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PubMed2004

How do paediatricians communicate with children and parents?

AIM: The outpatient clinic visit is the major focus of the hospital medical process for most paediatricians, children and parents. The importance of children as active participants in this interaction has been recognized. Our study aims are to describe and assess the components of doctor-parent-child communication in the outpatient setting. METHODS: Fifty-one medical paediatric clinic consultations were recorded on audio cassette, and communication was analysed according to quantitative methods. Questionnaires assessed parents' and children's perceptions. RESULTS: Doctors contributed most to the conversation (61%), children only 4%. Behaviour: Doctors' communication was 84% instrumental (e.g. asking questions, giving information or instructions), 13% affective behaviour (expressing concerns and worries) and 3% social (small talk). Parents' communication included giving information (83%), seeking information (13%) and social (4%). The child asked less information (3%) and had more social conversation (19%). CONTROL: Doctors dominated in turn taking (52%). Children took 9% of all turns. Perception: There was no correlation between parents' and children's perception and the informative or affective behaviour of the doctor. CONCLUSION: Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient-centred approach.

Adult↗
PubMed1998

A strategy for informing patients and health professionals about unconventional cancer therapies.

BACKGROUND: A Guide to Unconventional Cancer Therapies was produced by the Ontario Breast Cancer Information Exchange Project with the intention of meeting needs of patients, family members, and health professionals for information about unconventional therapies. Concerns raised by health professionals during the development of the guide serve as a focus for considering its impact on cancer patients who purchased it. MATERIALS AND METHODS: Purchasers of the guide were sent a survey questionnaire inquiring about their access to, use of, and attitudes toward it. RESULTS: A total of 634 individuals responded to the survey, including cancer patients, health professionals, and family members. The guide was rated moderately helpful overall, and health professionals found it significantly more helpful than did cancer patients. A minority of patients were influenced to try an unconventional therapy as a result of reading the guide. Those who did try a new therapy typically chose ones that are most popular and have few potential negative effects. CONCLUSIONS: As an informational strategy, the Guide to Unconventional Cancer Therapies has been successful. Concerns expressed by some health professionals about potential harm through implementing the strategy have been shown to be largely unwarranted, at least for study respondents.

Breast Neoplasms↗
PubMed2006

Patterns of eyecare utilization by young Australian children: findings from a population-based study.

OBJECTIVES: To report factors associated with childhood eyecare utilization in a random sample of 1740 Sydney schoolchildren aged 6, examined during 2003-4. METHODS: Information on use of eyecare services, defined as any previous consultation with an ophthalmologist or optometrist, was sought from parents. Children had comprehensive eye examinations, including visual acuity (VA), cover testing, cycloplegic refraction and dilated fundus examination. RESULTS: Prior ophthalmic or optometric assessment was reported by 465 children (29.2%), and was not associated with gender (p = 0.9), parental employment (p = 0.4) or home ownership (p = 0.9). Children of East Asian (odds ratio, OR, 0.7, 95% confidence interval, CI, 0.5-0.9) or other ethnicities (OR 0.7, CI 0.6-1.0) were less likely than European Caucasian children to have been examined. Parent-expressed concern about their child's vision was associated with a 10-fold increased likelihood of previous eye examination (OR 10.2, CI 7.3-14.5). Complaints of eyestrain were associated with a 4-fold increase (OR 4.4, CI 3.2-5.9). Most children with VA < 20/40 in at least one eye (63.1%), amblyopia (80.0%) or strabismus (86.4%) had been assessed. CONCLUSIONS: One third of this childhood sample reported prior examination by an eyecare professional. Given that most children needing vision assessment had been examined and likely effects of parental motivation, this rate seems reasonable and appropriate.

Australia↗
PubMed2002

Perception of voluntary screening for paediatric HIV and response to post-test counselling by Nigerian parents.

