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PubMed2004

Better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease.

BACKGROUND: Many patients with coronary heart disease (CHD) are not managed adequately, and we often fail to reach treatment targets. AIM: To investigate if knowledge of risk factors for CHD, measured by a questionnaire, would show any relation to advice to compliance to lifestyle changes to attain treatment goals and adherence to drug therapy. METHOD: Men and women <71 years who had had a cardiac event were screened consecutively (509) from the medical records. Responders (392) were interviewed, examined and received a questionnaire. Three hundred and forty-seven patients answered the questionnaire regarding their general knowledge of risk factors for CHD, compliance to lifestyle changes to attain treatment goals and adherence to drug therapy. RESULTS: There were statistically significant correlations between general knowledge about risk factors for CHD and compliance to certain lifestyle changes: weight, physical activity, stress management, diet, attainment of lipid level goals and the likelihood of taking prescribed blood pressure-lowering drugs. General knowledge of risk factors had no correlation to blood glucose or blood pressure levels nor on smoking habits or treatment patterns for prescribed lipid- and blood glucose-lowering drugs. CONCLUSION: Knowledge correlates to patient behaviour with respect to some risk factors, which should be recognised in preventive programs.

Coronary Disease↗
PubMed2006

Patients' knowledge regarding medication therapy and the association with health services utilization.

BACKGROUND: Upon discharge from the hospital, patients are significantly deficient in their knowledge of their medications. Provision of information has been shown to have an effect on health measures such as compliance to medication therapy, quality of life, and utilization of hospitalization services. AIMS: To assess patients' knowledge about their long term medication therapy and to measure the association between knowledge and health service utilization in the community. METHODS: A prospective study was performed, with home telephone interviews conducted 1 week and 1 month after discharge. The study population included 130 patients discharged to the community with new prescriptions for long term medications. RESULTS AND CONCLUSIONS: About 60% of the patients reported receiving no counseling regarding their new medication. About 30% utilized 3 or more types of service (family physician, specialist, nurse, etc.). Eighteen percent (18%) visited the ER during the month after discharge, of whom 35% visited twice or more. Higher levels of patient knowledge predicted higher levels of health services utilization (OR=4.76 95% CI: 1.74-13.06). The younger patients tended to utilize a larger variety of health services compared to the older patients (OR 0.32 95% CI: 0.13-0.79). The results of this study provide that patients with higher levels of knowledge utilized the health care system more often, perhaps indicating greater awareness and self care.

Age Factors↗
PubMed2005

Protective medical legislation deficient knowledge of maternity (health and safety) rights for work-adjustment exists amongst flexible trainee doctors: is there a risk to maternal and foetal health?

OBJECTIVE: To assess awareness, identify knowledge source and evaluate uptake amongst doctors of "health and safety rights" (HSR) contained within the current European protective medical legislation for pregnant workers. STUDY DESIGN: A descriptive cross-sectional pilot study, by a postal questionnaire during the period 1998-1999, targeted 97 UK doctors (West Midlands region) after their first pregnancy. RESULTS: Of 67 respondents (response rate 73%), 41 (61%) were Registrars (SpR) and 25 (37%) SHOs: 80% work-schedules did not change during pregnancy. Only 11% (95% CI, 4-21%) of the doctors surveyed actually knew their maternity rights. 66.2% had no knowledge of maternity legislation; 80% of respondents had not taken up health and safety rights. Fifty-two percent (95% CI, 40-65%) reported maternal and neonatal complications. CONCLUSIONS: In a self-selected group of flexible trainees following their first pregnancy, only one in five female doctors have adequate knowledge about the legislative "health and safety rights" of work-schedule adjustment. A combination of reasons may contribute to the low uptake of these rights. The question of whether or not poor knowledge and uptake of legislative rights may be detrimental towards pregnancy and neonatal complications requires a large prospective study. An improvement in the knowledge of current maternity legislation could occur by targeting all medical students, all doctors, postgraduate trainers and National Health Service (NHS) employers.

Adult↗
PubMed2005

Fishing, fish consumption, and knowledge about advisories in college students and others in central New Jersey.

