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PubMed2002

Perception of risk information. Similarities and differences between Danish and Polish general practitioners.

OBJECTIVE: The objective of the study was to gain better insight into how general practitioners (GPs) perceive risk reduction and the way this perception may be influenced by healthcare environment. DESIGN: Questionnaires with clinical episodes were sent to Danish and Polish GPs, who were randomised into four groups, each receiving the same case story with differently phrased information about risk reduction achieved through medical treatment. The GPs were asked whether they would recommend medical treatment, knowing the case story and expected risk reduction. SUBJECTS: Danish and Polish GPs. RESULTS: A greater proportion of Polish GPs than Danish GPs would definitely or probably recommend treatment (93% versus 72%; p < 0.001). Both groups of doctors were more inclined to recommend treatment when the achievable benefits were presented in terms of relative risk reduction rather than absolute risk reduction or number needed to treat. CONCLUSION: Neither information on number needed to treat nor relative risk reduction alone provides doctors with all the information they need to recommend treatment or prevention to their patients. The present study showed that the professional handling of risk information is affected by differences produced by healthcare cultures.

Adult↗
PubMed2004

Preparedness for cardiopulmonary resuscitation in primary care.

OBJECTIVE: To evaluate preparedness for resuscitation of patients in cardiac arrest in primary care. DESIGN: Questionnaire study sent to every health centre in Finland (n = 277). SETTING: Primary care. MAIN OUTCOME MEASURES: Resuscitation training frequency and prevalence of automated external defibrillators and nurse-performed early defibrillation. RESULTS: One-hundred-and-forty-one health centres (51%) responded to the survey. Fifty-nine percent had appointed one person to be in charge of resuscitation training. The nurses in these health centres were trained to defibrillate (p < 0.001), physicians had advanced life support training (p < 0.001) and the first defibrillation was likely to be performed by a nurse on the ward (p < 0.01) more often. In 87% of health centres, it was not customary to defibrillate before the physician arrived beside the patient. Forty-four percent of the health centres used only manual defibrillators, 26% used automated external defibrillators and 30% used both. Only 18% of respondents considered resuscitation training in their health centre to be sufficient and systematic. CONCLUSION: Resuscitation training appears insufficient and non-systematic in most health centres in Finland. Automated external defibrillators are not in common use. In health centres with an appointed person in charge of resuscitation training, the training is more often regular.

Cardiopulmonary Resuscitation↗
PubMed2006

Impact of physician-related factors on sickness certification in primary health care.

OBJECTIVE: To investigate what factors are associated with physicians' decisions on whether or not to sickness certify the patient at a consultation. DESIGN: Questionnaire survey sent to physicians in general practice and their patients. SETTING: General practitioners in Orebro county, central Sweden. SUBJECTS: Sixty-five physicians with up to 10 patients each. MAIN OUTCOME MEASURE: Whether a sickness certificate was issued. RESULTS: Physicians with long experience in family medicine and those working part time issued more sickness certificates when all encounters with patients were considered. When only musculoskeletal problems were studied physicians with long experience or who were trained in social insurance medicine as undergraduates issued more sickness certificates. When only appointments for infections were studied, part-time physicians issued more sickness certificates. No impact of the physicians' sex on sickness certifying was found. CONCLUSIONS: Length of professional experience and physicians' working time appear to influence practices in sickness certifying.

Adolescent↗
PubMed1989

College students' knowledge and health beliefs about AIDS: implications for education and prevention.

A questionnaire designed to measure the application of the dimensions of the Health Belief Model (HBM) to AIDS prevention and to practicing safer sex was administered to 139 undergraduates aged 22 years and under. Students generally had good knowledge about the facts of AIDS, which was consistent with other studies. We found an important difference between students' beliefs about practicing safer sex to prevent AIDS depending on whether their level of knowledge was high or low. The HBM posits that all of its dimensions must be present in order for belief to be followed by action. However, students with low knowledge indicated that the perceived barriers to practicing safer sex were higher than did students with high knowledge about AIDS. These results suggest that special efforts need to be made to teach students with low knowledge more about AIDS and that the barriers to safer sex can and should be overcome. There were no differences between students known to be sexually active compared with those who may or may not have been sexually active. One explanation was a possibly high number of students in the group identified as "perhaps sexually active" who actually were sexually active. Similarly, there were no differences between college students who did or did not know someone with AIDS, but this may have been due to the small number of students who did know such a person. Students' preferences for the format and methodology of AIDS education also were presented. In general, the students preferred small-group discussions and formats such as movies or panel discussions where they could remain "anonymous."(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1997

Coping resources and self-perceived well-being of college students who report a parental drinking problem.

