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Differences between African Americans and whites in their perceptions of Alzheimer disease.

To design optimal health services and education programs for Alzheimer disease (AD), it is important to understand cultural differences in perceptions of the disorder. In this study, we investigated differences between African Americans and whites in their beliefs, knowledge, and information sources regarding AD. We distributed a written questionnaire through lay and professional organizations and meetings in the southeastern United States, yielding a sample of 452 adults (61% white, 39% African American; 78% female; mean age 47 years; 33% with family history of AD). The questionnaire assessed the following: (1) illness beliefs, (2) factual knowledge, (3) sources of information, and (4) perceived subjective threat of AD. African Americans and whites were generally similar in their beliefs about common symptoms, prominent risk factors, and the effectiveness of treatments for AD (although whites expressed greater certainty in these beliefs than African Americans). In comparison to whites, African Americans showed less awareness of facts about AD, reported fewer sources of information, and indicated less perceived threat of the disorder. These preliminary findings suggest important distinctions between African Americans and whites in their knowledge about, and conceptualization of, AD. Follow-up studies with more representative samples and more fully validated measures will be necessary to confirm these differences. Health psychologic research suggests that such differences in illness perceptions could shape response to disease burden, assessment and diagnosis, and available health care options.

Adult↗

Mothers' and fathers' knowledge of adolescents' daily activities: its sources and its links with adolescent adjustment.

To elucidate the benefits ascribed to parental monitoring, the authors examined links between parental knowledge and methods of obtaining knowledge about adolescents' activities, and links between these constructs and adolescent adjustment. The roles of parent gender, adolescent gender, and family earner status in these associations were also studied. Participants were 95 adolescents (ages 10 to 17 years, 60% male and 40% female) and their parents. Mothers knew more about adolescents' activities than did fathers and were more likely than fathers to gain information by active supervision or voluntary disclosure from the adolescent. Fathers, more than mothers, received information via spouses. Active methods of supervision predicted more knowledge among fathers and mothers from dual-earner families but not among mothers from single-earner families. More maternal knowledge predicted lower adolescent deviance. No method of gaining knowledge predicted adjustment directly.

Adaptation, Psychological↗

Nurse practitioner knowledge of complementary alternative health care: foundation for practice.

AIM: With the increasing use of complementary alternative treatments by the general public in the United States of America (USA), it is critical that nurse practitioners have the most up-to-date information about the use and safety of these modalities. A strong knowledge base is crucial in delivering competent and culturally sensitive care, yet the level and source of nurse practitioner knowledge in this area is largely unknown. The purpose of this study was to investigate the level and source of nurse practitioner knowledge of complementary alternative health care practices, as well as their referral practices involving these treatments. METHODS: Using a cross-sectional descriptive research design, a sample of 151 nurse practitioners from Missouri and Oregon completed an adapted version of Sapp's self-administered survey that explored these issues. Evaluation of the psychometric properties of the adapted instrument demonstrated good face validity, test-retest reliability (kappa = 0.81) and internal consistency reliability were 0.90 and 0.92 for two subscales with continuous response categories. FINDINGS: Eighty-three percent of the nurse practitioners recommended complementary alternative treatments to their patients with the most frequent being massage therapy, chiropractic care, acupuncture or acupressure, nutritional therapy and herbal treatment. However, only 24% reported that formal nurse practitioner education was a source of knowledge about these treatments. Instead, over 60% relied on their personal experiences for this knowledge, as well as lay and professional journals. CONCLUSION: Nearly 9 out of 10 nurse practitioners recommend the use of complementary alternative therapies to patients, but their source of knowledge is not derived from professional education. Attention needs to be given to increasing content about complementary alternative therapies in formal academic programs, professional conferences and in-service education opportunities.

Adult↗

A two-microphone dual delay-line approach for extraction of a speech sound in the presence of multiple interferers.

