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PubMed2006

Perceived insufficient milk as a barrier to optimal infant feeding: examples from Bolivia.

In its recently adopted Global Strategy on Infant and Young Child Feeding, the World Health Assembly called for urgent action in addressing the barriers to optimal feeding practices. This paper examines mothers' concerns about milk insufficiency as a major contributor to suboptimal infant feeding decisions, using survey data from peri-urban areas of two Bolivian cities. Mothers in the lowland modernizing city of Santa Cruz were more likely than mothers in the highland traditional city of Cochabamba to express concern about insufficient milk, and also less likely to feed their infants according to international recommendations. Furthermore, perceived milk insufficiency was particularly common among mothers of infants younger than 6 months of age -- an age at which infants are particularly vulnerable to the adverse effects of breast-feeding cessation and complementary feeding initiation. The paper concludes with policy, programme and research recommendations to address the critical problem of perceived insufficient breast milk.

Adult↗

PubMed2000

Willingness to participate in HIV-1 vaccine trials among young Thai men.

OBJECTIVES: Willingness to participate in HIV-1 vaccine trials and associated factors were investigated in a sample of 2670 Royal Thai Army conscripted recruits. METHODS: Self administered questionnaires were used. Data were collected during the final visit of a longitudinal cohort study of HIV-1 epidemiology. Cross sectional analysis of data from this visit was performed. RESULTS: 32% of the respondents reported they would "definitely" join an HIV-1 vaccine trial. Greater willingness was associated with perceived risk of HIV-1 infection and a desire to help Thai society, although tangible incentives and intentions to reduce condom use in a vaccine trial also were associated with increased willingness. Concerns about physical harm and anticipated social pressure from family not to join were the most substantial impediments to willingness. Concerns about "social harm" (for example, participation would give appearance of having AIDS virus, a partner might refuse sex) also appeared to inhibit interest in joining trials and approached significance. CONCLUSIONS: Willingness to participate was somewhat greater than in other investigations of non-injection drug user (IDU) cohorts in Thailand, with fewer concerns expressed about physical harm. Motivations appear to involve tradeoffs among perceived risk, anticipated social pressure, altruism, and tangible rewards. The absence of significant problems associated with vaccine trials to date, along with the presence of educational interventions in the study may help explain the lower level of concerns here relative to other Thai studies.

AIDS Vaccines↗

PubMedDate not supplied

Professional skills, concerns, and perceived importance of work with families in early intervention.

Innovations brought about by Public Law 99-457 require early intervention personnel to expand their work practices to involve and support families in the provision of early intervention services. To support training needs in this area, and to understand possible barriers to change, this study examined the extent to which 142 early interventionists from two states felt competent in working with families, valued family roles, and were concerned about changing to family-centered practices. Relationships among these characteristics and experience, discipline, and job category were explored. In general, nurses and social workers scored higher than did educators and other health-care professionals on several dimensions of family-centered care. Many professionals expressed concerns about collaboration.

Persons with Disabilities↗

PubMedDate not supplied

The use of stratefied sampling of blend and dosage units to demonstrate adequacy of mix for powder blends.

In response to concerns expressed by applicants regarding inconsistent policies in establishing blend uniformity acceptance criteria to demonstrate adequacy of mix, the FDA Office of Generic Drugs (OGD) issued the draft document Guidance for Industry, ANDAs: Blend Uniformity Analysis (August 1999). Both generic and innovator pharmaceutical companies raised a number of concerns following the publication of this document. As a result, the Product Quality Research Institute (PQRI) Blend Uniformity Working Group (BUWG) was established in February 2000. One of the primary goals of this group was to draft a scientifically based alternative to the OGD document. The resulting recommendation addresses both FDA and industry concerns by substantially enhancing product quality assurance without increasing regulatory burden. The PQRI BUWG recommends that these blend and dosage unit uniformity requirements be administered uniformly throughout the industry. PQRI submitted the following recommendation to the FDA on December 31, 2002, providing the Agency with an alternative strategy to consider when drafting future regulatory policy to assess blend and dosage unit uniformity.

