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PubMed2005

Politicizing dominant discursive constructions about teenage pregnancy: re-locating the subject as social.

Authors of research examining the issue of teenage pregnancy represent authoritative social voices, in strong positions of warrant that participate in shaping dominant social attitudes towards the subject. Their research projects are used to develop policies, information, service provision and practices that are major forces in shaping the actual experience of being pregnant as a teenager. This article examines local examples of such research and locates interpretation of these alongside other international studies. Prevalent in the research is the taken for granted assumption that pregnancy in adolescence is undesirable, and that research knowledge can, and should be, applied to reduce rates of teenage pregnancy. Despite clear indications of social issues being a major source of negative impacts of being pregnant in adolescence, the dominant theme is of teenage pregnancy as an individual health or behavioural problem in need of a psychological solution. This article would like to draw attention to and make visible the contingent, political and potentially problematic nature of those constructions. The suggestion is made that future work could benefit from genuine attention to: 1) social issues, especially in relation to resources and access; 2) work that explores meanings around pregnancy for young people, and 3) the application of politically engaged reflexivity in research.

Adolescent↗
PubMed2004

Building for health? The construction managers of tomorrow.

Attitudes to health and health promotion have an impact on health-related behaviour. This is important when considering the different settings where health promotion can take place. The workplace is increasingly becoming recognised as an important setting for health promotion. Research has formerly concentrated on workplaces that are static, i.e. on one site; however, the greater challenge lies in the industries that have transient populations, such as the construction industry. High levels of accidents and ill health have long been synonymous with the construction industry and yet there has been limited research carried out into attitudes to health and the extent of health promotion activities within the industry. The aim of this research was to investigate the attitudes, beliefs and knowledge to health and health promotion of final year students who will graduate to work as construction managers. The students that participated in the study had had the experience of both university and a year-long placement within the industry. The method used for data collection was semi-structured, face-to-face interviews. Students from the BSc (Hons) Building and Construction Management courses were invited for interviews and a response rate of 85% was achieved. Results revealed that the students were aware of factors that influenced health, but tended to focus on health-related behaviours. This attitude influenced the measures they suggested to promote health in the workplace. The students' knowledge of health within the construction industry was disappointing. Work experience in the industry had exposed them to various sources of health information, but little action was taken to involve employees and structural issues Limited the effectiveness of this information. Policy development in the construction industry appeared to rely on disciplinary procedures with an emphasis being placed on employees signing declarations after receiving the information. The conclusion of this research was that attitudes to health are dominated by the structures within the organisation, with those paid on an hourly basis being less likely to participate in workplace health promotion. The information provided to site workers is limited in its approach and application. The impact of employment structure and the work environment presents a challenge to promoting health in this environment.

Adult↗
PubMed2004

The challenge of improving food and nutrition in Latin America.

The Latin American Region has exhibited a marked increase in the consumption of high-energy-density foods (high in fats and sugars) and a decrease in physical activity, with rising trends of sedentary life among the urban population. Social and economic progress led to a decline in infectious diseases, while higher income fostered the consumption of meats, fats and oils, and sugar and reduced the consumption of grains and legumes. The result has been a gradual increase in life expectancy at birth and a greater burden of disease linked to obesity and other nutrition-related chronic diseases (diabetes, cardiovascular disease, certain types of cancer, and osteoporosis). The region is currently facing the challenge of a double disease burden--the unresolved problem of malnutrition caused by nutritional deficits on the one hand, and the steady increase in chronic disease on the other. The need to develop policies and programs that make the healthy choice the easy choice in terms of diet and physical activity is presented. These should encompass not only individual choices, but also environmental factors that condition food and physical activity behavior. Food supply, and hence consumption, is largely driven by the productivity of the food-production chain; demand and consumption are determined by the way food is produced, processed, distributed, marketed, and advertised. These factors are beyond the consumer's control, and they operate to maximize profit, not health. Public health policies should focus not only on the demand side, but also on the supply of more healthful food products. Examples of potential interventions to increase the demand for healthful foods and the supply of healthier choices are presented and discussed.

Diet↗
PubMed1997

A Multisectoral Approach to Prevention of Lead Poisoning in Hungary: Lessons Learned and Potential for Replicability Elsewhere.

