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PubMed2006

Validation of a brief, reliable scale to measure knowledge about the health risks associated with obesity.

BACKGROUND: Obesity represents a serious threat to health through its association with conditions such as type 2 diabetes mellitus, coronary heart disease and certain types of cancer. Knowledge regarding risk to health is an important determinant of behaviour and is the focus of many health education strategies. To the authors' knowledge, there is no valid and reliable measure of knowledge regarding the health risks associated with obesity. AIM: To validate a short, reliable psychometric scale measuring knowledge regarding the effects of obesity on health, the Obesity Risk Knowledge (ORK-10) scale. METHODS: The ORK-10 scale was administered to a sample of individuals with no specific obesity-related expertise (n=230) and a sample of experts (n=200). Univariate and multivariate statistical analyses were used to investigate the scale's criterion validity. RESULTS: The ORK-10 scale has good internal consistency (Cronbach's alpha coefficient>0.7) and is acceptable for use in a UK adult population with an estimated reading age of 12-13 years. The scale demonstrated strong criterion validity, as those with educational or vocational expertise in the field of obesity achieved significantly higher scores than nonexperts (median 9.0 vs 4.0, Z=-17.364; P<0.001). This relationship was maintained after controlling for the potentially confounding factors of age and level of education. Nonexperts demonstrated low levels of knowledge regarding the health risks associated with obesity. CONCLUSIONS: The ORK-10 scale meets standard psychometric criteria for reliability and validity. This scale could be used to assess the effectiveness of health education interventions, to target the provision of health information and to investigate the interaction between knowledge and obesity-related behaviour.

Adolescent↗

PubMed1995

What is relapse in schizophrenia?

Relapse can be defined as "the return of a disease after partial recovery". This definition is directly applicable to schizophrenic disorder. Relapse in this condition can be evaluated at the symptomatic, phenomenological and behavioural levels. Relapse impinges on inter-personal, social and occupational spheres of the patient's activity. In turn, relapse has wider implications for the family in general, for the provision of medical and social facilities and for health economics. There are no generally accepted criteria for relapse but outcomes such as violence or suicide, extreme psychotic behaviour and rehospitalization have been used. Less obvious criteria include major and minor symptom worsening and prodromata. Relapse is a relative term and must take into account the following factors: the patient's condition before the original onset of illness; his level of functioning before the present episode; the severity of the relapse in terms of symptom severity, duration and interference with personal functioning; the appearance of any new symptoms or behaviour patterns; the type of treatment given prior to relapse, and hence relatively ineffective; the type of treatment given during relapse, and its efficacy. Relapses often follow a pattern which may be fairly specific to each individual patient. Social factors may have predictive power but these need validation in different samples.

Confusion↗

PubMed1991

The effect of a cost sharing provision in Japan.

This study evaluated the effect of a 10% cost sharing provision, introduced in October 1984, on demand for medical services. We analysed the data of 1701 health insurance societies, all of which joined the National Federation of Health Insurance Societies between 1983 and 1985. The case rate (per 1000 persons) and the number of serviced days (per case) were analysed as indicators of demand for inpatient, outpatient and dental medical services. The case rate was considered to be an indicator of the patient's behaviour, while the number of serviced days was influenced by the doctor's behaviour. Multiple linear regression analysis was used with each indicator to isolate the effect of the cost sharing provision, adjusted for other variables which influenced demand for medical services. The case rate was reduced significantly in all medical services. This means that a patient was discouraged from using a medical facility by the cost sharing provision. There was little difference among medical services. The number of serviced days was also reduced significantly in all medical services. There was a large difference among medical services. The effect on outpatient service was much greater than that on any other service.

Cost Sharing↗

PubMed2003

Risk factors associated with behavioural disorders of crib-biting, weaving and box-walking in Swiss horses.

