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PubMed2002

Addressing community concerns about asthma and air toxics.

People with asthma who live near or downwind from a source of toxic emissions commonly express concerns about the possible impact of hazardous air pollution on their health, especially when these emissions are visible or odorous. Citizens frequently turn to their local and state health departments for answers, but health departments face many challenges in addressing these concerns. These challenges include a lack of asthma statistics at the local level, limited exposure information, and a paucity of scientific knowledge about the contributions of hazardous air pollutants to asthma induction or exacerbation. Health agencies are creatively developing methods to address these challenges while working toward improving asthma surveillance data at the state and local levels. Recent community health investigations suggest that hazardous air pollutants that are occupational asthmagens or associated with odors may deserve more attention. In seeking to address community concerns about hazardous air pollution and asthma, community health investigations may also help to fill gaps in our scientific knowledge and identify areas for further research or environmental intervention. The solutions to community problems associated with environmental contamination and asthma, however, require sustained, coordinated efforts by public and private groups and citizens. Public health agencies can make a unique contribution to this effort, but additional resources and support will be required to develop information systems and epidemiologic capacity at the state and local levels.

Air Pollutants↗

PubMed2000

Perceived obstacles to career success for women in academic surgery.

HYPOTHESIS: We conducted this study to determine whether concerns expressed by male and female surgeons at 1 academic center are generally reflective of broader concerns for academic surgery and academic medicine. We reviewed published studies concerning women in academic surgery within the context of reporting the results of a survey of both male and female surgeons at 1 academic center. DATA SOURCES: We developed a survey that included demographic information, work experience, and social issues. The survey was distributed to the entire faculty. For key questions, we compared answers between male and female faculty. Additional data came from the published literature. STUDY SELECTION: We reviewed all available studies identified by a MEDLINE search with key words women and academic and medicine or physician. Included studies contained either data collection or editorial comment concerning women in academic medicine. DATA EXTRACTION: Data and opinions from all included studies paralleling survey questions were extracted from each article. DATA SYNTHESIS: Male and female faculty members reported different experiences and perceptions, specifically relating to relationships between family and professional life and perceptions of subtle sex-related biases. Both men and women reported insufficient mentoring and difficulties in balancing personal and professional responsibilities. CONCLUSIONS: Attitudes, behaviors, and traditions surrounding how we structure work and evaluate participation in academic surgery are more difficult to change than just addressing obvious inequities in support for female surgeons. However, attempting the deeper changes is worthwhile, because addressing obstacles faced by female faculty, many of which also affect men, will allow progress toward environments that attract and retain the best physicians, regardless of sex.

Academic Medical Centers↗

PubMedDate not supplied

Wilhelm Konrad Roentgen: a new kind of rays.

Wilhelm Konrad Roentgen presented a preliminary report on his discovery of x-rays in 1895. In his initial experiments with these rays, he had taken a radiograph of his wife's hand. This picture immediately implied a medical use for the new discovery by demonstrating the bones of the hand. Various aspects of medical treatment were soon revolutionized by the technique of radiography. There were concerns expressed by the medical community regarding the use of x-rays. Many of these concerns regarded deficiencies that were subsequently overcome by technical improvements, resulting in a higher quality of radiographs. However, the benefit of ever-improving radiographic techniques is undergoing greater scrutiny regarding its cost and utility.

Germany↗

PubMed1995

Ethical dilemmas in the lived experience of nursing practice.

Through a series of semistructured interviews with 12 nurses delivering direct patient care in acute, long-term and home care settings, information was sought regarding the ethical concerns of practicing nurses. Although these nurses frequently did not specifically identify the areas of expressed concern as ethical in nature, thematic analysis of the transcribed interviews uncovered four major ethical areas of concern common to these 12 nurses. These areas are: (1) Withholding of information and truth-telling; (2) Unequal access or inequalities in care; (3) Differences between business and professional values; (4) Breaking and reporting broken rules. Several reasons are offered to explain the failure of nurses accurately to identify specific practice dilemmas as ethical in nature and the sequelae of these failures. Possibilities involving ongoing education and mentored experiences in practice areas are reported.

Adult↗

PubMed2000

Physician/patient rapport concerns administrators.

