difficulties. Lack of cooperation between schools, parents and therapeutic institutions inhibits a multimodal treatment program. This study surveys teachers' knowledge and attitudes towards attention deficit hyperactivity disorder. METHOD: One hundred and ninety six elementary school teachers in Shiraz, Iran, anonymously completed a self-report questionnaire on ADHD. RESULTS: Knowledge about ADHD was relatively low. 46.9% of respondents agreed that ADHD is due to biological and genetic vulnerabilities and causation. 53.1%of all the teachers considered ADHD to be the result of parental spoiling. The attitude score towards ADHD children was also low. 64.8% agree that the same disciplinary rules used for all students should also be applied to ADHD children. 77.6% believe that ADHD students experience difficulties in their relations with their classmates. There was a significant correlation between teachers' knowledge of ADHD and their attitude. The main sources of knowledge about ADHD were: Television and radio; friends and relatives; periodical, newspapers and magazines. CONCLUSION: Knowledge about ADHD was sound to be very low. PRACTICE IMPLICATIONS: Health and/or Educational Ministry should promote a special course on ADHD for teachers and education should be part of the curriculum in faculty training. Providing these educational programs on television and radio may be highly effective as they were the most common source of information.

Adult↗
PubMed2006

Use of diabetes resources in adults attending a self-management education program.

OBJECTIVE: To identify the types of resources used to acquire information or assistance in the management of diabetes, and to identify persons who are more or less likely to use a variety of diabetes resources. METHODS: Through the use of a questionnaire and review of patient records, sociodemographic, clinical, and health care service utilization characteristics were obtained for 267 individuals with type 2 diabetes from a culturally diverse diabetes education centre. Descriptive analyses were performed to provide information on the types of diabetes resources used by age, sex and primary language spoken. Multivariable Poisson regression was used to predict low from high users of a variety of diabetes resources. RESULTS: On average, most patients used four different resources. The most commonly cited were physicians or endocrinologists; diabetes educators; and magazines, newspapers, books or television. Those who did not speak English, were born outside of Canada, had a lower level of education, or who were older used fewer diabetes resources. CONCLUSION: Notably, the characteristics of individuals who are less likely to use resources or a variety of resources reflect the basic determinants of health (i.e., age, sex, ethnicity or primary language spoken, and education). PRACTICE IMPLICATIONS: We need to develop resources that are equitably accessible and of interest to all patients, particularly for individuals who do not speak English, who have lower education and literacy levels, and who are older. Furthermore, imparting the skills on how to find and utilize currently existing resources to assist in chronic disease self-management should be promoted as a core aspect of self-management education.

Adult↗
PubMed2005

Introduction of direct-to-consumer advertising of prescription drugs in Canada: an opinion survey on regulatory policy.

BACKGROUND: Canada is strongly influenced by US cross-border direct-to-consumer advertising (DTCA) and has held consultations to discuss introduction of DTCA since 1996. This article describes a survey of Canadian drug policy experts carried out in 2001, during one such legislative review. The survey results are compared to more recent DTCA policy developments. METHODS: We recruited key informants on pharmaceutical policy to complete a faxed questionnaire that queried their opinions on DTCA information quality, effects on drug and health care use, and regulatory issues. Respondents were asked about the evidence they had used to back their opinions. Analysis was descriptive. RESULTS AND DISCUSSION: Of 79 identified potential participants, 60 (76%) participated, 40% of whom were from federal and provincial government; 3% were private insurers; 18%, 15%, and 8% were from health professional groups, consumer groups, and patient groups, respectively; 8% and 7% were from pharmaceutical and advertising industries, respectively. Opinions were highly polarized on the effects of DTCA on drug and health care use. Advertising and pharmaceutical industry respondents were generally positive, public sector, health professional and consumer groups generally negative. Over 80% believed DTCA leads to higher private and public drug costs and more frequent physician visits. Fewer judged billboards or television to be appropriate media for DTCA than magazines or the Internet, and most believed that children and adolescents should not be targeted. CONCLUSION: Given the polarization observed within this survey, we examined how DTCA policy has evolved in Canada since 2001. The federal government has legislative authority over DTCA, but bears few of the additional costs potentially incurred through policy change. These fall to the provinces, which provide an eroding patchwork of public coverage for prescription drugs in the face of rapidly increasing costs. No new federal legislation has been tabled since 2001. However, considerable shifts in administrative policy have occurred, all supportive of expanded advertising. Thus, the law continues to be restrictive but its application less so.