REASONS FOR PERFORMING STUDY: Studies on the prevalence of behavioural disorders in horses and on associated risk factors have revealed inconsistent results. There are many studies on the neuropharmacological, surgical or mechanical therapy of stereotypies, but little is known about their causation. OBJECTIVES: To explore risk factors associated with the occurrence of behavioural disorders in horses. METHODS: A sample of horse owners, selected randomly and representative for Switzerland, was contacted in a postal survey. Answers were provided for 622 stables (response rate 35.2%). Individual data of 2,341 horses were examined with path analysis (multivariable linear and logistic regression), and adjustment made for possible confounding effects due to age and breed. RESULTS: Out of 60 possible risk factors, 11 were associated with the outcome at the univariable level (null-hypothesis path model) and 3 factors remained after the backward logistic regression procedure. Mature Warmbloods and Thoroughbreds, assessed by the owners to be reactive, fed 4 times a day and without daily pasture, had increased odds of displaying crib-biting, weaving and box-walking. Furthermore, indirect associations of 5 factors with the outcome were identified. CONCLUSIONS: The final logistic regression model of risk factors leads to the hypotheses that causal prevention of stereotypic behaviours should be based upon housing and management conditions which allow tactile contact with other horses (e.g. mutual grooming), daily free movement (paddock or pasture), as well as the provision of high amounts of roughage but of little or no concentrates. POTENTIAL CLINICAL RELEVANCE: It is one of the aims of population medicine to prevent the development of behavioural disorders. Further research is needed to test the concluding hypotheses in experimental studies or to verify them in the context of similar observational studies.

Animal Husbandry↗

PubMed2003

Nutrition education in schools: experiences and challenges.

Health promotion from the early stages in life by fostering healthy eating practices and regular physical activity has the potential for a major impact on health and well-being during childhood and later stages in life.School-based nutrition education should consider the needs and interests of students, teachers and the school. Educational strategies include efforts to increase health awareness, communication and skill building. Previous literature reviews identified educational strategies directly relevant to a behavioural focus and theory-driven strategies among the elements conducive to successful programmes. Other features that contribute to gain effectiveness are the provision of adequate time and intensity for the intervention, involvement of families, particularly for younger children, and incorporation of self-assessment and feedback in interventions for older children. School meals provide a valuable opportunity for nutrition education. The emphasis on environmental and behavioural factors in successful school-based physical activity and nutrition interventions highlights the importance of involving parents and other community members.

Adolescent↗

PubMed2006

The 'mentally disordered' provisions of the New South Wales Mental Health Act 1990: their ethical standing and effect on services.

OBJECTIVE: To consider whether the mentally disordered provisions of the NSW Mental Health Act 1990 can be ethically justified and whether any departure from the usual justification for compulsory care comes at a cost. CONCLUSIONS: The shaky ethical standing of these provisions has encouraged mental health services in NSW to play a role in controlling unacceptable behaviour, even in the absence of mental illness. This places the Act in an exceptional position in comparison to other Western Mental Health Acts. It is causing increasing strain on services as well as having unforseen consequences on those detained.

Ethics, Professional↗

PubMed2005

Mammography screening participation: effects of a media campaign targeting Italian-speaking women.

OBJECTIVES: To evaluate the effect of a radio and newspaper campaign encouraging Italian-speaking women aged 50-69 years to attend a population-based mammography screening program. METHODS: A series of radio scripts and newspaper advertisements ran weekly in the Italian-language media over two, four-week periods. Monthly mammography screens were analysed to determine if numbers of Italian-speaking women in the program increased during the two campaign periods, using interrupted time series regression analysis. A survey of Italian-speaking women attending BreastScreen NSW during the campaign period (n=240) investigated whether individuals had heard or seen the advertisements. RESULTS: There was no statistically significant difference in the number of initial or subsequent mammograms in Italian-speaking women between the campaign periods and the period prior to (or after) the campaign. Twenty per cent of respondents cited the Italian media campaign as a prompt to attend. Fifty per cent had heard the radio ad and 30% had seen the newspaper ad encouraging Italian-speaking women to attend BSNSW. The most common prompt to attend was the BSNSW invitation letter, followed by information or recommendation from a GP. CONCLUSION: Radio and newspaper advertisements developed for the Italian community did not significantly increase attendance to BSNSW. IMPLICATIONS: Measures of program effectiveness based on self-report may not correspond to aggregate screening behaviour. The development of the media campaign in conjunction with the Italian community, and the provision of appropriate levels of resourcing, did not ensure the media campaign's success.