Chemistry, Pharmaceutical↗

PubMed2006

Providing advanced degrees in dental hygiene via computer mediated distance learning: a model program.

A chief concern regarding distance education for the health professions is quality of the experience. Distance education has the potential for expanding student access, providing individualized instruction, and promoting active learning among geographically separated members of learning groups. Students and professors who have participated in distance learning platforms have expressed concerns about technical problems, inability to interact in real time with each other, and other frustrations related to this type of delivery. The Dental Hygiene program at the University of Missouri-Kansas City (UMKC) has addressed these issues and enhanced an already successful program by putting the professor, a technologist, and the student in the same space, at the same time, in real time. This enhancement has substantiated the ability of distance education to provide instruction among geographically separated members of learning groups, making it a plausible solution to the shortage of educators in healthcare professions.

Computer-Assisted Instruction↗

PubMed2004

Barriers to caregiver administration of pain medication in hospice care.

Barriers to adequate pain management in hospice and palliative care settings are an important area of investigation. In this study, a Caregiver Pain Medicine Questionnaire (CPMQ) was developed and psychometrically tested. The CPMQ is a 22-item self-report instrument that measures concern about reporting pain, concern about administering analgesics, and difficulty administering analgesics. One hundred fifty-one caregivers of patients admitted to three Chicagoland hospice agencies participated; these individuals were family members, hired caregivers in the home, or staff nurses in skilled care facilities. While only a small percentage of the caregivers expressed concern about communicating information about the patient's pain, more than a quarter were concerned about addiction, tolerance, and side effects from medications. A fourth of the caregivers had difficulty administering medications because of fear of doing something wrong and difficulty deciding which or what amount of medications to give. Male caregivers and hired caregivers had greater concerns, both about reporting information about the patient's pain and administering medications. Greater concerns were also evident among less educated caregivers, caregivers who worked in blue-collar jobs, and caregivers who were homemakers or retired. Concerns of caregivers in the home were significantly greater than staff nurse caregivers in skilled care facilities only in the belief that pain could not be controlled and concern about addiction. Caregivers who had greater concern about addiction and tolerance, and more difficulty administering medications, rated the patient's pain as less completely controlled. These findings remind hospice staff members of the importance of assessing specific caregiver concerns about medication administration and devising appropriate strategies to address them.

Adult↗

PubMed2004

Adolescent and parent assessments of diabetes mellitus management at school.

This study explored opinions, concerns, and recommendations regarding care of Type 1 diabetes in schools. Thirty adolescent females and their parents participated in semi- structured, individual interviews that were audiotaped, transcribed, coded, and qualitatively analyzed. Responses emerged in three categories: knowledge/training of school staff; foods offered/available at school; and school rules. Participants expressed concerns that school personnel, particularly classroom teachers, possess limited knowledge of diabetes; that healthy food/beverage options are limited in the cafeteria, vending machines, and classrooms; and that school rules impede self-care of diabetes. Implications for enhancing diabetes management at school are noted.

Adaptation, Psychological↗

PubMed1983

A survey of attitudes concerning contraception and the resolution of teenage pregnancy.

This study reports the results of a survey of 498 respondents in a large midwestern community concerning their attitudes toward making contraceptive services available to teenagers and the manner in which a teenage pregnancy should be resolved. The results indicated that the large majority of respondents approved of the practice of making contraceptives available to teenagers but there were also significant differences in attitudes expressed which were dependent upon demographic characteristics of the respondent. There was also considerable variability in the attitudes expressed concerning the resolution of a teenage pregnancy. The preferred method of resolution depended again on the demographic characteristics of the respondent. Keeping the baby and placing the baby for adoption were the most frequent choices. These results are discussed with relation to the present strong political conservative movement in the nation.

Abortion, Induced↗

PubMed1997

Tetrahydrobiopterin, nitric oxide and regulation of cerebral arterial tone.

