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PubMed2000

Preoperative preparation. Value, perspective, and practice in patient care.

Preanesthesia preparation will continue to stimulate creativity and debate. Strategies for process improvement will take various shapes and require tools previously unfamiliar to many medical managers. At UNC Health System, anesthesiologists currently are committed to the centralized preanesthesia clinic approach used in PreCare. To date, their strategies have been validated by their institutional measures of success: a 0.7% first-case AM work-up rate, a 5% no PreCare visit rate, a 5% consent problem rate, and a 0% rejected specimen rate, with a 43% blood-draw rate for all patients. As their health system expands, however, other strategies and preparation modalities may become necessary. Telemedicine and Internet-dependent processes are appealing in the highly educated and technologically sophisticated marketplace. As the region becomes increasingly urbanized, local employment patterns prevent easy access to services, and functional compromises, such as bypassing PreCare or reliance on telephone or on-line interviews for preparation, may become necessary. The need to expand PreCare in the near future is already evident. As was found during initial planning, process improvement and space planning are enhanced by computer modeling. UNC Health System employed a proprietary animated simulation modeling (ASM) tool, MedModel, (ProModel, Orem, UT), although other techniques exist for the same purpose. Use of ASM as a strategy management tool allowed generation of ideal space-time-personnel scenarios that could expose potential problems before resources and physical restructuring occurred. ASM also can be used to compare data obtained from real-time observations to any reference scenario, including any that looks at economic measures of process, to help refine strategic visions before instituting tactical solutions. Used in this manner, ASM can reveal physical, temporal, personnel, and policy-related factors not otherwise seen as exerting effects on overall preprocedural preparation processes. Coupled with other classic planning techniques, such as time-motion studies, modified Delphi techniques, customer satisfaction surveys, benchmarking studies, and financial analysis and growth projections, ASM has helped enhance total quality management efforts in PreCare and other planning projects at UNC Health System. Other researchers have used other simulation techniques to assess clinic functions. Operational challenges that exist in preanesthesia preparation clinics place these clinics on the same level as other kinds of medical service clinics. The lessons learned in most clinic settings may be applied in a cross-wise manner to the preanesthesia clinic. Dexter contends that efficient delivery of care that respects patients' time and needs does more than assist the procedural preparation process; it also supports the physician's ethical obligation to the patient to give the best possible care. Documenting patient medical information, education efforts, and maintaining the medical-legal integrity of the preanesthesia preparation materials is another area of increasing concern and research. When hand-held computers capable of linking by way of infrared technologies or that use rented downloadable software to run specific applications become commonly used, the complexity of ensuring privacy will grow. The complexity, however, will not be insurmountable. Privacy problems exist in any information management system, whether paper-based (i.e., reducing redundant forms, eliminating indiscriminant photocopying of records), electronic-based (i.e., encryption, server access, system failure), or both. Electronic conveyance of medical information faces more legal and economic than technical hurdles. The penetration in US households of Internet services presently is less than 40%, whereas the penetration of personal computers is just over 50%. These figures are compared with penetration of corded telephones, televisions, and radios at levels greater tha

Anesthesiology↗
PubMedDate not supplied

Practices and perceptions of food safety among seniors who prepare meals at home.

Given senior citizens' vulnerability for food-borne illness, a need exists to determine the necessity and focus for education. Focus groups at senior centers reveal that the seniors (N=74) who prepare more than five meals a week at home use both inappropriate and appropriate practices to cook, cool, and thaw foods. Seniors rely of the distant past for knowledge and identify barriers to altering practices but state that information from educators about the health effects of inappropriate practices will convince them to change. For future food safety education, seniors recommend programs, videotapes, television, newspapers, radio, church bulletins, and written educational pieces.

Aged↗
PubMedDate not supplied

Social marketing improved the use of multivitamin and mineral supplements among resource-poor women in Bolivia.