Advertising↗
PubMed2006

Cancer in the mass print media: fear, uncertainty and the medical model.

Cancer is increasing in incidence and prevalence in North America and around the world. The mass print media play an important role in information provision about prevention, diagnosis and treatment of this disease, as well as informing health policy and personal experience. This paper reports on a content analysis of the portrayal of cancer in the highest circulating magazines available in Canada and published in Canada or the USA in 1991, 1996, 2001. It includes both manifest and latent analysis of the framing and content of cancer stories. Manifest analysis documented the dominance of the medical as compared to the lifestyle and political economy frames and the predominance of articles on breast as compared to other cancers. Latent themes included: an emphasis on fear of cancer in that: (1) cancer and fear are frequently conflated; cancer is said to grow outside of awareness; cancer is portrayed as (almost) inevitable; cancer is associated with normal experiences; early detection is associated with diagnosis; and scary statistics are emphasized; (2) contradictions and confusion exist within and between articles; and (3) metaphors of war and battle are used frequently. The paper concludes with a discussion of the implications of the linking of fear with cancer in the context of medicine as the solution.

Fear↗
PubMed2006

The paradoxical reliance on allopathic medicine and positivist science among skeptical audiences.

A number of studies have found an association between what people see, hear and read in the mass media and their corresponding actions and beliefs. This link has been demonstrated both at the micro and at the macro levels of analysis. However, when people are asked directly about the impact of mass media they tend to deny that they are personally affected. In fact, they tend to describe themselves as critical and skeptical media consumers. The purpose of this paper is to explore this contradiction through 12 in-depth focus group discussions undertaken in Ontario, Canada in 2004. Findings from the focus group interviews confirm earlier research in that people claimed that they were not susceptible to media influence. At the same time as they said that they took information from the mass media "with a grain of salt", they articulated sophisticated and nuanced accounts of how and why they evaluated some information as good and some as bad. In general they evaluated media stories on the basis of the values of allopathic medicine and positivistic science. Moreover, in the context of the focus groups and their explicit comments on their skepticism, they discussed health information from the magazine articles that they were given to read (on either HIV/AIDS, Alzheimer's disease, or a heart disease). Possible explanations for these paradoxical findings are discussed.

Attitude to Health↗
PubMed2004

Influence of different sources of information on attitude toward organ donation: a factor analysis.

OBJECTIVES: To determine media through which the population receives information on donation; to analyze the association between the sources of information and the psychosocial variables with respect to the opinion on donation; and to determine how each source of information influences this opinion. MATERIALS AND METHODS: A questionnaire on donation was administered to a random sample of 2000 persons stratified by age, gender, and geographical location, of whom 1143 respondents claimed to have no experience with donation and/or transplantation. A statistical analysis was done between the sources of information or the psychosocial variables or their co-variation to determine their specific impact on the population. RESULTS: The medium with the greatest impact on the population is television; the second factor is the press and radio; the third is magazines and talks with friends/family; the fourth is hoardings and posters, and campaigns about organ donation; and the last factor is information given by health professionals. In the factor analysis between sources of information and psychosocial variables, an association was observed between press, radio, and information given by health professionals and a higher education level; and between information provided by discussions in schools, by age, and a higher level of education. Sources of Information sources as that have a favorable effect on donation include discussions, (P = .0079), and information by health professionals (P < .0005) and by friends (P = .0132) and by family (P = .0044). CONCLUSIONS: Opinion on donation is more favorable among subjects who have received information on an individual basis and at specialized meetings. The only psychosocial variable associated with some sources of information is the level of education.

Adolescent↗
PubMed2006

An internet-based survey on parental attitudes towards immunization.

Parental misperceptions have been identified as major barriers towards immunizations in children. By use of a German internet vaccine forum for lay persons, a survey was performed to assess current attitudes of parents regarding prevalent issues related to childhood vaccination. Of 6025 participants, 5722 (95.0%) regarded their paediatrician as the most important source of information regarding immunization, followed by leaflets (48.0%), health magazines (44.7%), and the internet (38.7%). Of currently generally recommended childhood immunizations, those against pertussis, Hib and especially measles-mumps-rubella were considered least important by parents. Furthermore, 22.6% of survey participants felt that immunizations are administered "too early" in life and 21.0 and 12.2% thought that overload of the child's immune system and induction of allergies, respectively, would be side effects of immunizations. This survey provided information on prevalent parental attitudes towards immunization, which should be used to plan information strategies to counteract existing misperceptions.