Tetrahydrobiopterin is an essential cofactor required for activity of nitric oxide synthases. Existing evidence suggests that, during activation of constitutive and inducible isoforms of nitric oxide synthase, tetrahydrobiopterin is needed for allosteric and redox activation of enzymatic activity. However, precise mechanisms underlying the role of tetrahydrobiopterin in regulation of nitric oxide formation is not fully understood. In cerebral and peripheral arteries, increased availability of tetrahydrobiopterin can augment production of nitric oxide. In contrast, in arteries depleted of tetrahydrobiopterin, production of nitric oxide is impaired. Proinflammatory cytokines enhance mRNA expression of the rate-limiting enzyme of tetrahydrobiopterin biosynthesis, GTP cyclohydrolase I and stimulate production of tetrahydrobiopterin. The ability of vascular tissues to synthesize tetrahydrobiopterin plays an important role in regulation of nitric oxide synthase under physiological conditions as well as during inflammation and sepsis. More recent studies concerning expression and function of recombinant nitric oxide synthases suggest that availability of tetrahydrobiopterin is important for production of nitric oxide in genetically engineered blood vessels. In this review, mechanisms regulating availability of intracellular tetrahydrobiopterin and its role in control of vascular tone under physiological and pathological conditions will be discussed.

Animals↗

PubMed2001

A qualitative study of subject recruitment for familial cancer research.

PURPOSE: Familial epidemiological studies of cancer raise familiar ethical issues relating to informed consent and recruitment of participants. When the family is the unit of study, however, additional complexity arises. Educating and recruiting participants must be tailored to the relatives', as well as the proband's needs. An understanding of the prospective participants' concerns will aid the development of strategies for recruitment and will facilitate informed and voluntary consent. In the present study, qualitative methods were used to investigate these issues. METHODS: Focus groups with cancer patients, relatives of cancer patients, and individuals from the general population were separately conducted to identify issues that concern people who are asked to participate in family studies. RESULTS: Many of the issues which arose in the course of the focus group discussions were similar to those in any study. Yet, some of the themes emerging from the discussions were specific to familial research. In particular, participants expressed that the study should be endorsed by a trusted and familiar source; group discussions might facilitate the consent process; the benefit of the research should be clear and personal, as well as benefit the participants' family members; risks of participation should be explicit (e.g., insurance discrimination); and education about the disease and its familial nature would maintain commitment to the study. Finally, participants expressed concerns about being approached by programs to facilitate the identification and recruitment of other family members for research on family health issues. CONCLUSIONS: Findings from this study will aid future familial studies in developing a protocol that both adequately informs potential participants of the nature of familial research and maximize participation.

Adult↗

PubMed2004

Smoking prevalence and knowledge of associated risks in adult attenders at day centres for people with learning disabilities.

BACKGROUND: Increased longevity among people with learning disabilities is accompanied by an increase in morbidity. A possible explanation is that living in the community and a move to greater independence may bring higher health risks through obesity and smoking. The study aimed to see if rates of smoking have increased from earlier published rates and to ascertain the awareness of the risks of smoking among people with learning disabilities. METHODS: A total of 435 people attending four social services day centres in a large urban area were assisted to complete a questionnaire. RESULTS: Twenty-seven (6.2%) reported that they currently smoked. Those with mild disabilities were much more likely to smoke than those with more severe disabilities and they also reported smoking more heavily. For those with mild levels of learning disability, a higher than expected proportion living in hospital and staffed housing smoked, a lower proportion living with parents smoked but for those living independently the proportion who smoked was no higher than expected. Smokers were more knowledgeable about the risks than non-smokers even if the level of learning disability was controlled for. Only a third of smokers were concerned about the risks. CONCLUSIONS: The study provides no evidence that rates of smoking are increasing among people with learning disabilities nor that those living independently were more likely to smoke. Knowledge of health risks is poor across the group, but higher among the smokers who were unlikely to express concern about the risks. This may indicate that more support may be needed along with health education in this group.

Adult↗

PubMed2002

Menopausal treatment dilemma: a challenge for women and nurses.