This paper describes algorithms for signal extraction for use as a front-end of telecommunication devices, speech recognition systems, as well as hearing aids that operate in noisy environments. The development was based on some independent, hypothesized theories of the computational mechanics of biological systems in which directional hearing is enabled mainly by binaural processing of interaural directional cues. Our system uses two microphones as input devices and a signal processing method based on the two input channels. The signal processing procedure comprises two major stages: (i) source localization, and (ii) cancellation of noise sources based on knowledge of the locations of all sound sources. The source localization, detailed in our previous paper [Liu et al., J. Acoust. Soc. Am. 108, 1888 (2000)], was based on a well-recognized biological architecture comprising a dual delay-line and a coincidence detection mechanism. This paper focuses on description of the noise cancellation stage. We designed a simple subtraction method which, when strategically employed over the dual delay-line structure in the broadband manner, can effectively cancel multiple interfering sound sources and consequently enhance the desired signal. We obtained an 8-10 dB enhancement for the desired speech in the situations of four talkers in the anechoic acoustic test (or 7-10 dB enhancement in the situations of six talkers in the computer simulation) when all the sounds were equally intense and temporally aligned.

Algorithms↗

Information desired and acquired by men with prostate cancer: data from ethnic focus groups.

Information and understanding are needed so that men with prostate cancer can effectively manage and cope with their disease. Although research has shown that cultural beliefs and practices influence the way people access health-related knowledge, little research has addressed how ethnicity affects the information desired and received among low-income men with prostate cancer. This research sought to (a) describe baseline knowledge at diagnosis, information subsequently received, information sources utilized, and knowledge believed to have been helpful and (b) explore differences in desired information among men of various ethnicities. Six ethnicity specific focus groups among men diagnosed with prostate cancer were conducted. With content analysis, themes emerging from each focus group were identified and compared. Results highlight disparities in the prostate cancer information desired and acquired by men of different ethnicities.

Adult↗

A survey of physicians' uses/opinions regarding nutrition education resources.

Since physicians are one of the public's main sources of nutrition information, a study was conducted to investigate physicians' sources of nutrition knowledge, patient education resources, and opinions about potential nutrition services. A questionnaire was mailed to a random sample of family physicians. The response rate was 53% (n = 255). Fifty-three per cent of respondents ranked their personal knowledge and training as their most frequent source of nutrition information. The most widely reported sources of patient education resources were Health and Welfare Canada and industry. Physicians ranked resources from Health and Welfare Canada as highest for quality characteristics, and industry information as lowest. Pamphlets were ranked as the most/very useful patient service (70%), and physician reimbursement as the most useful physician service (59%). One-quarter of physicians asked for patient information on heart disease. The results of this study suggest physician reimbursement for nutrition education needs to be addressed by health insurance plans if physicians are to be expected to provide nutrition intervention. Further nutrition training for physicians should be conducted through medical education, continuing education and medical journals.

Alberta↗

Sex information and attitudes in young people.

A questionnaire survey was conducted in the Wellington area among 696 senior secondary school pupils. The first part of the questionnaire studied aspects of sexual knowledge and the sources of information. The general level of knowledge was good at an elementary level but less than adequate when more detailed knowledge was considered. The role of peers, parents and schools was complementary. In the second part of the questionnaire a standard attitude test was administered. A majority of young people in this survey supported a standard of permissiveness with affection and did not support a double standard giving greater rights to males. Boys were more permissive than girls.

Adolescent↗

Automated knowledge extraction from the UMLS.

This paper presents our work in extracting disease-chemical relationship knowledge from the UMLS Co-occurrence table (MRCOC) using an automated method. We evaluated the quality of the knowledge from UMLS MRCOC by comparing it with knowledge from other sources: For disease-lab chemical relationships, knowledge was obtained from a decision support system (DXplain) and our own knowledge base of medical terminology (MED) through automated processes. For disease-drug chemical relationships, knowledge was manually acquired from the medical literature. Evaluations showed that the UMLS MRCOC knowledge has good sensitivity, especially regarding disease-drug relationships. We are using this knowledge to produce disease-specific views of patients' electronic patient record.

