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PubMed1998

Psychosocial and educational outcomes associated with home- and clinic-based pretest education and cystic fibrosis carrier testing among a population of at-risk relatives.

We report on the psychosocial and knowledge outcomes of two different approaches to cystic fibrosis (CF) gene pretest education and carrier testing offered to 288 proactively recruited first-, second-, and third-degree relatives of people with CF. One group received pretest education and gene testing in a clinical setting from a certified genetic counselor. The other group received pretest education in their homes from a specially prepared pamphlet and were asked to send in a buccal cell sample for genotyping. No statistically significant differences between groups were noted on measures of CF knowledge, anxiety, and positive or negative affect, either while waiting for their test results or within a few weeks after they had learned their results. At both measurement points, participants who had received home education and testing reported that the testing was more convenient, but that they had received less information than they would have liked, and they were more likely to report being confused by the testing, although their level of CF knowledge was comparable to that of people who had been seen by a genetic counselor. In light of the increasing interest in home-based medical testing of all kinds, this study suggests that CF carrier testing in the home warrants further consideration as one possible approach to facilitating access to testing.

Adolescent↗
PubMed1998

The general practitioner's role in breast cancer screening: a survey in Otago-Southland.

AIMS: To study the experience of general practitioners in Otago and Southland with the existing breast cancer screening programme and the reviews on future programmes. METHODS: A questionnaire was sent to all 210 general practitioners in Otago and Southland in June 1996. RESULTS: The response rate was 71%. All the 141 respondents except one encouraged eligible women to take part in the programme; this was done mainly during individual doctor-patient consultations, by pamphlets and posters, and in the work of the practice nurse. Ten percent of practitioners had a practice-based recall system for breast cancer screening. Seventy-five percent of general practitioners currently provide a list of eligible women to the programme, and of these, 52% check the list to exclude ineligible women. Only 24% of practitioners supplying a patient list to the programme reported that a patient had ever requested that their name be excluded from the list. Twenty-five percent of general practitioners providing lists had a notice in the waiting room stating that. Of those who did not provide lists, concerns about logistics, ethical issues and cost were raised, although 40% of these general practitioners intended to provide lists in the future. In a future programme, 57% of general practitioners felt they should be paid for supplying lists defined by age only and 82% felt they should be paid for supplying a list of women eligible by both age and medical history. Most general practitioners felt that general practitioner lists were the preferred source for invitations to the breast screening programme and that general practitioners had an important part in any future programme. Screening at the ages 50-64 (as currently proposed) is supported by 95% of general practitioners; in addition, 64% supported screening at ages 65-69. Only a minority of general practitioners supported screening at ages 40-49 or ages 70-74. Most general practitioners would offer screening to women under age 50 with either a strong or a weak family history, or even with a past history of a fibroadenoma. CONCLUSIONS: These results show that almost all general practitioners support breast cancer screening programmes and feel that they have an important role in future programmes. The majority support extension of the programme to ages 65-69, but not to ages 40-49. The majority support screening women with individual risk factors at ages under 50, although their responses show that better information on the importance of different risk factors is required.

Attitude of Health Personnel↗
PubMed1997

The Mental Health Information Centre of South Africa: a report of the first 500 calls.

BACKGROUND: Despite significant advances in the understanding and treatment of psychiatric disorders in recent years, there remains a good deal of stigma and ignorance in the community. In order to increase awareness of psychiatric disorders in South Africa, we initiated a Mental Health Information Centre at the University of Stellenbosch. In this report, the first 500 calls to the centre are described. METHODS: A routine component of the service delivered by the Mental Health Information Centre is the gathering of data from callers. Data gathered from callers was collated and analysed. RESULTS: Callers from all areas of South Africa made use of the centre, asking for information about depression, obsessive-compulsive disorder and other mental health issues. Interventions included the mailing of pamphlets, referrals to general practitioners and mental health care professionals, and other forms of help. Most callers experienced significant satisfaction with the service. CONCLUSION: Psycho-education is an increasingly important component of psychiatric care. A mental health information centre may be a relatively inexpensive way of providing psycho-education to a large section of the community. Further research is necessary to determine the efficacy of such interventions.

Adult↗
PubMed1998

Knowledge, attitudes, and practices of senior high school students regarding human immunodeficiency virus infection.