Hungarian and American occupational and environmental health professionals are collaborating in a research and demonstration project designed to prevent lead poisoning in Hungary. Using a multisectoral approach, the project has three phases: data collection and review, risk communication, and facilitation of program and policy development. First, the project team reviewed relevant data of many types through a workshop at which commissioned papers were presented, key-informant interviews, and a survey of knowledge, attitudes, and practices. The team then conducted a multifaceted risk-communication program to disseminate information about lead hazards in general and what had been learned about lead exposures and lead poisoning in Hungary. It presented training workshops for workers exposed to lead at work and for groups serving as "mediators" who could affect others' behavior, such as nongovernmental organizations, labor unions, public health nurses, pediatricians, teachers and students, and coordinators of the Hungarian Healthy Cities Project. It also conducted a campaign of "concentrated action," using a variety of communication approaches directed to car owners, pregnant women, mothers of small children, and others, in order to convey knowledge and change attitudes, emphasizing emotional appeals. Project leaders will organize a multisectoral working group to develop, coordinate, and implement an overall activity plan aiming to reduce lead pollution. The approach developed and used in this project provides a model for preventing lead poisoning that may be transferrable or adaptable for use for preventing lead poisoning and other environmental health problems elsewhere.

Journal Article↗
PubMed2006

Experts' attitudes towards medical futility: an empirical survey from Japan.

UNLABELLED: BACKGROUND The current debate about medical futility is mostly driven by theoretical and personal perspectives and there is a lack of empirical data to document experts and public attitudes towards medical futility. METHODS: To examine the attitudes of the Japanese experts in the fields relevant to medical futility a questionnaire survey was conducted among the members of the Japan Association for Bioethics. A total number of 108 questionnaires returned filled in, giving a response rate of 50.9%. Among the respondents 62% were healthcare professionals (HCPs) and 37% were non-healthcare professionals (Non-HCPs). RESULTS: The majority of respondents (67.6 %) believed that a physician's refusal to provide or continue a treatment on the ground of futility judgment could never be morally justified but 22.2% approved such refusal with conditions. In the case of physiologically futile care, three-quarters believed that a physician should inform the patient/family of his futility judgment and it would be the patient who could decide what should be done next, based on his/her value judgment. However more than 10% said that a physician should ask about a patient's value and goals, but the final decision was left to the doctor not the patient. There was no statistically significant difference between HCPs and Non-HCPs (p = 0.676). Of respondents 67.6% believed that practical guidelines set up by the health authority would be helpful in futility judgment. CONCLUSION: The results show that there is no support for the physicians' unilateral decision-making on futile care. This survey highlights medical futility as an emerging issue in Japanese healthcare and emphasizes on the need for public discussion and policy development.

Aged↗
PubMed2006

Health-related quality of life of Canadian children and youth prenatally exposed to alcohol.

BACKGROUND: In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. OBJECTIVE: To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD. METHODS: A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with FASD were calculated. A one-sample t-test was used to compare mean HRQL scores of children and youth with FASD to those from the Canadian population. RESULTS: Mean HRQL score of children and youth with FASD was 0.47 (95% CI: 0.42 to 0.52) as compared to a mean score of 0.93 (95% CI: 0.92 to 0.94) in those from the general Canadian population (p < 0.001). Children demonstrated moderate to severe dysfunction on the single-attributes of cognition and emotion. CONCLUSION: Children and youth with FASD have significantly lower HRQL than children and youth from the general Canadian population. This finding has significant implications for practice, policy development, and research.

Adolescent↗
PubMed2004

Australian primary care policy in 2004: two tiers or one for Medicare?

The recent primary care policy debate in Australia has centred on access to primary medical (general practice) services. In Australia, access is heavily influenced by Commonwealth Government patient rebates that provide incentives for general practitioners not to charge copayments to patients (bulk billing). A steady decline in key access indicators (bulk billing) has led the Howard Government to introduce a set of changes that move Medicare from a universal scheme, to one increasingly targeted at providing services to more disadvantaged Australians. In doing so, another scene in the story of the contest between universal health care and selective provision in Australia has been written. This paper explores the immediate antecedents and consequences of the changes and sets them in the broader context of policy development for primary care in Australia.

Editorial↗
PubMed2006

Admissions for personality disorders in Italy from 1988 to 1998.

BACKGROUND: Personality disorders affect a substantial proportion of the population. It is unclear, however, whether the burden of personality disorders on modern mental health services has been increasing. To fill this gap, we analyzed trends in admissions for personality disorders in Italy from 1988 to 1998. METHODS: We used the yearly data from the Italian Central Institute of Statistics to analyse trends in the total number of admissions for personality disorders and in the total number of first admissions for personality disorders. RESULTS: The absolute number of admissions for personality disorders almost trebled from 1988 to 1998, as well as the proportion of all psychiatric admissions that were for personality disorders. Whilst there has been a marked increase in the absolute number of first admissions, the proportion of all first psychiatric admissions that were for personality disorders showed a steady but modest increase, from 5.7% to 7.6%. CONCLUSION: In Italy, the burden of personality disorders on modern mental health services has been increasing. In terms of public health, these findings highlight the urgent need of developing policies to tackle the increasing demand of care of this difficult-to-treat patient population.

