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PubMed2005

A letter of concern from the People's Health Movement regarding the appointment of Ms. Ann Veneman as Executive Director of UNICEF, effective May 2005.

This letter from members of the People's Health Movement to U.N. Secretary General Kofi Annan expresses concern about the appointment of Ann Veneman as the new Executive Director of UNICEF, based on her past performance on issues affecting children's health, and criticizes the processes used in making this and similar U.N. appointments, which reward powerful countries with the ability to make political appointments to important posts.

Administrative Personnel↗

PubMed2005

Triggering anti-smoking advice by GPs: mode of action of an intervention stimulating smoking cessation advice by GPs.

OBJECTIVE: To assess the mode of action of an intervention (GP desktop resource, GDR) that increased the frequency of general practitioner (GP) advice to stop smoking. METHODS: Analyses were undertaken to differentiate between three hypotheses regarding the mode of action of the GDR. That the GDR acts: (1) by altering GPs' attitudes, (2) independently of attitudes in prompting GPs to intervene with smokers or (3) by altering the relationship between attitudes and behaviour. RESULTS: The GDR was an independent predictor of the number of patients advised to stop smoking (beta = .345, p < .001). Concern about the doctor-patient relationship was the only attitude variable that independently predicted advice giving, in this case negatively (beta = -.465, p < .001). Possession of the GDR did not alter GPs' views on whether intervening with smokers harmed the doctor-patient relationship, but did weaken the relationship between this attitude item and the number of patients advised to stop smoking (beta = .595, p < .001 for the interaction). CONCLUSION: This study is the first to show that concern over the doctor-patient relationship was an independent predictor of advice giving while in other studies it has merely been noted as something that GPs express concern about. A simple device designed to trigger action on the part of GPs appeared to work by mitigating the negative effect of an attitudinal barrier to action. It would be interesting to explore this phenomenon more generally in relation to health promotion activities on the part of health professionals. PRACTICE IMPLICATIONS: Recommendations that GPs engage in health promotion activities with their patients need to consider that GPs' concerns over harming the doctor-patient relationship may deter them from making such interventions. The GDR appears to be effective in prompting GPs to advise their smoking patients to stop and its widespread distribution to GPs should be considered.

Adult↗

PubMed2001

A large-scale analysis of mRNAs expressed by primary mesenchyme cells of the sea urchin embryo.

The primary mesenchyme cells (PMCs) of the sea urchin embryo have been an important model system for the analysis of cell behavior during gastrulation. To gain an improved understanding of the molecular basis of PMC behavior, a set of 8293 expressed sequenced tags (ESTs) was derived from an enriched population of mid-gastrula stage PMCs. These ESTs represented approximately 1200 distinct proteins, or about 15% of the mRNAs expressed by the gastrula stage embryo. 655 proteins were similar (P<10(-7) by BLAST comparisons) to other proteins in GenBank, for which some information is available concerning expression and/or function. Another 116 were similar to ESTs identified in other organisms, but not further characterized. We conservatively estimate that sequences encoding at least 435 additional proteins were included in the pool of ESTs that did not yield matches by BLAST analysis. The collection of newly identified proteins includes many candidate regulators of primary mesenchyme morphogenesis, including PMC-specific extracellular matrix proteins, cell surface proteins, spicule matrix proteins and transcription factors. This work provides a basis for linking specific molecular changes to specific cell behaviors during gastrulation. Our analysis has also led to the cloning of several key components of signaling pathways that play crucial roles in early sea urchin development.

Animals↗

PubMed2000

How do the mental health issues differ in the withholding/withdrawing of treatment versus assisted death?

This article reviews ten of the most common mental health-related arguments against assisted death and applies them to the withholding/withdrawal of treatment to determine if the concerns expressed are truly unique to assisted death. After this analysis it is suggested that the mandatory involvement of a mental health professional can alleviate many of the concerns specifically associated with assisted death and that a mental health professional may also be helpful in situations involving the withholding/withdrawal of treatment.

