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PubMed2002

[What messages did the Norwegian tobacco industry communicate to consumers in its advertising?].

BACKGROUND: A Norwegian official report, NOU 2000: 16, Tort liability for the Norwegian tobacco industry, concludes that Norwegian law and judicial practice allows lawsuits against the tobacco industry for damages. A crucial claim in such suits would be that the industry withheld information on health risks and addiction and instead used advertising messages that undermined the information campaigns initiated after the reports on smoking and health from the U.S. Surgeon-General and the Norwegian Board of Health in 1964. This article reports a study of differences in tobacco advertising in Norway before and after 1964. MATERIAL AND METHODS: A total of 1,945 photographs of advertisements in two popular weekly family magazines over the 1955 to 1975 period were stored in a database along with information on date of publication, size, copy and message, presumed target group, and characteristics of persons and situations shown. RESULT: Up until 1964, advertisement space per year in these magazines totalled 100 dm2 (11 sq. feet). The amount of advertising space then increased up until 1973, to 2,033 dm2 (219 sq. feet). The share featuring women went up from 33 in the 1955-64 period to 62% in 1965-75, when 51% of advertisements showed women smoking while 31% showed men smoking. Pre-1964 advertisements primarily contained information to smokers on price, type of tobacco, packaging and country of origin; after 1964 the advertisements developed a more universal appeal associating smoking with various social situations marked by style, well-being and comfort. The tobacco was said to be pure, fresh, mild and natural, and the filter was claimed to have protective properties. INTERPRETATION: It is probable that the cognitive dissonance created by more health information on smoking after 1964, i.e. the necessary motivation to quit, was reduced as a result of strategic changes in the amount and content of advertising.

Advertising↗
PubMed2006

[Effect of acupuncture combined behavior intervention on children with autism].

OBJECTIVE: To investigate the effect of acupuncture combined behavior intervention on children with autism. METHODS: Patients were treated by "Jin's three-needling" as the main measure with the assistance of behavior intervention, and the changes were compared among the three groups (29 cases in combination group, 15 cases in acupuncture group and 10 cases in intervention group) before and after treatment of various factors and scores estimated by the autism behavior checklist (ABC) and autism development checklist (ADC). RESULTS: In the combination group, the total scores of ABC and most factors of ABC including body movement, social communication and language factor were improved significantly after treatment (P < 0.01), but there was no significant changes in sense factor and daily life self-caring factor (P > 0.05). Comparison of most items of ADC before and after treatment also showed significant difference (P < 0.01). CONCLUSION: Acupuncture combined behavior intervention has better therapeutic efficacy in the treatment of children with autism.

Acupuncture Therapy↗
PubMed1998

Microsurgical management of intracranial epidermoid cysts.

BACKGROUND: Intracranial epidermoid cysts are slow-growing congenital neoplasms that usually spread and adhere to critical neurovascular structures along the basal cistern, particularly the cerebellopontine angle (CPA) and parasellar region. Clinical symptoms include trigeminal neuralgia, headache and dizziness, progressive hemiparesis, unstable gait and hemifacial spasm. With the aid of modern imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), an effective microsurgical approach can be planned preoperatively to completely remove tumors and avoid complications. METHODS: Twenty-six patients with intracranial epidermoid cysts were microsurgically treated between July 1984 and June 1997. Diagnostic procedures included enhanced CT and/or CT cisternography and MRI. All patients underwent microsurgical treatment for tumor removal. RESULTS: Total tumor removal was achieved in 12 patients (46.2%), near-total removal in seven (26.9%), partial removal in six (23.1%) and stereotactic biopsy in one patient (3.8%). Postoperative deterioration of the neurologic condition was found in three patients who required further surgery, aseptic meningitis in four patients and communicating hydrocephalus requiring shunting in three patients. The functional prognoses were excellent in 23 patients (88.5%), good in two patients (7.7%) and fair in one patient (3.8%). Among the 26 patients, three died of pneumonia three, six and nine months after surgery, respectively. CONCLUSIONS: MRI is particularly useful for defining the anatomic limits of tumor tissue and surgical planning. The surgical results were excellent in patients with near-total tumor removal, as well as in patients with total removal. Aggressive surgical tumor removal may result in transient, but significant, cranial nerve palsy and should be avoided. Perioperative administration of steroids and wound protection may be beneficial for preventing the development of postoperative aseptic meningitis and hydrocephalus.

Adult↗
PubMed2002

Validation of the Non-communicating Children's Pain Checklist-Postoperative Version.