Nine hundred eighty undergraduates from a major university completed a questionnaire designed to collect data on the associations between parental drinking and the students' coping resources and well-being. Three groups were identified: those with a parental alcohol problem (DP+), those with no problem (DP-), and those who were unsure. Discriminant analysis revealed similarities between the DP+ and unsure participants on the response variables. The coping resource scores of the DP- group were significantly higher than the scores of the DP+ and unsure groups. The unsure group had the lowest mean scores on the total coping resources inventory and on the Cognitive, Emotional, and Spiritual and Philosophical subscales. The DP+ group had significantly lower scores than the DP- group on the Cognitive, Spiritual and Philosophical, and Physical scales. Although DP+ students' perception of well-being was significantly lower than that of their DP- peers, the entire sample was reasonably healthy, as measured by the General Well-Being Schedule.

Adaptation, Psychological↗
PubMed1998

Risk factors for impaired length growth in early life viewed in terms of the infancy-childhood-puberty (ICP) growth model.

A difference in length or height growth is observed between populations in developing and developed countries and, within a country, between well-off and poor subpopulations. The aim of this community-based study was to identify possible risk factors for growth stunting in early life using the infancy-childhood-puberty (ICP) growth model. A periurban slum, a village and an urban slum, plus a local control group in Lahore, Pakistan, were investigated. In total, there were 425 infants born from September 1984 to March 1987 in the study. Children were followed from birth to 24 months and anthropometric data were recorded at each examination. A well-designed questionnaire was used to collect background information to identify risk factors for growth faltering over this period. The age at onset of the childhood component was determined individually using the ICP growth model. A late onset was defined as onset after 12 months. Univariate odds ratio analysis identified 20 significant risk factors for a delayed childhood onset in the total sample. Backward logistical analysis showed that only six variables were significant, i.e. small number of rooms in a household, episode(s) of diarrhoeal diseases, poor house structure, low body mass index, early end of breastfeeding and birth in warm season. Stratified analysis showed that episode(s) of diarrhoeal diseases and birth in warm season were the only significant risk factors in the two poor areas. This study also found that the impact of diarrhoeal diseases on length growth persisted after allowing for birth season. Seasonal variation in length growth was seen in the age at onset of the childhood component. General socioeconomic status was found to be a risk factor for growth faltering in early life. Diarrhoeal diseases and being born in a warm season are particular risk factors for growth faltering in early life.

Adolescent↗
PubMed1999

Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey.

There has been limited epidemiological research about nocturnal enuresis in Turkey. The objectives of this study were to ascertain the prevalence of nocturnal enuresis and the epidemiological factors associated with this in Turkish children aged 7-11 y, living in Manisa. Included in the study were 2000 children from various primary schools in Manisa. Parents were asked to fill out our specially designed questionnaire. In all, questionnaires for 1703 children were completed and returned to the department (871F, 51.1%; 832M, 48.9%). The prevalence of nocturnal enuresis for females was 10.6%, for males it was 16.9% and the overall prevalence was 13.7%. The prevalence of nocturnal enuresis decreased with age. Enuresis nocturna was found to be more common in children with a family history of bedwetting (76.5%). Deep sleeping, poor toilet habits and low educational level of the family were associated with enuresis. Consanguineous marriage did not influence the incidence of enuresis nocturna. There was no difference between enuretics and nonenuretics with reference to breastfeeding, being firstborn or being right- or left-handed. In our opinion, enuresis is an important problem for both families and children in Turkey for which specific guidelines should be developed. Various methods have been tried in the treatment of enuresis because of its multi-factorial aetiology. Child, family and physician co-operating together achieve the best help to both child and family.

Child↗
PubMed1989

Perimenstrual symptoms: relationships with chronic stress and selected lifestyle variables.

