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PubMed2004

Osteoporosis-related life habits and knowledge about osteoporosis among women in El Salvador: a cross-sectional study.

BACKGROUND: Osteoporosis is a systemic skeletal disorder, characterized by reduced bone mass, deterioration of bone structure, increased bone fragility, and increased fracture risk. It is more frequent to find among women than men at a 4:1 ratio. Evidence suggests that to adopt changes on some life habits can prevent or delay development of osteoporosis. Several osteoporosis-risk factors have been confirmed in the US and western Europe, but in El Salvador there are neither reliable epidemiological statistics about this skeletal disorder nor studies addressing osteoporosis-risk factors in women. The aim of this study was to determinate the extent of osteoporosis knowledge, the levels of both daily calcium intake and weight-bearing physical activity, and the influence of several osteoporosis-risk factors on these variables in three age groups of Salvadorean women. METHODS: In this exploratory cross-sectional study, an osteoporosis knowledge assessment questionnaire including a food frequency and a physical activity record section were used to collect data and it was delivered through a face-to-face interview. A convenience sample (n = 197) comprised of three groups of women aged 25-35 years, 36-49 years, and over 49 years was taken. Among-group comparisons of means were analyzed by two-way ANOVA. To determinate the overall influence of osteoporosis-risk factors, the multivariate analysis was used. RESULTS: Study results indicated that better educated women had more knowledge about osteoporosis than women with a low education level, regardless of age, even though this knowledge was rather fair. Older women got more weight-bearing physical activity at home and less at place of employment than reported by the younger women; however, neither group performed sufficient high-intensity WBPA to improve bone mass. Regardless of age, the most women consumed 60% or less than the Dietary Reference Intake of calcium and depend on household income, lactose intolerance and coffee rather than milk consumption. CONCLUSION: In summary, the majority of women in this study have modest knowledge on osteoporosis. The knowledge base is not linked to preventive health habits, including sufficient calcium intake and performance of weight-bearing physical activities. They are thus at increased risk for low bone mass.

Adult↗
PubMed2006

Evaluating indices of traditional ecological knowledge: a methodological contribution.

BACKGROUND: New quantitative methods to collect and analyze data have produced novel findings in ethnobiology. A common application of quantitative methods in ethnobiology is to assess the traditional ecological knowledge of individuals. Few studies have addressed reliability of indices of traditional ecological knowledge constructed with different quantitative methods. METHODS: We assessed the associations among eight indices of traditional ecological knowledge from data collected from 650 native Amazonians. We computed Spearman correlations, Chronbach's alpha, and principal components factor analysis for the eight indices. RESULTS: We found that indices derived from different raw data were weakly correlated (rho<0.5), whereas indices derived from the same raw data were highly correlated (rho>0.5; p < 0.001). We also found a relatively high internal consistency across data from the eight indices (Chronbach's alpha = 0.78). Last, results from a principal components factor analysis of the eight indices suggest that the eight indices were positively related, although the association was low when considering only the first factor. CONCLUSION: A possible explanation for the relatively low correlation between indices derived from different raw data, but relatively high internal consistency of the eight indices is that the methods capture different aspects of an individual's traditional ecological knowledge. To develop a reliable measure of traditional ecological knowledge, researchers should collect raw data using a variety of methods and then generate an aggregated measure that contains data from the various components of traditional ecological knowledge. Failure to do this will hinder cross-cultural comparisons.

Adolescent↗
PubMed2006

The mother-child nexus. Knowledge and valuation of wild food plants in Wayanad, Western Ghats, India.