Decision Support Systems, Clinical↗

Adults' knowledge about the use of child restraint devices.

BACKGROUND: Injuries are the number one cause of morbidity and mortality among children age 14 and younger in the United States, and motor vehicle crashes account for most of these injuries. Although child restraint devices (CRDs) have been shown to protect children involved in motor vehicle crashes, only minimal decreases in mortality and morbidity have occurred since their introduction. This study evaluated the accuracy and sources of adult knowledge about CRDs. METHODS: A self-administered questionnaire was completed by patients at a community-based family practice clinic to obtain demographic information, assess knowledge of recommendations for CRD use, and identify sources of this knowledge. RESULTS: Of the 368 participants, 36% were men, 52% were women, and 12% did not indicate gender. The frequencies of correct responses on positioning infants younger than nine months of age and weighing less than 20 lbs in a CRD were: upright, 47%; rear middle-seat location, 22%; and rear facing, 54%. For toddlers older than nine months who weighed more than 20 lbs, the frequencies of correct responses on positioning were: using a booster seat plus a seat belt, 71%; rear-middle location, 17%; and front facing, 66%. In addition, only 42% of the respondents correctly identified the booster seat as not crash-test certified, and 44% indicated that a CRD should not be reused after an accident. The majority of respondents indicated that the year of manufacture was important and that loose objects in the car were not safe. TV/radio (51%), newspaper/magazine (41%), and relatives (31%) were the most common sources of information about CRD use. CONCLUSION: Our findings suggest that a lack of knowledge about CRD use among adults contributes to improper use of these devices. This may explain the minimal effect CRD use has had on reducing morbidity and mortality of children from motor vehicle crashes.

Accidents, Traffic↗

Review of endovascular brachytherapy physics for prevention of restenosis.

Intraluminal irradiation of coronary and peripheral arteries has been shown to reduce neointimal hyperplasia following balloon angioplasty, thereby inhibiting restenosis. Several irradiation techniques are being investigated, including temporary intravascular insertion of high activity gamma- or beta-emitting seeds and wires; inflation of dilatation balloon catheter with radioactive liquid or gas; insertion of miniature x-ray tubes via coronary catheters; permanent implantation of radioactive stents; and postangioplasty fractionated external beam irradiation. Unlike conventional brachytherapy, intravascular treatment of restenosis requires accurate knowledge of dose at distances of 0.5-5 mm from the radioactive source. This requirement presents special problems with regard to source calibration and dose specification, because dose gradients at such close distances from a radioactive source are extremely large. This makes it virtually impossible to define the characteristics of an ideal radiation source without some knowledge of the location and radiosensitivity of the target tissues, plus the radiotolerance of normal tissues. Hence, the current debate over whether beta or gamma sources are to be preferred. Imprecise knowledge of dose-volume effects for coronary arteries, plus uncertainties in the biological time sequencing of restenosis fuel a second debate on whether external beam treatments may be efficacious, and whether or not permanent radioactive stents may prove superior to high dose, single fraction brachytherapy. We review here the dosimetric properties of the various irradiation techniques and isotopes that have been proposed, including aspects of radiation safety, dose homogeneity, and practical aspects of source delivery.

Animals↗

Student desires for a university drug education program.

A questionnaire was designed to determine the type of drug education program most desired by undergraduate students attending a major university. The survey was to provide the basis for a comprehensive drug education program. The 101 item questionnaire elicited responses from 656 undergraduates in categories ranging from knowledge base to credible information sources. The analysis of student desires as they relate to program design is included in this article. The students strongly believed the university should provide a drug education program. In particular they desired a credit course dealing with both drugs and alcohol. They also wanted regularly published articles on drugs in school publications. The most credible knowledge sources were PhDs and MDs. Students also wanted contact with former drug users. More than half the students believed that values clarification and "coping skills" training would decrease their drug use. In general more women than men were likely to utilize such resources.