Coercion↗

PubMed2003

Health and access issues among Australian adolescents: a rural-urban comparison.

INTRODUCTION: Previous research has reported rural-urban differences in health concerns and access issues. However, very little of this has concerned young people, and what has been published has been mainly from countries other than Australia and may not generalise to Australian youth. The study described in this paper is a subset of a larger study on health concerns and access to healthcare for younger people (12-17 years) living in New South Wales (NSW), Australia. This paper reports findings on rural-urban similarities and differences. The specific study objective was to identify and describe rural-urban differences, especially those associated with structural disadvantage. METHOD: The reported findings form part of a larger state-wide cross-sectional study of access to healthcare among NSW adolescents. Adolescents were drawn from high schools in ten of the 17 Area Health Services in NSW. These Area Health Services were selected because they represent most aspects of rural-urban NSW with respect to population characteristics and health services. Eighty-one focus groups were conducted with adolescents (35 with boys and 46 with girls), of which 56 were conducted in urban, 22 in rural and 3 in regional areas. The focus groups were tape-recorded, transcribed and analysed using the computer software package NUD*IST 4. RESULTS: The analysis revealed certain health concerns that were common to both rural and urban adolescents: use of alcohol and illicit drugs, bullying, street safety, diet and body image, sexual health, stress and depression. However, certain concerns were mentioned more frequently in rural areas (eg depression), and two concerns were raised almost exclusively by rural youth (youth suicide and teenage pregnancy). There were also structural differences in service provision: adolescents in rural areas reported disadvantage in obtaining access to healthcare (limited number of providers and lengthy waiting times); having only a limited choice of providers (eg only one female doctor available), and cost (virtually no bulk billing--ie direct charge to Medicare with no patient co-payment). A lack of confidentiality as a barrier to seeking service access was raised by both rural and urban youth, but was a major concern in rural areas. No issues specific to urban areas were raised by urban youth. Male and female rural adolescents were more likely than urban adolescents to express concerns over limited educational, employment and recreational opportunities, which they believed contributed to their risk-taking behaviour. Gender differences were evident for mental health issues, with boys less able to talk with their peers or service providers about stress and depression than girls. These gender differences were evident among adolescents in both rural and urban areas, but the ethos of a self-reliant male who does not ask for help was more evident among rural boys. CONCLUSIONS: While Australian rural and urban youth shared many health concerns, rural-urban differences were striking in the almost exclusive reporting of youth suicide and teenage pregnancy by rural adolescents. The findings suggest that structural disadvantage in rural areas (limited educational, employment opportunities, and recreational facilities) impact adversely on health outcomes, particularly mental health outcomes, and contribute to risk-taking behaviour. Such disadvantages should be considered by health-service policy makers and providers to redress the imbalance. Gender differences were also evident and efforts to target the specific needs of Australian adolescent boys are warranted.

Journal Article↗

PubMed1992

Ethnography as narrative discourse: community integration of people with developmental disabilities.

Quality of life is recognized as a critical variable in community integration of people with developmental disabilities. A major concern expressed in the literature is to establish a measure of congruence between the perception and experiences of these people and their social environment. In response to this concern, this study presents a framework of analysis based on ethnography as narrative of the old and the new. The old narrative is that of segregation, leading to confined form of space and time. The new narrative is that of interdependence achieved through cyclical form of space and time. It is argued that community integration of people with developmental disabilities has taken place in relation to linear form of time and space, perpetuating the old narrative of isolation and segregation. The new narrative of interdependence requires the accommodation of differences by the non-disabled. The quality of life for people with disabilities is then a function of accommodation of differences.

Adult↗

PubMed1991

Comparative investigation of c-erbB2/neu expression in head and neck tumors and mammary cancer.