Risks to humans and other organisms from consuming fish have become a national concern. Over the past 3 years there have been a number of national advisories regarding saltwater fish. Although information on fishing, consumption patterns, and public knowledge about advisories has been examined for at-risk populations, there is little information about the latter for a general population. Overall knowledge about advisories, ratings for information about the risks and benefits of eating fish, and the relationship between fishing, consumption patterns, and knowledge about advisories was examined in a sample of 180 college students and others residing in central New Jersey, USA. The null hypothesis of no differences in fishing, consumption, and knowledge about advisories as a function of age, gender, ethnicity, and education was tested. A significantly higher proportion of men fished compared to women, and significantly fewer Blacks and Asians fished than did Whites or Hispanics. More Asians who fished did so in salt water, compared to others. There were no gender differences in consumption patterns, and few age or ethnic differences, mainly due to low sample sizes in some ethnic groups. Significantly fewer young people and fewer Asians ate fish compared to others. Overall, more people knew about the benefits of eating fish than the risks. Half as many people had heard about advisories concerning tuna, and less than a third knew about advisories concerning shark and swordfish than had heard general warnings. There were no gender differences in knowing about advisories, but there were several ethnic differences: a lower percentage of Asians generally knew that there were advisories, and fewer Blacks knew that there were benefits from eating fish than others. People in the age group 21-45 years were less aware of both the benefits and the risks from eating fish compared to older people. These data suggest that risk managers need to target younger people for information about the risks and benefits of consuming fish, particularly given that this is the population that will become pregnant over the next few years. Contrary to some previous research, subjects trusted family, friends, and other fishermen less for knowledge about the risks and benefits of fish consumption than other sources, such as doctors, governmental officials, and university professors. Even with this limited sample size, it is clear that people have heard more about the benefits of fish consumption than the risks, and a relatively low percentage have heard about the recent US Food and Drug Administration warnings about swordfish and shark.

Adolescent↗
PubMed2005

A survey of general practitioners' knowledge of symptoms and epidemiology of schizophrenia.

OBJECTIVE: To explore general practitioners' (GPs) knowledge of the symptoms and epidemiology of schizophrenia, and the GPs' characteristics associated with level of knowledge. METHOD: Survey questionnaires exploring practice in patients with early psychosis were mailed to all GPs in South-Western France (N=3829). GPs were asked to fill out questions anonymously on the symptoms and epidemiology of schizophrenia. RESULTS: The response rate was 23.6%. GPs had a fair theoretical knowledge of schizophrenia symptoms, but underestimated the prevalence and the risk of suicide. Recent attendance at a continuing medical education (CME) course on schizophrenia was the main predictor of level of knowledge on epidemiological figures, although its impact was relatively modest. Regarding risk factors, the implication of genetic factors was considered as null or modest by more than half of the GPs, while a large proportion of them stated that mother-baby interactional disturbances were frequently implicated in the aetiology of the disorder. CONCLUSION: GPs' level of knowledge on the public health impact and risk factors for schizophrenia needs to be improved in order to promote the delivery of accurate and de-stigmatising information to primary care patients.

Adult↗
PubMedDate not supplied

When is a patient with heart failure adequately informed? A study of patients' knowledge of and attitudes toward medical information.

OBJECTIVE: The primary aim was to explore patients' knowledge of heart failure and their attitudes toward medical information (prognostic information in particular) and to assess different patient-related factors that might hamper the improvement of patients' knowledge. Moreover, taking the data obtained into account, we analyzed ethical aspects of information disclosure to patients with heart failure. SETTING: The study was performed at Sahlgren's University Hospital in Gothenburg, Sweden. DESIGN: The study was a qualitative analysis of semistructured interviews. PATIENTS: The sample included 40 patients with various stages of chronic heart failure. RESULTS: Many patients had only a limited understanding of their disease, but they still claimed that they were satisfied with the information they received. Some of them seemed to accept, to be indifferent to, or to be unaware of their low level of knowledge. The majority did not request prognostic information. CONCLUSION: We argue that patients with heart failure are adequately informed when they have reached the level of knowledge that enables them to be managed as effectively and securely as possible while being satisfied with the information provided. To give adequate information, health care providers should determine the patients' level of knowledge and explore why those patients who have a limited understanding do not assimilate or request information.