Of primary interest in the present study was the assessment of the association between several contextual factors, including chronic stress, exercise, alcohol, nicotine, and caffeine intake, and the self-report of perimenstrual symptoms. Two hundred and eleven women completed questionnaires designed to assess chronic stress, perimenstrual symptoms, and physical health. The results indicated that stress accounted for a significant amount of the variance in perimenstrual symptoms. Stress, however, accounted for a substantially greater amount of variance in scores on a general health measure than in self-reports of perimenstrual symptoms. Of those lifestyle variables assessed, only duration of current level of strenuous exercise was associated with perimenstrual symptoms to a meaningful extent.

Adolescent↗
PubMed2002

HIV/AIDS and care provider attributions: who's to blame?

The discovery of HIV/AIDS prompted a profusion of research focusing on the disease and its causes. Though the bulk of this research emphasizes behavioural risk factors, treatment and disease progression, researcher efforts are beginning to examine the public's attitude toward individuals who are HIV-positive or have developed AIDS. Utilizing Weiner's Attribution Theory, the current study examines the beliefs of social service providers who work directly with individuals affected by HIV/AIDS. Forty-six (28 female and 18 male) HIV/AIDS social service providers from three community-based organizations were asked to read a hypothetical scenario depicting an individual at-risk for HIV/AIDS because of multiple high-risk behaviours. The gender of the target was manipulated and at the conclusion of the scenario participants completed a questionnaire designed to assess attributions. Results of the study show that social service providers who perceive individuals as more responsible for their illness report increased anger, attribute more blame and express less willingness to help those at-risk for HIV/AIDS. This research suggests that despite growing numbers of media campaigns and national distribution of information regarding the disease and its transmission, in general, people continue to stigmatize and place blame on those at-risk.

Adult↗
PubMed2002

Recipients in need of ancillary services and their receipt of HIV medical care in California.

For many individuals with access to quality medical care, HIV disease is no longer a critical short term illness but a chronic condition giving rise to more clients requiring ongoing medical care. Programs funded by the federal Ryan White Comprehensive AIDS Resources Emergency Act not only provide essential medical care for these individuals but also facilitate access to medical care services. These programmes fund services, including case management, transportation, and translation assistance, that feature ongoing assistance and enable individuals to remain in the health care system. Because of the importance of maintaining the strict drug regimen, retention in care is also an important part of the overall HIV care component. This study analyzed the relationship of ancillary services and a federal health programme client's receipt of medical care and retention in the health care system. We defined a cohort in need of ancillary services in part by a questionnaire designed to identify factors relating to need. These factors included education, language, and substance use. By merging client level data files we were able to identify medical service utilization trends among the individuals in the cohort who received a high number of ancillary services (more than 11 ancillary service visits in the two-year study period, n = 138) and those who received few services (fewer than six ancillary service visits in the two-year study period, n = 132). Results suggest that the receipt of ancillary services is associated with receipt of and retention in primary medical care. We found that for federal health programme clients in need of ancillary services, a positive relationship existed between their receipt of ancillary services and their access to primary medical care (p </= 0.001). This observation held constant when age, race, gender, and insurance coverage were controlled for. Also, these clients were more likely to be seen by a medical doctor at least once in three consecutive six-month periods when they received needed ancillary services (p </= 0.01).

Adult↗
PubMed2001

Improving waterborne disease outbreak investigations.

This article is a summary of discussions held and recommendations made at a workshop for the investigation of waterborne disease outbreaks in Chapel Hill, North Carolina, December 7-8, 1998. Suspected waterborne outbreaks in the United States are primarily investigated by state and local public health officials who may infrequently conduct enteric disease outbreak investigations. Thus, it is important that officials have a formal plan to ensure that epidemiological studies are methodologically sound and that effective collaboration occurs among the epidemiologists, scientists, and engineers who will conduct the investigations. Laboratory support to analyze water samples and clinical specimens should be arranged well in advance of when services may be needed. Enhanced surveillance activities can help officials recognize additional outbreaks and initiate investigations in a timely manner. Epidemiologists should pay more attention early in the investigation to study design, questionnaire development, and sources of bias, especially recall bias, that may affect the interpretation of observed associations. Improved investigations can increase our knowledge about important etiological agents, water systems deficiencies, and sources of water contamination so that waterborne outbreaks can be more effectively prevented.

Data Collection↗
PubMed2002

Harm to the liver among employees of the Municipal Police Force.