OBJECTIVE: To test the hypothesis that social marketing improves women's awareness and consumption of multivitamin and mineral supplements. DESIGN: Formative research and baseline and final surveys using a multistaged stratified cluster sample. SETTING: Department of Santa Cruz, Bolivia. PARTICIPANTS: Women 15 to 49 years old (n=1709 at baseline and n=1735 at final survey). INTERVENTION: Social marketing campaign using radio and television spots. MAIN OUTCOME MEASURES: Awareness and use of multivitamins, including VitalDía, the brand promoted as part of this social marketing campaign. ANALYSIS: Cross-tabulations to assess changes over time in awareness and use of multivitamins. Logistic regression analyses to identify determinants of multivitamin use. RESULTS: The campaign increased women's awareness and use of multiple supplements, including VitalDía. Awareness of multiple supplements nearly doubled among women with 6 to 8 years of schooling, tripled among women with 4 to 5 years of education, and more than quadrupled among women with less than 4 years of schooling. After 9 months of social marketing, 11% of women had taken VitalDía one or more times, 7% had taken it at least once in the last 3 months, and 4% had used it one or more times in the last month. Improvements in the use of VitalDía were evident for women of all socioeconomic and educational levels, with the greatest increases occurring in the least advantaged groups. Additionally, women who had a positive perception of the benefits of multivitamins were 1.7 times (95% confidence interval 1.2-2.3; P <.01) more likely than women who did not have a positive perception to ever use VitalDía, once the effects of social class were adjusted. CONCLUSIONS AND IMPLICATIONS: Social marketing of multiple supplements reached resource-poor women and can be used to bridge gaps in access, improve awareness of supplementation as an option, and increase the likelihood that women will try supplements.

Adolescent↗
PubMed2005

From awareness to adoption: the effect of AIDS education and condom social marketing on condom use in Tanzania (1993-1996).

This paper uses retrospective event-history data covering a four-year period to examine the timing of exposure to HIV/AIDS education and social marketing condom promotion campaigns, relative to the timing of changes in sexual risk behaviour in Tanzania. Analysis of the event-history data shows that the process of exposure to AIDS education messages and exposure to brand advertising for Salama brand condoms was very different. While exposure to AIDS education was early and gradual, exposure to Salama brand condoms started later, but was much more rapid. After one year of advertising, over half of the target population had been reached by the Salama advertising campaign, mostly through newspapers, radio and television. During the study period, condom use increased from 15% at the beginning of 1993 to 42% at the end of 1996. Increases in condom use were driven both by men who became sexually active, and by men who were not yet protected, or not fully protected. The results further show that it is uncommon for men who adopted condom use to return to more risky behaviour, which suggests that behaviour change in the study population is permanent.

Adolescent↗
PubMedDate not supplied

Knowledge of severe acute respiratory syndrome among community physicians, nurses, and emergency medical responders.

INTRODUCTION: The preparedness levels of front-line clinicians including physicians, nurses, emergency medical responders (EMRs), and other medical staff working in clinics, offices and ambulatory care centers must be assessed, so these personnel are able to deal with communicable and potentially lethal diseases, such as severe acute respiratory syndrome (SARS). In order to determine the knowledge of these clinicians, a survey of their understanding of SARS and their use of educational resources was administered. METHODS: A questionnaire was distributed to physicians, nurses, and EMRs attending conferences on SARS in the summer of 2003. Questions related to information sources, knowledge of SARS, and plans implemented in their workplace to deal with it. Statistical analysis was performed using the Statistical Package for the Social Sciences (10.1 Program, SPSS Inc., Chicago, Illinois). RESULTS: A total of 201 community healthcare providers (HCPs) participated in the study. A total of 51% of the participants correctly identified the incubation period of SARS; 48% correctly identified the symptoms of SARS; and 60% knew the recommended infection control precautions to take for families. There was little difference in knowledge among the physicians, nurses, and EMRs evaluated. Media outlets such as newspapers, journals, television, and radio were reported as the main sources of information on SARS. However, there appears to be a growing use of the Internet, which correlated best with the correct answers on symptoms of SARS. Fewer than one-third of respondents were aware of a protocol for SARS in their workplace. A total of 60% reported that N-95 masks were available in their workplace. CONCLUSION: These findings suggest the need for more effective means of education and training for front-line clinicians, as well as the institution of policies and procedures in medical offices, clinics, and emergency services in the community.

Community Health Services↗
PubMed1994

Fifty years of language maintenance and language dominance in bilingual Hispanic immigrants.

Spanish language tests of 801 Cuban and Mexican immigrants showed no evidence of language loss during 50 years of U.S. residence; a few years after immigration, their English vocabulary approximated that of English monolinguals. The critical-age hypothesis was not supported for the acquisition of English vocabulary when English schooling and language usage were controlled by multiple regression. Most Ss continued to speak about as much Spanish as English; but read, wrote, and heard (on television and radio) far more English than Spanish. Under these conditions, Ss maintained Spanish dominance on tests of vocabulary recognition, lexical decision, and oral comprehension. Dominance was task specific and shifted to English on a category generation task about 12 years after immigration. No evidence of bilingual language interference was found; this is attributed to the strong Spanish foundation of the participants.