Attitude↗
PubMed2006

Canine intestinal helminths in Finland: prevalence, risk factors and endoparasite control practices.

In this survey, the prevalence of canine gastrointestinal helminths in Finland was investigated by coprological examination (n = 541) and possible risk factors for helminth infections in dogs were analysed. In addition, the dog owners (n = 296) completed a questionnaire about use of anthelmintics, sources of information about parasites and antiparasitic treatments and reasons for choosing the drugs. The prevalence of gastrointestinal helminths was 5.9%. Eggs from four different species were identified in the faecal samples. Toxocara canis eggs were present in 17 dogs (3.1%), Uncinaria stenocephala eggs in 14 dogs (2.6%) and Diphyllobothrium latum eggs in 2 dogs (0.4%). Moreover, one sample contained eggs of Trichuris vulpis (0.2%). Kennel housing and visits abroad were identified as risk factors for T. canis and U. stenocephala infections. Most dogs (86.0%) received anthelmintic treatment at least once a year. Hunting dogs were dewormed least; one-third was treated less than once a year. Approximately, half of the owners occasionally changed the anthelmintic used. The most important trait of the anthelmintic was its broad spectrum, fenbendazole being the most commonly chosen. Veterinarians, dog magazines and dog breeders were the predominant sources of information concerning parasites and deworming strategies.

Animal Husbandry↗
PubMed1995

Position of the American Dietetic Association: food and nutrition misinformation.

Food and nutrition experts, including ADA members, need to take an active role in helping consumers recognize misinformation. The challenge of dealing with food and nutrition misinformation is long-standing and persistent. However, qualified dietetics professionals, in partnership with other members of the health-care team, educators, and representatives of the food industry, can be a forceful voice against food and nutrition misinformation. Qualified dietetics professionals can positively shape the food choices of Americans by collaborating with the media to communicate balanced nutrition information to consumers and to counter misinformation; writing letters to the editors of newspapers and magazines to counter inaccurate and biased articles; calling television and radio shows that interview nutrition extremists and purveyors of misinformation to express their professional concerns; directing the news media and consumers to responsible sources of nutrition information; encouraging researchers to present their results with a balanced perspective; collaborating with the food industry to provide reliable nutrition information; and cooperating with other practitioners to expose emerging misinformation, misbeliefs, frauds, and quackery before they are widely accepted.

Consumer Advocacy↗
PubMed1997

Obstacles to nutrition labeling in restaurants.

OBJECTIVE: This study determined the major obstacles that foodservices face regarding nutrition labeling. DESIGN: Survey questionnaire was conducted in May 1994. In addition to demographic questions, the directors were asked questions addressing willingness, current practices, and perceived obstacles related to nutrition labeling. SUBJECTS/SETTING: Sixty-eight research and development directors of the largest foodservice corporations as shown in Restaurants & Institutions magazine's list of the top 400 largest foodservices (July 1993). STATISTICAL ANALYSES PERFORMED: P tests were used to determine significance within a group for the number of foodservices that were currently using nutrition labeling, perceived impact of nutrition labeling on sales, and perceived responsibility to add nutrition labels. Regression analysis was used to determine the importance of factors on willingness to label. RESULTS: Response rate was 45.3%. Most companies were neutral about their willingness to use nutrition labeling. Two thirds of the respondents were not currently using nutrition labels. Only one third thought that it was the foodservice's responsibility to provide such information. Several companies perceived that nutrition labeling would have a potentially negative effect on annual sales volume. Major obstacles were identified as menu or personnel related, rather than cost related. Menu-related obstacles included too many menu variations, limited space on the menu for labeling, and loss of flexibility in changing the menu. Personnel-related obstacles included difficulty in training employees to implement nutrition labeling, and not enough time for foodservice personnel to implement nutrition labeling. APPLICATIONS: Numerous opportunities will be created for dietetics professionals in helping foodservices overcome these menu- or personnel-related obstacles.