Female↗

When medical group and HMO part company: disenrollment decisions in Medicare HMOs.

Medicare beneficiaries who enroll in "risk contract" Health Maintenance Organizations (HMOs) are covered for services only if they are provided or approved by the HMO. Thus, their enrollment decisions involve selecting a health care delivery system and may be influenced by whether the HMO has contracts with particular providers. Disenrollment decisions, in turn, may be influenced by breaks in contracts between the HMO and its medical groups. This study examines decisions made by Medicare HMO enrollees when their HMO terminated its relationship with a major medical group; the group then signed a contract with a competing HMO. Beneficiaries were forced to choose between remaining with their HMO and switching to another provider, and switching to the competing HMO where they could keep their provider. Beneficiaries demonstrated considerable loyalty to their providers; nearly 60% switched to the competing HMO. Previous research on health care coverage decisions has been based on models which did not address consumers' knowledge, options, and information sources. In this decision context, we found that knowledge and information sources were the most important determinants of beneficiary decisions.

Aged↗

Pregnancy experience, knowledge of pregnancy, childbirth and infant care and sources of information among obstetric patients at King Khalid Hospital, Riyadh.

One hundred obstetrics patients were interviewed at King Khalid Hospital (Saudi Arabia) concerning their current pregnancy experience, knowledge of pregnancy and child care and sources of information on these topics. Interviews were conducted and a short knowledge test given to nulliparous, primaparous and multiparous patients. The overall mean score of respondents was 50.4%. Significant information deficits existed in: the implications of prescription drugs and dental care during pregnancy; time of conception; when to contact a physician for personal care. Nulliparous patients scored lower, and information deficits appeared in: when to call a physician for infant care, immunization for newborns and events during pregnancy. Respondents did not perceive physicians and nurses as significant sources of information when compared with alternative sources.

Adolescent↗

Knowledge, attitude, the perceived risks of infection and sources of information about HIV/AIDS among pregnant women in an urban population of Delhi.

Knowledge, attitude, perceived risks of infection and sources of information about HIV/AIDS were assessed among pregnant women. Large proportion of study subjects was illiterate (44.5%) and least was graduate or more (3.5%). Subjects mainly belonged to middle (46.1%) and lower socioe-conomic status (53.8%). Only 39.3% of subjects heard of AIDS. There was rising trend on heard of AIDS with various educational levels. Only 45% subjects responded correctly that AIDS was not transmitted by mosquito bite. Lower level of correct knowledge was also observed among all educational groups and it was lowest 21.1% among illiterate. Senior secondary or graduate or more educated responded 100% correct to question that one could get AIDS by having sex with prostitutes while illiterate responded 78.9% correctly. More educated had higher correct knowledge on modes of transmission compared to illiterate and less educated. Among various groups of educational status, the relationship of correct knowledge on modes of transmission was statistically significant. Of those heard of AIDS 79.3% perceived threat of AIDS to the health of local community. Mass media was source of information on HIV/AIDS among 86.3% out of which television was most popular source (74.6%). Large proportion of subjects (48.6%) had preference to get information on AIDS from doctors.

Adolescent↗

Factors influencing high school students' knowledge of physical therapy.

A questionnaire in a closed-question format was used to survey 403 California high school students' accuracy of knowledge and available sources of information about physical therapy. Most students had some knowledge of physical therapy. The most recognized physical role was "instructing a patient in exercises" (83%). Very few students, however, were familiar with the role "provides wound care" (16%). A relatively common misconception was the belief that a physical therapist "prescribes medication" (24%). Very few significant differences in the recognition of individual tasks were found between junior and senior, male and female, urban and rural, or health career and nonhealth career oriented students. Health career students were more knowledgeable about physical therapy than any other group. The category of personal contacts was cited by the most students as their source of information (61%), and television (in the media category) was the most frequently cited single source (35%). Other studies have established that many high school students are making career decisions. This study of high school students' knowledge of physical therapy may assist in identifying career information useful to students and in stimulating a viable pool of applicants for physical therapy programs.