Adult↗
PubMed2006

Recruitment and selection of couples for intervention research: achieving developmental homogeneity at the cost of demographic diversity.

Demographic and relationship quality data were collected from 704 individuals recruited to participate in a randomized study of relationship enhancing interventions. Recruiting at bridal shows produced partners who were more satisfied, earlier in their relationships, and less likely to be parents, with a marginally higher proportion of Latino couples. Radio and television coverage produced more established couples with higher levels of relationship discord. Self-selection effects revealed that couples from demographic groups at greater risk for divorce (those who had not completed high school, those with children at marriage, and African American couples) were more likely to agree to participate. In contrast, imposing a set of common selection criteria served to exclude couples from demographic risk groups and selected for couples with higher marital quality. Implications for recruiting couples to participate in preventive interventions are outlined.

Adult↗
PubMed1998

Knowledge and perception regarding radiotherapy and radiation in patients receiving radiotherapy: a qualitative study.

This study aimed to acquire information about the knowledge patients have about radiation and radiotherapy, and the sources and impact of this knowledge. Data collection was by semi-structured interviews with 30 randomly selected adult patients conducted during the first half of a course of radiotherapy. Data analysis used three major themes: language, understanding and sources of knowledge. Few interviewees had any idea of the physical characteristics of radiation treatment, or they found it difficult to explain. Knowledge about radiation use, other than for medical purposes, most commonly concerned the atom bomb. Patients understood radiotherapy in terms of its action on cancer. Almost all offered a sensible description of why radiotherapy was being used to treat their cancer. Most talked about radiation attacking their cancer in some way and many worried about its damaging effect. A third gave detailed information about what they had become aware of through the written press, or radio or television. The message taken from press reports was largely negative.

Adult↗
PubMedDate not supplied

Motivation of voluntary plasmapheresis donors.

A totally voluntary plasmapheresis program recruits 900 individual donors per year at a cancer institute, where 500 to 900 units of platelets are transfused each month. Staff and donors use a film and brochures to recruit donors from the local community. Television and radio spots, with donor recognition pins, certificates, receptions, and picnics are utilized. Donor motivation was studied by use of: 1) California Psychological Inventory--measures a variety of "normal" personality traits; 2) Study of values--measures theoretical, economic, aesthetic, social, political, religious values; 3) Internal-External Control Scale--measures degree to which a person blames self vs. external events for what happens to him; 4) Faith in People Scale--measures individual's confidence in his fellow man; 5) Anomia Scale--measure of feelings of self-to-others alienation; 6) Mach IV Scale--measure of persons tendency to manipulate others; and 7) Biographical Data Form. Results are presented for 25 male donor subjects studied, as they compare with normative data for the scales used. Donors appeared to have the same traits as do the general population, but appeared lower in Machiavellianism than non-plasmapheresis donors. Prospective study plans include additional subjects to provide appropriate control groups.

Adult↗
PubMed2002

Is the prevention of genital chlamydial infections by community involvement possible?

This chapter presents different means by which community initiatives have been undertaken to reduce the prevalence and incidence of genital and allied infections caused by Chlamydia trachomatis. As most of these infections in the majority of infected individuals do not produce symptoms that are likely to urge them to attend any health care unit, screening programmes are mandatory to be able to influence the epidemic of infections with this agent. In many societies there has been a skewed gender distribution in the number of chlamydia-positive persons; this probably indicates that diagnostic service activities have been directed more against one gender than the other. The important role of partner notification, as in the case of other sexually transmitted infections, has been documented. Different means of community initiative have included counselling of school children and groups of persons more likely to be infected. Counselling by the pharmacy has an important role in many societies. Selected cohorts have been offered - via the mass media, Internet, radio and television programmes - sampling kits which can be mailed to a laboratory for testing. The establishment of youth clinics has been found effective for detecting teenagers harbouring C. trachomatis, similarly to screening at antenatal clinics. The offer of free consultations, aetiological tests and therapy has been a part of community initiatives, mimicking the services offered for some of the classic sexually transmitted infections. This chapter considers the usefulness of different test methods and stresses the need to retest those found to be positive. Barriers to the successful introduction of screening activities and diagnostic services are also considered.