Age Distribution↗

PubMed1977

General practitioners and the independent contractor status.

Primary medical care can be provided either by a bureaucratic hierarchical organization or alternatively by independent contractors. Most members of the caring professions in medicine, nursing, and social work are employed in bureaucracies, whereas general medical practitioners, general dental practitioners, opticians, and pharmacists are independent contractors.The independent contractor status has recently been heavily attacked from within the medical and nursing professions, and also from outside. It has been suggested that contracting for services is an inappropriate and anomalous way of arranging medical care, which should now be stopped. However, this process of contracting for services can be analysed, using perspectives from some of the behavioural sciences, to reveal hidden depths in the independent contractor status which suggest that the provision of primary medical care is best carried out by independent contractors.

Contract Services↗

PubMed1996

Issues in the management of sexually transmitted diseases in Papua New Guinea.

This paper outlines three important issues in the clinical management of sexually transmitted diseases (STDs) in Papua New Guinea which have, until now, gone unrecognized or been neglected. Suggestions for possible solutions are made. The high prevalence of both chlamydial and trichomonal infections in women cannot be ignored. Both of these infections have been shown to increase the transmission of HIV. The current algorithm for the treatment of vaginal discharges does not include treatment for trichomonal infection in the first instance, yet trichomoniasis has been shown to be the most common STD in community studies both here and elsewhere. Trichomoniasis is usually asymptomatic in men, but still increases the risk of HIV transmission; furthermore, it causes illness in their female partners and thus needs to be treated. The current recommended regimens for the treatment of gonococcal and chlamydial infection are complex due to the number of drugs recommended for gonorrhoea to combat the problem of drug resistance, and the length of therapy for chlamydia. Compliance with such a regimen is likely to be poor, particularly in asymptomatic partners. We need to consider the relative advantages provided by a drug which could be given as a single oral dose for chlamydia, and perhaps for both infections. Azithromycin is one possibility, as it has been shown to be effective for chlamydial infection in numerous studies, and has been found satisfactory for gonorrhoea where local isolates were susceptible. Testing of a small number of isolates from Papua New Guinea has shown that azithromycin may be suitable for use here, but further susceptibility testing needs to be performed. Utilization of services for STDs, particularly by women, is extremely low. This is due to a combination of factors involving limited knowledge of symptomatology and its significance, the asymptomatic nature of many infections, the structure of the services, health worker behaviour, and social attitudes. To address these issues we must make modifications to STD service provision, as well as provide widespread information about the potentially serious consequences of contracting STDs, including both infertility and AIDS. Possible modifications to the services are discussed, and include making routine screening available for women through currently existing services such as family planning and antenatal clinics and considering the possibility of establishing Women's Health Clinics which would provide all primary reproductive health services in an integrated manner.

Anti-Bacterial Agents↗

PubMed2005

Countertransference and self-injury: a cognitive behavioural cycle.

AIM: This paper discusses the emotional, cognitive and behavioural effects of self-injury on nurses as helpers, and shows the usefulness of a cycle that can affect care provision for this group of people. BACKGROUND: People self-injure for many different reasons, such as feeling angry, sad, guilty or frightened, and these emotions are often linked to feeling helpless, powerless or out of control. Self-injury has often been reported as a coping strategy to gain control. Psychoanalytic and cognitive behavioural concepts have been used to understand why people self-injure and also inform intervention strategies. Unfortunately, negative emotional responses in professionals may interfere with the effectiveness of any therapeutic relationship. DISCUSSION: Negative emotional responses from nurses can affect the way they think about and behave towards clients who self-injure. During clinical supervision or education, nurses' thoughts can be challenged to become less negative, so that their resulting behaviour can also become less punitive. Non-punitive or more positive behaviour can in turn challenge some of the negative self-beliefs of clients. CONCLUSIONS: Knowledge about countertransference when working with people who self-injure may reduce nurses' negative thoughts and behaviours, which may result in improved client care.

Cognitive Behavioral Therapy↗

PubMedDate not supplied

[Drinking water and garbage: customs and beliefs among schoolchildren of a marginal population].