This study focuses on the mother-child nexus (or process of enculturation) with respect to knowledge and valuation of wild food plants in a context where accelerated processes of modernization and acculturation are leading to the erosion of knowledge and cultural values associated with wild food plant use, in Wayanad, Western Ghats, India. Wild food plants in this biodiversity hotspot form an important part of local diets and are used as famine foods and medicines. In general, the collection and consumption of these foods are increasingly stigmatized as symbols of poverty and 'tribalness' (equivalent to 'backwardness'). The study, which falls within the discipline of ethnobotany, involves three socio-cultural groups--the Paniya and Kuruma tribes and non-tribals. Further, it examines the impact in the enculturation process of an unusual educational programme sponsored by the MS Swaminathan Research Foundation that is oriented towards creating awareness among children of cultural identity and local biological resources--the study compares children having participated in the programme with those who have not, with their mothers. The process of enculturation is assessed by comparing wild food plant knowledge and values between mothers and their children, and by examining events where knowledge transmission occurs, including collection and consumption. For that, quantitative and qualitative data collection and analysis tools were used, and methods included semi-structured interviews, photo identification and informal interviews of key informants. Results ratify that women are the knowledge holders and are the primary means of knowledge transmission to their children. Nevertheless, fewer children are collecting wild food plants with mothers and learning about them, apparently because of children's lack of time. On the other hand, older people acknowledge that a "change in taste" is occurring among younger generations. In general, there is a simultaneous transmission from mothers to children of contrasting values pertaining to wild food plants: that they are 'good food' but also that they are symbols of low status and poverty, leading to feelings of shame and inferiority. Finally, the study concludes that the educational programme, through a "learning by doing" approach counteracts social stigma and encourages learning among children of all ages and socio-cultural groups, particularly stimulating non-tribal children to learn from tribals.

Adolescent↗
PubMedDate not supplied

Knowledge, attitudes, and practices surrounding breast cancer screening in educated Appalachian women.

PURPOSE/OBJECTIVES: To determine how and what women learn about breast cancer and screening practices and which factors influence women's breast cancer screening practices. DESIGN: Descriptive analysis of questionnaire data collected at the time of enrollment in a clinical trial. SETTING: Breast care center of a mid-Atlantic academic health sciences center. SAMPLE: 185 women in a predominantly Appalachian, entirely rural state. METHODS: Participants completed the Modified Toronto Breast Self-Examination Inventory and questions related to personal mammography practices at the time of enrollment before randomization in a longitudinal clinical intervention study. MAIN RESEARCH VARIABLES: Women's demographics, knowledge of breast cancer screening practices, adherence to breast cancer screening guidelines, and motivation, knowledge, and practice proficiency surrounding breast cancer screening. FINDINGS: These educated women had knowledge deficits about breast cancer, breast cancer risk factors, and screening guidelines, particularly the timing and practice behaviors of breast self-examination. Women who had received healthcare and cancer-screening instruction by healthcare providers, including advanced practice nurses, had greater knowledge of breast cancer and detection practices. CONCLUSIONS: Women still have knowledge deficits about breast cancer, breast cancer detection, and personal risk factors. In addition, some educated women in this study failed to practice breast cancer screening according to current guidelines. IMPLICATIONS FOR NURSING: Practitioners must continue to remind and update women about breast disease, and women's cancer-screening practices must be reinforced. All levels of providers should improve their rates of performing clinical breast examinations with physical examinations. Nurses, who greatly influence women's health care, must remain current in their knowledge of breast disease, screening, and treatment.

Adult↗
PubMed1999

A comparison of HIV/AIDS knowledge among high school freshmen and senior students.

Statistical data show that heterosexual transmission of AIDS among teenagers is a significant problem. The purpose of this study was to assess and compare the level of knowledge concerning HIV/AIDS among high school freshmen- and senior-level students and to determine the association between certain demographic variables and the students' knowledge level. A convenience sample of 169 freshmen and 274 senior high school students were surveyed at a local area high school (N = 443). A 49-item knowledge questionnaire, used by the high school district HIV/Abstinence program, and a demographic questionnaire developed by the investigators were used to collect the data. The findings revealed that both the freshmen and senior students had several misconceptions about HIV/AIDS, including the modes of transmission, the sure way of preventing the sexual transmission, donating blood, and the usual causes of death for people with AIDS. A comparison of the mean knowledge scores among freshmen and senior students indicated there was no significant difference among the two groups. The mean knowledge score of the seniors was significantly affected by whether they had received HIV/AIDS education. However, this was not the case for the freshmen. African American students, especially the female students, had significantly lower knowledge scores than other ethnic groups.

Adolescent↗
PubMed2004

Experiential learning influences residents knowledge about hormone replacement therapy.