Normal tissues, primary tumors, and metastases of mammary and salivary glands and oral/laryngeal mucosa have been analyzed with Northern-blots employing 32P-labeled RNA probes for the expression of the neu oncogene. Neu oncogene expression of a mRNA species of 4.6 kilobases was found in all normal salivary (five) and mammary glands (four) as well as in two normal or inflamed samples of tongue mucosa. This expression was regarded as baseline activity of the neu gene for the respective tissues and was used as standard for the evaluation of benign and malignant tumors. None of 14 squamous cell carcinomas of the oral and laryngeal mucosa showed enhanced neu transcription level. Five fibroadenomas, one benign variant of phylloid tumor, one carcinosarcoma, and one of two proliferative fibrocystic diseases of the breast showed lacking or normal baseline expression of the neu oncogene, as did one monomorphous cystadenolymphoma of the parotid gland. In contrast, four parotid pleomorphic adenomas and one salivary gland adenocarcinoma showed enhanced neu expression. For mammary adenocarcinomas, increased neu oncogene expression concerned ten of 34 cases--all being variants of ductal carcinomas--and all metastases analyzed (six) deriving from three primaries. One adenoid cystic carcinoma also showed enhanced neu expression. Neu overexpression may reflect accidents of genomic reconstitutional events occurring regularly within the differentiation pathway of epithelial/myoepithelial cells. This assumption was supported by further immunohistochemical analysis which showed stainings of myoepithelial and myoepithelia-like cell populations in tumors, especially pleomorphic adenomas and adjacent normal-looking tissues.

Adolescent↗

PubMed1995

AIDS patients' perceptions of nursing care quality.

The authors propose a model, adapted from literature on quality in health care and services marketing, that identifies dimensions of quality in nursing care for persons with AIDS. In focus groups, respondents expressed concern about structural factors such as formal hospital practices, and process factors, which include nurses' knowledge of AIDS treatment and issues, their use of universal precautions, discrimination issues, expressions of empathy, and provision of health status information to the patient.

Acquired Immunodeficiency Syndrome↗

PubMed2001

The possible effects on health, comfort and safety of aircraft cabin environments.

A consultation was undertaken to investigate the views and concerns of stakeholders in the aircraft industry about the possible harmful effects on personal health, comfort and safety of aircraft cabin environments. Stakeholders were identified from a variety of sources including Government agencies, the Internet, House of Lords inquiry, and suggestions of interviewees. They represented: aircraft crews, aircraft constructors and engineers, government departments and authorities, holiday/flight companies, insurance companies, non-governmental organisations, occupational health physicians, passenger representatives, and independent researchers and consultants. Eighty-seven were contacted of which 57 were interviewed over the telephone using a semi-structured questionnaire. Their concerns were transcribed into a standard format and analysed qualitatively. Key stakeholders, along with Government officials, were invited to a workshop to discuss and prioritize the issues raised during the interviews. The main concerns expressed by the participants fell into five main areas: deep vein thrombosis, air quality, infection, cosmic radiation, and jet lag and work patterns. In addition, a number of safety concerns were raised as well as comments on the provision of appropriate advice to passengers. It was generally felt that further research was required on each of these subjects, as well as an improvement in the quality, quantity and availability of information provided for passengers prior to boarding a flight.

Air Pollution, Indoor↗

PubMed1998

The use of specialist palliative care services by patients with human immunodeficiency virus-related illness in the Yorkshire Deanery of the northern and Yorkshire region.

To examine the use of palliative care services by patients affected by human immunodeficiency virus (HIV) in hospices which do not specialize in the care of HIV patients, a tape-recorded, semistructured interview was carried out in 12 hospices in the UK. The interview explored concerns about such provision, as well as actual issues encountered. The study revealed that all 12 hospices accepted referrals for people affected by HIV and had clear working practices on infection control. between 1990 and 1996, 48 individuals affected by HIV had contact with the hospices. The number of referrals was not related to the size of the hospice. Thirty-nine individuals had a total of 655 days of inpatient care (range 1-35 days); mean length of stay 12.7 days. Twenty-four (62%) died during their first admission. Referrals came from disparate sources and this affected the amount and type of specialist HIV support available to the hospice. The paucity of referrals raised concerns in most of the units as to how to maintain skills. Issues about maintaining confidentiality of diagnosis in a multiprofessional team, and after death were highlighted. All units expressed concerns about the impact on fundraising of HIV-related admissions. Overall it was felt that the hospice units were failing to meet the palliative care needs of the majority of people affected by HIV or acquired immunodeficiency syndrome (AIDS) in the region. Possible reasons for this are given.