In a recent survey of hospital emergency department (ED) administrators, 40% of respondents reported concerns regarding physicians' rapport with patients. ED administrators also indicated they were concerned about the quality of care given in the ED. More than 20% of respondents expressed concern about the professional competence, availability, and quality of care given in the ED. In fact, one in 10 administrators surveyed would choose an ED other than the one at their hospital if they were seriously hurt.

Emergency Service, Hospital↗

PubMed1991

Quality assurance in rural hospitals.

Within the last decade there has been an expanding amount of information on quality assurance in healthcare. Despite the prolific citations on the topic, only a few address the needs and concerns regarding quality assurance programs in rural healthcare institutions. The author summarizes the more frequently expressed concerns of nursing administrators in implementing a comprehensive quality assurance program in the rural environment.

Accreditation↗

PubMed1989

Comparison groups in research on families with mentally retarded members: a methodological and conceptual review.

A review and critique of the use of comparison groups in mental retardation family research was provided. Issues addressed include matching on age versus competency of the mentally retarded family member, description of comparison groups in published research, demographic equivalence of groups, matching strategies, populations from which samples were drawn, appropriateness of tasks/instruments across groups, and the role of theory in comparison group selection. Unique concerns relating to sibling research and studies of mentally retarded parents were discussed. Caution was expressed concerning the translation of comparison research findings into intervention targets for families with mentally retarded members. Alternatives to comparison group designs were presented as well as recommendations for selecting and describing comparison samples.

Adolescent↗

PubMed1997

Expression of glucose transporters in human pancreatic tumors compared with increased FDG accumulation in PET study.

UNLABELLED: Although overexpression of GLUT-1 glucose transporter has already been reported in human cancers, the mechanism of glucose entry into pancreatic cancers remains unknown. To evaluate the relationship between GLUT glucose transporters and FDG uptake, FDG-PET was performed in 34 preoperative patients (mean age, 60.9 yr) with suspected pancreatic tumors, including 28 malignant and 6 benign tumors. METHODS: FDG uptake at 50 min after injection of 185 MBq of [18F]FDG with >5 hr of fasting was semiquantitatively analyzed as standardized uptake values (SUVs). The GLUT expression was studied by immunohistochemistry of paraffin sections from these tumors after operation using anti-GLUT-1, -2, -3, -4 and -5 antibodies to obtain immunohistochemical grading ("strong," "weak" and "negative") by three experienced physicians. RESULTS: Of 26 malignant tumors proved by histological examination, 23 (88%) tumors were positive for the expression of GLUT-1 glucose transporter, and 17 (61%) showed strong expression. On the other hand, 13 (46%), 0 (0%), 9 (36%) and 13 (46%) malignant tumors were positive for the expression of GLUT-2, -3, -4 and -5 glucose transporters, respectively. Three of six benign tumors showed strong GLUT-1 expression. Concerning GLUT-2, -3, -4 and -5, only one benign tumor showed positive GLUT-5 expression. Thus, GLUT-1 showed relatively high sensitivity but low specificity (50%) for detecting malignant tumors, whereas GLUT-2, -3, -4 and -5 had lower sensitivities but higher specificities. Correlations between SUVs and grading of GLUT immunoreactivity were significant in GLUT-1 (strong, 4.49 +/- 2.95; weak, 3.42 +/- 1.21; negative, 2.52 +/- 0.84) (p < 0.05) but not in the remaining four GLUT transporters. CONCLUSION: These data indicate that GLUT-1 has a significant role in the malignant glucose metabolism and may contribute to the increased uptake of FDG in PET imaging in patients with pancreatic tumor.

Adult↗

PubMedDate not supplied

Long-term care--a growing employer concern.

More and more American workers are experiencing long-term health problems themselves or with their families. Employers are beginning to express concern over the time and productivity losses that employee involvement in these long-term problems is causing. Both governmental and employer plans for assisting workers will have to be designed, employers say, but government action may be delayed by other priorities.

Health Benefit Plans, Employee↗

PubMed2001

Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial.

