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PubMedDate not supplied

Perceived health needs of urban African American church congregants.

Theory-based assessment of congregant expectations and needs should be conducted prior to beginning a parish nurse program. However, no such assessments are found in the literature. Using Andersen's Health Access Model as a framework, investigators conducted interviews with 117 randomly selected congregants in five urban African American churches to describe their perceived needs and expectations. Causing most concern were the following: (a) symptoms of illness--high blood pressure (50.4%), dental problems (43.6%), and back pain (41%); and (b) health habits/risks--weight (75%), exercise (63%), and diet (63%). Younger adults were significantly more concerned about all aspects of their health than their older counterparts. Women were significantly more likely to express concern about health habits and health risks than males. No significant relationship was found between perceived need and access to care. Although terming health care services "adequate", congregants expressed many unmet health needs. This seemingly contradictory finding may illuminate a concrete role for the parish nurse, i.e., addressing personal health care concerns not alleviated by the current "adequate" health care delivery system. This study's significance lies not only in providing programming guidance, but also in theoretical insights into the role of the parish nurse.

Adult↗

PubMed2005

Patients with worry: presentation of concerns and expectations for response.

Patients with the same underlying concern express this with different styles that predict preference for physician responses. One hundred primary care patients imagined having chest pain and selected from a videotape, the most likely response which they would tell their physician: (1) symptoms only--no disclosure of underlying concern; (2) symptoms and a "Clue" to an underlying concern; or (3) symptom with an explicit concern. Depending on their preferred expression, they were presented videotaped doctors responses to that disclosure and ranked their response preferences. Patients stating they would present with symptoms only (17%) preferred a biomedical question response; patients selecting a symptom and a clue (43%) were equally comfortable with a biomedical question, facilitation or, an exploration of the clue. Of patients presenting with an explicit concern (40%), most wanted the physician to acknowledge and explore the origins of that concern.

Adolescent↗

PubMed2004

Perceptions of general environmental problems, willingness to expend federal funds on these problems, and concerns regarding the Los Alamos National Laboratory: Hispanics are more concerned than Whites.

Perceptions about general environmental problems, governmental spending for these problems, and major concerns about the US Department of Energy's Los Alamos National Laboratory (LANL) were examined by interviewing 356 people attending a gun show in Albuquerque, New Mexico. The hypothesis that there are differences in these three areas as a function of ethnicity was examined. We predicted that if differences existed, they would exist for all three evaluations (general environmental problems, government spending, and environmental concerns about LANL). However, this was not the case; there were fewer ethnic differences concerning LANL. Hispanics rated most general environmental problems higher than Whites and rated their willingness to expend federal funds higher than Whites, although all groups gave a lower score on willingness than on concern. Further, the congruence between these two types of ratings was higher for Hispanics than for others. In general, the concerns expressed by subjects about LANL showed few ethnic differences, and everyone was most concerned about contamination. These data indicate that Hispanics attending a gun show are equally or more concerned than others about environmental problems generally but are not more concerned about LANL. The data can be useful for developing future research and stewardship plans and for understanding general environmental problems and their relationship to concerns about LANL. More generally, they indicate that the attitudes and perceptions of Hispanics deserve increased study in a general population.

Conservation of Natural Resources↗

PubMed2003

Bioethical theory and practice in genetic screening for type 1 diabetes.