An important goal of nursing research in women's health is to develop knowledge and identify interventions that strive to promote, maintain, and enhance well-beingfor women. A new emphasis on the quality of life, health promotion, and cost-effective delivery modes has opened the door to nontraditional approachesfor a myriad of disease conditions. As women look to their healthcare providers for information regarding treatments for uncomfortable menopausal symptomatology, inconclusive and contradictory information has added to the confusion concerning hormone replacement therapy (HRT). A woman who has declined traditional treatments for menopausal symptomatology may resort to alternative therapies to meet her healthcare needs. As alternative therapies can be wide-ranging, the woman may seek information from healthcare providers regarding these therapies. Sensitivity to the woman's expressed concerns and knowledge of various traditional and alternative treatment modalities is essential in providing individualized wholistic care. This article reviews the literature and concludes care of perimenopausal/menopausal women who decline, traditional hormone replacement therapy for uncomfortable menopausal symptomatology and seek alternative treatments has received insufficient attention by the medical and nursing profession.

Attitude to Health↗

PubMed1992

Self-perceived information needs and concerns of elderly persons.

The research was intended to identify the dimensions underlying self-perceived information needs and concerns of an elderly population. The spontaneously mentioned needs and concerns expressed in 271 letters from a sample of the population were extracted and a multidimensional scaling procedure was used to represent the 58 most frequently mentioned items in configurations of varying dimensionality. To interpret the multidimensional spaces, another sample of 176 elderly subjects was asked to rate the 58 concerns on eight properties. These ratings were then regressed onto the multidimensional configurations. The results indicate that the most frequently mentioned information needs and concerns of elderly persons can be parsimoniously understood in terms of three underlying dimensions: (1) Improving the Quality of Life vs Securing the Necessities of Life, (2) Health-related vs Not Health-related, and (3) Individual vs Societal Responsibility.

Activities of Daily Living↗

PubMed1991

Sexual counseling with a developmentally disabled couple: a case study.

This article describes the process of sexual counseling with a developmentally disabled couple, illustrating principles and techniques that were unique to this couple's concern. The author asserts that this aspect of a marital relationship should not be denied a couple simply because they are handicapped. Her intent is to help nurses understand some of the issues involved in sexual counseling with developmentally disabled persons, and to motivate nurses to help those who may express concerns.

Female↗

PubMed2006

Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study.

OBJECTIVE: To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN: Exploratory qualitative study using in depth interviews. SETTING: Hospital outpatient clinic in West London. PARTICIPANTS: Nineteen patients with moderate to severe asthma (12 "attenders" and 7 "non-attenders"). RESULTS: Patients' main reasons for attending were the wish to improve control over asthma symptoms and a concern not to jeopardise the valued relationship with their doctor. Memory lapses, poor health, and disillusionment with the structure of outpatient care were important factors implicated in non-attendance. The patients were generally sceptical about the suggestion that greater opportunity for telephone consulting might improve access to care. They expressed concerns about the difficulties in effectively communicating through non-face to face media and were worried that clinicians would not be in a position to perform an adequate physical examination over the telephone. Email and text messaging were viewed as potentially useful for sending appointment reminders and sharing clinical information but were not considered to be acceptable alternatives to the face to face clinic encounter. CONCLUSIONS: Memory lapses, impaired mobility due to poor health, and frustration with outpatient clinic organisation resulting in long waiting times and discontinuity of care are factors that deter patients from attending for hospital asthma assessments. The idea of telephone review assessments was viewed with scepticism by most study subjects. Particular attention should be given to explaining to patients the benefits of telephone consultations, and to seeking their views as to whether they would like to try them out before replacing face to face consultations with them. Email and text messaging may have a role in issuing reminders about imminent appointments.

Adult↗

PubMed1985

The role of the consumer in quality assurance.