BACKGROUND: Knowledge concerning hormone replacement therapy (HRT) is rapidly changing. PURPOSE: We sought to understand the factors that influence how residents assimilate this knowledge. METHODS: We conducted an anonymous survey of residents in an internal medicine residency. Questions included personal demographic information and aspects of training (didactic and experiential) regarding and knowledge about HRT. Data were analyzed using univariable and multivariable linear regression. RESULTS: Sixty-nine of 92 residents (75%) completed the survey. The gender and race of respondents did not differ significantly from the overall group. Knowledge scores were higher among residents in nontraditional (Women's Health, Primary Care, and Internal Medicine-Pediatrics) training tracks (p = .04) and among residents with patient population of < or = 30% postmenopausal women (p = .049). Demographic characteristics and didactic training about HRT did not influence knowledge. CONCLUSIONS: Nontraditional residency track and higher proportion of postmenopausal women in a practice (experiential learning) improve knowledge about HRT. Didactic training has no effect.

Attitude of Health Personnel↗
PubMed2002

Knowledge of the human body: a distinct semantic domain.

BACKGROUND: Patients with selective deficits in the naming and comprehension of animals, plants, and artifacts have been reported. These descriptions of specific semantic category deficits have contributed substantially to the understanding of the architecture of semantic representations. OBJECTIVE: This study sought to further understanding of the organization of the semantic system by demonstrating that another semantic category, knowledge of the human body, may be selectively preserved. METHODS: The performance of a patient with semantic dementia was compared with the performance of healthy controls on a variety of tasks assessing distinct types of body representations, including the body schema, body image, and body structural description. RESULTS: Despite substantial deficits on tasks involving language and knowledge of the world generally, the patient performed normally on all tests of body knowledge except body part naming; even in this naming task, however, her performance with body parts was significantly better than on artifacts. CONCLUSIONS: The demonstration that body knowledge may be preserved despite substantial semantic deficits involving other types of semantic information argues that body knowledge is a distinct and dissociable semantic category. These data are interpreted as support for a model of semantics that proposes that knowledge is distributed across different cortical regions reflecting the manner in which the information was acquired.

Atrophy↗
PubMed1996

Israeli professionals' knowledge and attitudes towards AIDS.

This paper explores Israeli professionals' knowledge about and attitudes towards AIDS. While AIDS in Israel is not generally considered to be a pressing crisis, the aim of the research is to document and analyze what professionals in the helping professions know and how they feel about AIDS. The study also explores thoughts and feelings concerning AIDS-related education and training. The study sample consists of 370 professionals, including social workers, nurses, occupational therapists, psychologists, and special education teachers and counselors. Results indicate that professionals' knowledge scores were significantly higher than their attitude scores. Significant differences were found according to nationality and perception of adequate training. Jews were more knowledgeable than Arabs, and those who perceived their AIDS-related training as adequate were more knowledgeable than those who did not. The attitude scores related to both gender and nationality. Women scored higher than men, and again Jews scored higher than Arabs. Two regression models predicting both knowledge and attitude are presented and their implications are discussed. As far as differences among the various professional groups, no differences appear in their knowledge scores; however, nurses scored significantly lower on the attitude scale than did the other groups.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Screening for breast and cervical cancers: the importance of knowledge and perceived cancer survivability.

INTRODUCTION: This study examines the association between recent screening for breast and cervical cancers, knowledge of cancer risk factors, and perceptions of surviving cancer. METHODS: Data were from the Cancer Control Supplement to the 1992 National Health Interview Survey (NHIS-CCS). The dependent variable combined breast and cervical cancer screening practices into a single composite index. Two independent variables combined women's knowledge about breast and cervical cancers into single indicators--one representing risk factor knowledge, the other representing perceived likelihood of surviving breast and cervical cancers following early detection. RESULTS: Multivariate analysis showed that recency of screening for both breast and cervical cancers was associated with knowledge of cancer risk factors and perceptions of surviving cancer. Education, household income, and smoking status also were correlates of comprehensive screening. Significant interactions between income and perceived survivability, and between education and perceived survivability suggested that the effects of income and education on comprehensive screening varied with perceptions about surviving cancer. CONCLUSION: The study suggests that knowledge and attitudinal questions can be combined for two diseases to enhance understanding of who is most likely to be screened comprehensively for breast and cervical cancers. Although national trends show that large percentages of women over age 50 are having mammograms and Pap tests, this progress is not likely to be sustained unless existing barriers are eliminated. Limited knowledge about breast and cervical cancer risk factors and misperceptions about survival from cancer represent two of these barriers.