Due to the potential ethical and psychological implications of screening, and especially in regard of screening on children without available and acceptable therapeutic measures, there is a common view that such procedures are not advisable. As part of an independent research- and bioethical case study, our aim was therefore to explore and describe bioethical issues among a representative sample of participant families (n = 17,055 children) in the ABIS (All Babies In South-east Sweden) research screening for Type 1 diabetes (IDDM). The primary aim is the identification of risk factors important for the development of diabetes and other multifactorial immune-mediated diseases. Four hundred, randomly chosen, participant mothers were asked to complete a questionnaire exploring issues of information, informed consent, bio-material, confidentiality and autonomy, and of prevention/intervention. 293 completed the questionnaire, resulting in a response rate of 73.3%. The majority of questions had the form of 6-point Likert-type response scales (1-6). We found that the majority of respondents felt calm in in regard of samples and written material, and also concerning the possibility of their child in the future being identified as having high risk of developing Type 1 diabetes. An important finding concerning access and control of mainly biological data was indicated, with the respondents expressing concern for potential future use. We believe our findings indicate that this kind of empirical studies can substantially contribute to our understanding of bioethical issues of medical research involving genetics. Issues, such as safeguards ensuring the ethical criteria of autonomy and respect, were emphasised by our respondents. We believe the issues brought up may promote further discussion, and do suggest issues for consideration by, among others, researchers, bioethicists and Institutional Review Boards.

Adult↗

PubMed2005

Patient participation in medical consultations: why some patients are more involved than others.

BACKGROUND: Patients vary in their willingness and ability to actively participate in medical consultations. Because more active patient participation contributes to improved health outcomes and quality of care, it is important to understand factors affecting the way patients communicate with healthcare providers. OBJECTIVES: The objectives of this study were to examine the extent to which patient participation in medical interactions is influenced by 1) the patient's personal characteristics (age, gender, education, ethnicity); 2) the physician's communication style (eg, use of partnership-building and supportive talk); and 3) the clinical setting (eg, the health condition, medical specialty). RESEARCH DESIGN AND SUBJECTS: The authors conducted a post hoc cross-sectional analysis of 279 physician-patient interactions from 3 clinical sites: 1) primary care patients in Sacramento, California, 2) patients with systemic lupus erythematosus (SLE) from the San Francisco Bay area, and 3) patients with lung cancer from a VA hospital in Texas. MAIN OUTCOME MEASURES: The outcome measures included the degree to which patients asked questions, were assertive, and expressed concerns and the degree to which physicians used partnership-building and supportive talk (praise, reassurance, empathy) in their consultations. RESULTS: The majority of active participation behaviors were patient-initiated (84%) rather than prompted by physician partnership-building or supportive talk. Patients who were more active participants received more facilitative communication from physicians, were more educated, and were more likely to be white than of another ethnicity. Women more willingly expressed negative feelings and concerns. There was considerable variability in patient participation across the 3 clinical settings. Female physicians were more likely to use supportive talk than males, and physicians generally used less supportive talk with nonwhite compared with white patients. CONCLUSIONS: Patient participation in medical encounters depends on a complex interplay of personal, physician, and contextual factors. Although more educated and white patients tended to be more active participants than their counterparts, the strongest predictors of patient participation were situation-specific, namely the clinical setting and the physician's communicative style. Physicians could more effectively facilitate patient involvement by more frequently using partnership-building and supportive communication. Future research should investigate how the nuances of individual clinical settings (eg, the health condition, time allotted for the visit) impose constraints or opportunities for more effective patient involvement in care.

Adult↗

PubMedDate not supplied

Addressing environmental health concerns near Trecatti landfill site, United Kingdom.

Residents near the Trecatti landfill site located in South Wales, United Kingdom, expressed concern about odors and health effects they attributed to site emissions. The authors compared routinely collected, population-based, health data from potentially exposed electoral wards (i.e., United Kingdom electoral tracts) with data from both wards nearby, matched for socioeconomic deprivation scores, and with wards where residents were likely to attend the same hospital. Mortality rates were higher for all causes and neoplastic diseases (but not respiratory disease) in the exposed wards, but there was no change in rates after the site opened. Hospital data revealed a transient increase in admissions for asthma during the 3 yr that preceded the peak in odor complaints. The birth prevalence of congenital malformations was raised in the exposed wards, but the authors could not exclude a possible artifact resulting from differences in reporting practices between hospitals. The absence of environmental monitoring in the community during the period of public concern was a significant weakness of this study.