Aged↗
PubMedDate not supplied

Arrhythmia knowledge: a qualitative study.

OBJECTIVE: The objective is to identify and describe critical care nurses' perception of arrhythmia knowledge. In addition, this study is the first step in developing levels of arrhythmia competency. DESIGN: A qualitative research design was used. Focus group technique using a semistructured group session, with a moderator, was used to gather data. Data were analyzed by the constant comparative method. SUBJECTS: The subjects were critical care nurses who work in acute care settings where they read electrocardiographic data and make treatment decisions. PROCEDURES: Five focus groups were conducted over a period of 12 months. Group size ranged from four to eight participants. Participants were asked to describe their perceptions of arrhythmia knowledge and to assign a rating score related to the level of knowledge needed to identify specific arrhythmias. RESULTS: Basic, intermediate, and advanced levels of arrhythmia knowledge were identified. This study revealed a deficit in nurses' ability to recognize and identify specific arrhythmias including heart block, aberrant conduction, and tachyarrhythmias. Understanding of lead placement concepts varied greatly among participants. CONCLUSIONS: The insight and perspective of critical care nurses related to the level of arrhythmia knowledge are needed for the development of competency measures and evidence-based teaching strategies.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Public knowledge of heart attack in a Nepalese population survey.

OBJECTIVE: Limited knowledge of heart attack symptoms may prevent patients from seeking time-dependent thrombolytic therapy, an intervention that offers impressive survival benefit. Previous studies carried out in developed countries demonstrated a deficit of knowledge about a wide range of heart attack symptoms. The aim of this study was to describe knowledge of heart attack, knowledge of heart attack symptoms, and anticipated first response to symptoms among the lay public in Nepal. METHODS: A total of 1192 participants (657 men and 535 women age 16 to 88 years old) were interviewed in a cross-sectional manner. Those <16 years of age, all health professionals, and individuals with a history of heart attack were excluded. RESULTS: A total of 862 (72.3%) participants had heard of heart attack. Significantly more male than female participants had heard of heart attack (P <.001). Of the respondents, 91.7% with >or=10 years of education (ED-2) had heard of heart of attack, whereas only 54% respondents with <10 years of education or who were illiterate (unable to read and write) (ED-1) had heard of heart attack, and in both the male and female populations, a higher percentage of the ED-2 group had heard of heart attack than the ED-1 group (92.6% vs. 60% and 85.6% vs. 49.6%, respectively). A significantly higher number of respondents from 31 to 50 years of age (AGE-2) had heard of heart attack than those 16 to 30 years of age (AGE-1) and those >50 years of age (AGE-3) (P <.001). Among 862 respondents who had heard of heart attack, 21.3% could not name any heart attack symptoms. A total of 16 different heart attack symptoms were named. Fainting or collapsing (48%), chest pain (22.4%), shortness of breath (9%), dizziness (8.4%), palpitations (7.4%), and sweating (7.4%) were the leading symptoms named by respondents. Fainting or collapsing and chest pain and shortness of breath were named more frequently among the ED-2 group respondents and the AGE-3 group men. Only 3.7% could name >or=2 typical heart attack symptoms. A significantly larger number of the ED-2 group named >or=2 typical symptoms than their counterparts (P <0.001). A large number (77.6%) of respondents preferred immediate hospital referral and/or doctor consultation after a heart attack. CONCLUSIONS: In Nepal, better-educated men are more aware of heart attack. Fainting or collapsing and chest pain and shortness of breath were leading heart attack symptoms named by the general population. Public heart attack awareness is not adequate and knowledge of wide range of heart attack symptoms is deficient in the Nepalese general population.

Adolescent↗
PubMed2004

Organ and tissue donation: a survey of nurse's knowledge and educational needs in an adult ITU.