Nigeria may be taken to represent countries with an evolving HIV/AIDS epidemic. With particular reference to paediatric HIV, the voluntary testing of young children and their parents may provide an important entry point for the institution of control measures. However, there is a paucity of knowledge about how individuals perceive voluntary testing. This knowledge is important to the development of guidelines for counselling. To reduce this gap, 258 parents of hospitalized children (> 1 month to 15 years of age) were interviewed using a structured questionnaire. In addition, to complement the data, four examples of seropositive mother's responses during post-test counselling are presented and analyzed. In the survey, 223 (86%) parents were HIV/AIDS aware but only 88 (39%) of these parents could describe one or more route(s) of transmission and none described vertical transmission. Among the respondents, 153 (62%) of 248 would consent to the screening of self, and 195 (85%) of 230 to the screening of a hospitalized child if based on his/her clinical condition. Perceptions of good health and lack of exposure, and despair owing to lack of a specific treatment, were the common reasons for refusing consent. These represent some of the issues which would need to be addressed to increase the acceptance of voluntary testing. The fear of a break up of families with seropositive mothers but seronegative fathers was a major concern expressed during post-test counselling. HIV-discordance among couples may be frequent and should be considered in the formulation of policies on counselling and voluntary testing.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Identifying helpful and unhelpful behaviours of loved ones: the PWA's perspective.

Twenty-five gay men with AIDS were interviewed about their social support networks and asked to describe specific interpersonal exchanges with network members which they perceived to be helpful and unhelpful. Content-analysis of responses revealed 12 main categories of helpful behaviours (providing encouragement, companionship, information, practical assistance, material aid, philosophical perspective, support for other network members, expressing concern, sharing feelings, acting as role model, allowing reciprocity, interacting naturally) and 11 categories of unhelpful behaviours (pessimism, physical avoidance, criticizing one's response to AIDS or medical treatment, making unreasonable demands, patronizing attitude, rude comments, insincerity, breaking confidentiality, acting judgmental or ashamed). The perceived helpfulness of particular behaviours varied depending on which network member performed them and the timing of the support attempt. Implications for increasing the effectiveness of support attempts by network members are discussed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Toward a comprehensive evaluation of the impact of electronic aids to daily living: evaluation of consumer satisfaction.

PURPOSE: It is generally accepted that electronic aids to daily living (EADLs) play an important role in the lives of many people with severe disabilities by providing the means to access and control devices for daily living activities. Despite this, little proof exists to support the contention that consumers are satisfied with relevant aspects of these assistive devices. The purpose of this study was to explore consumer satisfaction with EADLs and investigate the value that people with degenerative neuromuscular conditions place on these technologies. METHOD: Interviews were conducted with 40 EADL users and non-users to compare their views about these devices and their daily life experiences. Users were interviewed twice, six months apart, to establish the stability of their views and experiences with EADLs. The Functional Independence Measure (FIM instrument), the personal profile and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) were administered to determine functional levels of participants, gather personal data pertinent to the study of device utility and explore user satisfaction with EADLs. RESULTS: Results suggest that overall consumers were quite satisfied with their EADLs and that this was relatively stable over time. However, some consumers expressed concerns regarding the cost of these technologies and their associated services. Both users and non-users rated EADLs similarly in relation to relative degree of importance ascribed to them. CONCLUSIONS: Combining the QUEST with outcome measurement tools that explore other important dimensions such as the effect on quality of life and psychosocial impact will help service providers to justify the costs associated with the prescription of sophisticated, costly assistive devices such as EADLs.

Activities of Daily Living↗
PubMed2005

Reactions to invisible disability: the experiences of young women survivors of hemorrhagic stroke.

PURPOSE: To discuss how young, female and invisibly disabled, long-term survivors of hemorrhagic stroke experience the reactions of others as they negotiate the social environment. METHOD: Open-ended and in-depth interviews were conducted with 22 women to learn about their post-stroke experiences, and the interviews were analyzed for common issues and themes. RESULTS: Participants expressed concerns about the reactions of others in the context of discussing popular understandings about who is affected by stroke, and the significance of having invisible disabilities. Participants' experiences were mediated by the cultural belief that stroke is a disease of old age, and by the belief that disabilities worth taking seriously are readily visible. The existence of these beliefs about stroke and disability made it difficult for participants to deal with the reactions of others. CONCLUSIONS: Participants must negotiate their everyday lives within a social context that they are ill-prepared to deal with. Rehabilitation practices need to take this into account and counsel stroke survivors about what to expect and what they need to do for a good QOL in the community.