A survey of knowledge, attitude and practice (KAP) regarding human immunodeficiency virus infection was performed on 899 students from 3 government-administered high schools located in the Bangkok Metropolitan area. Initially, all students completed a written questionnaire (pre-test) regarding HIV/AIDS. Following this, they attended a slide lecture presentation given by a specialist physician. The same test questionnaire was then completed by the same students six weeks (post-test) later for comparison of their previous KAP. The subjects composed of male to female ratio equal to that of the median age 15-16 years old. Sixty-seven per cent of the subjects were living with their parents, 16.3 per cent with relatives and 15 per cent with friends. Ninety nine per cent of the subjects had received information on HIV/AIDS before enrollment to this study. The source of knowledge ranged from television (89.1%), teachers (81.6%), pamphlets (80.2%), newspapers (75%), radio (55%), health care workers (53.4%), friends (38.6%) and only 32.5 per cent from their parents. The subjects' knowledge about HIV/AIDS and risk factors in the post-test questionnaire was significantly increased (P < 0.001) from the pre-test status. However, their attitudes to an HIV infected person were not significantly changed in the post-test questionnaire: only the "attending school" question showed significantly (P < 0.05) increased numbers of agreement. Similarly, the attitudes and practices to prevent HIV infection were not significantly (P > 0.05) different between pre-test and post-test questionnaires. The result of this study is to recommend regular school-based programs of education to increase awareness of preventive strategies for HIV/AIDS and sexually transmitted diseases.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The perception of the image of nursing.

A quantitative research study in the form of a descriptive survey was undertaken with the aim of determining the public's perception of the image of nursing at the Umtata District of the Eastern Cape Province. Twenty participants were selected systematically from queues of patients in the Out Patient department of Umtata General Hospital. A semi-structured interview schedule was used the prime method of data collection. Data analysis was done by means of a computer software package called SAS. The findings revealed that 95% (N = 19) of the respondents viewed the nursing profession as a calling whilst only 5% (N = 1) viewed nursing as a job. Thirteen factors were identified as contributory to the changing image of nursing. Recommendations proposed included the dissemination of nursing information in the form of pamphlets, and implementation of health development programmes at public gatherings with the aim of increasing public awareness regarding new developments in the nursing profession. Training in assertiveness was also suggested with the aim of helping nurses express themselves as opposed to their tendency to withdraw into subservient roles.

Adult↗
PubMed1998

[How can primary health care influence patients' alcohol drinking habits. "Simple intervention" results in a new therapeutic perspective].

A review of findings in randomised trials with at least one-year follow-up suggests that primary care physicians can intervene briefly and successfully for patients manifesting symptoms of excessive drinking but no serious dependence. The risk level can be assessed by summing the preceding week's intake of spirits, wine and beer in standard measures and then convert it into grams of pure alcohol. Denial is minimised by using a non-judgmental lifestyle approach, and defining problems in terms of lifestyle habits and its consequences. Nervous problems, hypertension and dyspepsia are the most common diagnoses in the target group. Measurement of biochemical markers can be used, the serum gamma-glutamyl transpeptidase (GGT) level being still the most useful. Questionnaires are of limited value as they are associated with high false-positive rates. To motivate patients to reduce alcohol consumption, an intervention strategy with feedback is proposed, mainly based on the monitoring of symptoms and clinical findings including biochemical markers, and a self-help pamphlet is recommended. It is emphasised that the goal should be realistic to the patient, and that controlled drinking is an acceptable goal even in cases of mild dependence.

Alcohol Drinking↗
PubMed1998

[Our experience of home parenteral nutrition (HPN) for digestive disease patients].

The number of patients receiving home parenteral nutrition (HPN) has been increasing mainly among end-stage cancer patients. In our hospital, twenty-four patients received HPN therapy with digestive disease from April 1995 to May 1998. Most of them were in the terminal stage of advanced gastric cancer. Many patients received other treatments such as narcotics, blood transfusion, chemotherapy, and so on with HPN. Their average age was 71 years old. The duration of HPN varied from 4 to 180 days (mean: 50.9 days). The duration of intravenous hyperalimentation varied from 14 to 300 days (mean: 98.2 days). The duration from insertion of catheter to discharge varied from 0 to 75 days (mean: 24.8 days). We have provided HPN guidance to patients and their families with pamphlets and checklist before discharge. Nurses play an important role in introduction of HPN. But some patients could not to be treated with HPN because of family factors, their wish to be in the hospital, and so on. We consider the following important in order to carry out HPN more smoothly. 1) Early selection of patients for HPN. 2) Early lecture for methods of HPN to patients and family. 3) To know and prepare familial environment. 4) Try to stay home overnight with IVH repeatedly. 5) Establishment of home care system on call for emergencies. 6) To keep in close contact with other services in the area.

Aged↗
PubMed1999

Readability levels of patient education material on the World Wide Web.

BACKGROUND: Patient education is an important component of family practice. Pamphlets, verbal instructions, and physicians' self-created materials have been the most common resources for patient education. Today, however, the popularity of the World Wide Web (Web) as a ready source of educational materials is increasing. The reading skills required by a patient to understand that information has not been determined. The objective of our study was to assess the readability of medical information on the Web that is specifically intended for patients. METHODS: An investigator downloaded 50 sequential samples of patient education material from the Web. This information was then evaluated for readability using the Flesch reading score and Flesch-Kinkaid reading level. RESULTS: On average, the patient information from the Web in our sample is written at a 10th grade, 2nd month reading level. Previous studies have shown that this readability level is not comprehensible to the majority of patients. CONCLUSIONS: Much of the medical information targeted for the general public on the Web is written at a reading level higher than is easily understood by much of the patient population.