BACKGROUND: This study evaluated the psychometric properties of the Non-communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV) when used with children with severe intellectual disabilities. METHODS: The caregivers of 24 children with severe intellectual disabilities (aged 3-19 yr) took part. Each child was observed by one of their caregivers and one of the researchers for 10 min before and after surgery. They independently completed the NCCPC-PV and made a visual analog scale rating of the child's pain intensity for those times. A nurse also completed a visual analog scale for the same observations. RESULTS: The NCCPC-PV was internally reliable (Cronbach alpha = 0.91) and showed good interrater reliability. A repeated-measures analysis of variance indicated NCCPC-PV total and subscale scores were significantly higher after surgery and did not differ by observer. Postoperative NCCPC-PV scores correlated with visual analog scale ratings provided by caregivers and researchers, but not with those of nurses. A score of 11 on the NCCPC-PV, by caregivers, provided 0.88 sensitivity and 0.81 specificity for classifying children with moderate to severe pain. CONCLUSIONS: The NCCPC-PV displayed good psychometric properties when used for the postoperative pain of children with severe intellectual disabilities and has the potential to be useful in a clinical setting. The results suggest familiarity with an individual child with intellectual disabilities is not necessary for pain assessment.

Adolescent↗
PubMed2003

Health care utilization and expenditures associated with child care attendance: a nationally representative sample.

OBJECTIVE: Participation in center-based child care among preschool-aged children is associated with an increased incidence of communicable illness. Although estimates of health care utilization and costs associated with child care attendance exist in other countries with different health care systems, nationally representative data for the United States are lacking. The objective of this study was to determine the patterns of health care utilization and costs associated with attendance at different types of child care, among a nationally representative sample of preschool-aged children. METHODS: A nationally representative sample of children aged 0 to 5 years enrolled in the Medical Expenditure Panel Survey, 1997 Cohort were studied. Data were analyzed by cross-sectional analysis within a single calendar year. The Rand Health Insurance experiment 2-part multivariate regression model was used to accommodate skewed expenditure data. RESULTS: A total of 871 children were included in the study. A total of 484 (56%) attended no child care provided by anyone other than their primary caregiver; 134 (15%) attended center-based child care; 76 (9%) attended friend or neighbor care; and 170 (20%) attended in-home or relative care. In a weighted multivariate model, children in center-based child care were more likely than those not in child care to have attended at least 1 office-based visit (adjusted odds ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.0-7.9) and emergency department visit (aOR: 2.0; 95% CI: 1.1-3.6) and to have received a medication prescription (aOR: 2.8; 95% CI: 1.2-6.1). The adjusted 2-part model predicted total health care expenditures for those not attending child care to be 642 dollars (95% CI: 508-813), versus 985 dollars (95% CI: 714-1336) for a similar population in center-based child care. Expenditure data for office-based visits and medication prescriptions mirrored these trends. CONCLUSION: In the immediate term, children in center-based child care tend to use more health care services. This increased utilization translates into modest per-child differences in health care expenditures. We hypothesize that this pattern of utilization and expenditure is attributable primarily to a higher incidence of minor, self-limited, communicable illness among children in center-based child care.

Child Care↗
PubMed2005

A qualitative report of patient problems and postoperative instructions.

PURPOSE: While surgery related stress may interfere with the patient's ability to concentrate on instructions, language difficulty or low health literacy may also impede appropriate doctor/patient communication. The purpose of this study is to understand from a sample of minority patients the types of problems encountered during healing and the level of information regarding elements of postoperative instructions they recalled receiving at an inner-city safety net hospital. We initiated a qualitative study to understand the care sequence process and provision of informed consent and postoperative instruction. METHODS: African American or Latino patients, 18 years of age or older, who had third molars removed under general anesthesia or received treatment for a mandibular fracture were recruited to participate in a focus group to discuss their treatment. Patients described their problem and any informed consent given about treatment risks and benefits and postoperative information they recalled. RESULTS: A total of 137 former patients were approached, 57 agreed to participate (42%) and 34 of those (60%) completed the interview. Subjects included 14 females and 20 males. Five categories of patient problems were reported: physical, eating, treatment-related, psychosocial, and other problems. People reported 5 categories of coping strategies: medication use, physical treatments, dietary solutions, rest, and clinical assistance. Twenty people recalled being given informed consent, and 5 participants recalled no elements of informed consent. Overall, 14 participants recalled elements of postoperative instruction. CONCLUSION: Gaps in patient understanding of postoperative care suggest room for improvement in postoperative instructions. Additional research is necessary to design and test high-quality postoperative instructions for surgical treatment and recovery in populations with limited health related literacy.

