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PubMed2004

Skin-sparing mastectomy in the UK--a review of current practice.

BACKGROUND: Skin-sparing mastectomy (was first described in 1991 and has achieved popularity because it facilitates immediate breast reconstruction, preserving the infra-mammary fold and breast envelope. Little is known about the use of skin-sparing mastectomy in the UK. METHODS: All members of the BASO Breast Specialty Group were contacted in June 2001 with a questionnaire to determine the popularity of skin-sparing mastectomy, techniques used, indications, contra-indications and outcomes. RESULTS: Of 300 questionnaires sent, 130 were returned by September 2001. The number of respondents using skin-sparing mastectomy increased from 27 (21%) in 1997 to 95 (73%) in 2001. Of respondents, 35 (23%) avoided skin-sparing mastectomy because of their uncertainty about the benefits (22/35), indications (16/35) or oncological safety (13/35). Where skin-sparing mastectomy was performed, it was combined with immediate breast reconstruction in 90% of cases, using latissimus dorsi (84%), subpectoral (70%) or TRAM flap reconstruction (54%). Skin-sparing mastectomy was performed by breast surgeons alone (62%), or with a plastic surgeon (47%) and the preferred incisions were peri-areolar (68%) and elliptical (26%). Most respondents used skin-sparing mastectomy for prophylaxis, in situ cancer and early invasive disease and avoided skin-sparing mastectomy in patients with skin tethering (62%), where radiotherapy was planned (49%) and in smokers (28%). Complications seen by respondents included skin envelope necrosis (68%), haematoma formation (46%), cosmetic failure (41%) and local recurrence (12%). CONCLUSIONS: Skin-sparing mastectomy is becoming popular in the UK, but experience is limited. The variation in indications and techniques indicate the need to establish evidence-based guidelines for the wider practice of skin-sparing mastectomy in the UK.

Breast Neoplasms↗

PubMed2005

Genetic and environmental influences on self-concept in female preadolescent twins: comparison of Minnesota and Seoul data.

It has been argued that culture significantly influences the developmental basis of self-concept. The goal of the present study is to compare the relative importance of genetic and environmental factors to explain individual differences in various dimensions of self-concept in female preadolescents of Minnesota in the United States and Seoul in South Korea. Two hundred and eighteen monozygotic (MZ) and 137 dizygotic (DZ) twin pairs from the Minnesota Twin Family Study (MTFS) and 74 MZ and 42 DZ twin pairs from the Seoul Twin Family Study (STFS) completed the 6 cluster scales of the Piers-Harris Children's Self-Concept Scale (P-H). The 6 cluster scales of the P-H include Popularity, Physical Appearance and Attributes, Behavior, Intellectual Competence and School Status, Anxiety, and Happiness and Satisfaction. Univariate model-fitting analyses were performed. In both samples, a model incorporating shared and nonshared environmental influences fitted the data best for Popularity, Anxiety, and Intellectual Competence and School Status, whereas a model including additive genetic and nonshared environmental factors provided the best fit for Physical Appearance and Attributes, and Behavior. The univariate model did not yield an adequate fit for Happiness and Satisfaction. For Physical Appearance and Attributes, and Intellectual Competence and School Status, estimates of additive genetic and environmental factors were significantly different between the MTFS and the STFS samples. For Popularity, Anxiety, and Behavior, however, the genetic and environmental estimates were comparable between the two samples.

Anxiety↗

PubMed2004

[The role and practices of the curandeiro and saludador in early modern Portuguese society].

This paper will explore the role and practices of magic-using folk healers - curandeiros and saludadores - in early modern Portuguese society. The article will examine the ambivalent place of the folk healer as a figure both central to and marginal in Portuguese popular culture. In considering some of the services offered by unlicensed popular healers and their recourse to the unorthodox magical means inherent in popular curing, the paper will investigate curandeiros and saludadores illicit sources of power. Further, this work will examine the prominence of men as folk healers in southern Portugal during the seventeenth and eighteenth centuries. Finally, by looking at the notoriety of Luso-African folk healers, the paper will assess the importance of race as a factor in the culture of Portuguese magical curing.

History, 17th Century↗

PubMed1995

Off-road cycling injuries. An overview.