Abortion, Spontaneous↗

PubMedDate not supplied

Importation of prescription medications: experiences, opinions, and intended behaviors of U.S. community pharmacists.

OBJECTIVE: To describe community pharmacists' experiences with consumer demand for imported pharmaceuticals and their opinions about economic, policy, and patient care issues surrounding importation of medications and their willingness to procure these products from international sources, if legally permitted. DESIGN: Cross-sectional study. SETTING: Four states in the United States (Michigan, Minnesota, Illinois, and Florida). PARTICIPANTS: Community/outpatient pharmacists. INTERVENTIONS: Telephone-based survey conducted in March 2004. MAIN OUTCOME MEASURES: Self-reported opinions of pharmacists on importation of prescription drugs. RESULTS: Of 401 respondents, approximately 90% agreed that the Medicare prescription drug benefit would not diminish consumer interest in importation of medications, and a similar proportion agreed that interest was not limited to the elderly. A majority of pharmacists (69%) agreed that their primary concern about importation was the quality (i.e., purity) of the drugs. However, 57% of pharmacists agreed that drugs purchased through Canada would not pose a greater risk of medication-related problems if U.S. pharmacists oversaw the process and were available to provide patient monitoring and education. Pharmacists strongly favored regulatory actions that might decrease counterfeiting. Nearly one third (32%) of pharmacists believed that consumers should be allowed to purchase medications from Canada legally, while 44% of pharmacists believed that pharmacies should be able to procure prescription drugs from Canada legally. Almost 70% of pharmacists said that they would consider ordering medications from Canada, if legally permitted. Approximately one half of the pharmacists surveyed were concerned about job security as a result of the trend toward importation. This concern was significantly higher among pharmacy owners (chi-square [df= 1] = 9.82; P < .01). CONCLUSION: Pharmacists expressed concern about safety, liability, and the economic ramifications of prescription drug importation. More favorable opinions were expressed for situations in which imported drugs would be channeled through U.S. pharmacies.

Attitude of Health Personnel↗

PubMed1989

Depression and self-report disclosure after live related donor and cadaver renal transplants.

Important psychological reactions are associated with renal transplantation in general. Differences in psychological adjustment between recipients of kidneys from cadavers (CRs) and recipients of kidneys from live related donors (LRRs), however, have been poorly researched. In this study 10 LRRs (mean age 35,7 years; mean number of years after transplant 4,5) were compared with 30 CRs (mean age 38,6 years; mean number of years after transplant 5,3). The prevalence of depression and self-disclosed stress-inducing factors which might have affected long-term psychological adjustment after the transplant were investigated. The psychological status of each patient was assessed by means of a clinical interview, a mental status examination, the Beck Depression Inventory and a self-report questionnaire. There were found to be no long-term statistically significant differences between the LRR and CR groups in terms of the prevalence of depression, although 20% of the patients overall were depressed to varying degrees. The CR group was more concerned about the psychological and personal characteristics of the donors and their families than the LRR group, who expressed concern about the future well-being of the donors. Many members of both groups expressed having experienced both fear of graft rejection, before and immediately after the transplant, and anxiety, which decreased with time. The therapeutic value of a positive psychological climate in the renal unit and of supportive family relationships was confirmed for both groups. In comparison with their existence while on dialysis, most of the patients, irrespective of donor type, ultimately enjoyed an enhanced quality of life.

Adult↗

PubMed2003

Breast cancer survivors' attitudes about communication of breast cancer risk to their children.