The aim of this paper is to present the results of a survey that was undertaken to assess nurses' knowledge and educational needs towards organ donation within one adult general intensive care unit. The survey consists of 31 registered nurses who completed a confidential questionnaire that aimed to assess their existing knowledge and deficits in organ and tissue donation. The survey highlights the sample lacked confidence in approaching relatives for donation consent, deficits in brain stem death testing and donor criteria. It was also apparent that a significant number of nurses could not identify which tissues can be donated and the contraindications for tissue donation. A majority of the sample stated their knowledge of donation issues would improve if an educational programme were developed on organ donation. This is further supported by previous work by [Bidigare S, Oermann M, 1991. Attitudes and knowledge of nurses regarding organ procurement. Heart & lung 1:20-3; Smith-Brew S, Yanai L, 1996. The organ donation process through a review of the literature. Part 1. Accident & emergency nursing 4:5-11; Roark D, 2000. Overhauling the organ donation system. Am J Nurs 6:44-9] who suggest that educational programmes covering donation issues should enhance nurses' knowledge and confidence in the organ donation process and ultimately increase the number of potential donors.

Adult↗
PubMed2006

Knowledge, attitude, and practices related to standard precautions of surgeons and physicians in university-affiliated hospitals of Shiraz, Iran.

OBJECTIVE: To measure levels of knowledge, attitudes, and practice toward standard precautions (SP) in medical practitioners of Shiraz University of Medical Sciences affiliated hospitals in Iran. METHOD: In this cross-sectional study, knowledge, attitude, and practice related to SP among four medical staff groups - surgeons, surgical residents, physicians and medical residents - were assessed using a questionnaire. RESULTS: Across the four medical staffing groups the median levels of knowledge ranged from 6 to 7 (maximum score 9), median attitude scores were high ranging from 35 to 36 (maximum score 45), while median practice scores were low, ranging from 2 to 3 (maximum score 9). A moderate relationship between knowledge and attitudes was found in surgical residents and medical residents (r=0.397, p=0.030 and r=0.554, p=0.006, respectively). No significant correlation was found between knowledge and practice between the groups. A significant but poor (r=0.399, p=0.029) relationship between attitude and practice was found in surgical residents. CONCLUSION: Specific training programs may have to target newly graduated medical practitioners to establish acceptance of appropriate practices that will enable them to adopt and adhere to SP while their older counterparts may require more intense continuous assistance.

Adult↗
PubMed2005

Bedside, classroom and bench: collaborative strategies to generate evidence-based knowledge for nursing practice.

The rise of evidence-base practice (EBP) as a standard for care delivery is rapidly emerging as a global phenomenon that is transcending political, economic and geographic boundaries. Evidence-based nursing (EBN) addresses the growing body of nursing knowledge supported by different levels of evidence for best practices in nursing care. Across all health care, including nursing, we face the challenge of how to most effectively close the gap between what is known and what is practiced. There is extensive literature on the barriers and difficulties of translating research findings into practical application. While the literature refers to this challenge as the "Bench to Bedside" lag, this paper presents three collaborative strategies that aim to minimize this gap. The Bedside strategy proposes to use the data generated from care delivery and captured in the massive data repositories of electronic health record (EHR) systems as empirical evidence that can be analysed to discover and then inform best practice. In the Classroom strategy, we present a description for how evidence-based nursing knowledge is taught in a baccalaureate nursing program. And finally, the Bench strategy describes applied informatics in converting paper-based EBN protocols into the workflow of clinical information systems. Protocols are translated into reference and executable knowledge with the goal of placing the latest scientific knowledge at the fingertips of front line clinicians. In all three strategies, information technology (IT) is presented as the underlying tool that makes this rapid translation of nursing knowledge into practice and education feasible.

Cooperative Behavior↗
PubMed2006

Salience of Guilty Knowledge Test items affects accuracy in realistic mock crimes.