Off-road bicycles, commonly called 'mountain bikes', have become increasingly popular worldwide since their introduction in the western US in the late 1970s. This popularity is partly because these vehicles can be ridden on a wide variety of terrain which is not accessible to other types of bicycle. Although early versions were rather crude, off-road bicycles today typically include high strength, lightweight frames with a wide array of available suspension and braking systems. Virtually all aspects of the technology continue to evolve, including components and protective equipment. As the popularity of off-road cycling has increased, so too has the interest and level of participation in the competitive aspects of the sport. Currently, 2 organisations--the National Off-Road Bicycle Association (NORBA) and the Union Cycliste Internationale (UCI)--sponsor the major events within the US and around the world. To date, the majority of studies have been descriptive in nature, with data collected via self-report, questionnaire formats. Only 1 prospective study has been reported thus far, which surveyed a major international competition held in the US in 1994. Injury rates calculated on the basis of injuries per ride or event in competitive venues have been reported, ranging from 0.2 to 0.39% compared with 0.30% for recreational participants. Retrospective data collected from recreational and competitive riders indicate that from 20 to 88% of those surveyed reported having sustained an injury during the previous year of participation. The majority of injuries appear to be acute, traumatic episodes involving the extremities, with contusions and abrasions being the most common. In general, the incidence of more severe injuries such as dislocations, fractures and concussions is low. Comparisons between road and off-road cycling events indicate that off-road cyclists sustain more fractures, dislocations and concussions than their road-event counterparts. Future research should incorporate epidemiological methods of data collection to determine the relationships between vehicle design, terrain and safety equipment and riding-related accidents. Further, those engaged in such research should attempt to set a standard definition for injury.

Athletic Injuries↗

PubMed2003

Advances in female hormonal contraception: current alternatives to oral regimens.

Despite the wide variety of reversible contraceptives, unintended pregnancy rates in developed nations are still considered markedly elevated by most epidemiologists and clinicians. Indeed, the US has one of the highest unintended pregnancy rates among the industrialized nations of the world. Although many factors appear to influence this problem, what may play an important role in this apparent paradox is the process by which a woman obtains contraception. Although most nonbarrier methods have similar efficacy, the ability to use that method consistently and correctly will determine whether it provides maximal contraception. Oral contraceptives are the most popular method in the US; accordingly, the process by which US women obtain their contraception may not take into account the desire of many women to use nondaily methods. The recent introduction of nondaily methods in the US and elsewhere has provided more choice so that a successful contraceptive decision can be made in the first instance rather than after an adverse clinical outcome or unintended pregnancy with a method not as well suited to that woman's lifestyle. These new methods are not characterized by improved safety or efficacy; rather, they have novel components or delivery systems that may provide important options to women who may not be able to or willing to use existing methods of contraception. The transdermal patch, vaginal ring, and monthly injectable are combination estrogen/progestogen methods characterized by novel delivery systems and compliance regimens. The single rod implant is a facile and well accepted method that has not yet been approved for use in the US but has been an increasingly popular choice elsewhere. The levonorgestrel intrauterine system has been used in Europe for over 10 years and has recently been introduced in the US. This intrauterine contraceptive provides high efficacy and reliability, and may have considerable noncontraceptive benefit with regard to the nonsurgical treatment of uterine bleeding problems and endometrial protection for menopausal hormone therapy. The increasing popularity of these methods can be considered a testament to the desire of women to consider nondaily contraceptives as first-line, mainstream options. It is hoped that increasing use of these methods will lead to a considerable decrease in the rate of unintended pregnancy.

Contraceptive Agents, Female↗

PubMed2003

Improving Web searches: case study of quit-smoking Web sites for teenagers.