Food Labeling↗
PubMed1992

From Fanny to Fernand: the development of consumerism in pain control during the birth process.

Obstetric anesthesia has been the object of public interest and patient advocacy from its introduction in the 1840s to the present. Early arguments concerned the significance of pain in childbearing and became a popular issue involving physicians, clergymen, and journalists. The first obstetric anesthesia, either, given in the United States was administered in Cambridge, Massachusetts, in 1847. For the next several decades general anesthesia was the only feasible means of relieving labor pain. At the turn of the century a combination of scopolamine and morphine was introduced in the United States by a popular women's magazine; the National Twilight Sleep Association was launched. After the decline of this movement, the "natural" childbirth method came into national prominence. In spite of their differing pharmacologic characteristics, there are sociologic parallels between the patient advocacy of Twilight Sleep and that of psychoprophylaxis. This study focuses on the public perception of these movements, which were begun by physicians and subsequently endorsed by militant lay groups.

Anesthesia, Obstetrical↗
PubMed1996

A passion for the mundane, and our medical education and threatened teaching hospitals.

Teaching hospitals, a critical component of medical education and a provider of indigent care, are in crisis. Competition from our own well-trained graduates practicing in sophisticated community hospitals, the rapid development of managed care, federal restructuring of funding, and erosion of our public economic base are important factors. The failure of teaching hospitals is likely to adversely alter medical education and threaten our professional status as doctors and educators as we compete to survive. The problem is identified, but the clear solution is not. My treatise began with the idea that the public recognizes that their teaching hospitals are in crisis. Yet there is some element of public optimism reflected in a Time magazine article that states, "Whatever happens, no one doubts that teaching hospitals will survive." Although neither government nor medicine are widely respected as organized entities, we do have the best medical care system in the world and the most trusted politicians and doctors on an individual basis. We may or may not be able to improve things substantially, but we must try. In spite of difficulties in the process, we will ultimately live up to Sir Winston Churchill's expectations: "The American people will...do the right thing, but only after they have tried everything else."

Education, Medical↗
PubMed2005

A new momentum in the field of transmissible spongiform encephalopathies (TSEs).

The present work is a critical survey answering a recent paper published by Stanley Prusiner's team in Science magazine. The authors claim that they used synthetic prions, instead of which they have tailored a particular recombinant protein, produced in E. coli, and devoid of its N-terminal part, therefore mimicking a truncated protein described by another team who isolated it from an iatrogenic TSE patient. This recombinant prion was lethal in normal mice, perhaps partly because, contrarily to what happens with the whole-length normal protein, these proteins are both neurotoxic, fibrillogenic and insensitive to proteolysis. Moreover, an accompanying nucleic acid could explain the infection, because, since 1982 and until now, the protein-only hypothesis has never been supported by any positive mechanism and experimental proof, and is becoming inadequate. Therefore, we have tried to elaborate an alternative hypothesis for the specific mechanism of infection in TSE. The transfer of at least a piece of nucleic acid from the infecting subject, perhaps the mRNA coding for the truncated protein described in human patients, could then reach the corresponding gene in the infected subject, where an endogenous reverse transcriptase would be able to integrate it. Once altered and stimulated, this last gene could, in turn, participate in the generation of nucleic acids able to code the generation of the truncated forms of the prion protein.

Animals↗
PubMed2001

Central liver hematomas caused by mountain-bike crashes.

BACKGROUND: Mountain biking, one of the most popular sports in recent years with more than 10 million riders, is implicated more and more in severe bike accidents with complicated injuries. In addition to head injuries, which are common and account for most of the fatalities, we have observed an increase in liver trauma over the years. METHOD: Approximately 19000 bike associated accidents were reported in 1998 in Austria. A total of 52 patients were admitted to our trauma ward between 1995 and 1997 with mountain-bike associated injuries. Of the 52, eight presented with subcapsular hematoma of the liver sustained by falling while riding. In all patients, nonoperative management was successful. These injuries were associated with a special form of bar-ends used on the mountain-bikes. After a broad response from the industry, facilitated by many articles in newspapers, life-style magazines, radio and television stations, this type of bar end has nearly vanished from the market. RESULTS: As a result, in 1998, only one case of liver injury was observed, and from 1999 to August 2000, no such injuries have been reported thus far.

Adolescent↗