Activities of Daily Living↗
PubMed1992

Tropical oils: nutritional and scientific issues.

Individually and in combination with other oils, the tropical oils impart into manufactured foods functional properties that appeal to consumers. The use of and/or labeling in the ingredient lists give the impression that these oils are used extensively in commercially processed foods. The estimated daily intake of tropical oils by adult males is slightly more than one fourth of a tablespoon (3.8 g), 75% of which consists of saturated fatty acids. Dietary fats containing saturated fatty acids at the beta-position tend to raise plasma total and LDL-cholesterol, which, of course, contribute to atherosclerosis and coronary heart disease. Health professionals express concern that consumers who choose foods containing tropical oils unknowingly increase their intake of saturated fatty acids. The saturated fatty acid-rich tropical oils, coconut oil, hydrogenated coconut oil, and palm kernel oil, raise cholesterol levels; studies demonstrating this effect are often confounded by a developing essential fatty acid deficiency. Palm oil, an essential fatty acid-sufficient tropical oil, raises plasma cholesterol only when an excess of cholesterol is presented in the diet. The failure of palm oil to elevate blood cholesterol as predicted by the regression equations developed by Keys et al. and Hegsted et al. might be due to the dominant alpha-position location of its constituent saturated fatty acids. If so, the substitution of interesterified artificial fats for palm oil in food formulations, a recommendation of some health professionals, has the potential of raising cholesterol levels. A second rationale addresses prospective roles minor constituents of palm oil might play in health maintenance. This rationale is founded on the following observations. Dietary palm oil does not raise plasma cholesterol. Single fat studies suggests that oils richer in polyunsaturated fatty acid content tend to decrease thrombus formation. Anomalously, palm oil differs from other of the more saturated fats in tending to decrease thrombus formation. Finally, in studies comparing palm oil with other fats and oils, experimental carcinogenesis is enhanced both by vegetable oils richer in linoleic acid content and by more highly saturated animal fats. The carotenoid constituents of red palm oil are potent dietary anticarcinogens. A second group of antioxidants, the tocotrienols, are present in both palm olein and red palm oil. These vitamin E-active constituents are potent suppressors of cholesterol biosynthesis; emerging data point to their anticarcinogenic and antithrombotic activities. This review does not support claims that foods containing palm oil have no place in a prudent diet.

Animals↗
PubMed2005

Vaccination or immunization? The impact of search terms on the internet.

With steadily rising use of the Internet as a source of health information, public health authorities have expressed concern about the increasing visibility of unscientific information promulgated on the Internet by opponents of childhood vaccination. Searches were made on the four most popular Internet search engines using different combinations of the terms, "vaccination," "immunization," "immunisation," "immunize," "immunise," "vaccine," and "shots." Thirty results were tabulated for each search engine. Searching with the keyword "vaccination" resulted in a significantly higher percentage of antivaccination websites as compared with searches with all other keywords. Of all child-related websites retrieved, the single keyword "vaccination" yielded 40% provaccination sites and 60% antivaccination sites. By contrast, the single keyword "immunization" yielded 98% provaccination sites and 2% antivaccination sites. Using a combination of the words "vaccination" and "immunization" produced results between these two extremes. Thus, any use of the term "vaccination" during an Internet search is likely to expose a parent to a significant amount of antivaccination information. Recommendations are discussed for future research and methods to reduce the impact of misinformation on health consumers using the Internet.

Humans↗
PubMed2006

Communication in interdisciplinary team meetings: what are we talking about?

Interdisciplinary teams are central to the care of the older patient in long-term care settings. Critical to the success of caring for these patients is the communication between providers about patient care. This study examines professional communication practices in interdisciplinary team meetings, a common forum for discussing patient care. Two teams at a long-term care facility specializing in patients with Alzheimer's participated in this qualitative exploratory study. All team members participated in semi-structured interviews. In addition, seven team meetings in which 31 patients were discussed were audio and video taped. Team members discussed the importance of team meetings to help coordinate care provided to patients, while also expressing concern about the effectiveness of the meetings to reach this goal. Through detailed discourse analyses of transcripts of the meetings, we identified three different communication practices in team meetings: giving report, writing report, and collaborative discussion. Only the latter practice met the goals indicated by the team members to coordinate and make joint decisions about patient care and allowed for team members to collaboratively solve problems. We discuss one case study to exemplify how the use of these communication practices results in the omission of information central to making decisions regarding patient care.