BACKGROUND: The Web has become an important and influential source of health information. With the vast number of Web sites on the Internet, users often resort to popular search sites when searching for information. However, little is known about the characteristics of Web sites returned by simple Web searches for information about smoking cessation for teenagers. OBJECTIVE: To determine the characteristics of Web sites retrieved by search engines about smoking cessation for teenagers and how information quality correlates with the search ranking. METHODS: The top 30 sites returned by 4 popular search sites in response to the search terms "teen quit smoking" were examined. The information relevance and quality characteristics of these sites were evaluated by 2 raters. Objective site characteristics were obtained using a page-analysis Web site. RESULTS: Only 14 of the 30 Web sites are of direct relevance to smoking cessation for teenagers. The readability of about two-thirds of the 14 sites is below an eighth-grade school level and they ranked significantly higher (Kendall rank correlation, tau = -0.39, P =.05) in search-site results than sites with readability above or equal to that grade level. Sites that ranked higher were significantly associated with the presence of e-mail address for contact (tau = -0.46, P =.01), annotated hyperlinks to external sites (tau = -0.39, P =.04), and the presence of meta description tag (tau = -0.48, P =.002). The median link density (number of external sites that have a link to that site) of the Web pages was 6 and the maximum was 735. A higher link density was significantly associated with a higher rank (tau = -0.58, P =.02). CONCLUSIONS: Using simple search terms on popular search sites to look for information on smoking cessation for teenagers resulted in less than half of the sites being of direct relevance. To improve search efficiency, users could supplement results obtained from simple Web searches with human-maintained Web directories and learn to refine their searches with more advanced search syntax.

Adolescent↗

PubMed2004

Web content accessibility of consumer health information web sites for people with disabilities: a cross sectional evaluation.

BACKGROUND: The World Wide Web (WWW) has become an increasingly essential resource for health information consumers. The ability to obtain accurate medical information online quickly, conveniently and privately provides health consumers with the opportunity to make informed decisions and participate actively in their personal care. Little is known, however, about whether the content of this online health information is equally accessible to people with disabilities who must rely on special devices or technologies to process online information due to their visual, hearing, mobility, or cognitive limitations. OBJECTIVE: To construct a framework for an automated Web accessibility evaluation; to evaluate the state of accessibility of consumer health information Web sites; and to investigate the possible relationships between accessibility and other features of the Web sites, including function, popularity and importance. METHODS: We carried out a cross-sectional study of the state of accessibility of health information Web sites to people with disabilities. We selected 108 consumer health information Web sites from the directory service of a Web search engine. A measurement framework was constructed to automatically measure the level of Web Accessibility Barriers (WAB) of Web sites following Web accessibility specifications. We investigated whether there was a difference between WAB scores across various functional categories of the Web sites, and also evaluated the correlation between the WAB and Alexa traffic rank and Google Page Rank of the Web sites. RESULTS: We found that none of the Web sites we looked at are completely accessible to people with disabilities, i.e., there were no sites that had no violation of Web accessibility rules. However, governmental and educational health information Web sites do exhibit better Web accessibility than the other categories of Web sites (P < 0.001). We also found that the correlation between the WAB score and the popularity of a Web site is statistically significant (r = 0.28, P < 0.05), although there is no correlation between the WAB score and the importance of the Web sites (r = 0.15, P = 0.111). CONCLUSIONS: Evaluation of health information Web sites shows that no Web site scrupulously abides by Web accessibility specifications, even for entities mandated under relevant laws and regulations. Government and education Web sites show better performance than Web sites among other categories. Accessibility of a Web site may have a positive impact on its popularity in general. However, the Web accessibility of a Web site may not have a significant relationship with its importance on the Web.

Cross-Sectional Studies↗

PubMed1986

Sociometric status and social interaction: are the neglected children socially less active?

Previous studies have clearly established that isolated children display less social behaviors than popular ones and that poorly accepted as well as isolated children are at risk for future adjustment problems. These findings prompt the author to predict that children of the various sociometric statuses should display differential rates of social interaction with peers. Predictions were tested by administering during the second term to 99 kindergarten children a sociometric measure and by videotaping each child for 1 hr. during free play. Whether or not the child was in social interaction with peers was subsequently coded at 5-sec. intervals by two observers. Sociometric scores and inter- and intraobserver agreements were high. Popular children were the most socially active, followed by the average, the rejected, and then the neglected children, which confirmed all hypotheses. These results give strong support for the validity of the difference between the neglect and rejected vs the popular and the average children and suggested that such work must include the child's rate of social interaction with peers as a covariable in the analyses to identify differences between statuses.