Perceptions of breast cancer survivors regarding educating their children about hereditary breast cancer risk are underexplored. This study examined attitudes of early-onset breast cancer survivors concerning whether, at what age, and how their children should be educated about potential risk for hereditary breast cancer. Women with breast cancer diagnosed < age 50 years between 1994 and 1997 were recruited from 34 Virginia hospitals. Participants responded to two surveys. The Family History Questionnaire permitted participant classification into two groups based on risk for hereditary disease, as determined by personal and family history. The Knowledge, Attitudes and Beliefs Questionnaire addressed participants' concerns regarding their children's breast cancer risk, perceptions of their children's concerns about their own risk, and whether, at what age, and from what source their children should be informed about their own risk. Among 267 participants, the average age was 47.5 years; 90% were Caucasian, 7% were African American; 52% had suspected hereditary breast cancer. Of participants with children, 81% indicated concern about their children's breast cancer risk; 55% reported that their children had expressed concern about their own risk. Seventy-one percent of participants believed the age for informing children about hereditary breast cancer risk to be before 18 years. Eighty-four percent cited the child's parents and 65% cited health professionals as a preferred information source. No differences in responses between participants with suspected hereditary breast cancer versus presumed sporadic breast cancer were noted. These data establish the need for educational resources regarding hereditary breast cancer for children of early-onset breast cancer survivors.

Adolescent↗

PubMedDate not supplied

The drug Czar's anti-drug media campaign: continuing concerns.

In reviewing the anti-drug media campaign organized by the Office of National Drug Control Policy (ONDCP), we expressed concern about both its strategic direction and execution (Journal of Health Communication, 1999, 4:2 155-160). The response from ONDCP's director, General Barry R. McCaffrey, still leaves us concerned about the campaign's chances for success. We review ONDCP's strong opposition to including alcohol in the campaign, its continued reliance on fear appeals, and its relative inattention to building support for environmental prevention strategies. We voice again our concerns about ONDCP's underutilization of an expert review committee of behavioral scientists.

Health Policy↗

PubMed2001

Illness-related concerns of mothers of children with congenital heart disease.

OBJECTIVE: This study examined concerns expressed by mothers of children with congenital heart disease (CHD). The relationships among mothers' concerns, medical severity, and mother's emotional state were examined at two points in time. METHOD: Thirty-eight mothers of children with CHD aged 3 to 16 completed semistructured interviews and rating scales during hospitalization and 2 to 4 weeks after discharge. Mothers rated their distress about illness-related concerns, as well as their own depressed mood and anxiety. Mothers and two cardiologists rated the medical severity of each child's disease. RESULTS: Mothers' concerns were reliably grouped into five categories: medical prognosis, quality of life, psychosocial functioning, effects on family, and financial issues. During hospitalization, mothers were most concerned about medical prognosis. Distress about most concerns decreased postdischarge, as did mother's anxiety and depressed mood. Mothers' perceptions of medical severity were associated with distress about psychosocial issues postdischarge. Mother's anxiety was not associated with number of concerns reported, or with distress about those concerns. Maternal depressed mood was associated with fewer illness-related concerns, but greater distress about those concerns. CONCLUSIONS: Illness-related concerns can be meaningfully categorized and are not necessarily a function of disease severity or mother's emotional state. An awareness of common concerns will improve clinical care by enabling practitioners to anticipate and address concerns in a proactive way. The results may inform the development of supportive mental health interventions for families of children with CHD.

Adaptation, Psychological↗

PubMed2003

The unilateral DNR order--one hospital's experience.

Hospital or institutional policies that guide the activity of nurses in the care of their patients may, at times, be controversial. Nursing staffs often act as gatekeepers of patient care activities and the implementers of institutional policy. When nurses raise questions as to the appropriateness of a given policy statement, the institution should take serious notice and, perhaps, even study the policy outcomes that relate to the concerns expressed by the nursing staff. This article introduces a policy that originally prompted serious concerns by the nursing staff at one institution. The nursing staff voiced their concerns regarding a revision in the DNR policy that would allow physicians to write unilateral do-not-resuscitate (DNR) orders. Because of this, a review of this policy took place and the results were used to dispel unfounded concerns and also to improve the use of the policy. This article may help nursing administrators to understand better the importance of policy-related studies and it may also encourage nurses to question policy statements and guidelines that may present some concerns. Enhanced patient care will ultimately result by such teamwork and scholarly activity.

