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PubMed2005

Consistency of food intake over four eating sessions in the laboratory.

OBJECTIVE: The aim of this study was to test the consistency (repeatability) of laboratory measures of food intake, including eating microstructure (cumulative food intake curves), in non-obese humans across four eating sessions, each separated by 1 week. A secondary aim was to test the effect of dietary restraint on the food intake of female participants. METHODS: Mixed model analyses were used to compare average food intake across sessions, and intraclass correlation coefficients (ICC) were employed to compare within subject variability to total variance. High and low restraint females and low restraint males consumed four lunches in a Universal Eating Monitor (UEM) laboratory. The lunches consisted of one type of sandwich (chicken salad sandwich squares) or three types of sandwiches (chicken salad, ham, and turkey sandwich squares) presented in counterbalanced order. RESULTS: Measures of food intake were stable for men and women, regardless of sandwich variety. In females, level of dietary restraint (high vs. low) did not significantly affect food intake. DISCUSSION: The results indicate that eating behavior in the laboratory is sufficiently stable over time to justify evaluation of interventions designed to alter food intake using within subject designs.

Adolescent↗

PubMed2005

Drug release from tableted wet granulations comprising cellulosic (HPMC or HPC) and hydrophobic component.

The effects of component nature, proportion and processing on the release rate and mechanism were investigated for tablets comprising drug, cellulosic polymer and hydrophobic components. Four drugs differing in solubility (diclofenac sodium, ibuprofen, naproxen and indomethacin), two cellulosic polymers (HPC and HPMC) and hydrophobic Emvelop were used in two levels of mass fraction and weight ratio of drug:carrier and of cellulosic-hydrophobic component. Compression was applied after granulation or physical mixing. Drug release was evaluated in pH 6.5 phosphate buffer BP and elucidation of the release mechanism was attempted by fitting kinetic models. Statistical significance of the effects of formulation variables on the release rate and mechanism expressed by the coefficient, k, and exponent, n, of the power law kinetic model, respectively, was evaluated by ANOVA. It was found that for the release mechanism most significant is the effect of drug solubility followed by cellulosic polymer type, mixing procedure and drug mass fraction. Significant interaction between drug solubility and type of cellulosic polymer indicated that alteration in the swelling of HPMC and HPC is caused by the drug solubility. Weight ratio of cellulosic-hydrophobic component does not affect the release mechanism, but only the release rate. Similarly, for the release rate most significant was found the effect of drug solubility, followed by cellulosic polymer type, weight ratio of cellulosic-hydrophobic component, mixing method and drug mass fraction. Also significant were the interactions of drug solubility with the type and proportion of the cellulosic polymer and the processing applied. Depending on the drug solubility and type of polymer present, wet granulation can increase or decrease the release rate.

Cellulose↗

PubMed2006

Different public health geographies of the 2001 foot and mouth disease epidemic: 'citizen' versus 'professional' epidemiology.

Recently, there have been calls for health geographers to add critical and theoretical debate to 'post-medical' geographies, whilst at the same time informing 'new' public health strategies (Soc. Sci. Med. 50(9)1273; Area 33(4) (2002) 361). In this paper we reflect on how, alongside 'professional epidemiologies', 'citizen epidemiologies' can have credibility in informing public health policy and practice. We do this by drawing on mixed method and participatory research that used a citizens' panel to articulate the health and social outcomes of the 2001 foot and mouth disease disaster. We consider the difficulties of creating dialogue between on the one hand, time-limited, discrete, theoretical, visible and by implication legitimate, 'professional' knowledge and on the other, ongoing, holistic, experiential and often hidden 'citizen' knowledge of the foot and mouth disease epidemic. Despite significant evidence that in disaster and crisis situations, people need to be actively involved in key 'recovery' decisions (see for example At Risk Natural Hazards, People's Vulnerability, and Disasters, Routledge, London; A New Species of Trouble, Norton, New York), lay accounts, which may in themselves provide valuable evidence about the impact of the disaster, are often ignored. If health geographers are to critically inform 'new' public health policy then we need to consider research approaches that give voice to citizens' understanding of health outcomes as well as those of professionals. If 'new' public health is concerned with the material character of health inequalities, with fostering 'healthy' living and working environments, the promotion of community participation and individual empowerment (Area 33(4) (2002) 361), then we argue that situated, negotiated, everyday geographies of lay epidemiologies can and should inform public health policy.