Aged↗
PubMed2005

Safety-related knowledge and behavior changes in participants of farm safety day camps.

Significant resources are devoted to conducting farm safety day camps throughout North America, but the impact and effectiveness of these programs has not been systematically demonstrated. This project assessed changes in safety-related knowledge and behaviors among participants in the Progressive Farmer Farm Safety Day Camp program. A written pre-test and a three-month telephone post-test were administered to three samples of participants, ages 8 to 13, in camps held in 1999, 2000, and 2001. A sample of 20 to 30 camps was included in each year of the study, with a total sample of 1,780 participants for all three years. The pre-test and post-test contained questions related to first aid and to safety around animals, ATVs, farm equipment, flowing grains, and tractors. Three scores were computed from responses to 20 knowledge and behavior items. A knowledge score indicated the number of 8 knowledge items answered correctly, a behavior risk score indicated the amount of risk exposure for the child based on 8 behavior items, and an ATV safety gear risk score indicated, for those who rode ATVs, the level of risk due to lack of proper safety gear (4 items). From pre-test to post-test, there was an increase in knowledge scores and a decrease in behavior risk scores and ATV safety gear risk scores. These changes were consistent both for males and females, for farm residents and non-farm residents, and across all ages in the sample. These results support claims for the effectiveness of farm safety day camps for increasing knowledge and improving safe practices among camp participants.

Accident Prevention↗
PubMed2005

Impact of adherence, knowledge, and quality of life on anticoagulation control.

BACKGROUND: Patients receiving chronic warfarin therapy who have poor anticoagulation control are at increased risk for adverse events. However, it is unknown how adherence to warfarin, patient demographics, patient knowledge about therapy, and perceived impact of warfarin therapy on quality of life are associated with anticoagulation control. OBJECTIVE: To determine the association between these patient factors and anticoagulation control in patients attending 2 anticoagulation clinics in the Bronx, New York City. METHODS: A cross-sectional survey of 52 patients was conducted. The 4-item Morisky survey was used to assess self-reported adherence. Patient knowledge about warfarin therapy and the perceived impact of warfarin therapy on quality of life were determined by self-administered questionnaires. Associations between adherence, patient knowledge, impact of warfarin therapy on quality of life, and anticoagulation control were determined with t-tests, chi(2) analysis, and logistic regression. RESULTS: Only 14% of patients had good anticoagulation control. Adequate adherence was reported by 50% of patients and was significantly associated with good anticoagulation control (p = 0.01). Thirty-seven percent of participants had good knowledge of anticoagulation, and 19% of participants reported that warfarin negatively impacted their quality of life. Knowledge about warfarin therapy and impact of warfarin on quality of life were not significantly associated with anticoagulation control. CONCLUSIONS: Adherence is one of many factors that contribute to anticoagulation control. Adequate adherence, as determined by the Morisky survey, was significantly associated with anticoagulation control. Patient demographic characteristics, knowledge about warfarin therapy, and perceived impact of warfarin on quality of life were not associated with anticoagulation control.

Adult↗
PubMed2001

Children and road safety: increasing knowledge does not improve behaviour.

BACKGROUND: Programmes designed to teach children about road safety have often failed to assess their effectiveness in terms of either an increase in children's knowledge or an improvement in children's behaviour. AIM: The two studies reported here sought to address both issues, by focusing on the abilities of Primary 1 children (5 years old). SAMPLE: A total of 120 Primary 1 children within the age range 4-5 years old participated in this study, drawn from three different primary schools within an educational district of Scotland. METHODS: In the first study the effects of three different road safety interventions were tested, all of which employed commercially marketed products: 1) a three-dimensional model of the traffic environment; 2) a road safety board game; and 3) illustrated posters and flip-chart materials. In the second study the transfer of knowledge to children's behaviour in a real-life traffic environment was tested, using a subsample of 47 children who had taken part in the first study. RESULTS: Results from the first study showed, surprisingly, that all three interventions were effective in increasing children's knowledge about safe and dangerous locations at which to cross the street, and that this knowledge was retained for a period of six months. Study 2, however, showed that increased knowledge did not result in improved traffic behaviour. Children who had received training performed no better than children in a control group. CONCLUSION: These findings highlight the need to distinguish between children's road safety knowledge and their behaviour, particularly for teachers and parents, who may mistakenly believe that children who know more will be safer on the road.