BACKGROUND: Metastatic breast cancer carries with it considerable psychosocial morbidity. Studies have shown that some patients with metastatic breast cancer experience clinically significant anxiety and depression and traumatic stress symptoms. Supportive-expressive group psychotherapy was developed to help patients with cancer face and adjust to their existential concerns, express and manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control. METHODS: Of 125 women with metastatic breast cancer recruited into the study, 64 were randomized to the intervention and 61 to the control condition. Intervention women were offered 1 year of weekly supportive-expressive group therapy and educational materials. Control women received educational materials only. Participants were assessed at baseline and every 4 months during the first year. Data at baseline and from at least 1 assessment were collected from 102 participants during this 12-month period, and these participants compose the study population. RESULTS: Primary analyses based on all available data indicated that participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms on the Impact of Event Scale (effect size, 0.25) compared with the control condition, but there was no difference in Profile of Mood States total mood disturbance. However, when the final assessment occurring within a year of death was removed, a secondary analysis showed a significantly greater decline in total mood disturbance (effect size, 0.25) and traumatic stress symptoms (effect size, 0.33) for the treatment condition compared with the control condition. CONCLUSION: Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.

Adaptation, Psychological↗

PubMed1977

The relation of deviant symptoms and behaviour in a normal population to subsequent delinquency and maladjustment.

A survey of more than 6000 school children in 1961 established norms for symptomatology and behavior at ages 5-15. A follow-up to 1968 identified all children from the survey attending a child guidance clinic or appearing in court within that time. Those thus identified contained a significantly high proportion of boys who were reported as having more than 3 deviant items (i.e. occurring in approximately 10% of subjects in 1961). Specific health and behavioural items were found to have been reported in 1961 in proportions which were significantly different for children later appearing in child guidance clinic from those appearing in court. The amount of concern expressed by their parents over psychological and behavioural items distinguished court from clinic boys, while the concern shown by parents over items of physical health showed little difference in these 2 groups.

Adolescent↗

PubMed2004

Patient satisfaction with two different models of cancer genetic services in south-east Scotland.

There is a need to integrate primary- and secondary-care cancer genetic services, but the most appropriate model of service delivery remains unclear. This study reports patients' expectations of breast cancer genetic services and a comparison of their satisfaction with two service models. In the first model, risk assessment was carried out using mailed family history data. Women estimated as being at high/moderate risk were offered an appointment at the familial breast cancer clinic, and those at low risk were sent a letter of reassurance. In the second model, all women were seen by a genetic nurse specialist, who assessed risk, referred high/moderate-risk women to the above clinic and discharged those at low risk. Over 60% of all women in the study regarded access to breast screening by mammogram and regular check-ups as very important. This underlines the demand for a multidisciplinary service providing both clinical genetic and surgical services. Satisfaction was high with both models of service, although significantly lower among women not at increased cancer risk and thus not offered a clinical check-up and mammography. Increased cancer worry was associated with a greater expressed need for information and for reassurance through follow-up clinical checks and mammography. Better targeting of counselling to the expressed concerns and needs of these women is required to improve the service offered. GPs and patients expressed no clear preference for any specific service location or staffing configuration. The novel community service was less expensive in terms of both staff and patient costs. The potential to decrease health staff/patient contact time and to employ nurse practitioners with both clinical genetic and oncology training should be explored further. The rapidly rising demand for these services suggests that the evaluation of further new models needs to continue to be given priority to guide the development of cancer genetic services.

Adolescent↗

PubMed2005

Community psychiatric nursing: focus on effectiveness.

The focus for provision of mental health services is now the community in most developed countries. Different ways of organizing community mental health services are evident in the literature. Community psychiatric nurses (CPNs) have a key role to play in these services but the literature indicates that the CPN role varies from area to area within different models of service provision. This paper presents the findings of a study in which 13 service users and 15 CPNs in five focus groups discussed the effectiveness of mental health service. Selected staff and service users were chosen from a representative range of community mental health services across Northern Ireland. Service users expressed concern at the variety of CPN and other professional roles within multidisciplinary teams and some CPNs expressed dissatisfaction with their role and with role boundaries within teams. These findings suggest that further work is needed within community mental health services to ensure the role of the CPN remains effective and develops to meet the needs of service users.

Community Mental Health Services↗

PubMedDate not supplied

Legal issues in telemedicine.

The health care industry is in the process of addressing the problems that may arise from the development and implementation of telemedicine, including legal issues. Those issues include licensing of providers, confidentiality and privacy of patient information, and legal liability issues. The concerns expressed about licensing are addressed in legislation before the Michigan legislature. The technical aspects arising from concerns regarding privacy and confidentiality and legal liability issues have been recognized to exist as well. The following discussion will seek to highlight these issues to facilitate further analysis of them.

Confidentiality↗

PubMed1992

[Patients and solicitude].