A study of 80 children from 6th and 7th grades was conducted to determine their beliefs and behaviours about drinking-water and garbage management. The children come, in their totality, from a poor suburban population of the north of Buenos Aires. The survey showed that most of the children kept some drinking-water provision at home. Therefore, they had to collect, treat, and store the water. The pupils had correct knowledge about the process of contamination and some adequate behaviours concerning the hygiene of collection containers, but also showed inadequate conceptions about the protection of such containers and water treatment. The children reported inadequate behaviours and incorrect beliefs about the elimination of garbage. These results establish the need for teaching-learning experiences designed to reinforce correct knowledge and behaviours and modify the incorrect ones.

Argentina↗

PubMed1998

From selfish individualism to citizenship: avoiding health economics' reputed 'dead end'.

Recent interpretations of citizenship are firmly rooted in the value of social membership and social participation. Citizens are described as having a moral right to draw upon the support of the community, but at the same time have a responsibility to contribute to the provision of social services such as health care. In contrast, contemporary health economics has been criticised for taking a narrow and individualistic view of human behaviour. This paper examines the extent to which economic theory and practice have been developed to accommodate a more 'civic' view, namely, the notions of mutual concern for community members, social participation and social rights. It is argued that because the provision of health care is often linked to feelings of compassion and social responsibility and not just to individual well-being, this sort of insight may enrich economic analysis and, in turn, provide a way around health economics' reputed 'dead end'.

Altruism↗

PubMed1997

Respite-care needs--met and unmet: assessment of needs for children with disability.

The study aimed to ascertain the current use of respite-care services by families with children with a learning and/or a physical disability in a South London, UK, health authority, to estimate the type and extent of the unmet need, and to set standards for the provision of such services. Over 1200 families were sent an 11-page questionnaire. The results indicated that the child's level of dependency and the presence of behaviour and communication problems led to significantly higher levels of experienced stress among carers. This was also associated with a significantly greater use of respite care except by families of children with behavioural problems. The results showed that respite care was generally perceived as an inadequate service, though 88% of respondents had no knowledge of the existence of respite-care services. Recommendations are made in relation to information provision, choice, and flexibility for carers and for quality standards in general.

Adolescent↗

PubMed1999

Assessing parental effort in a Neotropical parrot: a comparison of methods.

Various behavioural or body condition indices are frequently used to measure avian parental effort. To determine which of the indices provide meaningful short-term assessments of parental effort, we used four of them concurrently on breeding green-rumped parrotlets, Forpus passerinus, and then compared the results with field metabolic rate (FMR) measurements obtained using the doubly labelled water (DLW) technique. Nest provisioning rate correlated significantly with FMR among both males and females, while proportion of time away from the nest was correlated with FMR in females but not in males. Adult mass change during the breeding cycle and feeding latency were both unrelated to FMR. Our results suggest researchers should be cautious in assuming that any indirect method of quantifying parental effort is reliable for a particular species. We also tested whether the relatively invasive DLW protocol causes potentially confounding changes in study animals' subsequent behaviour. Paired observations before and after DLW injection showed no measurable changes in parrotlet nest attendance patterns or nest provisioning rate. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed2000

Cervical cancer and sexual lifestyle: a systematic review of health education interventions targeted at women.

A systematic review was conducted to determine the effectiveness of health education interventions to promote sexual risk reduction behaviours amongst women in order to reduce transmission of human papillomavirus (HPV), a leading agent in the development of cervical cancer. A comprehensive search was conducted to identify relevant studies. Studies were included in the review if they evaluated educational interventions targeting women only and measured the impact on either a behavioural outcome such as condom use for sexual intercourse, partner reduction or abstinence, or a clinical outcome such as incidence of a STD. Thirty studies met the inclusion criteria for the review; all had the primary aim of preventing HIV and other STDs rather than cervical cancer. Ten of the 30 studies were considered to provide the strongest evidence for a causal relationship between the intervention and the change in outcomes measured. Each of these 10 most rigorous studies showed a statistically significant positive effect on sexual risk reduction, typically with increased use of condoms for vaginal intercourse. This positive effect was generally sustained up to 3 months after intervention. It was concluded that educational interventions targeting socially and economically disadvantaged women in which information provision is complemented by sexual negotiation skill development can encourage at least short-term sexual risk reduction behaviour. This effect has the potential to reduce the transmission of HPV and thus possibly reduce the incidence of cervical carcinoma.