Ethics↗
PubMed2002

A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP).

BACKGROUND: Despite clear evidence for the efficacy of lowering cholesterol levels, there is a deficiency in its real-world application. There is a need to explore alternative strategies to address this important public health problem. This study aimed to determine the effect of a program of community pharmacist intervention on the process of cholesterol risk management in patients at high risk for cardiovascular events. METHODS: A randomized controlled trial conducted in 54 community pharmacies (1998-2000) included patients at high risk for cardiovascular events (with atherosclerotic disease or diabetes mellitus with another risk factor). Patients randomized to pharmacist intervention received education and a brochure on risk factors, point-of-care cholesterol measurement, referral to their physician, and regular follow-up for 16 weeks. Pharmacists faxed a simple form to the primary care physician identifying risk factors and any suggestions. Usual care patients received the same brochure and general advice only, with minimal follow-up. The primary end point was a composite of performance of a fasting cholesterol panel by the physician or addition or increase in dose of cholesterol-lowering medication. RESULTS: The external monitoring committee recommended early study termination owing to benefit. Of the 675 patients enrolled, approximately 40% were women, and the average age was 64 years. The primary end point was reached in 57% of intervention patients vs 31% in usual care (odds ratio, 3.0; 95% confidence interval, 2.2-4.1; P<.001). CONCLUSIONS: A community-based intervention program improved the process of cholesterol management in high-risk patients. This program demonstrates the value of community pharmacists working in collaboration with patients and physicians.

Alberta↗
PubMed1989

An educational booklet diminishes anxiety in parents whose children receive total parenteral nutrition.

A major cause of anxiety in parents of hospitalized children is insufficient information about hospital procedures. In an effort to determine the extent to which parental anxiety could be diminished and knowledge and satisfaction enhanced in regard to total parenteral nutrition (TPN), we developed a booklet that describes the mechanics of TPN administration and related procedures. When informal discussions were held between parents and members of the nutritional support team during four alternating periods (every five to six months), parents of first-time recipients of TPN either did not receive the booklet (period 1, n = 20; period 3, n = 30) or received it (period 2, n = 23; period 4, n = 27). Within one week of TPN initiation, parents in both groups completed the Spielberger State-Trait anxiety scale, an attitude questionnaire, and a quiz on TPN. No differences between groups were found in ethnic background, socioeconomic status, severity of illness, age of children, or route of TPN administration. Predisposition to anxiety was also similar between the groups. In contrast, acute situational anxiety was significantly greater in the group with no booklet than in the booklet group. Parents in the no-booklet group demonstrated less comfort in the care of their children and less knowledge about TPN than did the booklet group. Written information provided to parents decreased their anxiety and increased satisfaction with patient care more successfully than did verbal communication. Such a booklet may reduce parentally induced anxiety in the child and facilitate parent-hospital staff interactions.

Anxiety↗
PubMed1992

The pediatrician's role in encouraging parent-child communication about the acquired immunodeficiency syndrome.

OBJECTIVE: We explored whether communication from pediatrician to parent to child might assist in education about and prevention of human immunodeficiency virus (HIV) infection by comparing parents of children aged 10 through 17 years who did discuss acquired immunodeficiency syndrome (AIDS) with their children with parents of children aged 10 through 17 years who did not discuss AIDS with their children. RESEARCH DESIGN: Secondary analyses of the National Health Interview Survey, a general population survey with items on AIDS. We compared the relative importance of various characteristics in distinguishing parents who did discuss AIDS from those who did not. Variables included whether the parents had received an informational brochure about AIDS from a health care provider. RESULTS: Twenty percent of respondents had at least one child between ages 10 and 17 years; 62% of these parents had discussed AIDS with their children. This percentage was greater for parents living in metropolitan statistical areas with fewer than 100,000 persons compared with parents living in larger cities (73.6% vs 62.7%). Seventy-four percent of women (n = 4745) had spoken to their children about AIDS; only 49% of men (n = 3271) had done so. This gender difference was present in both one- and two-parent households. Hispanics were significantly less likely than non-Hispanics to have discussed AIDS with their children (men, 38.9% vs 49.9%; women, 62.6% vs 74.2%). Gender by far was most strongly associated with talking to children about AIDS, followed by self-assessed knowledge, knowing someone infected with the HIV, and actual knowledge about HIV and AIDS. Parents who reported reading an AIDS-related brochure were significantly more likely to have spoken with their children than were parents who had not read such a brochure (76.2% vs 57.4%). Thirty-seven percent of parents receiving a brochure received one from a health care provider. CONCLUSIONS: Pediatricians can assist in efforts to prevent HIV infection and AIDS by educating parents, especially mothers, about AIDS; by providing them with well-designed brochures about AIDS; and by encouraging them to discuss HIV with their children in a developmentally appropriate manner.

Acquired Immunodeficiency Syndrome↗