Journal Article↗
PubMed2026

Survey to inform personalised prescribing in a British South Asian community: pharmacogenomics and traditional medicine use.

BACKGROUND: Pharmacogenomics (PGx) uses genetic information to personalize medication, reducing adverse reactions and improving efficacy. Despite its promise, low public awareness and disparities in PGx acceptability among under-represented groups may exacerbate health inequalities. The objective of this study was to elucidate a British South Asian community's attitudes toward personalised prescribing. METHODS: Adults of Bangladeshi or Pakistani ancestry from the Genes & Health (G&H) study completed a survey. Community feedback guided theme prioritization. Multivariable logistic regression analyses (controlling for age and gender) explored relationships among survey variables, and case-control Genome Wide Association Studies (GWAS) and candidate variant enrichment analysis examined the genetic architecture underlying herbal remedy use. RESULTS: Out of 553 respondents (57% female, mostly aged 25-54), 72% reported medication inefficacy, and 54% experienced side effects. Herbal remedies were widely used (66%), notably Black seed (39%), Turmeric (37%), and Ginger (36%). Participants who reported not using traditional or herbal medicines had higher medication adherence MARS-5 scores (Odds Ratio (OR) 1.10, 95% Confidence Interval (CI) 1.05-1.16, p&#x2009;<&#x2009;0.0002). All three commonly used herbal remedies inhibit the pharmacogenomically variable CYP2C9 enzyme responsible for metabolising commonly used medications. 58% of respondents were willing to provide DNA samples for PGx testing, yet 70% agreed that they would be more likely to take medication as instructed if PGx results suggested the medicine would suit them. Concerns about PGx testing were common (27%), especially among non-English speakers. Most (69%) were concerned about misuse of PGx data, particularly by pharmaceutical companies (82%). Importantly, 87% demanded stronger PGx data protections compared to other health data. CONCLUSIONS: Compared to a national UK population, the surveyed subpopulation reported higher rates of adverse drug reactions (ADRs) and perceived medication inefficacy, yet fewer respondents indicated willingness to undergo PGx testing. This highlights the need for tailored implementation strategies and underscores the importance of engaging underrepresented populations in policy development. The inverse relationship between medication adherence and herbal remedy use indicates an association between cultural health practices and medication behaviours that merits further investigation. Increased awareness of the common use of these CYP2C9 inhibitors and further research into the genetic architecture underlying herbal remedy use are warranted.

Humans↗
PubMed1989

Perceived needs of families with children who have chronic health conditions.

Parents of children with a wide variety of chronic health conditions (N = 910) were surveyed about their use of health services, out-of-pocket expenses for health care and related items, and ratings of the importance of health and support services. The financial burden on this middle-class, insured sample was substantial, with about half indicating some out-of-pocket expenses for travel, parking fees, drugs and medication, bills after insurance payments, and doctor charges. The commonalities found in parents' reporting of important services needed support the use of a noncategorical approach to program planning and policy development for children with special health care needs.

Child↗
PubMed1993

Early intervention services in selected Florida counties: the provider perspective.

Early intervention providers in five Florida counties were interviewed to obtain their perspective on the current service system in preparation for the implementation of programs under Public Law 99-457. Recommendations from the providers' perspective that have implications for policy development include (a) increase public awareness of disability, handicap, and at risk conditions as well as awareness of services; (b) increase funding for early intervention services with particular attention to the needs of families for support and other services; (c) drastically improve the transportation system; and (d) focus on helping parents and the public to learn how to negotiate the system as it exists.

Child Health Services↗
PubMed2001

Homeless women and children's access to health care: a paradox.

Homeless women and children who reside in shelters experience many health-related problems. The aim of the qualitative study reported here was to (a) explore how shelter staffs manage health problems among their residents and assist them in accessing health services, and (b) identify clinical strategies for community health nurses working with this population. Findings demonstrate a paradox whereby homeless shelter staffs try to gain access to care for their residents through a system that is designed to keep them out. In addition, findings indicate a need for increased community health nursing services in homeless shelters. Strategies for resolving this paradox include providing assessment, policy development, and assurance of health care for homeless women and children.

Adult↗
PubMed1999

The impact of genetics on medical education and training.