Guilty Knowledge Test measuring electrodermal reactions was carried out in order to investigate the quality of different questions and the validity of the test in a situation that resembled a true crime. Fifty participants were randomly assigned to commit one of two realistic mock crimes, and were later tested with GKTs concerning both the crime they had enacted and the one they had no knowledge of. Different scoring systems (SCRs and peak amplitudes as well as raw and standardised scores) were employed and compared when analyzing the results. Although there were some false positives, the test was able to differentiate between the groups of guilty and innocent participants. With the best scoring systems, the test was able to classify up to 84% of the innocent and up to 76% of the guilty correctly according to a logistic regression analysis. ROC areas reflecting these same results reached values above .80. Questions on matters that demanded the participants' attention and were easier to remember had better discriminative power. With nearly all scoring methods, there was a significant interaction between the salience of the relevant items and the guilt of the participants. Participants reacted more strongly to salient relevant items when they were guilty, while no different reactions were observed for the non-salient items between guilty and innocent participants. It is suggested that, although the Guilty Knowledge Test appears to be a valid measure of guilty knowledge even in crimes that are close to real crimes, the principles on which guilty knowledge test questions are constructed should be more clearly specified.

Adult↗
PubMed2005

Knowledge about tobacco and subsequent use of cigarettes and smokeless tobacco among Swedish adolescents.

PURPOSE: To investigate whether knowledge of the risks and properties of tobacco among adolescents influences their future use of cigarettes and smokeless tobacco in different directions. METHODS: A prospective cohort study of 2581 adolescents whose knowledge of tobacco was assessed in the sixth grade by means of a multi-item scale. Tobacco use was assessed by annual surveys up to the ninth grade. RESULTS: Knowledge level was not associated with future use. Items dealing with addictive properties of nicotine were prospectively associated with smokeless tobacco ("snus") use only. CONCLUSIONS: A high level of knowledge of the risks associated with tobacco is not a predictor of future nonuse or of a shift to smokeless tobacco rather than cigarettes. Attitudes and expectations may determine knowledge rather than vice versa.

Adolescent↗
PubMed2005

HIV and sexual health knowledge and sexual experience among Australian-born and overseas-born students in Sydney.

PURPOSE: To examine differences between Australian-born and Asian-born first-year university students in Sydney in their sexual behavior and knowledge about the prevention and transmission of human immunodeficiency virus (HIV) and other sexually transmissible infections (STIs). METHODS: Students were recruited from a stall during the student Orientation Week in both 2002 and 2003 at the University of New South Wales. A short questionnaire was completed and returned anonymously. Data on age, gender, country of birth, sexual behavior, and sexual health knowledge were collected. A score was calculated based on the sum of the correct answers given to 12 HIV/STI transmission and prevention questions. The students were then divided into three groups according to their country of birth (Australia, Asia, and elsewhere) and their knowledge scores were compared. Students born in certain Asian countries were also asked their perception of the HIV epidemic in their home country compared with Australia. RESULTS: A total of 1185 first-year students completed the questionnaire. Although older on average, Asian-born students were less likely to have had sexual intercourse and had had fewer sexual partners. They also had consistently poorer HIV/STI knowledge scores than Australian-born students. Students born in China, Hong Kong, Indonesia, Malaysia, and Singapore but not Thailand underestimated the prevalence of HIV in their country of birth in comparison with Australia. CONCLUSION: The combination of poorer knowledge, apparent misconception of the extent of HIV epidemic in their home country (or Australia), and potential later frequent travel indicates a potential risk for later transmission of HIV/STIs. The university is an underused setting for prevention health education.

Adolescent↗
PubMed2006

Is it worth the RRISK? Evaluation of the RRISK (Reduce Risk Increase Student Knowledge) program for adolescents in rural Australia.

PURPOSE: This study evaluates the effectiveness of an intervention targeting adolescent risk-taking associated with drug and alcohol use, driving, and celebrating. METHODS: Pre- and post written surveys were administered in 21 intervention and 19 comparison schools in Northern New South Wales during March 2003 and 2004. The instrument covered knowledge and attitudes associated with self-reported potentially harmful and protective behaviors. Analysis was by multi-level regression. RESULTS: There were 2705 baseline and 1996 follow-up respondents. Adolescents in the intervention area who attended the Reduce Risk Increase Student Knowledge (RRISK) seminar demonstrated some significant improvements in knowledge, attitudes and behavior compared with those who did not attend, and some significant improvements in knowledge compared with students in comparison schools. CONCLUSIONS: A well-designed one-day seminar that builds on existing curricula, can achieve some significant medium-term benefits in knowledge attitudes and behaviors.

Adolescent↗
PubMed2007

Do readers with autism make bridging inferences from world knowledge?