At present, then, consumer-related concerns can be viewed as being in two categories. The first consists of those persons already within the dental care delivery system who, overall, are satisfied with the care they are receiving and tend to hold their dentists, and the profession as a whole, in high esteem. This group does express concern about the technical quality of the services provided to them but also recognizes that their ability to adequately judge this aspect of care without professional assistance is limited. Greater consumer input, however, is being sought in participation in treatment-planning decisions and in choices available to them. Similarly, patients are looking to their dental providers to show greater concern for their needs as individuals: their financial, emotional, language, family, and related health needs. In general, dentists are responding to these demands both out of genuine concern that their patients receive the best care under the most caring circumstances and out of economic necessity. In both traditional practices and in emerging group-practice arrangements, consumer input is being sought, both informally and in more structured arrangements such as the inclusion of consumer representatives in prepaid dental programs. Although there will, understandably, always be tensions in the relationship between consumer expectations and the actual state-of-the-art that determines to which level the provider can actually provide, the dental profession can pride itself in being most demanding on itself to meet the needs of the people we serve. In the latter category, that of persons at present not receiving dental care, we currently find an adversary relationship between professional and consumer groups. Differences exist not only in perceived solutions, but to the actual extent of the problems. Consumer demands that informed choice should include their ability to utilize nondental health providers for dental care, further serve to antagonize and alienate even those leaders of the profession who also seek to expand services to previously unserved or underserved population groups. Is the relationship between the profession and the underserved community and their spokespersons destined to be one of antagonism? If we accept the data that of those persons who do not seek dental care, 65 per cent simply "do not feel a need to do so," there would appear to be a mutuality of interest between the profession and consumer groups to mount a suitable outreach or educational program to reach this particular population group.(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude of Health Personnel↗

PubMed2002

Parent and physician attitudes regarding electronic communication in pediatric practices.

OBJECTIVE: To determine 1) the electronic mail (e-mail) capabilities of families, general pediatricians (GPs), and subspecialty pediatricians (SPs) from an integrated pediatric health care delivery system and 2) the knowledge base and attitudes of these groups regarding the potential issues involved in using e-mail for physician-patient communication. METHODS: Parents were interviewed in the offices of participating practices using a standardized survey tool. Pediatricians and staff were interviewed using a separate instrument. The data were entered into a database for analysis. RESULTS: A total of 325 parents and 37 physicians were interviewed. Fifty-seven percent of the 161 parents who were interviewed at the GP offices and 66% of the 164 families that were interviewed at SP offices had access to e-mail. Parents aged 31 to 40 years were significantly more likely to have access to e-mail than parents of other age groups. Access to e-mail increased with family income and parental education. Most (74%) parents who were interviewed expressed interest in using e-mail to contact their child's physician/physician's office for several purposes, including getting information or test results, scheduling appointments, and/or discussing a particular symptom. Although both groups of parents expressed concerns about confidentiality, parents at the GP offices were significantly more concerned (median(GP) = 95 vs median(SP) = 70). Seventy-four percent of GPs and 100% of SPs had access to e-mail; however, 79% did not want to use e-mail for physician-patient communication, citing concerns about confidentiality and the time demands that patient e-mail might engender. CONCLUSIONS: The majority of parents and pediatricians at both general and subspecialty pediatric offices are capable of communicating electronically. Parents and pediatricians are aware of the issues surrounding e-mail use for patient communication. Most parents express an interest in using e-mail for patient-physician communications, whereas most physicians are opposed to this practice.

Adolescent↗

PubMed1998

Women's perceptions and concerns about menopause.

The purpose of this study was to explore the following questions: What are the perceptions of midlife women as to the care they receive from a variety of healthcare providers? What are the issues and concerns that influence their decision making about hormonal therapy? What strategies do women find helpful in accommodating to menopause? What are the knowledge and perceptions/role of the partner during the menopause transition? The research design for this study used a nonrandom survey. The nonrandom convenience sample consisted of 320 midlife women 46-55 years of age. Data were gathered via a mailed self-administered Menopause Questionnaire. Descriptive statistics were used to analyze the survey data. Qualitative data revealed more in-depth and personal comments from women concerning menopause. The most significant findings were that respondents (1) were in conflict about hormone therapy (HT), yet they had read extensively about menopause and used a variety of strategies to cope with symptoms; (2) reported that they received conflicting information and advice about menopause from a variety of sources and expressed concerns about not being fully informed by their healthcare providers; and (3) who received care from nurse practitioners (NPs) were quite satisfied with their care.

Attitude to Health↗