Child↗

PubMed2000

Some late nineteenth century perspectives on sex and emotional expression.

A review of nineteenth century popular literature indicates a deep and sustained public interest in sex differences in emotional expression. The conclusions advanced by popular writers included a catalog of perceived sex differences, reinforced by an essentialist philosophy that provided justification for the separation of sexual spheres and restrictions on political, educational, and vocational opportunities for women. Current scientific research on sex differences appears in popular media and is often presented in the context of an essentialist philosophy comparable with that which was dominant in the nineteenth century. Unfortunately, the subtleties and complexities of sex differences are not always communicated to the public and there is thus a potential for misinterpretation or even misuse.

Emotions↗

PubMed1993

The rise and fall of phrenology in Australia.

In the first half of the nineteenth century phrenology, which was claimed to be the first science of the mind, experienced enormous popularity in the western world. It gave rise to a widespread movement attracting the attention of the professional and lay members of society. In Australia, as elsewhere, it had influence in penology and criminology, psychiatry, notions of racial inferiority, education, anthropology and popular application. By the second half of the nineteenth century, following advances in the knowledge of neuro-anatomy, it became relegated to the status of a pseudo-science. As such, it remained popular with charlatans and the public well into the twentieth century.

Australia↗

PubMed1999

Concurrent three dimensional neuroendoscopy: initial descriptions of application to clinical practice.

Applications of endoscopic technique neurosurgery are becoming increasingly popular as greater evidence of the safety and efficacy of these techniques is reported. Nevertheless, significant technical limitations need to be solved before neuroendoscopy can achieve widespread popularity. One limitation is the surgeon's difficulties in becoming anatomically oriented in a two-dimensional (2-D) environment. The lack of appropriate visual cues to orient oneself in three-dimensional (3-D) space makes relatively simple anatomical regions difficult to navigate. The authors describe an endoscopy system that allows for stereoscopic visualization during minimally invasive procedures and that acts as an adjunct to conventional open craniotomies. Four cases are described in which stereoendoscopy was used as either a primary means of visualization or as an adjunct to the operating microscope in conventional open neurosurgical procedures. The authors believe that stereoendoscopic vision is a significant advance in endoscope technology and will play a large role in the popularization of minimally invasive techniques in neurosurgery.

Journal Article↗

PubMed2001

Eliciting public preferences for healthcare: a systematic review of techniques.