Animal Husbandry↗

PubMed2006

Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada.

This study addresses links between economic and nutritional variation in an urban North American setting. We employed a mixed-methods approach including mapping, semi-structured interviews, and food outlet surveys to investigate the public health impact of variation in the cost and availability of food between two socioeconomically distinct neighbourhoods of the City of Hamilton, Ontario, Canada. Food cost in supermarkets was not found to be higher in the low-income neighbourhood, though it was much higher in the variety stores that predominate in the low-income neighbourhood. Moreover, there was a very low availability of produce in the variety stores. Reduced fresh produce availability and lower incomes have the potential to negatively influence public health in the less-affluent study area by increasing the difficulty of acquiring healthy foods.

Costs and Cost Analysis↗

PubMed2006

Snapshots and snippets: general practitioners' reflections on professional space.

The paper presents the results of a mixed methods study of British general practitioners' (GPs) reflections on professional space in terms of practice and self-identity. Inter-textual content analysis of 12 biographic and photographic datasets revealed four themes: workspace, re-appropriated space, life space and sacred space. GPs are ambivalent about their working environments, spending time and energy creating 'best fit' spaces, until lack of function becomes an habituated part of daily routine. Whilst some appear helpless in the face of change, others are making their presence felt through embodied, personalized or authorial spaces.

Attitude of Health Personnel↗

PubMed2005

Findings from a survey on GIS use in the UK National Health Service: organisational challenges and opportunities.

The use of geographical information systems (GIS) in a variety of application areas points to an increasing interest in the spatial aspects of health policies. Despite the fact that most public sector organisations in the United Kingdom (UK) have access to such software tools, there has not been a comprehensive review of take-up within the health sector. In this paper, we report on a recently completed mixed-method research project that has examined the current levels of GIS use in the UK National Health Service, and focus our discussion on health authorities (HAs). Couched within the context of previous studies that have been concerned with outlining the types of factors influencing IT implementation in the health sector, we illuminate the importance of behavioural, cultural and organisational factors on the diffusion of GIS in the UK National Health Service. It is noted that very few organisations had a GIS strategy and we contend that if GIS is to play a wider role in addressing issues surrounding 'joined-up' government, more advice and guidance is needed on policies promoting the exchange of geographical data between agencies concerned with tackling health issues. We conclude by drawing attention to the perceived lack of national guidance on GIS matters, more generally, within the UK health sector.

Data Collection↗

PubMed2004

Increasing the visibility of coding decisions in team-based qualitative research in nursing.

OBJECTIVES: To examine the use of the multi-rater Kappa measure of agreement (Nonparametric Statistics for the Behavioural Sciences, McGraw Hill, New York, 1988) in team based, mixed method, qualitative nursing research. DESIGN: The article presents an illustrative description of the application of the qualitative coding procedure and associated multi-rater Kappa measurement at four time points in 9 months amongst a five person health services research team. MAIN OUTCOME MEASURES: The multi-rater Kappa statistic. This is a measure of the extent to which observers achieve possible agreement beyond any agreement expected to occur by chance alone. RESULTS: Closeness to primary qualitative research data, working relationships over time, and focused research team discussion can all lead to greater agreement and convergence at the level of descriptive coding. The method of measuring agreement between groups of coders was easily applied and appeared a feasible option for similar research projects wishing to demonstrate transparency in their coding procedures. CONCLUSION: Measuring agreement beyond chance by the multi-rater Kappa statistic has some utility for research teams whose qualitative coding tasks are primarily descriptive. The method offers a standard and transparent approach for demonstrating agreement between coders and should be a feature of qualitative research reporting where appropriate.

Abstracting and Indexing↗

PubMed2004

Protection behaviour: a phenomenon affecting organ and tissue donation in the 21st century?

