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PubMed2001

The acceptability of the female condom: perspectives of family planning providers in New York City, South Africa, and Nigeria.

This article seeks to fill the gap in female condom acceptability research by examining family planning (FP) providers' attitudes and experiences regarding the female condom in three countries (South Africa, the US, and Nigeria) to highlight providers' potential integral role in the introduction of the female condom. The case studies used data drawn from three independent projects, each of which was designed to study or to change FP providers' attitudes and practices in relation to the female condom. The case study for New York City used data from semistructured interviews with providers in one FP consortium in which no special female condom training had been undertaken. The data from South Africa were drawn from transcripts and observations of a female condom training program and from interviews conducted in preparation for the training. The Nigerian study used observations of client visits before and after providers were trained concerning the female condom. In New York City, providers were skeptical about the contraceptive efficacy of the female condom, with only 8 of 22 providers (36%) reporting they would recommend it as a primary contraceptive. In South Africa, providers who had practiced insertion of the female condom as part of their training expressed concern about its physical appearance and effects on sexual pleasure. However, they also saw the female condom as a tool to empower clients to increase their capacity for self-protection. Structured observations of providers' counseling interactions with clients following training indicated that Nigerian providers discussed the female condom with clients in 80% of the visits observed. Despite the lack of a uniform methodology, the three case studies illuminate various dimensions of FP providers' perceptions of the acceptability of the female condom. FP providers must be viewed as a critical factor in female condom acceptability, uptake, and continued use. Designing training programs and other interventions that address sources of provider resistance and enhance providers' skills in teaching female condom negotiation strategies may help to increase clients' use of the female condom.

Attitude of Health Personnel↗

PubMed1995

Zidovudine adherence among individuals with HIV infection.

The objective was to investigate the relationships among health beliefs, attitudes, and zidovudine compliance in individuals with HIV infection. A survey was administered to 52 individuals with HIV infection. The survey items, which reflected concerns expressed about zidovudine, were generated based on barriers to and benefits of zidovudine and the perceived susceptibility to and perceived severity of HIV as described by the health belief model (HBM). These items were expressed as attitudes and beliefs. Items were subjected to factor analysis, and survey results were correlated with laboratory data to predict adherence to their prescribed medication-taking regimen. Data indicated that 42.3% of the subjects were compliant with zidovudine. Factor analysis identified four dimensions: problems taking and scepticism about zidovudine; degree of concern about HIV; perceived severity of HIV; and physical barriers to taking zidovudine. Logistic regression analysis (forward conditional entry) identified those who were having problems taking zidovudine and who were sceptical about its effectiveness, and ethnicity as significant independent predictors of compliance, correctly classifying 75% of cases (p < 0.01). The fact that subjects who have problems taking zidovudine or are sceptical about the value of zidovudine are less compliant, and that this dimension is a significant predictor of compliance, suggests that non-compliance is related to attitudes and beliefs about zidovudine. This is consistent with the HBM, which holds that the balance between barriers and benefits of a health-related behaviour are significant determinants of outcome.

Adult↗

PubMed2001

Establishing process indicators for joint working in mental health: rationale and results from a national survey.

Effective joint working in mental health is a national concern as indicated by a series of governmental directives and initiatives aimed at improving practice in this area. Joint working is fundamental to the successful implementation of 'community care'. Many people, particularly the public, equate the introduction of the Community Care Act (Department of Health, 1990), with the beginning of community care as a social policy. In reality, however, community care has a much longer history in the UK involving the shift in the 1950s from providing care in the hospital to providing care in the community. Thus, one of the most obvious reasons for this concern expressed in the media and felt by the public is that 'community care' isn't working. While this is an important consideration, it is not the only explanation as to why joint working has come to occupy such a prominent position in the minds of health strategists and politicians. This paper explores our concern with joint working in mental health and proposes one way in which joint working can be effectively monitored and measured.

Community Mental Health Services↗

PubMed2003

Protecting research subjects under the waiver of informed consent for emergency research: experiences with efforts to inform the community.

