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PubMed1990

Lay understanding of low-frequency electric and magnetic fields.

People do not start with a blank slate when they hear risk-communication messages. All such messages are processed through existing knowledge structures and understanding. Hence, to design effective and reliable risk-communication materials one must understand the state of people's knowledge--correct and incorrect--about an issue. We developed a simple "mental model" of what people minimally need to know to make informed decisions about field-related issues. Then we performed studies to explore how and to what extent respondents of various groups understood physical properties of 60-Hz electric and magnetic fields. Actual knowledge of respondents was then compared with the predicates of the model. Electrical engineering juniors and semi-technical employees of utilities displayed a good command of most of the concepts in the simple model, but little awareness of the limits to their knowledge. Lay respondents correctly knew only a few of the simplest elements of the model, but they displayed a much greater awareness of the limits to their knowledge. Both lay and semi-technical respondents were found to share several misconceptions. On average, they correctly rank-ordered some common field-exposure conditions by field strength, but they could not differentiate between electric and magnetic fields and could not differentiate among field strengths associated with different appliances. Most respondents dramatically underestimated the range of actual field strengths. Many respondents understood that field strength decreases with distance from a source, but they underestimated the rate of decrease. In contrast to X-rays and microwaves, which respondents appeared to think about in rather similar terms, 60-Hz fields were not thought of as being highly similar to any other agent, although the closest parallels were found with ultrasound. Changes in mood, thought, and behavior, and the existence of an "electrical aura," were all seen as plausible results of exposure to a 60-Hz field. Although lay respondents displayed a variety of incomplete and confusing ideas, most of these ideas probably do not pose significant obstacles to the learning of a correct, simple, mental model.

Communication Barriers↗
PubMed2003

Health care disparities in older patients with breast carcinoma: informational support from physicians.

BACKGROUND: Little is known about how disparities in the treatment of patients with breast carcinoma based on patient age and ethnicity are effected or mitigated at the patient-physician interaction level. The objectives of this study were to document physician provision of informational support to patients at the time of a new diagnosis of breast carcinoma and to assess differences according to patient age and ethnic group in terms of the information received and desired. METHODS: Participants were 222 patients with breast carcinoma in Los Angeles County, California, age >/= 55 years who were interviewed within 6 months of their diagnosis of breast carcinoma and/or within 1 month posttreatment. Respondents were asked about receipt and helpfulness of 10 tangible informational support items (e.g., whether booklets, videotapes, medical records, etc. were provided by physicians) and 15 interactive informational support items (e.g., whether physicians discussed breast cancer topics, such as risk of recurrence or treatment options). An index of the tangible informational support items and a scale of the interactive informational support items received were created for summary analyses. Patients' medical records were abstracted for breast carcinoma stage and treatment type; surgeons also were surveyed about sociodemographic and practice characteristics. RESULTS: In multiple linear regression analyses, older age (beta coefficient [beta] +/- standard error [SE], - 0.08 +/- 0.02; P = 0.001) and Latina ethnicity (beta +/- SE, - 1.21 +/- 0.40; P = 0.003) had a negative association with physician provision of interactive informational support, controlling for patient and physician sociodemographic characteristics, practice characteristics, breast carcinoma stage, comorbidity, number of physicians seen, visit length, social support, and patient self-efficacy in interacting with physicians (adjusted correlation coefficient [R(2)] for the model, 0.33; P < 0.00001). Both older patients and ethnic minority patients, as well as their respective comparison groups, rated most breast cancer information as at least as helpful. Both groups preferred interpersonal sources of information to written sources, although they received interpersonal sources less frequently. CONCLUSIONS: Older patients and Latina patients with breast carcinoma received less interactive informational support from their physicians compared with younger patients, differences that persisted after controlling for a wide range of sociodemographic, psychosocial, and physician factors. Improving the quality of communication at the patient-physician interaction level may be an important avenue to reducing age and ethnic group treatment disparities among patients with breast carcinoma.

Age Factors↗
PubMed2005

Closing the divide: diverse populations and cancer survivorship.