Aged↗
PubMedDate not supplied

The plutonium problem: the Royal Society sits on the fence.

A recent Royal Society report, Management of Separated Plutonium, considers the production and disposal of plutonium from the spent fuel from civil and nuclear power reactors. It accepts the need for dealing with plutonium stocks because of the toxicity of the element and as it can be used to fabricate nuclear weapons, and expresses concern that it might be illicitly acquired by terrorists. It recommends an independent Government commission on the management of plutonium, and considers the various options for this. However, it does not analyse the arguments against plutonium as a reactor fuel, and underestimates the risks of diversion to nuclear weapons and nuclear terrorism. This paper reviews the options, and concludes that separated plutonium should be added to high-level waste, vitrified, and eventually buried in a deep geological repository.

Facility Regulation and Control↗
PubMed2002

Unexpected application of counselling skills by a fertility research nurse.

Men attending the Andrology Laboratory for the first time were asked to complete questionnaires regarding their employment, lifestyle, diet and infancy for the Chemicals and Pregnancy Study UK (CHAPS-UK) research study. CHAPS-UK is a multi-centre study investigating reasons for male infertility. During one interview, a patient expressed concerns about his sexual relationship with his wife. Initially, he described his concerns about infertility but as the nurse used her counselling skills, the patient was able to voice his psychosexual difficulties. This was the first time in 5 years of marriage the patient talked about his situation to another person. The research nurse was able to combine good communication and counselling skills to facilitate the patient's need to face his problem, which enabled him to make a constructive decision about his need for further help. This case highlights the difficult situation in which fertility nurses can find themselves and reinforces the need for nurses involved in the care of infertile couples to have training in counselling skills and the ability to make appropriate referral to an infertility counsellor when required.

Fertility↗
PubMed2004

Preimplantation genetic diagnosis and the welfare of the child.

Preimplantation genetic diagnosis is a form of very early prenatal diagnosis. The technique combines assisted reproductive technology with molecular genetics and cytogenetics to allow the identification of abnormalities in embryos prior to implantation. Since its introduction in 1990 this approach has been applied to an increasing number of single gene disorders, chromosomal rearrangements, and more recent indications such as aneuploidy screening and HLA matching. Since its inception the technology has attracted much attention: geneticists have expressed concerns about the robustness and validity of diagnosis based on single cell analysis, perinatologists were anxious about the effect of embryo biopsy on normal fetal development; and philosophers and ethicists have argued the cases for and against embryo selection. This article attempts to highlight the difficult choices and ethical challenges confronting patients and clinicians in an effort to balance the recognition of parental autonomy with the obligation of clinics to consider the welfare of any child born as a result of this treatment.

Child↗
PubMed2005

Noise exposure levels from personal stereo use.

Hearing healthcare professionals often express concern about the possible increased risk of noise injury, and potential for subsequent hearing loss that may result from the rise in the use of personal stereo players (PSP) in the community. Measurements were made of a sample of 55 individuals who were using a PSP as part of their daily activity, for example commuting to work, in what could be considered noisy backgrounds. Thus measurements could be considered to exemplify the worst-case conditions. The average, A-weighted, eight-hour equivalent, continuous noise exposure level was determined to be 79.8 dB, with a statistically significant difference between males and females, of 80.6 dB and 75.3 dB respectively. There was no correlation between self-reported hearing loss and/or the incidence of tinnitus. The noise exposure results obtained did not indicate that there was a significant increase in the risk to potential noise injury from PSP use alone.

Adolescent↗
PubMedDate not supplied

The history of OSHA's asbestos rule makings and some distinctive approaches that they introduced for regulating occupational exposure to toxic substances.