The purpose of the study is to assess whether employees of the Municipal Police Force of a big city exposed to urban pollution are at risk of hepatotoxicity. The usual clinical practice tests like AST, ALT, gamma-GT, AP, conjugated and total bilirubin were carried out, accompanied by a questionnaire designed to identify the possible risk factors and the principal non-professional confounding factors for hepatotoxicity. The study covered 118 male Municipal Police employees performing traffic duties and 118 male blood donors engaged in office work. There were significant differences between exposed and controls with regard to the average AST and ALT values and values above the normal laboratory range; this was also the case for the distribution. The results suggest that there may be the possibility of liver damage among asymptomatic members of the Municipal Police Force and that periodic hepatic screening, with the above-mentioned tests, could be useful. It is presumed that chemical agents present in urban air in big cities may cause damage to the liver, even at exposure levels that fluctuate around the admissible environmental concentrations.

Adult↗
PubMed2000

Work-related cumulative trauma disorders and interpreters for the deaf.

With the passage of the Americans with Disabilities Act (ADA), increasing numbers of interpreters for the deaf are being employed in education, industry, or other settings. Professional interpreters are at risk for developing cumulative trauma disorders due to the nature of their work which involves rapid repetitive movements of the arms and hands. One hundred forty-five interpreters for the deaf responded to a survey questionnaire designed to identify their work experiences and development of physical pain/discomfort related to work. Incidence and duration of pain/discomfort is positively correlated with hours worked and time of onset. Regardless of age, training, or work experience, 119 (82%) of these respondents experienced disabling pain/discomfort during and following work. Thirty-nine (33%) of the 119 respondents indicated onset of pain or discomfort in the wrist and hand. These data suggest that interpreting for the deaf may result in debilitating pain/discomfort in hands, arms, shoulders, and back if the interpreter is not appropriately prepared to compensate for physical and attentional stresses. Implications include the need to provide periods of rest while working and to provide training for students learning to interpret for the deaf to minimize physical stress while working.

Adolescent↗
PubMed2004

A survey of chronic pain in the pediatric spinal cord injury population.

BACKGROUND/OBJECTIVE: Although several reports characterize pain associated with adult-onset spinal cord injury (SCI), little is known about the incidence and etiology of pain associated with pediatric-onset SCI. The purpose of this study was to assess the incidence and type of chronic pain in the pediatric SCI population and to evaluate the resulting impact on activities of daily living (ADLs). METHODS: Patients attending clinic in a pediatric tertiary care facility in a major metropolitan area having sustained an SCI during childhood were asked to participate. Participants were assessed using the Adolescent Pediatric Pain Tool and the Lansky Play Performance Scale, 2 standardized assessments of pain and function, respectively. In addition, a questionnaire designed to characterize the population and the types of pain reported was administered. RESULTS: Thirty-one participants were enrolled with an age range at the time of injury from 5 months to 18 years. Of this population, 65% reported chronic pain. The pain reports were classified as either nocioceptive (48%) or neuropathic (19%). Interference with ADLs and play was present in only 1 participant. CONCLUSION: Based on these pilot data, pain associated with a pediatric-onset SCI is common. The incidence of pain in this study approached the reported incidence of chronic pain in adult-onset SCI. In the present population, nocioceptive pain was more common than was neuropathic pain. These data suggest that although common, chronic pain associated with childhood SCI has a significantly smaller impact on daily activities than that reported in the literature for adult-onset SCI.

Adolescent↗
PubMed2000

Management of minor head injuries in emergency departments in Sweden. Time for a new strategy?

OBJECTIVE: To study how patients with minor head injuries are currently managed. DESIGN: Questionnaire to senior residents in emergency departments and data from registers covering all in-hospital care in Sweden. SETTING: All 92 emergency departments in Sweden. RESULTS: The response rate to the questionnaire was 100%. In Sweden, 75 emergency departments treat patients with minor head injuries. Four departments are paediatric. General surgeons are the main providers (87%) of care for patients with minor head injuries. All hospitals admit patients with a history of unconsciousness or amnesia. Skull radiography is not used routinely. The estimated use of computed tomography (CT) varies between 2% and 80%, the mean being 22%. The need for CT, or the result thereof, is not the deciding factor for admission. In 1996, 16877 patients were treated as inpatients for minor head injuries, (191/100000 inhabitants). The admission rates varied widely among departments, and the total figures have been constant since 1987. The mean hospital stay was 1.6 days, so a large number of hospital days are consumed. The resources more than cover routine CT investigations for those seeking care, and hospital care for those with abnormal findings or special needs. CONCLUSION: In Sweden, patients with minor head injuries are routinely admitted to hospital for observation. The estimated use of CT varies considerably. No clinics report using CT to triage patients for admission, a strategy that would be consistent with effectiveness and economic arguments.