STUDY OBJECTIVES: The US Food and Drug Administration (FDA) and Department of Health and Human Services created a method for obtaining a waiver of informed consent to permit research in emergency settings when patients are not competent. One of the requirements to obtain a waiver is public disclosure about the research. We describe approaches used to meet the public disclosure requirement. METHODS: We performed a qualitative content analysis of the FDA's repository for mandatory documentation of public disclosure efforts as of November 1999. Data from 4 studies were analyzed: 2 multi-institutional trials involving trauma and 2 smaller trials involving cardiac arrest. These efforts included both 1-way communications, such as announcements, and 2-way communications, such as focus groups and public meetings. Participation in and common concerns expressed during 2-way communications were noted, as was evidence of mechanisms of advance refusal and the collection of quantitative data on public opinion. RESULTS: One-way communications were the predominant method of disclosure. Many 2-way communications were not directed toward lay persons. Those that were often involved fewer than 15 participants. Concerns regarding inability to refuse study participation, racial biases affecting study design and execution, and ambiguity with regard to how community input would be used in study decision making were raised in several 2-way communications. A minority of participating hospitals announced mechanisms of advance refusal or collected quantitative data on public opinion concerning proposed research. CONCLUSION: Initial experience with obtaining a waiver of informed consent for emergency research suggests that community involvement and specific public concerns should be carefully considered in future applications for such a waiver.

Cardiopulmonary Resuscitation↗

PubMed2006

Evaluation of a hands-free wireless communication device in the perioperative environment.

The objective of this study was to evaluate the efficiency and reliability of a hands-free voice over Internet protocol (VOIP) communication system in the perioperative environment. Two surveys were administered to anesthesiologists and operating room (OR) nurses working at an academic medical center. Providers were queried by alphanumeric pages or VOIP queries during OR work shifts to measure communication response times. Providers, responding to the query, were asked to verbally complete a system performance survey to capture information regarding their workload and work environment at the time of the query. A user feedback survey was independently administered in writing to a convenience sample of OR providers to obtain information regarding provider communication preferences, concerns, and recommendations. OR providers responded to communication queries four times faster when using VOIP compared to alphanumeric pagers. Providers found VOIP to be much less reliable than conventional pager-telephone systems. Dead spots in the 802.11b network and errors in speaker recognition were frequently cited as sources of system failures. Providers also expressed concern in maintaining confidentiality of patient data or other clinical data communicated using this system. The results of this study suggest that VOIP is still a developing technology but one that is currently viable in the clinical setting. The technology can be used efficiently and securely in health care if users are given the proper training its functions and capabilities.

Anesthesiology↗

PubMed2004

Doctors' experience with handheld computers in clinical practice: qualitative study.

OBJECTIVE: To examine doctors' perspectives about their experiences with handheld computers in clinical practice. DESIGN: Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. SETTING: Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. PARTICIPANTS: 54 doctors who did or did not use handheld computers. RESULTS: Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. CONCLUSIONS: Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.

Attitude of Health Personnel↗

PubMedDate not supplied

Accuracy of teacher assessments of second-language students at risk for reading disability.

This study examined the accuracy of teacher assessments in screening for reading disabilities among students of English as a second language (ESL) and as a first language (L1). Academic and oral language tests were administered to 369 children (249 ESL, 120 L1) at the beginning of Grade 1 and at the end of Grade 2. Concurrently, 51 teachers nominated children at risk for reading failure and completed rating scales assessing academic and oral language skills. Scholastic records were reviewed for notation of concern or referral. The criterion measure was a standardized reading score based on phonological awareness, rapid naming, and word recognition. Results indicated that teacher rating scales and nominations had low sensitivity in identifying ESL and L1 students at risk for reading disability at the 1-year mark. Relative to other forms of screening, teacher-expressed concern had lower sensitivity. Finally, oral language proficiency contributed to misclassifications in the ESL group.

Child↗

PubMed1990

Concerns of families of children with learning disabilities.

The purpose of this report is to share the experiences and concerns of a group of parents of children with learning disabilities. Parents of eight different families were interviewed in depth, and seven themes emerged from the interviews. Parents discussed their involvement in their child's education, and their positive and negative experiences with school personnel as well as with seeking other sources of support. They expressed concerns about the social isolation and future well-being of their children with learning disabilities. They indicated many emotional strains from parenting children with learning disabilities, and that there are both positive and negative effects on the families. Implications for further research and practice are discussed.

Adolescent↗

PubMed2003

Training and supporting pharmacists to supply progestogen-only emergency contraception.