Ambulatory Care Facilities↗
PubMed2005

[Knowledge of colorectal cancer prevention in the Bavarian population above 50 years--survey in two districts].

PURPOSE: Colorectal cancer is the second main cause of cancer death in Germany, although several measures related to primary prevention are described, and the utilisation of existing diagnostic tools (faecal occult blood test = FOBT, colonoscopy) is known to significantly decrease incidence and mortality. However, screening rates remain low in Germany, and insufficient knowledge of prevention possibilities is assumed to be responsible. The aim of this study was to investigate the knowledge related to colorectal cancer prevention in a Bavarian population, in the context of a regional public awareness campaign ("Active against Colorectal Cancer"). METHODS: 618 individuals between 50 and 90 ys of age participated in a telephone survey (m: 219, f: 399, 63.2 +/- 9.17 ys); the participants were inhabitants of two Bavarian districts. The questionnaire consisted of open-ended questions concerning preventive behaviour, colorectal cancer screening, risk factors, early warning signs and knowledge of colorectal cancer information. RESULTS: More than 80% of participants recalled healthy diet as a possible protective factor against colorectal cancer; a distinctly smaller percentage, however, could correctly define concrete dietary factors: e. g., fruit and vegetables were named by 54.5%. 66% of participants knew that unusual rectal bleeding might be a warning sign of cancer. Colonoscopy was the screening test that was most frequently recalled (61.5%); fewer participants named FOBT (32.8%) and rectal examination (11.5%). The results demonstrate that for many knowledge items, females proved to be significantly better informed than males. The most frequent sources of colorectal cancer information were newspapers, magazines, television and/or radio (named by 76.7%), as well as physicians and pharmacies (45.1%). 11.5% of participants attended the regional public awareness campaign "Action against colorectal cancer"; this subgroup had a better knowledge of some aspects related to colorectal cancer prevention. CONCLUSION: Evidently, the interviewed Bavarian population of 50 years or older lack knowledge of risk or protection factors for colorectal cancer. Knowledge of existing screening tests was also poor. These findings can serve as starting point for information campaigns tailored for target groups.

Age Factors↗
PubMed2005

Alcohol advertising and youth: a measured approach.

Where alcohol industry self-regulation is the primary protection against youth exposure to alcohol advertising, independent, systematic monitoring of youth exposure can promote public awareness of and greater accountability in the industry's practices. Using commercially available databases, the Center on Alcohol Marketing and Youth has combined occurrence and audience data to calculate youth (aged 12-20 years) and adult (above the United States legal drinking age of 21 years) exposure to alcohol advertising on television and radio, in magazines and on the Internet. This research in the United States shows that alcohol companies have placed significant amounts of advertising where youth are more likely per capita to be exposed to it than adults. Further analyses by the Center have demonstrated that much of this excess exposure of youth to alcohol advertising in the United States could be eliminated if alcohol companies would adopt a threshold of 15% (roughly the proportion of 12-20-years-old in the population 12 and above) as the maximum youth audience composition for their advertising. Although adoption of such a threshold would still leave much youth exposure to alcohol marketing in such "unmeasured" activities as sponsorships, on-premise promotions and campus marketing, it would assist alcohol companies in reaching their intended audiences more efficiently while reducing overall youth exposure to their advertising.

Adolescent↗
PubMedDate not supplied

PCP (phencyclidine): an update.