Advance Directives↗

PubMed1980

Family emotional health: a survey of family practice patients.

As a step toward defining psychosocial areas in which resident training in family medicine is needed, this study assessed the concerns patients had about the emotional health of their families. A questionnaire was developed to survey the patient concerns (ie, worries or perceived problems) for the developmental, psychological, and social functioning of their families. Patients in three family practice settings were administered the questionnaire while waiting for their appointments. Sixty-four percent of the patients perceived one or more areas of concern in their families. Close to half (48.9 percent) had concerns about themselves. Concerns about the emotional well-being of spouses were identified by 39.5 percent of those having spouses, and for children, 38.2 percent of those having children. Also, 39.7 percent expressed concern about their parents' emotional health. Further, while only 3.5 percent of the patients were given a psychiatric diagnosis, 26.5 percent of the charts contained notes revealing psychosocial problems at some patient visit. The results point to a major need for family physicians to develop skills in child, adult, and family evaluation of psychosocial functioning.

Adult↗

PubMed2006

Studies of multiple sclerosis in communities concerned about environmental exposures.

Multiple sclerosis (MS) is an autoimmune disease that differentially affects women, people 30-60 years old, and Caucasians. Evidence indicates that it is a complex disease determined by both environmental factors and genetic susceptibility. People across the United States have expressed concern about perceived clusters of MS in their communities and the role of environmental exposures in the development of the disease. The Agency for Toxic Substances and Disease Registry (ATSDR) has funded several studies to address this issue, including a cluster investigation, several prevalence studies, and a case-control study. The cluster investigation illustrated that there are few data regarding the number of individuals with MS in the United States. Prevalence studies were conducted in Ohio, Missouri, and Texas to address this deficiency. The results support a regional difference in MS prevalence, although the reason for this difference is unclear. The results also underscore the need for additional epidemiological information about the distribution of MS in other areas of the United States and information on the underlying etiology of the disease. A case-control study is currently being conducted to examine potential risk factors for MS, including the role of environmental exposures and genetic susceptibility. Future research on MS should focus on large-scale studies and include collaboration among researchers with varied fields of expertise, such as epidemiology, neurology, and genetics.

Adult↗

PubMed1989

The developmentally disabled elderly: concerns of service providers.

We examined the availability of services for the developmentally disabled elderly and the concerns expressed by the service provider. We compared agencies which traditionally served individuals with developmental disabilities versus those serving the elderly populations. Although both types of agencies recognized the need for services, concern was raised as to who would provide them and how the two groups would blend.

Aged↗

PubMedDate not supplied

Domains of nursing intervention after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation.

PURPOSE: The purpose of the study was to explore individual and family experiences after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation during the first year of recovery. This report specifically addresses the domains of concern expressed and helpful strategies used by participants that are relevant to the development of future intervention programs. DESIGN: A grounded theory approach was used to gain an understanding of areas of concern of sudden cardiac arrest survivors and families that could be used when designing future nursing interventions. Semistructured interviews were conducted with both sudden cardiac arrest survivors and 1 family member each at 5 points during the first year of recovery (hospitalization; 1, 3, 6, and 12 months after hospitalization). Participants were asked to identify those specific areas that most concerned them and that they would like assistance with during the first year. A total of 150 interviews were conducted with 176 hours of data generated. SETTING: The study focused on 10 northwest urban community medical centers and participants' homes within a 50-mile driving distance from the medical centers. SAMPLE: The sample included 15 first-time sudden cardiac arrest survivors (13 men and 2 women) and 1 family member each between the ages of 31 and 72 years. RESULTS: Domains of concern identified by participants that can be used to design future nursing intervention programs included preventive care, dealing with automatic internal cardioverter defibrillator shocks, emotional challenges, physical changes, activities of daily living, partner relationships, and dealing with health care providers. Suggestions of helpful strategies used by participants during the first year are outlined. IMPLICATIONS: Domains of concern and helpful strategies identified by participants provide a framework for the development and testing of nursing intervention programs to enhance recovery following sudden cardiac arrest for survivors and their families.