Adolescent↗

Parental knowledge and practice of primary skin cancer prevention: gaps and solutions.

Over the past two decades there have been significant efforts in the United States to heighten awareness about skin cancer. Our goal was to assess parental knowledge, practice, and source of information about sun protection for their children. A questionnaire was administered to 158 parents of children at a dermatology clinic and 96 parents of children at a pediatric clinic (n=254). The survey included four parts: demographics, knowledge about skin cancer, sun protection practices, and sources of sun protection information. The mean knowledge score was 61% correct. Independent predictors of a higher score were fewer children and being a health care or other professional (p < 0.03). Independent predictors of parental sunscreen use were higher knowledge score, younger age, and fewer lifetime sunburns (p < 0.03); predictors of sunscreen use for children were higher knowledge score and fairer skin (p < 0.03). The top sources of sun protection information ranked by respondents were television and magazines; the top desired sources were primary care physicians and dermatologists. The knowledge results suggest the need for increased education about skin cancer prevention. Because the media is a major information source, it is important to ensure that messages about sun risks/protection are correct. The respondents' desire to learn more from primary care physicians emphasizes the need to educate physicians about sun protection.

Child↗

The demand for health education among patients with diabetes.

Education of the sick with diabetes has been a stable element of treatment for plenty of years. However, the system of trainings related to this disease is still not perfect and the knowledge of patients about this subject is insufficient. The objective of the study was to determine the demand for health education among patients with diabetes by means of evaluating the level of their knowledge. The study included 130 people suffering from diabetes at the age from 18 to 96 with the disease duration ranging from one year to above 20 years. The level of patients' knowledge about this disease was examined with the use of the survey questionnaire, especially designed for these reasons. The applied survey consisted of 54 questions of which a substantial part was concerned with general information about people suffering from diabetes. Further sections of the survey explored the knowledge about the nature of the disease, its complications, self-control, lifestyle and contained the questions concerning the sources of the acquired knowledge on this subject, participation in educational meetings and trainings concerning the issue of coping with diabetes as well as self-evaluation of the level of knowledge. The survey shows that 54.6% of the respondents cannot explain the mechanisms of type 1 diabetes, while 39.2% of the patients do not know the nature of type 2 diabetes. None of the patients was able to enumerate all the symptoms of hypoglycemia and hyperglycemia or the organs and systems most frequently affected by complications. More than 1/3 of the subjects did not know the proper nutrition rules in diabetes. None of the respondents was able to specify correctly all the control examinations and tests that should be taken at least once a year or once every six months. Only 6.1% of the patients evaluated their knowledge about diabetes at a very good degree, while 53.1% of them defined it as good. They were mostly insulin dependent patients under the care of diabetology clinics. However, as many as 40.8% of the respondents considered their level of knowledge unsatisfactory. The research results showed that the leading source of knowledge about the nature of the disease and ways of coping with it were diabetologists (61.5%), followed by nurses (33.8%) and general practitioners (26.1%). The survey results indicate the need for the increased accessibility and intensity of the educational activities in diabetological health care.

Adolescent↗

MDX--a medical diagnostic decision support system.

The MDX diagnostic decision support system contains a multitude of clinical facts as reported in a variety of medical textbooks and national medical journals. The database was custom designed for the medical diagnostic process and offers users the widest range of diagnostic knowledge available from a single source in the industry. The database consists of diseases, conditions, chemicals, drugs, and toxins that are known to cause medical illness. Each causal element has an associated file for signs, symptoms and findings. This fully referenced source of encoded clinical knowledge used in MDX comes from the world's experts as they transmit their experience in the written word of books and journals.

Databases, Factual↗