Patients are not only passive and vulnerable beings who need to be cared for. They are also autonomous, active and capable of caring for others as well as for themselves. In this study, the author has completed lengthy interviews with five women in order to identify different types of caring. Complicity-based caring is characterized by verbal and nonverbal behavior of patients who are sharing a common experience. This type of caring can be encouraged by a third-party who brings patients together with similar experiences. Action-oriented caring consists of intervening for other patients as an antidote for one's own fear, panic and anguish. Solidarity-based caring corresponds with assisting fellow patients in finding and maintaining their own identity, pride and dignity. Co-operative caring can be observed in group-type settings such as the behavior observed during support groups or vegetarian cooking classes for cancer patients. Self-centred caring refers to the various forms of concern one has for one's self. The experience of suffering can determine how caring is expressed. Concern can force individuals to examine their way of acting and interacting more carefully. Conscious choices are made to avoid empty and exhausting relationships and encourage the growth of positive relationships. Paradoxically, this change in perspective brings about an open mind and heart. It is at this time that caring for healthy individuals appears. Unfortunately, there is very little distinction between patients and healthy individuals, but rather sensitive relationships between individuals facing difficult life challenges.

Female↗

PubMed1999

Major concerns and needs of breast cancer patients.

Between 1989 and 1991, 102 breast cancer patients completed a questionnaire survey on concerns and needs at their first visit to the University Clinic after they were diagnosed or treated for breast cancer at other clinics. Their major concerns and needs were health, family, finances, work, the future, self-esteem, counseling and support for themselves and their family. Married women and those younger than 50 years were more likely to have concerns about their family. Nonwhites had more concerns about finances and work than white women, with an odds ratio (OR) of 6.58. Older women and those married, however, had less concerns about finances and work than younger women and those not married, with ORs of 0.96 and 0.34, respectively. Fewer nonwhite than white patients expressed concerns about their future (OR = 0.31). Young women were more concerned about self-esteem than older women. More nonwhites than whites and more married than unmarried women expressed needs for family counseling and support (OR = 3.58 and 3.68, respectively). Help for interpreting information was required more frequently by nonwhites than whites (OR = 7.25, 95% confidence interval [CI] = 2.19-24.00). Nonwhite women also tended to require more referrals than whites. In summary, major concerns and needs varied among patients of different demographic characteristics, especially those of age, race, and marital status.

Adaptation, Psychological↗

PubMed2005

Expressions of nonabandonment during the intensive care unit family conference.

PURPOSE: Palliative care consultants play an increasing role in assisting critical care clinicians with end-of-life communication in the intensive care unit (ICU). One of the ethical principles these consultants may apply to such communication is nonabandonment of the patient. Limited data exist concerning expressions of nonabandonment in the ICU family conference. This analysis examines expressions of nonabandonment during ICU family conferences. Our goal was to categorize these expressions and develop a conceptual model for understanding this issue as it arises in the ICU setting. METHODS: We identified family conferences in the ICUs of four hospitals. Conferences were eligible if the attending physician believed that discussion about withholding or withdrawing life support or the delivery of bad news was likely to occur. Fifty-one conferences were audiotaped, transcribed, and analyzed using grounded theory. RESULTS: We identified categories capturing expressions of nonabandonment in the ICU family conference. Clinicians expressed nonabandonment of the patient or family in three ways: alleviating suffering/ensuring comfort, allowing family members to be present at the bedside for the death, and being accessible to patients and families. Families expressed their own nonabandonment of the patient or concern about abandonment of the patient by the health care team in five ways: ensuring the patient's suffering is eased, being present at the bedside, ensuring the patient's end-of-life preferences are respected, ensuring that everything possible be done to cure the patient, and "letting go." These categories were placed into a conceptual model that differentiates explicit and implicit statements of nonabandonment. CONCLUSIONS: This paper describes categories and a conceptual model for understanding expressions of nonabandonment that may allow palliative care consultants to help critical care clinicians express nonabandonment and respond to families' expressions of nonabandonment in the ICU family conference. Future studies could use this model to develop a communication intervention for the ICU family conference.

Adult↗

PubMed1999

Concern about weight gain associated with quitting smoking: prevalence and association with outcome in a sample of young female smokers.

This study investigated the relationship between weight gain concern and outcomes of a large-scale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers.

Adult↗