Academic Medical Centers↗

PubMedDate not supplied

Challenges in addressing community concerns regarding clusters of multiple sclerosis and potential environmental exposures.

Citizens living around hazardous waste sites in the USA have expressed concern to public health officials at the local, state and federal level about a perceived high prevalence of multiple sclerosis (MS) in their communities. Many believe the occurrence of the disease is directly linked to exposure to chemical agents from the nearby hazardous waste site. Although the public's concern regarding these clusters should be addressed, epidemiologists have long known that evaluating perceived clusters is rarely fruitful for identifying an etiologic agent. In order to adequately address concerns regarding clusters of MS, as well as examining the role of environmental exposures and genetic susceptibility in the causal mechanism of disease, several activities need to be conducted including characterizing the occurrence of disease, developing a standardized case definition and establishing partnerships to develop innovative research techniques. Only with collaboration across disciplines and lessons learned from past research will we be able to effectively guide research efforts directed at determining the etiology of this disease.

Cluster Analysis↗

PubMed2003

Recruitment of U.S. medical graduates into psychiatry: reasons for optimism, sources of concern.

The authors explain the importance of recruiting U.S. medical graduates into psychiatry, give reasons for optimism about future recruitment, express concerns about problems that could hinder it, and recommend ways to address these concerns. Reasons for optimism include: features of the specialty, such as its focus on the doctor/patient relationship; its increasing job availability and incomes; its scientific achievements; the peaking and possible fading of the National Generalist Initiative; and a 5-year upward recruitment trend. Concerns are: low "overt" interest in psychiatry among entering medical students; clerkship directors' perceptions of a negative educational impact of managed care; graduating seniors' suboptimal satisfaction with their psychiatry clerkships; and what is likely to be a small impact of New Mexico legislation on prescribing privileges for psychologists. The authors make recommendations for addressing these concerns.

Career Choice↗

PubMed1975

Language behaviour and child psychotherapy.

The dichotomy between non-verbal or play therapy for the younger and verbal psychotherapy for the older child is questionable in view of the fact that lexical representation begins in the second year of life. It is equally doubtful whether, in the absence of certain communications expressed in verbal symbols, any type of interaction between therapist and child may be called psychotherapy. Language, in varying forms of syntactical and semantic complexity, constitutes the matrix which connects and makes coherent all interactive processes in psychotherapy. This paper attempts to relate some notions of language development to current concepts of child psychotherapy. Linguistic growth is characterized by a fixed gross developmental schedule as well as a specific and universal sequence of acquisition. For the preschooler, still lacking a flexible grammer and syntax to express intricate relationships of perceived events, the value of "interpretations" is doubted; simple statements concerning expression of affect are seen as a rudimentary psychotherapeutic intervention. For the latency child the play situation, with its familiar concrete activity, fuels the child's linguistic competence. Not the play itself but the resulting language becomes the major element of psychotherapy. In late childhood distancing devices and role playing may correct the sociolinguistic asymmetry (adult-child) which inhibits verbal behaviour.

Adolescent↗

PubMed1998

Dysmorphic concern: prevalence and associations with clinical variables.

OBJECTIVE: The aim of this paper is to describe the development of a questionnaire, the Dysmorphic Concern Questionnaire (DCQ), for the assessment of dysmorphic concern, and to establish correlations with clinical variables. METHOD: Consecutive admissions to a psychiatric hospital were surveyed. RESULTS: The DCQ showed good internal consistency, with most of the variance being explained by a single factor. Strong correlations with distress and work and social impairment lend face validity to the questionnaire. Dysmorphic concern was not significantly influenced by the patient's age, sex or diagnosis. In terms of specific psychotic symptoms, there were weak positive correlations with thought interference and persecutory ideation. However, the strongest correlations were with depressed mood, according to the Beck Depression Inventory (BDI) but not the Montgomery Asberg Depression Rating Scale; the discrepancy was largely accounted for by the 'cognitive' depressive items on the BDI. In terms of objective assessment of dysmorphic features, ratings on the Waldrop scale for minor physical anomalies showed no correlation with concern expressed by the patient. CONCLUSIONS: The strong correlation with depressive cognitions suggests that dysmorphic concern is often a reflection of a depressive cognitive set rather than being a diagnosis in itself.