Activities of Daily Living↗

PubMed1998

Operation Red Box: a pilot project of needle and syringe drop boxes for injection drug users in East Baltimore.

We assessed the acceptability and the use of a community-based needle and syringe disposal project designed to serve injection drug users. In June 1996, three surplus U.S. mail collection boxes were painted red and used as syringe and needle drop boxes in locations with high drug use in East Baltimore. Acceptance of the drop boxes was measured by focus groups of residents, drug users, and police, held before and after project implementation. Use was measured by weekly counts of needles recovered from the red boxes. A sample of all deposited needles was randomly chosen for needle washing and subsequent HIV antibody testing. Community impact was measured by systematic surveys of needles discarded on public sidewalks, in areas with and areas without drop boxes. Before implementation, members of focus groups expressed concerns that drop boxes could convey mixed messages to youth (e.g., seeming to condone drug use), might result in increased loitering, and could further community stigmatization. After project implementation, all focus groups expressed support of project expansion. In the first 10 months, 2971 needles were collected. Of 156 needles tested, 10.9% were positive for HIV antibody. Needle counts on the street showed no significant change in red box areas compared with control areas. In this pilot project, red boxes were accepted by the community and drug users. Police officers also used the boxes to dispose of confiscated needles. Although limited in the number of drop boxes and follow-up time, this pilot project shows promise as a community-based method of safe needle disposal.

Adolescent↗

PubMed1997

Not in our back yard: media coverage of community opposition to mobile phone towers--an application of Sandman's outrage model of risk perception.

Australia has the world's second highest per capita use of mobile phones. To meet rapid expansion in use, transmission towers are being erected hastily, backed by federal government exemptions from normal local government planning procedures. In a case study of media reportage of a successful resident protest about the placement of transmitters adjacent to a kindergarten, uncertain risks to health were the ostensible concerns voiced by the protesters. Eleven of the 12 primary components and six out of eight secondary components of Sandman's model of community risk perception were consistent with both the protesters' expressed concerns about the transmission towers and the way in which the issues involved were framed by the media.

Attitude↗

PubMed1994

Meningococcal disease in New Zealand: an audit of disease notification and contact management.

AIMS: To determine variations in practice across New Zealand for the notification and contact management of meningococcal disease and recommend action. METHODS: A retrospective survey using a questionnaire conducted during August and September 1992. The disease notification component of the audit looked only at process (post notification) rather than completeness of notification. RESULTS: The results indicated that there was considerable variation in practice across the country. Concerns expressed by respondents related to the availability of and payment for prescribed prophylactic antibiotics, contact definition, protocol availability and the appropriate delegation of duties. Deficiencies were identified in the above areas of concern as well as in follow-up procedures for contacts, record keeping and communication. CONCLUSIONS: Major variations in practice across the country which may be counterproductive to outbreak control should be minimised. A minority of area health boards (AHBs) and districts have well developed protocols that could be the basis for developing standards of good practice for the whole country.

Aftercare↗

PubMed1979

Reentry concerns of incarcerated substance abusers.

To facilitate planning of a state-wide reentry program for parolees with histories of drug and alcohol abuse, group interviews were conducted to determine the perceived problems and reentry service needs of 110 male and female inmates of Oregon correctional institutions. Expressed concerns about problems related to frustrations of prison experience, familial and peer relationships, parole supervision, and day-to-day survival skills point to significant gaps and biases in existing reentry services planned from an "objective" viewpoint that slights direct assessment of potential clients' needs.

Adult↗