Female↗

PubMed2002

Foraging enrichment for stabled horses: effects on behaviour and selection.

The restricted access to pasture experienced by many competition horses has been linked to the exhibition of stereotypic and redirected behaviour patterns. It has been suggested that racehorses provided with more than one source of forage are less likely to perform these patterns; however, the reasons for this are currently unclear. To investigate this in 4 replicated trials, up to 12 horses were introduced into each of 2 identical stables containing a single forage, or 6 forages for 5 min. To detect novelty effects, in the first and third trials the single forage was hay. In the second and fourth, it was the preferred forage from the preceding trial. Trials were videotaped and 12 mutually exclusive behaviour patterns compared. When hay was presented as the single forage (Trials 1 and 3), all recorded behaviour patterns were significantly different between stables; e.g. during Trial 3 in the 'Single' stable, horses looked over the stable door more frequently (P<0.001), moved for longer (P<0.001), foraged on straw bedding longer (P<0.001), and exhibited behaviour indicative of motivation to search for alternative resources (P<0.001) more frequently. When a previously preferred forage was presented as the single forage (Trials 2 and 4) behaviour was also significantly different between stables, e.g in Trial 4 horses looked out over the stable door more frequently (P<0.005) and foraged for longer in their straw bedding (P<0.005). Further study is required to determine whether these effects persist over longer periods. However, these trials indicate that enrichment of the stable environment through provision of multiple forages may have welfare benefits for horses, in reducing straw consumption and facilitating the expression of highly motivated foraging behaviour.

Animal Feed↗

PubMedDate not supplied

Effects of spatial allowance, group size and perches on the behavior of hens in cages with nests.

The behaviour of laying hens housed in 'welfare-improved' cages fitted with one nest per hen was investigated with manipulations of group size (two or four birds), spatial allowance excluding the nests (600 cm2 or 1200 cm2 per bird) and perch provision (presence or absence). More time was spent in the nests by birds housed at 600 cm2 than at 1200 cm2, and by birds housed in pairs than in four. Perch provision had no significant effect on time spent in the nest but resulted in reduced nest soiling by birds housed at 1200 cm2, and increased 'comfort' behaviour by some groups.

Animals↗

PubMed2006

Effectiveness of oral midazolam for paediatric dental care: a retrospective study in two specialist centres.

AIM: To analyse retrospectively the outcomes for children undergoing oral care under conscious sedation with oral midazolam and local analgesia at Leeds dental Institute, England and Westmead Dental Hospital, Sydney, Australia. Secondly, the study assessed the suitability of oral midazolam for paediatric dental treatment. STUDY DESIGN: Retrospective study of clinical outcomes based on dental records. METHODS: All children included in the study had been treated between September 2000 to August 2004 and full dental records were available. The dental records were examined using a standard pro forma sheet and data collected for: age, previous behaviour using the Frankl [1962] scale, units of work planned and achieved using the modified index of O'Sullivan and Curzon [1991], midazolam dosage and treatment outcome. RESULTS: The study population consisted of 101 children aged 1-11 years in both Leeds (57 children) and Westmead (44 children). There were significant differences between Leeds and Westmead with respect to age (mean +/-SD) in years 5.0+/-1.0 versus 2.9+/-1.6; number of treatment visits 1.7 versus 1.1; sedation dose used 0.5-0.7 mg/kg versus 02.-0.3; type and amount of treatment planned 8.3 units versus 3.3 and achieved 7.5 versus 2.2, for both centres respectively. There was also a difference in overall success rates of rendering the children dentally fit of 65% v. 91%, respectively. CONCLUSION: Oral midazolam was found to be a useful drug for the management of young children with behaviour problems. It was found, however, not to be effective in all cases and for the provision of all types of paediatric dentistry. The results indicate that, when using oral midazolam in children, the treatment should be restricted to simple restorations and extractions over a maximum of two visits.

Administration, Oral↗