Currently, there is a "divide" between cancer survivorship initiatives and minority participation. The level of participation is nearly nonexistent in many cancer support and control initiatives. Cancer survivorship resources that facilitate access to treatment, psychosocial interventions, clinical trials, and research are key components to eliminating this divide. Differences in cancer results among minority populations are caused by several factors, including biologic reactions to environmental activities, socioeconomic status, perceived beliefs and notions of medical professionals, a lack of resources to participate in cancer support groups, and having personal contact with cancer survivors. Health professionals, advocates, and researchers hold the key to opening more opportunities for the improvement of cancer survivorship among minorities. The belief that "one size fits all" is unrealistic. These beliefs can influence participation in innovative clinical trials, decisions about treatment, emotional responses, and social support relationships. To help ensure participation in these programs, researchers and health workers must understand the role of social and psychosocial implications and results of the assessment, strategies, and sustainability that must be included in the development stage of any cancer support and survivorship initiatives. For this article, the authors examined mechanisms that can be used by cancer-control researchers and program staff to limit the divide between cancer survivorship initiatives and minority participation. They identified three strategies that must be used to address this divide effectively: the inclusion of minorities in clinical trials, intervention studies, treatment, and research programs; the development of culturally sensitive environments; and the ability to sustain minority participation. In summary, cancer survivorship includes many components that are developed individually and collectively to formulate sound strategies for including minorities in cancer-control initiatives. These programs should go beyond basic support groups and should include research studies, clinical trials, and alternative treatments for increasing cancer survival rates and quality of life among minorities. The divide can be addressed only through a proactive initiative that brings cancer survivorship initiatives and minority communities together in full partnership.

Attitude of Health Personnel↗
PubMed2002

Anorexia nervosa with comorbid psychosis and borderline mental retardation: a case report.

UNLABELLED: Anorexia nervosa (AN) is often associated with comorbid depression or anxiety, but rarely with mental retardation or psychosis. METHODS: The present report describes the case of a 22 year-old woman who met diagnostic criteria for anorexia nervosa, borderline mental retardation, and schizoaffective disorder. RESULTS AND DISCUSSION: The case highlights the difficulties in differential diagnosis with these seemingly incompatible disorders. It also provides some insights into the unclear relationship between anorexia nervosa and these comorbid conditions.

Adult↗
PubMed2006

Improving identification of cognitive impairment in primary care.

OBJECTIVES: To compare the relative level and predictors of accuracy of a brief cognitive screen, the Mini-Cog, with spontaneous detection of cognitive impairment by subjects' primary care physicians. PARTICIPANTS: A heterogeneous community sample (n=371) of predominantly ethnic minority elderly assessed by standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). RESULTS: The Mini-Cog detected cognitively impaired subjects much more effectively than did subject's own physicians (p<0.0001), correctly classifying 83% of the sample and 84% of cognitively impaired subjects. Physicians correctly classified 59% of all subjects but identified only 41% of cognitively impaired subjects. The Mini-Cog's advantage over physicians was greatest when impairment was mildest (screen vs physician recognition at CDR 0.5, 58% vs 6%; at CDR 1, 92% vs 41%). Additional subject variables associated with missed detection by physicians were non-Alzheimer type dementia and low education, low literacy, and non-English speaking, factors that had little or no effect on the performance of the Mini-Cog. Ethnic differences, also observed for physician recognition, were not significant in final regression equations. The number and recency of primary care visits, and duration of the primary care relationship, were not associated with physicians' recognition of cognitive impairment. CONCLUSION: This study demonstrates that recognition of cognitive impairment by primary care physicians is adversely influenced by important patient and disease characteristics. Results also show that use of the Mini-Cog would improve recognition of cognitive impairment in primary care, particularly in milder stages and in older adults subject to disparities in health care quality due to sociodemographic factors.

Aged↗
PubMed2001

Equity of access to a memory clinic in Melbourne? Non-English speaking background attenders are more severely demented and have increased rates of psychiatric disorders.