OBJECTIVE: To describe and evaluate the training and support provided to the first cohort of community pharmacists to supply progestogen-only emergency contraception (POEC) under a Patient Group Direction (PGD) in Lambeth, Southwark and Lewisham, London. DESIGN: The study comprised (a) a systematic analysis of written and oral data from pharmacists before and during training, and at 5 and 13-14 months after launch; (b) analysis of telephone calls to clinical support and (c) analysis of written pharmacy records. SUBJECTS: A total of 20/22 pharmacists in the first training cohort; 6/23 pharmacists who applied but were not accepted were also followed up. RESULTS: A formal course with role-play was a successful training method, and the course also served as a team-building exercise. Subsequent interviews demonstrated that pharmacists had understood the concept of client confidentiality and gained confidence over time in the use of the PGD. The on-call consultants received 152 calls in the first 12 months of the scheme. Over 80% of the calls concerned clinical criteria (notably including 22% that were queries about oral contraceptives). Frequency ranged from one to eight calls per week with 28% made at weekends. In over half (60%) of the calls the pharmacist was subsequently able to make a supply. Queries over client management resulted in several changes in the protocol. The primary expressed concern for all pharmacists at all time points was how clients might 'misuse' or 'abuse' the service, and this remained a concern despite the fact that it also applies to other routes of supply of POEC. However, the PGD cohort was more positive on local benefits than pharmacists who were not selected. CONCLUSIONS: Training and support have enabled this often-underused group of professionals to participate in an extended reproductive health service. Mobile phones are an essential support tool.

Cohort Studies↗

PubMed2004

General practitioners' concerns about childhood immunisation and suggestions for improving professional support and vaccine uptake.

In recent years childhood vaccination has been vigorously debated. Professional and parental confidence in the measles, mumps and rubella (MMR) vaccine in particular has been shaken, as reflected by its decreased uptake. A semi-structured postal questionnaire survey of general practitioners (GPs) working in the Highland region of Scotland was undertaken to assess their views on vaccination issues. A 73% response rate was achieved. Of respondents 28% expressed concerns about the possible side effects of MMR. Of GPs 98% thought it was 'likely' that the benefits of the DTP-Hib, polio and men C vaccines outweighed the possible risks. For the first and second doses of MMR 92% and 86%, respectively, believed this to be true. Approximately three quarters of GPs described themselves 'very confident' in discussing the DTP-Hib vaccine with parents, compared with 57% for MMR. Some respondents were misinformed regarding the adverse events associated with the MMR vaccine. There is professional concern about MMR. Initiatives to support GPs in promoting vaccination in order to improve immunisation rates are discussed.

Attitude of Health Personnel↗

PubMed1997

College students' knowledge and attitudes about cesarean birth.

BACKGROUND: Numerous clinicians and researchers have expressed concern about the necessity and potential adverse consequences of many cesarean births in the United States. The purpose of this study was to explore college students' attitudes and beliefs about cesarean section. METHODS: One hundred two college students (66% women) completed a 20-item questionnaire that asked if they viewed cesarean delivery as a potentially negative experience, as a normal or acceptable method of childbirth, and as medically necessary, and asked about their beliefs concerning risk and prevention of cesarean birth. RESULTS: The number of "undecided" responses in the study was striking (7.8% to 69.6% across the 20 items). In general, women and men responded similarly, although women were significantly more likely than men to say they would be profoundly disappointed if their babies had to be delivered by cesarean section. Despite expressing cynicism about the cesarean birth rate (40% agreed that many unnecessary cesarean births occurred) and not viewing the procedure as a normal way of giving birth (47%), most respondents (over 70%) disagreed that giving birth by cesarean would be a negative experience or would make a woman feel like a failure. CONCLUSION: A high level of uncertainty exists about certain aspects of cesarean birth among young women and men, highlighting the need for information for prospective parents. Most college students did not view the cesarean birth experience as either potentially negative or normal. Future research should explore coverage of cesarean birth in childbirth education classes and the roles physicians, nurses, and midwives play in preparing expectant parents for the possibility of cesarean delivery.

Adult↗

PubMed2005

Informed consent should be obtained from patients to use products (skin substitutes) and dressings containing biological material.

BACKGROUND: Biological products (tissue engineered skin, allograft and xenograft, and biological dressings) are widely used in the treatment of burns, chronic wounds, and other forms of acute injury. However, the religious and ethical issues, including consent, arising from their use have never been addressed in the medical literature. AIMS: This study was aimed to ascertain the views of religious leaders about the acceptability of biological products and to evaluate awareness among healthcare professionals about their constituents. METHODS: The religious groups that make up about 75% of the United Kingdom population were identified and a questionnaire on 11 biological products was sent to its leaders. Another questionnaire concerning 17 products (11 biological and 6 synthetic dressings) was sent to 100 healthcare professionals working in seven specialist units in the UK. RESULTS: All religious leaders (100% response rate) replied, some after consultation with international bodies. Among them, 77% said that patients should be informed of the constituents of the biological products and consent obtained. Some leaders expressed concerns about particular products including the transmission of viral and prion diseases, cruelty to animals, and material derived from neonates. None of the healthcare professionals (73% response rate) surveyed knew the constituents of all the products correctly. CONCLUSION: Ignoring religious sensitivities and neglecting consent in the usage of biological products could have very serious implications, including litigation. Hospitals and manufacturers should take immediate measures to enlighten healthcare professionals of the constituents of these products so that they can obtain informed consent from patients.