Adaptation, Psychological↗
PubMed1997

The Caregiver Activity Survey (CAS): development and validation of a new measure for caregivers of persons with Alzheimer's disease.

BACKGROUND: Most instruments that measure the impairments associated with Alzheimer's disease assess symptom severity. Little attention has been paid to the illness's impact on the time formal and informal caregivers spend caring for Alzheimer's individuals. A tool that measures the time spent caregiving would help to determine the economic impact of the illness. The Caregiver Activity Survey (CAS) was developed to measure the time caregivers spend aiding Alzheimer's patients with their day-to-day activities. METHODS: The test-retest reliability of the CAS was assessed during a 3-week study with 42 Alzheimer's patients and their caregivers. The CAS was validated with the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog), the Mini Mental State Exam (MMSE) and the Physical Self Maintenance Scale (PSMS). RESULTS: The final version of the CAS consists of six items (communicating with the person, using transportation, eating, dressing, looking after one's appearance and supervising the person). The six-item CAS total score has high test-retest reliability, with ICC = 0.88 between weeks 1 and 3. The scale has strong convergent validity with the ADAS-Cog (r = 0.61), MMSE (r = -0.57) and PSMS (r = 0.43). Efforts to include a dimension that reflects caregiver burden were not successful, in part due to the reluctance of caregivers to acknowledge that caregiving is bothersome. CONCLUSIONS: The CAS provides a new tool that measures time spent caring for Alzheimer's individuals. The instrument may be used to augment existing clinical assessments that measure the efficacy of potentially therapeutic agents for persons with Alzheimer's disease.

Activities of Daily Living↗
PubMedDate not supplied

Efficacy of critical incident monitoring for evaluating disaster medical readiness and response during the Sydney 2000 Olympic Games.

INTRODUCTION: Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI. OBJECTIVE: To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents. METHODS: Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings. RESULTS: A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communication-related issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Pre-deployment planning was the most important factor for future incident impact minimization. CONCLUSIONS: Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.

Anniversaries and Special Events↗
PubMed2003

Analytic global OSCE ratings are sensitive to level of training.

PURPOSE: There are several reasons for using global ratings in addition to checklists for scoring objective structured clinical examination (OSCE) stations. However, there has been little evidence collected regarding the validity of these scales. This study assessed the construct validity of an analytic global rating with 4 component subscales: empathy, coherence, verbal and non-verbal expression. METHODS: A total of 19 Year 3 and 38 Year 4 clinical clerks were scored on content checklists and these global ratings during a 10-station OSCE. T-tests were used to assess differences between groups for overall checklist and global scores, and for each of the 4 subscales. RESULTS: The mean global rating was significantly higher for senior clerks (75.5% versus 71.3%, t55 = 2.12, P < 0.05) and there were significant differences by level of training for the coherence (t55 = 3.33, P < 0.01) and verbal communication (t55 = 2.33, P < 0.05) subscales. Interstation reliability was 0.70 for the global rating and ranged from 0.58 to 0.65 for the subscales. Checklist reliability was 0.54. CONCLUSION: In this study, a summated analytic global rating demonstrated construct validity, as did 2 of the 4 scales measuring specific traits. In addition, the analytic global rating showed substantially higher internal consistency than did the checklists, a finding consistent with that seen in previous studies cited in the literature. Global ratings are an important element of OSCE measurement and can have good psychometric properties. However, OSCE researchers should clearly describe the type of global ratings they use. Further research is needed to define the most effective global rating scales.

Canada↗
PubMedDate not supplied

One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery.

UNLABELLED: As intensive care nursery personnel increasingly seek to provide comprehensive care to families, there is a renewed emphasis on offering family support programs. PURPOSE: The purpose of this study was to identify parents' utilization and evaluation of a support program based in a newborn intensive care unit (NICU) that offered a combination of formats for support services: group support, one-to-one support, and telephone support. METHODS: Program records and a survey developed by the author documented parental use and evaluation of services. Data analysis consisted of descriptive statistics and qualitative content analysis of demographic data, survey results, and parental comments. RESULTS: Of the total 477 participants, 78% utilized 1 support service format exclusively. Eighteen percent utilized 2 support formats concurrently. A subsample of 48 parents completed an evaluation survey. Continuity of care was a critical component of the program overall. Group support offered more opportunities for families to problem-solve communication issues with nursery personnel and provide information that assisted parents' involvement in their babies' care. CONCLUSIONS: Parent support programs that utilize only one type of format may not be optimal for providing the range of support needed by many NICU families. Parent support programs offer an important mechanism to assess provider approaches to facilitate family-centered care.