Accident Prevention↗
PubMed1997

Nutrition knowledge and obesity of adults in community residences.

Variation in nutrition knowledge of adults with mild or moderate mental retardation (30 obese, 27 nonobese) from four community agencies was examined as a function of their body mass and level of mental retardation. They completed a nutrition knowledge test adapted for individuals with mental retardation. Multiple regression analyses revealed significant effects of level of mental retardation and body mass on nutrition knowledge. Adults with mild mental retardation possessed greater nutrition knowledge than did those with moderate mental retardation, and obese individuals possessed more knowledge than did nonobese individuals. The unexpected relation between nutrition knowledge and degree of obesity implies an influential role for environmental factors in the development of obesity.

Adult↗
PubMed2001

Measuring practical knowledge among prospective and current teachers of deaf and hard of hearing students.

Research on teaching and teacher research has a long history. However, in the field of the education of deaf and hard of hearing students, this research is limited. The study addresses one particular area of research on teaching and teacher research: practical knowledge of teachers of deaf and hard of hearing students. Practical knowledge is defined as how educators think about their classroom practice. By means of a survey designed and tested by the researcher, four hierarchical groups (beginning education students, graduating education students, novice teachers, and experienced teachers) in the education of deaf and hard of hearing students were surveyed on their practical knowledge. Practical knowledge codified as images, rules of practice, and practical principles. Results were measured to demonstrate for categories and characteristics of practical knowledge storage among prospective and current teachers of deaf and hard of hearing students. The instrument was designed as an assessment tool to measure aspects of this knowledge, apply it to levels of pedagogical expertise, and expand research in this area.

Adult↗
PubMed2003

Condom use and the accuracy of AIDS knowledge in Côte d'Ivoire.

CONTEXT: Condom use remains low in Côte d'Ivoire, despite an increasing prevalence of HIV and widespread awareness of how the virus is transmitted. Information is needed about characteristics that predict condom use and about the role of AIDS knowledge and sex differences in the use of condoms. METHODS: Data from the 1994 Côte d'Ivoire Demographic and Health Survey were analyzed for respondents who had had sex in the two months before the survey. Logistic regressions were performed separately by sex to determine whether the accuracy of men's and women's knowledge about AIDS predicted condom use at their most recent sexual intercourse. RESULTS: Accuracy of knowledge about AIDS did not significantly predict condom use. For male respondents, the odds of condom use at last intercourse were significantly lower among those aged 35 or older than among those aged 15-19 (odds ratios, 0.3-0.5). The odds were also lower among married men (0.4) and those who reported friends, family or neighbors as their only source of AIDS knowledge (0.5). Compared with uneducated men, men with secondary or higher education were significantly more likely to report condom use (1.7). Among women, those aged 25 or older had significantly lower odds of condom use at last intercourse than those aged 15-19 (0.2-0.6). The odds of use were significantly reduced among women who were married (0.2) and those who had learned about AIDS from family, friends or neighbors or from television or radio (0.3-0.6); however, the odds were significantly higher for women with secondary or higher education than for uneducated women (2.2). CONCLUSION: The level of accuracy of AIDS knowledge did not predict the likelihood of recent condom use in this sample. Efforts to increase educational attainment in Côte d'Ivoire may be more effective in increasing condom use than a focus on improving the accuracy of AIDS knowledge.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Knowledge and management of diarrhea among underserved minority parents/caregivers.

OBJECTIVE: Dehydration resulting from diarrhea continues to be a cause of morbidity, mortality, and increased health care costs in the United States. This study assesses parental knowledge of the causes and signs of diarrhea and dehydration. It also examines parental-care practices during an episode of diarrhea. METHODS: A survey was given to 219 parents/caregivers of children less than 5 years of age who presented to a pediatric continuity clinic. A bilingual interviewer was used to administer the surveys to participants for assessing knowledge of causes, signs, and treatment of diarrhea; signs of dehydration; and care practices during an episode of diarrhea. RESULTS: A wide variation in the level of awareness of signs, causes, and treatment of diarrhea was detected. General knowledge of diarrhea was related positively to accessibility of health information, level of education, ethnicity, and experience with dehydration. General knowledge of diarrhea, adjusted for level of education, was higher in African Americans than in Hispanics. CONCLUSIONS: In children, dehydration from diarrhea may be prevented by increasing parents'/caregivers' general knowledge of diarrhea and dehydration and the appropriate usage of oral rehydration solutions. Intervention programs designed to increase parents'/caregivers' knowledge must be culturally sensitive and appropriate for diverse educational backgrounds and must assist in improving access to health-related information.