UK statistics show that whilst waiting lists for transplantation surgery continue to increase, donor numbers are static. This paper describes the hermeneutic phase of a mixed method study and puts forward the concept of protection behaviour as one explanation for nurses' reticence to discuss post-mortem donation wishes with patients' relatives. The desire to protect appears to influence attitudes, confidence levels and perceived ability to become involved in donor identification and donation discussion, consequently affecting the availability of transplantable organs and tissue. By understanding more fully why protective behaviours are employed, it increases the likelihood of a solution being found.

Adult↗

PubMed2005

Can a facilitated programme promote effective multidisciplinary audit in secondary care teams? An exploratory trial.

This 24-month exploratory study evaluated whether a 6-month programme supported by a trained external facilitator was feasible, acceptable and led to the adoption of a multidisciplinary approach to audit by secondary care staff. Undertaken in five acute hospital sites in the East Midlands UK, 22 multidisciplinary teams were randomised to either an intervention or control arm. Employing mixed methods, a range of outcomes, including collaborative behaviour, was measured. The intervention was feasible and acceptable to staff. Involvement in the facilitated programme had a positive impact on self-reported knowledge (P=0.000 post-intervention and at 4-months follow-up), skills (P=0.000 post-intervention and P=0.02 at 4-months follow-up) and attitudes (P<0.01 post-intervention), appeared to have some influence on improving self-reported (P<0.05 post-intervention) and observed collaborative behaviour (P=0.01) and led to better quality audit resulting in measurable improvements to care. Improved collaborative behaviour may have resulted from an increase in assertive behaviour by nurses. Research to test approaches to support teams to work effectively together is currently hampered by a lack of suitable research instruments and needs addressing before main (phase 111) trials are undertaken.

Assertiveness↗

PubMedDate not supplied

Risk behavior, perceptions of HIV risk, and risk-reduction behavior among a small group of rural African American women who use drugs.

HIV/AIDS is a health crisis for African Americans. African American women are exposed to HIV primarily through sexual behavior, which is an increased risk for women who use drugs. The study design was a mixed method consisting of an ethnography with ongoing participant observation and in-depth interviews and a questionnaire. The purpose of the questionnaire component was to explore drug use, sexual behavior, health history, and perceptions. The questionnaire was administered at months 6 and 18. Data for this report were derived from the first questionnaire with 30 respondents. The majority of respondents (82.7%) used polysubstances consisting of cocaine, marijuana, and alcohol. Between 33% and 50% exchanged sex for drugs or money, with less than half ever using condoms. About 37% perceived that they had no risk of acquiring HIV, whereas 52% perceived a 25% chance. The pattern of HIV testing in which 33% of the women were tested 10 times or more was unexpected because of the low perception of risk. The principal conclusion was that there is great need to intervene with prevention efforts targeting rural women who use drugs in an attempt to curb increasing rates of sexually transmitted infections including HIV.

Adolescent↗

PubMed2006

Nursing students' mathematic calculation skills.

This mixed method study used a pre-test/post-test design to evaluate the efficacy of a teaching strategy in improving beginning nursing student learning outcomes. During a 4-week student teaching period, a convenience sample of 54 sophomore level nursing students were required to complete calculation assignments, taught one calculation method, and mandated to attend medication calculation classes. These students completed pre- and post-math tests and a major medication mathematic exam. Scores from the intervention student group were compared to those achieved by the previous sophomore class. Results demonstrated a statistically significant improvement from pre- to post-test and the students who received the intervention had statistically significantly higher scores on the major medication calculation exam than did the students in the control group. The evaluation completed by the intervention group showed that the students were satisfied with the method and outcome.

Adult↗

PubMed2006

Parents of children with cancer: factors influencing their treatment decision making roles.

This study examined the factors that parents identified as influencing their role in treatment decision making (TDM) for their child with cancer. Content analysis of qualitative data from semistructured interviews with 36 parents as part of a mixed-methods study revealed numerous themes related to parents' TDM roles. Factors that were frequently identified included: relationship with the physician, nature of communication, trust in the physician, parents' and physician's knowledge and experience, and importance of parental role. Parents acknowledged a strong sense of responsibility and feeling of "ownership" of their child. Parents initially lacked knowledge and experience, but acquiring these over time contributed to a more active participation in TDM.