Adult↗
PubMed1998

Picture archiving communication system does not decrease the number of radiographs needed to evaluate the trauma patient.

BACKGROUND: Picture Archiving Communication System (PACS) is a sophisticated software and hardware package that enables clinicians to retrieve, review, and digitally manipulate radiographs from computer workstations throughout the hospital. PACS was instituted at Brooke Army Medical Center in July 1993. METHODS: Fifty consecutive trauma and 50 consecutive motor vehicle crash (MVC) trauma admissions to an urban trauma center were reviewed before PACS (January 1993) and 18 months after PACS was instituted (January 1995). Patients were compared by the number of radiographs needed during the initial evaluation by type and total. The trauma groups were subdivided by mechanism and also compared. Demographic and physiologic data were collected for each patient. RESULTS: There are no differences in the demographic and physiologic data between groups. For the 50 consecutive trauma admissions, only two areas of statistical difference were found: more chest films were obtained in the MVC PACS group and more pelvis films were obtained in the gunshot wound pre-PACS group. For the 50 consecutive MVC trauma admissions, the PACS group had more chest and total radiographs per patient than the pre-PACS group. More computed tomographic scans of the neck were obtained in the PACS group. CONCLUSION: PACS did not decrease the number of radiographs needed to adequately and fully evaluate the trauma patient.

Accidents, Traffic↗
PubMed2006

Reliability of the functional independence measure for children in normal Thai children.

BACKGROUND: The Functional Independence Measure for children (WeeFIM) is a new instrument for evaluating functionality in disabled children aged 9-100 months. It was developed to determine a child's functional capacity and performance. With no baseline information about Thai children, it is difficult to assess whether a patient is initially high or low with respect to function. METHODS: The aim of this study, therefore, was to evaluate the interrater, intrarater reliability and appropriateness of the use of the WeeFIM and to establish a normative data profile suitable for Thai children. The WeeFIM is an instrument used to assess independence in self-care, sphincter control, transfer, locomotion, communication, and social cognition. RESULTS: Direct interviews were conducted in the communities for 569 normal Thai children (289 girls and 280 boys) aged 6-100 months. The interrater and intrarater reliability scores were examined. The WeeFIM total and domain scores increased progressively with age. Intraclass correlation coefficients for the reliability for the WeeFIM domain score ranged from 0.90 to 0.99. Total WeeFIM intraclass correlation coefficients values were greater than 0.97 for all analyses. The authors classified the 18 items into six groups according to the degree of correlation with age. Most items were highly correlated with age as indicated by a Spearman's correlation coefficient greater than 0.8. The interrater and intrarater reliability of the WeeFIM subscores was high. CONCLUSION: The current study demonstrated that WeeFIM could be employed as a useful and reliable instrument for assessing functional independence for Thai children. Therefore, usage of WeeFIM with different age criteria for achieving independence should be adopted. Normative functional independence measures for a large group of Thai children will enhance the knowledge base about their development measurement and provide a database for future investigations on clinical population in Thailand.

Adolescent↗
PubMed1999

Rates and risk factors for dementia and Alzheimer's disease: results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups. European Studies of Dementia.

OBJECTIVE: To investigate the risk of AD associated with a family history of dementia, female gender, low levels of education, smoking, and head trauma. BACKGROUND: These putative factors have been identified in cross-sectional studies. However, those studies are prone to bias due to systematic differences between patients and control subjects regarding survival and how risk factors are recalled. METHODS: The authors performed a pooled analysis of four European population-based prospective studies of individuals 65 years and older, with 528 incident dementia patients and 28,768 person-years of follow-up. Patients were detected by screening the total cohort with brief cognitive tests, followed by a diagnostic assessment of those who failed the screening tests. Dementia was diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (revised), and AD was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Incident rates and relative risk (95% CI) express the association of a risk factor for dementia. RESULTS: Incident rates for dementia and AD were similar across studies. The incidence of AD increased with age. At 90 years of age and older the incidence was 63.5 (95% CI, 49.7 to 81.0) per 1,000 person-years. Female gender, current smoking (more strongly in men), and low levels of education (more strongly in women) increased the risk of AD significantly. A history of head trauma with unconsciousness and family history of dementia did not increase risk significantly. CONCLUSION: Contrary to previous reports, head trauma was not a risk factor for AD, and smoking did not protect against AD. The association of family history with the risk of AD is weaker than previously estimated on the basis of cross-sectional studies. Female gender may modify the risk of AD, whether it be via biological or behavioral factors.

Age Distribution↗
PubMed2026

Final-year nursing students' clinical practice experiences: a reflection study.