Individuals with autism frequently show impairments in text reading comprehension. This often is attributed to poor ability to draw inferences during reading and to inadequate access to relevant knowledge. The current study tested this hypothesis by measuring the time taken to read the same question, relating to either physical or social world knowledge, when it was either relevant or irrelevant to the bridging inference evoked by a preceding two-sentence vignette. In the study, 16 normally developing adolescents and 16 adolescents with autism were matched on word reading accuracy, chronological age, and vocabulary but differed significantly in text comprehension. A strong priming effect was found, robust over participants and over items; participants read those questions that were relevant to the inference evoked by the vignette faster than they read those questions that were irrelevant, and no interaction with group membership or type of knowledge was found. This indicates that readers with autism, just like controls, were activating appropriate world knowledge primed by implicit inferences while reading the vignettes. Thus, the comprehension problems in these readers cannot be attributed to an inability to make implicit inferences or to draw on relevant world knowledge. Instead, we suggest that these problems must be sought at a higher level of text processing.

Adolescent↗
PubMed2006

Sustainable rangeland management using a multi-fuzzy model: how to deal with heterogeneous experts' knowledge.

While fuzzy specialists commonly use homogeneous experts' knowledge to construct fuzzy models, it is much more difficult to deal with knowledge elicited from a heterogeneous group of experts. This issue is exemplified in the area of sustainable rangeland management (SRM). One way to deal with the diversity of opinions is to develop a fuzzy system for all experts and to combine all these, the so-called primary systems, into one multi-fuzzy model. To derive each of the primary fuzzy systems, several semi-structured interviews were held in three different areas of the Fars province in Southwest Iran using the knowledge of a group of administrative experts. To obtain the final output of the multi-fuzzy model, we applied different 'voting' methods. The first method simply uses the arithmetic average of the primary outputs as the final output of the multi-fuzzy model. This final output represents an estimation of the right rate of stocking (RRS). We also propose other (un)supervised voting methods. Most importantly, by harmonising the primary outputs such that outliers get less emphasis, we introduce an unsupervised voting method for calculating a weighted estimate of the RRS. This harmonising method is expected to provide a new useful tool for policymakers dealing with heterogenity in experts' opinions: it is especially useful where limited field data are available and one is forced to rely on experts' knowledge only. By constructing the three fuzzy models based on the elicitation of heterogeneous experts' knowledge, our study shows the multidimensional vaguenesses that exist in SRM. Finally, by comparing the final RRS with its common values, this study strongly points to the existence of overgrazing in pastures in the three regions of the Fars province in Southwest Iran.

Administrative Personnel↗
PubMed2006

Knowledge and use of medicinal plants by people around Debre Libanos monastery in Ethiopia.

The study was conducted around Debre Libanos monastery from October 2005 to June 2006. A total of 250 villagers, 13 monks and 3 nuns were interviewed using semistructured questionnaire on the knowledge and use of medicinal plants. The informant consensus factor (ICF) and the fidelity level (FL) of the species were determined. Eighty medicinal plant species were reported. The average medicinal plant reported by a female is 1.67+/-0.33 and a male is 5.77+/-0.71 with significant difference between them (alpha=0.05, p=0.023). The ICF values demonstrated that local people tend to agree more with each other in terms of the plants used to treat 'Mich' and headache (0.69) and intestinal illness and parasites (0.68) but a much more diverse group of plants are cited to treat problems related to rabies (0.14) and unidentified swelling and cancer (0.11). The FL values are also similar to ICF values. The knowledge of the villagers close to the monastery is found to be higher than those distant from the monastery and the correlation between Abichu and Telaye (r=0.970, alpha=0.05, p=0.001), and Zegamel and Doreni (r=0.745, alpha=0.05, p=0.027) is significant indicating the relationships between the number of plants reported by the informants and the distance from the monasteries to the villages. This study was not able to determine the knowledge difference between the villagers and the monastery dwellers because the monks and nuns were not willing to give information on the knowledge and use of medicinal plants. This may result in the long run in loss of local knowledge in the surrounding area and the country at large for preparation of pharmacologically effective remedies.

Animals↗