Adult↗

PubMed1994

Selective expression of clusterin (SGP-2) and complement C1qB and C4 during responses to neurotoxins in vivo and in vitro.

This study concerns expression of the genes encoding three multifunctional proteins: clusterin and two complement cascade components, C1q and C4. Previous work from this and other laboratories has established that clusterin, Clq and C4 messenger RNAs are elevated during Alzheimer's disease, and in response to deafferenting and excitotoxic brain lesion. This study addresses hippocampal clusterin, ClqB and C4 expression in response to neurotoxins that caused selective neuron death. Kainate, which preferentially kills hippocampal CA3 pyramidal neurons but not dentate gyrus granule neurons induced clusterin immunoreactivity in CA1 and CA3 pyramidal neurons and adjacent astrocytes, but not in dentate gyrus granule neurons. In contrast, colchicine, which preferentially kills the dentate gyrus granule neurons, induced clusterin immunoreactivity in the local neuropil as punctate deposits, but not in the surviving or degenerating dentate gyrus granule neurons. Clusterin messenger RNA was increased in astrocytes. ClqB and C4 messenger RNAs increased within 48 h after kainate injections, particularly in the CA3 pyramidal layer, less in the dentate gyrus-CA4, and less in CA1. Clq immunoreactivity was detected in CA1 pyramidal neurons and also as small punctate deposits in the CA1 region at eight and 14 days after kainate. The increase of both clusterin and ClqB messenger RNAs after kainate injections was blocked by barbiturates that prevented seizures and neurodegeneration. In primary hippocampal neuronal cultures treated with glutamate, a subpopulation of cultured neurons that survived glutamate toxicity also had parallel elevations of clusterin and ClqB messenger RNA. In conclusion, cytotoxins that target selective hippocampal neurons increase the expression of both clusterin and ClqB in vivo and in vitro. These results show that elevations of clusterin messenger RNA or protein can be dissociated from each other and from cell death. These increased messenger RNAs were associated with immunoreactive deposits that differed by cell type and intra- versus extracellular locations. These results suggest that the complement system is involved in brain responses to injury.

Animals↗

PubMed2004

Do maternal concerns at delivery predict parenting stress during infancy?

OBJECTIVE: In a previous study, we found that new mothers could and would express concerns about their parenting, including concerns about maltreatment and poor care. In this study, we examine the utility of early maternal concerns for predicting parenting stress in the first year. Parenting stress is important because it has been shown to be related to maltreatment and poor parent-child relationships. METHOD: A sample of 246 mothers were interviewed shortly after delivery in a publicly funded hospital about their parenting concerns, and 93% were reinterviewed in their homes about their parenting when the infants were 6 to 12 months old. Standardized measures with demonstrated psychometric properties were employed, including a measure of parenting stress due to the demands of the parenting role, characteristics of the child that make him or her difficult to care for, and stress due to difficult interactions. RESULTS: Multiple regression results indicate that both mothers concerns at delivery and sociodemographic variables are significant predictors of all three types of parenting stress in infancy. Maternal concerns were more powerful than sociodemographics in predicting stress related to the demands of parenting, while sociodemographics were more powerful for the prediction of stress related to difficult child characteristics and difficult mother-infant interaction. CONCLUSIONS: These findings suggest that knowledge of new mothers' parenting concerns might be useful for predicting parenting problems, as well as for engaging mothers' in and enhancing the effectiveness of parenting services.

Adolescent↗