BACKGROUND: Limited resources coupled with unlimited demand for healthcare mean that decisions have to be made regarding the allocation of scarce resources across competing interventions. Policy documents have advocated the importance of public views as one such criterion. In principle, the elicitation of public values represents a big step forward. However, for the exercise to be worthwhile, useful information must be obtained that is scientifically defensible, whilst decision-makers must be able and willing to use it. AIMS AND OBJECTIVES: The aim was to identify techniques that could be reasonably used to elicit public views on the provision of healthcare. Hence, the objectives were: (1) to identify research methods with the potential to take account of public views on the delivery of healthcare; (2) to identify criteria for assessing these methods; (3) to assess the methods identified according to the predefined criteria; (4) to assess the importance of public views vis-à-vis other criteria for setting priorities, as judged by a sample of decision-makers; (5) to make recommendations regarding the use of methods and future research. METHODS: A systematic literature review was carried out to identify methods for eliciting public views. Criteria currently used to evaluate such methods were identified. The methods identified were then evaluated according to predefined criteria. A questionnaire-based survey assessed the relative importance of public views vis-à-vis five other criteria for setting priorities: potential health gain; evidence of clinical effectiveness; budgetary impact; equity of access and health status inequalities; and quality of service. Two techniques were used: choice-based conjoint analysis and allocation of points technique. The questionnaire was sent to 143 participants. A subsample was followed up with a telephone interview. RESULTS: The methods identified were classified as quantitative or qualitative. RESULTS - QUANTITATIVE TECHNIQUES: Quantitative techniques, classified as ranking, rating or choice-based approaches, were evaluated according to eight criteria: validity; reproducibility; internal consistency; acceptability to respondents; cost (financial and administrative); theoretical basis; whether the technique offered a constrained choice; and whether the technique provided a strength of preference measure. Regarding ranking exercises, simple ranking exercises have proved popular, but their results are of limited use. The qualitative discriminant process has not been used to date in healthcare, but may be useful. Conjoint analysis ranking exercises did well against the above criteria. A number of rating scales were identified. The visual analogue scale has proved popular within the quality-adjusted life-year paradigm, but lacks constrained choice and may not measure strength of preference. However, conjoint analysis rating scales performed well. Methods identified for eliciting attitudes include Likert scales, the semantic differential technique, and the Guttman scale. These methods provide useful information, but do not consider strength of preference or the importance of different components within a total score. Satisfaction surveys have been frequently used to elicit public opinion. Researchers should ensure that they construct sensitive techniques, despite their limited use, or else use generic techniques where validity has already been established. Service quality (SERVQUAL) appears to be a potentially useful technique and its application should be researched. Three choice-based techniques with a limited application in healthcare are measure of value, the analytical hierarchical process and the allocation of points technique, while those more widely used, and which did well against the predefined criteria, include standard gamble, time trade-off, discrete choice conjoint analysis and willingness to pay. Little methodological work is currently available on the person trade-off. RESULTS - QUALITATIVE TECHNIQUES: Qualitative techniques were classified as either individual or group-based approaches. Individual approaches included one-to-one interviews, dyadic interviews, case study analyses, the Delphi technique and complaints procedures. Group-based methods included focus groups, concept mapping, citizens' juries, consensus panels, public meetings and nominal group techniques. Six assessment criteria were identified: validity; reliability; generalisability; objectivity; acceptability to respondents; and cost. Whilst all the methods have distinct strengths and weaknesses, there is a lot of ambiguity in the literature. Whether to use individual or group methods depends on the specific topic being discussed and the people being asked, but for both it is crucial that the interviewer/moderator remains as objective as possible. The most popular and widely used such methods were one-to-one interviews and focus groups. (ABSTRACT TRUNCATED)

Data Collection↗

PubMed1999

Music, emotion, and autobiographical memory: they're playing your song.

Very long-term memory for popular music was investigated. Older and younger adults listened to 20-sec excerpts of popular songs drawn from across the 20th century. The subjects gave emotionality and preference ratings and tried to name the title, artist, and year of popularity for each excerpt. They also performed a cued memory test for the lyrics. The older adults' emotionality ratings were highest for songs from their youth; they remembered more about these songs, as well. However, the stimuli failed to cue many autobiographical memories of specific events. Further analyses revealed that the older adults were less likely than the younger adults to retrieve multiple attributes of a song together (i.e., title and artist) and that there was a significant positive correlation between emotion and memory, especially for the older adults. These results have implications for research on long-term memory, as well as on the relationship between emotion and memory.

Adolescent↗

PubMed2001

The use of analgesic drugs by South African veterinarians.

According to a survey, non-steroidal anti-inflammatory agents were the most popular analgesic used in South Africa for management of peri-operative pain, acute post-operative pain and chronic pain. The most popular non-steroidal anti-inflammatory agents are flunixin meglumine and phenylbutazone. The most popular opioid type drug is buprenorphine, followed by morphine. In the peri-operative setting, analgesic agents were not actively administered to 86.3% of cats and 80.7% of dogs. Analgesic premedications were frequently administered, e.g. xylazine or ketamine, but no specific drug was administered for post-operative pain. Veterinarians need to critically review their anaesthetic and analgesic practices in order to achieve balanced anaesthesia.

Analgesics↗

PubMed1993

The National Health Service reforms as an electoral issue in the United Kingdom.

The implementation of National Health Service (NHS) reforms left the Conservative Government with a major electoral problem. As Britain approached the 1992 general election, opinion polls revealed a popular perception that the Conservatives were planning to privatise the NHS. This perception was both fuelled and acted upon by the Labour Opposition which, at its 1991 annual conference, signalled its intention to make the health service a major item on the electoral agenda. In this article several issues associated with popular perceptions of the health reforms are explored including increased levels of copayment, the language of commerce, entrepreneurial activities within the NHS, and 'opting out'. The ways in which the Labour Party sought to place health on the electoral agenda are examined, together with the response of the government. Labour sought to portray the reforms as creeping privatisation while the Conservatives dismissed this as a crude propaganda ploy and have stressed their commitment to a more effective NHS. It is argued that the British experience exemplifies the perennial problems for any government seeking to introduce substantive changes to a national health system in a partisan political environment: the need to explain changes and legitimize them, and the danger that reforms will be politicized by an opposition eager for issues with immediate popular impact.