OBJECTIVES: This study aimed to explore the most impactful clinical practice experiences of final-year nursing students and the future-oriented actions developed in response to these experiences. METHODS: A retrospective descriptive qualitative design was used. Following reflection training in the internship practice course, 134&#xa0;final-year nursing students were asked to describe the experience that affected them most during clinical practice. A total of 123 written reflections were analyzed using content analysis. RESULTS: Three themes emerged: near-miss events, incivility behaviors, and positive preceptoring roles. Negative experiences were mainly related to patients, relatives, and nurses and often led students to feel fear and inadequacy. Students reported action plans focused on effective communication, safe patient care, and becoming positive role models. CONCLUSIONS: These findings highlight the importance of supportive clinical learning environments and positive professional socialization during the transition from student to&#xa0;nurse. IMPLICATIONS FOR INTERNATIONAL AUDIENCE: Nursing students worldwide may encounter incivility and near-miss events during clinical practice, potentially adversely affecting their learning experiences and professional development.

Humans↗
PubMed2004

[Assessment of quality of life in patients with laryngeal cancer after surgical treatment].

OBJECTIVES: To evaluate quality of life of patients undergoing surgical treatment for larynx cancer and to compare quality of life between patients with total laryngectomy and partial laryngectomy. PATIENTS AND METHODS: Thirty-two questions were asked to patients who underwent total laryngectomy (22 subjects) or partial laryngectomy (24 subjects). These questions were based on the European Organization for Research on Treatment of Cancer questionnaires Quality of Life--C30 (EORTC-QoL-C30) and adapted to our nation. Patients with total laryngectomy and partial laryngectomy were compared according to the answers. RESULTS: We found significant statistical differences between total and partial laryngectomy patients in 12 questions. When functional disorders were evaluated, the most significant was one associated with communication. However, pain, smell disorders and increased secretion were associated with morbidity that resulted from the type of surgery. It was observed that patients with total laryngectomy were particularly affected psychologically and economically. CONCLUSION: Patients subjected to total laryngectomy experience serious physical and psycho-social disadvantages that arise from the treatment. In order to establish these negative effects and to minimize them, tools of assessment of quality of life should be developed. This assessment should be appropriate for our nation, providing information and psychological support for individuals and their families.

Adult↗
PubMedDate not supplied

Chemical contaminants in foods: some analytical considerations.

Data on the incidence and levels of chemical contaminants in foods are needed for continuous assessment of the safety of the food supply and to inform the public about the safety of food. A larger share of the total analytical resource--federal and state government, private sector, and academia--could profitably be directed to collection and publication of data on the occurrence of chemical contaminants in foods. The quest for more data must be accompanied by measures to ensure data reliability and comparability and to estimate the uncertainty of measurements. Research to improve the efficiency of analysis may be the top priority for future methods improvement studies. Analytical chemistry will continue to be an essential factor in assuring a safe food supply and in communicating to the public accurate information and conclusions about food safety.

DDT↗
PubMedDate not supplied

Development of a uniform record for patients with burns of the hand.

This study reports the development of a uniform record for patients with burns of the hands. The steps in the development of the record are outlined and discussed. The use of a uniform standardized record is intended to improve communication within a network of three burn centers and to facilitate joint research projects. A data entry method to facilitate pooling and subsequent data analysis is also described.

Burn Units↗
PubMed2005

Patient attitudes to receiving copies of outpatient clinic letters from the ocular oncologist to the referring ophthalmologist and GP.

AIM: To investigate patients' views and understanding on receiving a copy of the outpatient clinic letter from the ocular oncologist to the referring ophthalmologist and GP. METHODS: Face-to-face interviews were conducted with 52 patients attending outpatient ocular oncology follow-up clinics, in a semistructured format using a qualitative open-ended questionnaire. The clinics are held at Liverpool Ocular Oncology Centre, a tertiary specialist referral centre at St. Paul's Eye Unit in Royal Liverpool University Hospital. RESULTS: Patients' views on receiving a copy of the outpatient letter, their understanding of the letter, and improvements suggested. A total of 58% of patients had received a letter and 97% of them said they were glad they had it. Of this group 77% had shown it to family/friend. Consistent comments included: 'help with accepting the news;' 'good to be informed and to know what to expect;' 'confirmed what was said in the consultation.' Of the patients who had not received a copy of the letter, 64% replied that they would have liked a copy. A total of 80% of patients reported that they fully understood the letter. In all, 17% wanted medical terms to be explained, when asked to suggest improvements. CONCLUSIONS: Sending patients copies of the consultant outpatient letter seemed to be highly appreciated and a useful method of information giving regarding diagnosis and management.

Adult↗