Adolescent↗
PubMed1998

Comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding drug therapy for acute myocardial infarction.

OBJECTIVES: This study assesses the knowledge and practice of emergency physicians regarding the treatment of acute myocardial infarction (AMI) and compares the results with previously published data on cardiologists and primary care practitioners. BACKGROUND: Debate surrounding the respective roles of emergency physicians, primary care practitioners, and specialists figures prominently in discussions regarding the nation's evolving health-care system. Data are lacking about the comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding conditions commonly treated by all three groups, eg, AMI. METHODS: A survey of 1,045 emergency physicians, nationally, was conducted in 1995 regarding five short-term pharmacologic interventions employed for many years in the standard treatment of AMI. The emergency physicians were questioned about the effect on survival of each intervention and the likelihood that they would prescribe each intervention. The findings were then compared with previously published data on the knowledge and practice of cardiologists and primary care practitioners obtained in New York and Texas in 1993. Identical clinical queries and eligibility criteria were employed in all groups. RESULTS: The responding emergency physicians' knowledge was similar or significantly greater than that of responding cardiologists for the effect on survival of most of the short-term interventions, and their practice patterns were similar or significantly better than responding cardiologists for all interventions studied. Emergency physicians and cardiologists had significantly better knowledge and practice in this area compared with responding primary care practitioners. CONCLUSIONS: For the management of AMI, emergency physicians, on average, have a similar or greater awareness of the effects on survival and similar or better practice patterns regarding most acute pharmacologic interventions when compared with those of cardiologists; both groups, on average, have a superior knowledge and practice when compared with primary care practitioners. These results illustrate the importance of emergency medicine and support further consideration of an expanding role for the emergency physician in the nation's evolving health-care system.

Adrenergic beta-Antagonists↗
PubMed1998

Intervention to improve physician documentation and knowledge of child sexual abuse: a randomized, controlled trial.

OBJECTIVE: To determine if written feedback improves the chart documentation and knowledge of physicians doing evaluations for child sexual abuse and to learn what other factors are associated with better documentation and knowledge. DESIGN: Randomized, controlled trial. SETTING: A statewide network of physicians performing child abuse evaluations. PARTICIPANTS: All physicians who performed evaluations for sexual abuse during 1991 to 1992. One hundred forty-seven physicians were randomized to control (n = 75) and intervention (n = 72) groups, 122 (83%) remained at follow-up, and 87 of the 122 (71%) had done evaluations for child sexual abuse. INTERVENTIONS: Tailored written feedback based on chart reviews and relevant articles were sent to a randomly selected one-half of the physicians during a 3-month period. MAIN OUTCOME MEASURES: The quality of documentation and physician knowledge before and after the intervention. RESULTS: Documentation by chart review of up to five randomly chosen records per physician (preintervention, n = 552; postintervention, n = 259) by reviewers blinded to intervention status and physician knowledge was assessed by survey (78% completion). Change in documentation and knowledge for physicians in the intervention group was not statistically significant compared with the control group. The risk ratio for a mean overall history rating of excellent/good was 0.89 (0.63, 1.25) and for a mean overall physical examination rating of excellent/good was 1.03 (0.73, 1.45). Both groups improved significantly during the time period. The largest improvements in the time period were in documenting the history of where abuse occurred, in the physical examination position, hymenal description, penile findings, and knowing that chlamydia infection should be assessed by culture. A structured medical record, female physicians, and credits in continuing medical education were associated with better documentation. CONCLUSIONS: Tailored feedback to the physician with directed educational materials did not seem to improve most aspects of documentation and knowledge of child sexual abuse, although notable improvement was seen during the time period studied. This study suggests that chart audits may not be the best use of resources for trying to improve physician behavior; credits in continuing medical education and use of structured records may be more likely to be beneficial.

Child↗