Adult↗

PubMed2005

Changes in the meaning of pain with the use of guided imagery.

The purpose of this study is to determine how verbal descriptions of pain change with the use of a guided imagery technique. A mixed method, concurrent nested design was used. Participants in the treatment group used the guided imagery technique over a consecutive 4-day period, and those in the control group were monitored. Verbal descriptions of pain were obtained before randomization and at four daily intervals. A total of 210 pain descriptions were obtained across the five time points. Data were analyzed using content analysis. Six categories emerged from the data: pain is never-ending, pain is relative, pain is explainable, pain is torment, pain is restrictive, and pain is changeable. For participants in the treatment group, pain became changeable. The meaning of pain as never-ending was a prominent theme for participants before randomization to treatment and control groups. It remained a strong theme for participants in the control group throughout the 4-day study period; however, pain as never-ending did not resurface for participants in the treatment group.

Adult↗

PubMed2004

What girls need: recommendations for preventing violence among urban girls in the US.

The last decade saw increases in arrests of girls for violent behavior and a corresponding concern that girls' involvement in violence was increasing in the USA. However, there are few empirical studies of the dynamics of violence by girls, leaving providers of violence prevention programs and policy-makers without evidence on which to base gender-appropriate prevention strategies. To address this gap, qualitative interviews were conducted with a diverse sample of 61 urban girls aged 11-17. Findings were compared with quantitative interviews from the prospective cohort of 961 girls from whom these respondents were drawn, from the Project on Human Development in Chicago Neighborhoods. Mixed-method techniques were employed. Qualitative data were analyzed for girls' recommendations for preventing involvement in violence. Data from the larger cohort were used to test these recommendations quantitatively. Due to study design, in the qualitative sample, 36 girls (64%) were involved in recent violence, most often with or against other girls. Pro-social behavior was common among both violent and nonviolent girls. In the overall cohort sample, 24.9% of girls reported violent perpetration and 97% reported pro-social activities. Eight themes regarding staying safe and preventing violence emerged from the qualitative interviews: girls stayed safe by staying home, avoiding dangerous people, staying busy with after-school activities, remaining calm when confronted, using escorts, and fighting back if attacked. Girls' protective influences included: empathic parental involvement, positive relationships with peers and older youth, and involvement in safe and constructive activities. These findings emphasize that safety in community, school, and family settings is critical for girls in avoiding violence and other risky behaviors. Violence prevention programs should focus on enhancing girls' relationships with mothers, older girls, and friends their age.

Adolescent↗

PubMed2006

What "Dr. Mom" ordered: a community-based exploratory study of parental self-care responses to children's ADHD symptoms.

Little is known about family initiated self-care interventions in response to symptoms of attention deficit/hyperactivity disorder (ADHD), and how self-care may co-exist with professional treatments. This paper explores parental self-care strategies for children with hyperactivity or attention problems, and examines factors and domains that influence their use from the mixed method perspective. As part of a longitudinal cohort study of ADHD detection and service use, caregivers of a representative US community sample of 266 children at high risk for ADHD completed a questionnaire that assessed five self-care strategies (behavior modification, coping, diet, over-the-counter medication use and religious practices), and made open-ended inquiry about discipline changes in response to behavioral concerns. Questionnaire responses were analyzed using logistic regression approaches. Open-ended answers were open coded; secondary analysis followed Spradley's model of domain analysis. Quantitative findings showed that behavior modification was the most commonly tried self-care strategy, followed by coping, diet, and religious practices. Over-the-counter trial was least common. The parents of professionally treated children were more likely to have employed behavior modification, coping strategies and over-the-counter medications than the parents of untreated children. Two-thirds of parents had changed their disciplinary action within three domains that were identified through qualitative analysis, including changes related to (a) the prevention of disciplinary problems (e.g., sustain eye contact, activation, consistency, clear instructions), (b) the solution of disciplinary problems (e.g., time-outs; privilege removal), and (c) parental coping associated with disciplinary problems (e.g., control own emotions, become less judgmental and more tolerant, and develop more appropriate expectations). These findings suggest that self-care strategies are commonly employed and appear to co-exist with professional treatment. Therefore, healthcare providers should actively explore parents' use of such strategies as some of them may interfere with prescribed treatments (e.g., over-the-counter) or absorb parental resources without likely benefit (e.g., diet).