This paper explores, mainly from the UK perspective, some of the issues relating to the current, and potential, impact of advances in genetics and molecular biology on the education and research training of healthcare professionals. We start by describing some of the expectations for progress in the use of genomic technologies and genetic data in healthcare delivery and the need for policy development to ensure timely translation of advances in science and technology into improved patient care. We review briefly the likely evolution of clinical genetics service provision to build the requisite scientific basis in primary care and explore how user needs could be addressed. Strategic issues for the future medical curriculum are introduced and linked with the concerns about the current status of clinical academic research. The issues for research training, career progression, nurturing of research 'at the bedside', definition of the research agenda and weaknesses in both academic infrastructure and support costs are reviewed in the context of the urgent imperative for medicine to harness the accelerating pace of progress in genomics.

Curriculum↗
PubMed2001

Performance-related pay in health care.

OBJECTIVE: Performance-related pay (PRP) has been widely extended within the British public sector in the last 15-20 years, mostly because of pressure from central government. Its penetration in the National Health Service (NHS) has not so far been very deep but it has been sufficient to permit preliminary judgements on its likely impact. METHODS: Review of published accounts of the extent of use of PRP in the NHS and its impact, plus two case studies. RESULTS: There have been few rigorous studies reported. PRP has been introduced for a variety of reasons: an incentive to motivate staff; to enhance staff recruitment and retention; to signal a change in organizational culture; to control staff costs; to reduce the power of trades unions; to reinforce staff development policies. Very few NHS provider organizations have implemented PRP. Despite this, senior managers see real merit in it in improving staff performance and delivering a clear message about the importance of organizational performance. Employees are much more skeptical, seeing PRP as having no effect or being detrimental. CONCLUSIONS: PRP has had, at most, only a very modest beneficial impact in the British NHS. In the absence of better evidence, it would be sensible for government to continue to encourage local initiatives rather than propose a mandatory national scheme. It would also be prudent to subject local schemes to rigorous evaluation.

Employee Incentive Plans↗
PubMed2003

The relative value of nursing work: a study in progress.

The nursing shortage is likely to continue and, without intervention, may worsen. While retention and recruitment are constantly discussed among nursing leaders, the shortages, particularly in specialty areas, continue. Nurses have frequently stated that they are not valued for their knowledge. Yet many nurses have university degrees, post graduate degrees, specialty certificates and specialty credentials. Nurses seek recognition for what they know and what they do. To date, however, there is no objective method that is used to assess the value of nurses and their work. The study of relative value may provide a method for recognizing nurses' work. The concept of relative value deals with logical operators and facilitates assigning value to a nurse's overall knowledge base and capacity to perform nursing work. Currently, nursing shortages are concentrated in specialty areas. Nurses who work in specialized areas need specialized knowledge in a narrow field of nursing. Specialty nurses are not interchangeable with specialists in other areas or with generalists. A study is in progress to calculate the relative value of nursing work in 15 specialties. The goal is to assess relative value from the point of view of the knowledge base in the specialties and between specialties. In this paper, the research team reports on the background of the study, the study's parameters and its progress to date. Outcomes will include devising a way to recognize nurses' work, developing policies related to retention and recruitment and finding a long-term solution for dealing with the nursing shortage in specialty areas.

British Columbia↗
PubMed2000

Public health: a new nursing role for community practitioners.

This article discusses the six key activities identified by the Royal College of Nursing (1994) as essential ingredients for public health nursing. Examples of public health practice and community nurse involvement are given to illustrate each activity. Public health skills such as health profiling, building healthy alliances and policy development are outlined. Current barriers to community nurses participating in these activities are identified and models of public health practice are reviewed. The potential for a radical transformation of community nursing practice is discussed in the context of an expanding public health role of community nurses in Scotland. Options for future practice are presented and discussed.

Community Health Nursing↗
PubMedDate not supplied

Euthanasia: a contemporary nursing issue.

Euthanasia remains a contentious issue. The medical profession has difficulty in coming to terms with euthanasia because of professional and ethical conflicts. There has been little guidance from the UKCC on the issue of euthanasia. Nurses may be in a better position to examine the issue more objectively. There is an opportunity for the nursing profession to take a leading role in developing policy.

Ethics, Nursing↗
PubMed1986

The social worker's role on the institutional Ethics Committee.

As institutional Ethics Committees become more prevalent in hospitals, social workers will be serving as committee members. The evolution of IECs is reviewed; and their proposed functions of education, policy-development, case consultation and/or review are examined. Potential roles for social work in the implementation of each function are suggested.

Ethics↗