Adolescent↗
PubMed2002

Trauma management and education in europe: a survey of twelve geographically and socioeconomically diverse European countries.

OBJECTIVE: To record the current standards of management and education in trauma surgery in 12 geographically and socioeconomically diverse countries in Europe. DESIGN: Questionnaire study. SETTING: Teaching hospital, Austria. INTERVENTION: Questionnaire sent to experts on trauma in Austria, France, Germany, Italy, The Netherlands, Norway, Portugal, Romania, Spain, Sweden, Turkey, and the United Kingdom. MAIN OUTCOME MEASURE: Comparison of management of patients before, during, and after admission to hospital, and opportunities for initial and in-service training. RESULTS: Management of patients and opportunities for training varied considerably from country to country, ranging from an organised trauma service throughout with specialised training to a haphazard and variable service that depended more on individual hospitals, doctors and patients. CONCLUSIONS: Standardisation of management and training would be desirable, and should be possible at least in countries that are members of the European Union.

Clinical Competence↗
PubMedDate not supplied

Training volunteers as conversation partners for people with aphasia.

BACKGROUND: One of the most disabling consequences of aphasia is the way it excludes the person from conversation. A number of studies have attempted to tackle this problem by training the conversational partners of aphasic people. This study offers an evaluation of this approach. AIMS: Six volunteers were trained in conversing with people with moderate or severe aphasia. The study aimed to evaluate whether training changed the volunteers' knowledge about aphasia and their interactions with aphasic people. It also explored whether changes in the volunteers were matched by improved participation of the aphasic people in conversation. METHODS & PROCEDURES: Volunteers were recruited from an aphasia group in Milton Keynes. They were trained as a group over three sessions (9 hours in total). The training drew on the techniques of Kagan (1998, 1999). It included presentation of information using different media, group discussions, viewing of videos and role play. The course aimed to improve (1) the volunteers' understanding of the nature of aphasia, (2) the volunteers' knowledge about communication strategies to use with aphasic people and (3) the skills of the volunteers in supporting aphasic people in conversation. An additional aim was to increase the aphasic subjects' participation in conversation. Two evaluation methods were employed. Specially designed questionnaires were administered before and after training to evaluate the volunteers' knowledge and understanding. Volunteers were also videotaped in conversation with aphasic people before and after training. The videos were rated by speech and language therapists, using nine-point rating scales, derived from Kagan (1999). OUTCOMES & RESULTS: Significant improvements were seen on the questionnaire scores and in ratings of the volunteers' videos. The rating gains were attributed to the training course, since baseline scores were stable and improvements only occurred after the training period. There were comparable gains in the participation of the aphasic subjects, which again occurred after training. CONCLUSIONS: The study demonstrates that a short training course can change the knowledge and practice of experienced volunteers. The findings have implications for teaching generic skills to volunteers working with aphasic people.

Aged↗
PubMed2005

Mental health policy development: case study of Cambodia.

OBJECTIVE: To identify key issues in the mental health policy development process in Cambodia that will contribute to an increased understanding of how mental health policy gets on the public policy agenda, how it stays there and why policy implementation fails or succeeds. The research was formative because mental health policy analysis is a young and newly emerging discipline. METHOD: A retrospective case study methodology was used to research the development of the draft Cambodian Mental Health Plan 2003-2022. Ten key informants involved in the policy development process were interviewed using a semistructured questionnaire designed to collect qualitative data about the policy formation process, stakeholders and context. RESULTS: The research identified key issues influencing mental health policy development. These are the need to include the Ministry of Health (MoH) in the development of mental health plans; the significance of timing; the usefulness of mental health plans; the impact of the post-conflict context on policy development; and the evolution of stakeholder groups and their need to learn how to debate the merits of mental health reform. CONCLUSIONS: The findings are formative given methodology limitations. However, important insight is provided into the dynamics of the policy development processes that occurred in Cambodia. This allows the generation of important hypotheses for future mental health policy process research in both Cambodia and other post-conflict developing countries.

Cambodia↗