Adaptation, Psychological↗

PubMed2006

"We're tired, not sad": benefits and burdens of mothering a child with a disability.

Caregiver burden has received considerable emphasis in the literature on the social experience of mothering children with disabilities. Little attention has been paid, however, to either the nature of the burdens perceived or to maternal ability to see beyond the burdens to the benefits of their caregiving role. This study utilizes a mixed methods approach to examine these neglected aspects of the social experience of mothering children with disabilities. Findings of a survey of 81 mothers of children with disabilities in Florida, USA and follow-up interviews with 7 of these mothers indicate that: 1. For most of the mothers included in the study, "the burden of care" is a matter of socio-structural constraints (Objective Burden) rather than emotional distress (Subjective Burden); 2. Despite the socio-structural constraints associated with caring for a child with complex needs, most mothers perceive valuable benefits in having a child with a disability; and 3. Perceived Stigma has an important positive impact on both dimensions of burden and, through its impact on Subjective Burden, can decrease the perceived benefits of caring for a child with a disability.

Adult↗

PubMed2026

Driven toward care, avoiding the end: A systematic review and meta-analysis of the relationship between death anxiety and healthcare utilisation.

Both overuse and underuse of the healthcare system have been recognised as significant problems. Relatedly, growing research has recognised the key role of death anxiety in driving various health-relevant behaviours. However, the relationship between death anxiety and healthcare utilisation has not yet been systematically explored. The current systematic review and meta-analysis addressed this gap. In total, 987 papers were screened for inclusion, of which 63 were included in the final review (Ntotal = 21,271). This included 33 quantitative studies, 27 qualitative studies and 3 mixed-methods designs. In total, 17 studies contained sufficient data to be meta-analysed. Overall, the included studies highlighted a significant relationship between death anxiety and healthcare utilisation; in particular, positive associations with desire for life-prolonging treatments and contact with hospitals and medical professionals. By contrast, a negative association was found with other aspects of healthcare utilisation, including hospice use and end-of-life communication. The sample type emerged as a significant moderator, suggesting that the relationship between death anxiety and healthcare usage was strongest in non-medical samples. The current findings suggest that death anxiety plays a key role in utilisation of the healthcare system. The fear of death may need to be targeted in psychological interventions, in order to ensure maximal effectiveness of health services, and improve outcomes for healthcare users.

Humans↗

PubMed2026

Challenges of genomic testing for patients and clinicians in Latin America: Foundations of a qualitative multi-country study.

Genomic medicine is expanding across Latin America (LATAM), yet access to essential ancillary services such as genetic counselling remains limited. 'Latin-SEQ' is a study that provides whole exome sequencing (WES) for neuromuscular diseases across 18 countries, aiming to improve diagnostic rates and generate region-specific genetic insights. However, funding constraints exclude genetic counselling and cascade testing, raising concerns about equitable and harm-free care. This paper reports early findings from 'Latin-SEQ Plus,' a mixed-methods study exploring patient and healthcare practitioner (HCP) perspectives on WES and genetic counselling. Data were generated via surveys with patients and HCPs, and participatory workshops with HCPs across six countries. We found that patients strongly valued genetic testing for diagnostic clarity, improved care, and family planning. HCPs acknowledged the diagnostic benefits of WES but highlighted absence of local genetic counselling services, inconsistent pre and post-test practices, and uncertainty in managing incidental findings and variants of uncertain significance (VUS). Psychological impacts related to WES results are not always addressed, underscoring risks of psychological and emotional harm for patients. Access to WES and genetic counselling is limited in LATAM due to financial hardship and the absence of a clear genetic counselling infrastructure. Our findings also reveal a mismatch between patient expectations and HCPs' capacity to deliver comprehensive genomic care. We argue for urgent investment in genetic counselling infrastructure, HCP training, culturally tailored resources, and policy frameworks to support equitable implementation of genomic medicine in LATAM.

Humans↗