The steady rise in the promiscuous use of phencyclidine (PCP) as a "recreational" drug has recently gained nationwide attention because of the numerous violent and/or bizarre incidents caused by the use of this drug. Because the media often exaggerate reports of bizarre and violent behavior to make a "good" story, the potential PCP user may be tempted to ignore the media warnings. In the case of PCP, however exaggerated the story, a real danger does exist. So, despite numerous newspaper, radio and television warnings about the possible consequences of PCP use and abuse, the incidence of toxic reactions continues to climb. In many cases PCP is sold as other drugs, particularly THC, and in various colored capsules, tablets, liquids and crystals which may explain the increased usage despite the numerous warnings against its use. The advances in laboratory techniques and chemical processess have enabled the clandestine chemist to prepare relatively pure PCP and thus eliminate many of the toxic side effects due to impurities in the drug. In addition, 30 or more psychoactive PCP analogues have been developed and are starting to make an appearance on the street. PCP is perhaps the most potent psychotomimetic compound known at the present time and is capable of inducing a psychosis which is clinically indistinguishable from schizophrenia. The psychosis-producing effects of PCP are the most common toxic effects seen in hospital emergency rooms; but as the amount of PCP taken and/or the simultaneous involvement of other drugs, particularly barbiturates, occurs, severe medical problems (e.g., coma, seizures, respiratory arrest) begin to appear. Death from high doses of PCP or PCP plus other drugs does occur, but the principal cause of death from PCP abuse is due to trauma, homicide or suicide (usually of the bizarre or violent form). Young adult males, persons predisposed to mental illness and naive drug users appear to be the most susceptible to the adverse effects of PCP. The fact that chronic PCP users are starting to increase in number is mute testimony that not all users experience "bad trips" with PCP. Unfortunately for the user, however, this does not guarantee that the next trip will not be a bad one. The effects of chronic use seem to be twofold: severe depression with suicidal thoughts and numerous violent, agitated behavioral patterns. Neither seems to be a suitable alternative. At the present time there is not specific antidote for toxic PCP reactions and the prolonged psychosis induced in some cases does not appear to respond to the standard antipsychotic medications as quickly as do the functional psychoses. The major improvement from a medical standpoint is the development of more sensitive laboratory techniques to confirm the presence of PCP in body fluids. This advance has undoubtedly led to the apparent increase in the number of PCP cases reported by hospitals and to the accuracy of clinical diagnosis by medical, drug or law enforcement communities...

Brain↗
PubMed1998

Perceptions of HIV/AIDS and caring for people with terminal AIDS in southern Thailand.

This study presents data collected from village-based ethnographic research conducted in southern Thailand in 1995-1996, and focuses on perceptions of HIV/AIDS infection, patients with AIDS and their provision of care. Individual interviews were conducted with 300 village women. These data were supplemented by data from 14 focus group discussions involving 100 participants, both men and women, randomly selected from six villages in Hatyai district, Songkla Province, Thailand. In addition, 23 people with HIV/AIDS and their caregivers participated in subsequent in-depth interviews. Participants generally obtained their information about HIV/AIDS from television and radio, and the information they obtained was generally negative. AIDS was perceived as a disease associated with dirt, danger and death, although it was also considered to be a disease of karma (rok khong khon mee kam) and a 'woman's disease' (rok phu ying) associated with prostitution. Few women perceived themselves to be at risk of infection because they 'trusted' their husbands to be faithful. There were some differences in attitudes towards caring for AIDS patients among people who lived in semi-urban and rural areas, and with areas which had not yet experienced AIDS among community members. Focus group discussions clarified issues related to the illness and patterns of caregiving among men and women. Areas of misperception and confusion were identified and will be used for interventions.

Attitude to Health↗
PubMed2006

New treatments for psoriasis: which biologic is best?

Psoriasis is a chronic, debilitating disease affecting not only the skin, but also having a significant impact on a patient's quality of life. The treatment of severe psoriasis is quite challenging due to the chronic, relapsing nature of the disease and the difficulties inherent in treatment planning. Though the biologics are perhaps the most promising of available psoriasis treatments, the decision to institute a given therapy may be fraught with complexity for the clinician. Patients now hear of these promising new treatments for psoriasis via print, television and radio advertising; they frequently come to their physician asking if they are eligible for any of these agents and, if so, 'which biologic is best?'. This paper attempts to determine the ideal biologic agent based upon several parameters: FDA- and EU-approved indications, therapeutic efficacy, impact on quality of life, cost-effectiveness, and safety profile. Certainly the physician is central to medical decision-making, though ultimately patient preference may play the largest role in determining the 'best' biologic agent. There is no single ideal biologic for all patients and a physician's job is to educate patients on the relative advantages and disadvantages of each agent. Through informed discussion, the clinician can help each individual patient decide which biologic agent is ideal for them.

Adalimumab↗
PubMedDate not supplied

The effectiveness of media use in health education: evaluation of an HIV/AIDS radio [corrected] campaign in Ethiopia.

An effective vehicle to change behaviors is entertainment education. To demonstrate entertainment education effects, researchers must first indicate that participants have been exposed to their program. Exposure to effective programs has been associated with increases in knowledge about program topics, attitude change, and self-efficacious perceptions. The purpose of this study was to develop and test a new exposure technique that accurately and precisely determines direct exposure levels to Ethiopia's Journey of Life. Overall, the study found very high listenership, storyline recall, liking of the program, and strong desire to change behavior while maintaining low error rates in terms of verbatim recall of storylines and reported listenership to a fictitious program.

Acquired Immunodeficiency Syndrome↗