OBJECTIVES: The aim of this study was to compare demographic and clinical features of patients from Non-English Speaking Background (NESB) with those from English Speaking Background (ESB) who attended a memory clinic in Melbourne, Australia. METHODS: Data on 556 consecutive patients attending the memory clinic were analysed retrospectively. All patients were assessed by a geriatrician (Italian speaking) or psychogeriatrician with the aid of Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) interview schedule. Patients were classified into the categories of dementia, functional psychiatric disorder (including depression), cognitive impairment other than dementia and normal, using ICD 10 criteria. Severity of dementia was determined using the Clinical Dementia Rating scale. Demographic information and use of community services were also documented. RESULTS: Of those seen, 148 (28.8%) were of NESB, the majority Italian (69, 12.4%). Patients of NESB were younger (p = 0.001), less educated (p = 0.001) and less likely to live alone (p = 0.009) compared to persons of ESB. Those of NESB were more likely present with a functional psychiatric disorder (particularly depression) or normal cognition (p = 0.001). Patients of NESB with dementia presented at a later stage of their disease as determined by CDR (p = 0.003). Those of NESB scored significantly lower (more impaired) on CAMCOG in all patients seen (including normal and psychiatric groups) (p = 0.02). CONCLUSIONS: The clinical and demographic features of people of NESB referred to a memory clinic in Melbourne, Australia, differ from their ESB counterparts, with specific groups being under represented. This has implications for equity of assessment, service provision and utilisation for those of ethnically diverse backgrounds.

Aged↗
PubMed2002

Access to a community aged psychiatry service by elderly from non-English-speaking backgrounds.

OBJECTIVE: With the ageing of Australia's ethnic communities, aged mental health services need to examine issues pertaining to accessibility and appropriateness in the context of this sociodemographic change. The aim of this review of referrals to a community aged-psychiatry service was to compare for differences between patients from non-English-speaking backgrounds (NESB) and English-speaking backgrounds (ESB). METHOD: Sociodemographic and clinical variables were retrospectively collated for a 12-month period and analysed according to NESB and ESB status. The 1996 Australian Census data were used for comparison of catchment area representation of different ethnic groups. RESULTS: 40.8% of patients referred to the service were from NESB, and 78.8% of these were assessed with an interpreter. Taken as broad ethnic groups, the referral of elderly European migrants was similar to their representation in the local population, while elderly migrants from Asia and other non-European backgrounds were under-represented. Sociodemographic differences were found in that the elderly from NESB were more likely to be poorly educated, have a low proficiency in English, and to have been employed in unskilled occupations. On the other hand, patterns of referral, diagnosis, past psychiatric history and outcome did not differ significantly between the two groups. Clinical variables relating to referral source, past psychiatric history, and outcome did not differ significantly across the two groups. CONCLUSIONS: This 12-month review of referrals to an aged psychiatry community service found that nearly half were of elderly patients from NESB. The lower utilisation of the service by certain ethnic groups may reflect obstacles in their pathway to care. Alternatively, strong family networks, or a lower prevalence of mental illness in these elderly, may explain the findings in this report.

Aged↗
PubMed2004

Hepatitis C virus-infected patients report communication problems with physicians.

We examined the prevalence and nature of perceived problems in the interaction between physicians and patients diagnosed with hepatitis C virus (HCV) infection. This cross-sectional study included 322 outpatients diagnosed with chronic HCV infection and treated at a tertiary referral hospital's hepatology clinic. Patients were asked to provide demographic information and to complete a semistructured interview, the Sickness Impact Profile (SIP) and Hospital Anxiety Depression (HAD) scale. A team of two blinded coders analyzed the interviews. A total of 131 (41%) study patients reported communication difficulties with physicians involved in their care. The main difficulties were the poor communication skills of physicians (91 [28%]), physician incompetence regarding the diagnosis and treatment of HCV infection (74 [23%]), feelings of being misdiagnosed, misled, or abandoned (51 [16%]), or being stigmatized by their physician (29 [9%]). Patients were twice as likely to report difficulties with subspecialists as compared with generalists. Nonresponse with antiviral therapy correlated with perceived physician conflict even after adjusting for treatment in relation to the time of interview, whereas previous or ongoing substance abuse and mode of acquisition did not. In a multivariate model, patients' psychosocial problems were the best predictors of communication difficulties. In conclusion, a substantial number of patients with HCV infection report difficulties when interacting with physicians, which may be due to coexisting emotional or social problems. However, perceived stigmatization by physicians and a sense of abandonment reflect the need for further educational efforts. These should target both specialists and primary care providers to inform them about the psychosocial challenges facing these patients.