The Occupational Safety and Health Administration (OSHA) has regulated occupational exposure to asbestos since 1971. Since issuing its first asbestos standard, OSHA has modified it several times in response to new information about the health risk of exposure and concern expressed by workers and public health groups. As each modification has reduced worker exposure and disease risk, each also has introduced new concepts including emphasis on ancillary provisions in standards regulating occupational exposure to toxic substances to enhance worker health; medical removal protection; two attempts at emergency temporary standards; use of historical and objective exposure data to assess worker exposure; the need to eliminate significant risk of disease posed by asbestos; and the presumption of hazard in absence of exposure information. These and other advances have affected all subsequent OSHA standards aimed at reducing occupational exposure to toxic substances.

Air Pollutants, Occupational↗
PubMed1998

Determinism and mass-media portrayals of genetics.

Scholars have expressed concern that the introduction of substantial coverage of "medical genetics" in the mass media during the past 2 decades represents an increase in biological determinism in public discourse. To test this contention, we analyzed the contents of a randomly selected, structured sample of American public newspapers (n=250) and magazines (n=722) published during 1919-95. Three coders, using three measures, all with intercoder reliability >85%, were employed. Results indicate that the introduction of the discourse of medical genetics is correlated with both a statistically significant decrease in the degree to which articles attribute human characteristics to genetic causes (P<.001) and a statistically significant increase in the differentiation of attributions to genetic and other causes among various conditions or outcomes (P<. 016). There has been no statistically significant change in the relative proportions of physical phenomena attributed to genetic causes, but there has been a statistically significant decrease in the number of articles assigning genetic causes to mental (P<.002) and behavioral (P<.000) characteristics. These results suggest that the current discourse of medical genetics is not accurately described as more biologically deterministic than its antecedents.

Genetic Determinism↗
PubMed2002

Uncertain science and a failure of trust. The NIH radioepidemiologic tables and compensation for radiation-induced cancer.

In the late 1970s, the U.S. Congress was debating a number of different proposals to provide monetary compensation to residents of Utah and Nevada who had been exposed to radioactive fallout from government nuclear weapons testing in the 1950s. Yet scientists and government officials expressed concern that such a program would end up compensating many people for cancers that were not caused by the fallout. Thus, after much debate, Congress directed the National Institutes of Health to produce a set of statistical tables--the radioepidemiologic tables--to target compensation awards to "deserving" individuals. Advocates of the tables, notably Senator Orrin Hatch, argued that reliance on scientific data would provide compensation decisions with predictability and evenhandedness. Yet in the end, the effort to employ the tables failed. The substantial scientific uncertainties in the tables and in their application to individual claims failed to deliver the authority they promised. Additionally, the goal of fairness and objectivity could not be convincingly met because of persistent controversy and mistrust surrounding the government's role in the study of health effects of low-level radiation.

Compensation and Redress↗
PubMed1999

Sickle cell telemedicine and standard clinical encounters: a comparison of patient satisfaction.

OBJECTIVES: To determine patient satisfaction with telemedicine encounters among adults with sickle cell disease and compare their scores with SCD patients who have standard medical encounters (as controls). METHODS: Adults patients were recruited from a list of participants in sickle cell telemedicine clinics and prospectively at the time of clinic encounter. Patients were assigned to telemedicine or standard encounter groups. Demographic and pertinent clinical data were obtained for all subjects, and the Client Satisfaction Questionnaire (CSQ-8) was administered. Patients were also asked for open-ended comments regarding their satisfaction with the service. Their responses were recorded verbatim. RESULTS: Patients with telemedicine (n = 60) and standard encounters (n = 60) were comparable in gender, genotype, education, employment, and mean number of sickle cell disease-related complications. Patients in the telemedicine group were younger (p< 0.005), more likely to have Medicaid insurance (p = 0.009), and more likely be taking hydroxyurea (p = 0.003) than patients in the control encounter group. Mean CSQ scores for the telemedicine group were high (total: 28.82+/-3.06), and there was no difference for any item between encounter groups (p = 0.389). Patients in the standard encounter group were more likely to provide positive open-ended comments regarding the encounter (95% vs. 70%; p = 0.001). Negative comments were generally in the area of confidentiality. CONCLUSIONS: While some patients expressed concern about confidentiality with telemedicine, the benefits of improved access and continuity of care were recognized, and overall satisfaction with telemedicine was high. These findings support the use of telemedicine as an acceptable health care delivery option for rural, underserved populations with sickle cell disease.

Adult↗