Attitude to Health↗

PubMed2002

Cancer patients who experienced diagnostic genetic testing for cancer susceptibility: reactions and behavior after the disclosure of a positive test result.

The aim of this prospective study was to evaluate the consequences of the disclosure of a positive genetic test result to patients affected with cancer. Personal repercussions and patients' behavior with the transmission of their results to relatives were considered. We conducted semistructured interviews with 23 cancer patients identified as carriers of a cancer-predisposing mutation for hereditary breast ovarian or nonpolyposis colorectal cancers, 1 month after the disclosure of the test result. Eight patients spontaneously expressed distressed reactions ("you no longer feel cured"), and 14 patients reported at least one negative feeling (dissatisfied, discouraged, unhappy, or worried), despite expecting to be a carrier. Sixteen patients expressed concerns about the risk of developing another cancer, and 18 were concerned for their children's future, in that they may carry the mutation and develop a cancer. Although 8 patients found that disadvantages of knowing their genetic status outweighed the advantages, all but 1 did not regret having undergone genetic testing. All of the patients transmitted their results to at least one close relative. Although 6 of them expressed difficulties in being the only person who could transmit the information and 9 said it was a heavy responsibility, all except 1 did not want someone else to have to inform their families. Our results illustrate the potential negative impact of diagnostic genetic testing in patients with cancer. This includes distressed reactions and difficulties in transmitting their results to relatives. Future large-scale studies are warranted to confirm our findings.

Adaptation, Psychological↗

PubMed2002

Expression of progastrin-releasing peptide and gastrin-releasing peptide receptor mRNA transcripts in tumor cells of patients with small cell lung cancer.

PURPOSE: Small cell lung cancer (SCLC) is a rapidly growing neoplasm accounting for approximately 20% of patients with lung cancer. Progastrin-releasing peptide (proGRP) is produced in about two-thirds of SCLC tumors and is used as a specific marker for SCLC. Although GRP is known to have a variety of biological functions, only limited information is available concerning expression of proGRP mRNA and protein, and that of the receptor for GRP (GRPR) in SCLC tumors. METHODS: In individuals with SCLC, the levels of serum proGRP(31-98) were measured by enzyme-linked immunosorbent assay. Expression of proGRP as well as GRPR mRNA in SCLC tumor tissues was investigated by reverse transcription-nested polymerase chain reaction (PCR) amplification. The proportions of alternatively spliced proGRP mRNA transcripts were analyzed in proGRP-producing tumors by nested and competitive PCR amplification. Finally, production of proGRP protein in SCLC tumor was evaluated by using immunohistochemical staining with a polyclonal human anti-proGRP antibody. RESULTS: ProGRP mRNA transcripts could be detected only in tumor tissues recovered from individuals with high serum proGRP levels. The proportions of mRNA subtypes in each case were nearly the same, revealing type I of 55.4+/-7.6%, type II with 21-b deletion of 1.8+/-3.6%, and type III with 19-b deletion of 42.8+/-4.3%, respectively. ProGRP protein production was demonstrated in tumor tissues exclusively from individuals exhibiting high serum proGRP levels. In contrast, GRPR mRNA transcripts were detectable in cancer cells from two of five proGRP-expressing tumor tissues. CONCLUSIONS: ProGRP mRNA expression is closely related with the synthesis of proGRP protein which is eventually released into the blood. It is suggested GRP may function as an autocrine growth factor for cancer cells in a subgroup of SCLC patients through, at least in part, upregulation of GRPR expression.

Adult↗

PubMedDate not supplied

Eating and body image concerns among obese and average-weight children.

Research compared obese and average-weight children with regard to concerns about being or becoming overweight, history of dieting, concerns about the effects of eating food, and perceived discrepancy between real and ideal body image. Participants included 526 obese and average-weight elementary-age school children to whom questionnaires were administered. Gender (male/female), obesity status (obese/average-weight), and grade level (lower elementary/upper elementary) were considered. Obese children were significantly more likely to engage in dieting behaviors, to express concern about their weight, to restrain their eating, and to exhibit more dissatisfaction with their body image than average-weight children. Girls were more likely to exhibit these behaviors than were boys. These findings suggest the importance of studying the emergence of disordered eating habits in childhood.

Adolescent↗

PubMed2003

Personnel reductions and structural changes in health care: work-life experiences of medical secretaries.