Attitude to Health↗

PubMed2000

[Snacking behavior among elementary and junior high school students and its relationship to stress-coping].

The aim of the present study was to investigate current problems of snacking behavior and their relationship to stress coping among 1,486 fourth through ninth grade students from 10 elementary schools and six junior high schools. An anonymous self-completed questionnaire was utilized which included items about 1) selection of snack foods, which were classified into healthy, popular, complementary and western-style snacks, 2) problems of snacking behavior, which included external and emotional eating scores, and 3) stress coping scale. The stress coping scale contained two sub-scales; problem-focused and emotion-focused coping. The results were as follows: 1) Students who frequently went without breakfast did not select healthy foods, i.e., fruits and dairy products, but popular snacks, i.e., potato chips, pop corn and sweet beverage. 2) Both external and emotional eating scores increased by age in girls but was not apparent in boys. 3) Students who preferred either western-style or popular snacks showed higher score of external and emotional eating. 4) The score of problem-focused coping was positively correlated with preference for health snacks, but emotion-focused coping was positively correlated with external and emotional eating scores. The close relationship between snack food selection and problematic aspects of eating behavior suggests that modification of eating behavior is necessary to develop healthy snack habits in early adolescents. Also, it is interesting that snacking behavior is closely related to stress coping, which suggested the behavioral intervention for healthy eating habit should be included in development of stress-coping skills against various kinds of demands in life.

Adaptation, Psychological↗

PubMed2000

[Theater of Life: theory, method and practice].

Theater of Life is an educational model that integrate theater theories and techniques as a strategy for health education. Theater as an educational technique has become a useful tool for the health context. In this work the author discuss the role of social change as an important element in health education and suggests the use of theatrical techniques for it's promotion. Also offers information about the different approaches of popular theatre and popular education incorporated in this model, Theatre of the Oppressed by A. Boal, Popular Education by P. Freire, Poor Theater by J. Grotowoski and Education for Peace by C. Beristain and P. Cascón and explain the basic principles of each one of them. In the methodology section the author explains the different steps for implementing the strategy: solidarity and connection games, story telling technique and script development, presentation and forum. In the practice section the author shares the process of model development and the significance events that had contribute to their elaboration.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Attitudes and practices of physicians and naturopaths toward herbal products, including use during pregnancy and lactation.

BACKGROUND: The popularity of complementary therapies continues to grow, and physicians are asked increasingly by their patients for information regarding these modalities. PURPOSE: To assess the impact of these trends on physicians and medical students, and compare their attitudes and practices with those of the naturopaths and their students, with particular interest in the use of herbal products during pregnancy and breastfeeding. MATERIALS AND METHODS: A detailed questionnaire was distributed by a medical student and a naturopathic student to a randomly selected group of physicians, medical students, naturopaths and naturopathic students. They were asked a variety of questions about their background, attitudes and practices concerning herbal products. RESULTS: Thirty-eight per cent of the questionnaires were returned, with a total of 242 respondents. Fifty-four per cent of physicians discussed complementary therapies with their patients, whereas 100% of naturopaths discussed conventional medicines with their patients. The most popular product recommended by both medical doctors and naturopaths was echinacea, followed by St John's Wort. Eighty-six per cent of physicians, 74% of medical students, 66% of naturopaths and 50% of naturopathic students think that complementary medical education should be incorporated into the standard medical curriculum. Only one physician actually recommended a herbal product to a pregnant patient compared with 49% of the naturopaths who felt comfortable doing so. CONCLUSIONS: Complementary medicine has become a reality, and physicians are recommending herbal products to their patients, although on a smaller scale than are naturopaths. However, the two most popular herbal products are the same in each group. Physicians are less likely to recommend herbal products to pregnant and breastfeeding women than are naturopaths.

Attitude of Health Personnel↗