Adult↗
PubMedDate not supplied

Caregiver strain and caregiver burden of primary caregivers of stroke survivors with and without aphasia.

Little is known about how the burden and strain of caring for stroke patients with or without aphasia affects primary caregivers. This article (a) critically examines the literature on the burden and strain of care experienced by caregivers of stroke patients and (b) examines the relationship between aphasia and caregiver burden and strain. Two literature reviews of three databases were conducted. Fourteen articles (12 quantitative articles, 1 mixed-design article, and 1 qualitative article) were found to comply with the study criteria for the first literature search. A second literature search focused on the effects of stroke survivors' aphasia on caregiving; none of the articles retrieved met the inclusion criteria. This article suggests that there is a lack of research in this area and that several key initiatives are needed, including the development of an instrument with psychometric properties appropriate for assessing the burden and strain on caregivers of stroke patients. Implications for future nursing practice and research are highlighted.

Adaptation, Psychological↗
PubMed2006

Technical challenges faced by the immigrant psychoanalyst.

This paper delineates the technical challenges faced by immigrant analysts. These include (i) maintaining cultural neutrality toward "native" patients, (ii) wondering about the patient's motivations for choosing an ethnoculturally different analyst, (iii) scanning the patient's associations for interethnic clues to deeper transferences, (iv) negotiating the dilemmas posed by conducting analysis in a language other than one's mother tongue, and (v) avoiding shared projections, acculturation gaps, and nostalgic collusion in working with homoethnic immigrant analysands. While by no means irrelevant to the clinical work of non-immigrant analysts, these tasks seem to have a greater importance for the immigrant analyst. Brief clinical vignettes are offered to illustrate these propositions and to highlight the tension between the universality of fundamental intrapsychic and relational configurations, on the one hand, and the nuances of cultural and linguistic context, on the other.

Communication Barriers↗
PubMed2002

Methodological concerns for non-Hispanic investigators conducting research with Hispanic Americans.

The fastest-growing ethnic population in the United States, Hispanic Americans are underrepresented in health care research because of an insufficient number of Hispanic American researchers, study teams without Spanish-speaking members, a lack of Spanish-language instruments, and investigator ignorance about cultural differences. Culturally insensitive research produces biased results that can inaccurately represent Hispanic Americans. The purpose of this article is to discuss methodological concerns when conducting research with Hispanic Americans including: instrument response format, translation issues, population-related extraneous variables, and response tendencies that can influence results.

Communication Barriers↗
PubMed2007

Evaluation of a pediatric palliative care educational workshop for oncology fellows.

BACKGROUND: Recent efforts have focused on improving pediatric palliative care to relieve physical and psychological suffering throughout the course of illness, as well as to improve care at the end-of-life (EOL). One area of attention has been medical training, as healthcare providers have often reported feeling ill-equipped to manage EOL issues. As a pilot study, we developed and evaluated a daylong educational workshop on pediatric palliative care for oncology fellows. PROCEDURE: Fellows (N = 32) from 20 hospitals participated in one of two workshops covering palliative care topics, such as pain/symptom management, communication, ethics, and bereavement. Training, knowledge, behavior, and attitudes regarding pediatric palliative care were assessed before the workshop, and knowledge was re-assessed immediately afterwards. RESULTS: Fellows reported a general lack of training in EOL care, and only 41% rated their education as at least "somewhat" adequate. Colleagues and personal experience were more often sources on EOL care, rather than formal classes or textbooks. Although fellows reported open attitudes toward palliative care, such as involving adolescents in decision-making, only half felt comfortable in the presence of a dying person. Fewer than half felt comfortable providing EOL care, managing families' expectations, or knowledgeable enough to discuss hospice with patients/families. Following the workshop, knowledge of palliative care increased significantly from 75 to 85% correct. CONCLUSIONS: Fellows reported open beliefs about palliative care, but acknowledged weaknesses in their training and level of competence. The workshop showed efficacy in improving knowledge, but additional research is needed to evaluate larger educational initiatives and their long-term impact on clinical services and family satisfaction.

Adult↗
PubMed2000

Multicultural mental health services.

Oregon has a significant Indochinese minority community. Seen through the eyes of this group, few of the difficulties minorities encounter when seeking culturally competent services have changed under the Oregon Health Plan.

Asia↗