OBJECTIVE: To explore the experiential aspects of 'psychosocial stressors and motivators' for medical secretaries, following a period of personnel reductions and structural changes in Swedish health care. The focus was to understand and describe work-life experiences for this specific group of women and how they managed in what can be presumed to be a more demanding work situation. METHOD: A descriptive qualitative study with repeated in-depth interviews of six medical secretaries (mean age: 45 years) in a large hospital in Sweden. The first interview took place in the autumn of 1997 (in connection with the last round of the 20% staff redundancies), 1998 and 2000. Thematic content analysis from audiotaped and transcribed interviews was used to obtain understanding. RESULTS: The study provided three main themes from the women's perceived stressors, motivators and coping options. The descriptions of their stressors provided the metaphor, 'energy thieves' with three underlying subthemes: 'too much work,' 'lack of recognition' and 'the dilemma of health, family and finances.' Experienced motivators, labeled as 'energy givers' had two subthemes: 'professional pride' and 'the comprehensive whole.' The women's descriptions about managing increasing demands were thematized as altering between 'being submissive and taking actions' with three subthemes: 'unequal communication,' 'resigned and passive reactions' versus 'cautious and solution-oriented coping.' Expressions concerned mainly 'energy thieves,' inclusively worries about 'lacking energy' (intrinsic stressor), combined with passive and cautious coping behavior. However, the descriptions became somewhat more varied and balanced with enriching and solution oriented factors in the follow-up interviews. CONCLUSIONS: There is an evident contrast between a demanding reality of work, described by medical secretaries in this study, and their expressed desire to have a more reasonable work environment that allowed them to be able to complete their work. They also wanted to be heard regarding their requests about work options and decent salaries. This study demonstrates the importance of making feelings of inferiority and injustice visible as well as to support professional pride and more assertive coping behavior. This is also valid for the need to enhance equal/congruent communication between interdependent workers. The study has implications for managers and health workers supporting and empowering women, providing administrative service in a clinical health care context. The subthemes being identified within the metaphor 'energy thieves,' in relation to resigned/passive reactions and cautious coping styles, could be used in stress prevention, while the understanding of 'energy givers' and the support of active and solution-oriented coping conducts could be used in health promotion work.

Adaptation, Psychological↗

PubMed1998

Differential expression and function of PACAP and VIP receptors in four human colonic adenocarcinoma cell lines.

Human colonic adenocarcinoma cell lines have conserved several features of the native tissue. Among these is the expression of cell surface receptors for hormones and neurotransmitters that may be involved in the regulation of proliferation and differentiation processes in these cancer cells. Here, we confirm that high-affinity binding sites for the Vasoactive Intestinal Polypeptide (VIP) and for the VIP analogue Pituitary Adenylate-Cyclase Activating Polypeptide (PACAP), were expressed in 4 human colonic adenocarcinoma cell lines, HT29, SW403, DLD-1 and Caco-2, that spontaneously displayed variable phenotypic properties in culture. We demonstrated that after long-term treatments, VIP and PACAP significantly reduced cell proliferation in the 4 cell lines and modulated intracellular cAMP and cGMP levels. Furthermore, conspicuous differences were observed from one cell type to another concerning expression of the receptor subsets or the effects of the neuropeptides on cell growth and on cyclic nucleotides production.

Adenocarcinoma↗

PubMed2002

Career destinations and views in 1998 of the doctors who qualified in the United Kingdom in 1993.

OBJECTIVE: To report career destinations and views in 1998 of doctors who qualified in the United Kingdom (UK) in 1993. DESIGN: Postal questionnaire survey. SETTING: This study took place in the United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1993. MAIN OUTCOME MEASURES: The percentage of doctors in each branch of medicine five years after qualification, and their views on their training and career opportunities. RESULTS: The NHS and universities in the UK employed 88% of respondents (men 90%, women 86%). UK general practice employed 24% of respondents (men 19%, women 28%). There were significant differences (P < 0.01) between the percentages of men and women working in the surgical specialties (men 28%, women 10%), paediatrics (men 8%, women 15%) and obstetrics and gynaecology (men 5%, women 10%). Respondents not in paid employment comprised 1.4% of men and 6.6% of women. 45% of respondents agreed that their postgraduate training was of a high standard, with 26% disagreeing and 29% unsure. 47% of specialist registrars felt their training was too short and 78% were concerned about the availability of consultant posts on completion. CONCLUSIONS: Although loss of doctors from the British workforce through emigration or unemployment is not increasing, our findings confirm a substantial shift away from careers in general practice. The number of home-trained GPs from this generation of doctors will be inadequate to meet service needs. GPs and hospital specialist doctors expressed concerns about quality of training, lack of careers advice, the shortness of specialist registrar training and availability of consultant posts on completion of training.

Career Choice↗