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PubMed1997

Carers' knowledge of dementia and their expressed concerns.

OBJECTIVE: The authors wished to determine how much carers from different settings caring for patients with dementia knew about the disorder and elicit their main concerns about the disease. DESIGN: A survey questionnaire was administered to 136 carers. SETTING: Two old age psychiatric services and an Alzheimer's support group in urban areas of the UK. PARTICIPANTS: The carers came from one of three categories: (1) carers with no prior contact with elderly mental health services (preassessment group); (2) carers who had been in contact with mental health care professionals (postassessment group); (3) carers in contact with an Alzheimer's Disease Society support group. MEASURES: A questionnaire on the subject of dementia. Carers' worries about the disorder were also recorded. RESULTS: Carers in contact with an Alzheimer's support group were the most knowledgeable and carers in the preassessment group were the least knowledgeable on the subject of dementia. While carers in the postassessment group had a level of knowledge above that of the preassessment group, this difference failed to reach statistical significance. CONCLUSION: The study highlights the need for elderly mental health teams to evaluate their methods of dissemination of knowledge to carers, develop educational packages for carers and evaluate their effectiveness.

Aged↗
PubMed1986

Effects of a concurrent clinical education assignment on student concerns.

Students participating in a concurrent pattern of clinical education spend part of the day or week in didactic instruction and the remaining portion in clinical education. The purpose of this descriptive study was to identify concerns expressed by students before and after an early concurrent assignment and before a nonconcurrent assignment. Twenty junior level baccalaureate degree students participated in open-ended taped interviews before and after a concurrent assignment that occurred during the first six months of their professional program. The most frequently expressed concerns were about interpersonal interactions, the students' knowledge, and treatment procedures. The students expressed more concerns before the concurrent assignment than after the concurrent assignment and before a nonconcurrent assignment. We conclude that the concurrent assignment builds students' confidence in their affective and psychomotor skills.

Adult↗
PubMed2004

Present concerns of survivors of human rights violations in South Africa.

Most research on persons subjected to physical torture for political reasons has framed this experience as traumatic, with the sequelae approximating the diagnostic criteria of posttraumatic stress disorder (PTSD). However, responses to checklists, questionnaires, and structured interview schedules may reflect the effect of demand characteristics more than the actual concerns of respondents. Thus semi-structured qualitative interviews were conducted with 20 South Africans who were detained for political reasons during the apartheid era. The interviews were transcribed and analyzed with the assistance of the Atlas.ti 4.5 programme. Results showed that the major concerns expressed by the sample were somatic problems, economic marginalization, non-clinical emotional distress, and dissatisfaction with the present political dispensation in South Africa. Respondents also expressed concerns that reflected symptoms of traumatization, but these were not salient in comparison with the other themes that emerged. These data suggest that a model of trauma and the diagnostic category of PTSD may be less appropriate than suggested by most of the literature in accounting for the concerns of many South African former political detainees. This paper critiques the hegemony of the psychiatric model of traumatization in conceptualizing the needs of this population, and suggests an alternate perspective that is broader and more inclusive than a psychiatric paradigm. It also discusses the research and possible clinical implications of the results in terms of addressing the needs of former detainees in South Africa.

Adult↗
PubMed2003

Consistency among methods of assessing concerns about the Los Alamos National Laboratory.

In making environmental remediation and restoration decisions, risk assessors and managers need to take into account the environmental concerns of people living around an industrial facility, as well as those residing in the general region. Yet such information is usually anecdotal rather than quantitative, and rarely compares perceptions among different alternatives methods. The concerns of individuals living in Santa Fe, NM, near the Department of Energy's Los Alamos National Laboratory (LANL) were characterized. On an open-ended question, the public's greatest concerns were for contamination (35%), ecological health (16%) and human health (14%). When asked to rate their level of concern from a list of possible concerns, people rated accidents/spills and storage of additional nuclear material the highest, and changes in property values the lowest. Unexpectedly, ethnicity, education, and income did not explain variations in ratings for most concerns about LANL. There was generally agreement between the concerns expressed on the ratings and on the open-ended question, although on the latter individuals expressed concern for larger issues, rather than specific issues. Preferences for future land use reflected their concerns for maintaining a safety buffer of an ecosystem around the site.

Adult↗
PubMed1999

Health concerns and risk behaviors of rural adolescents.

Although much has been written about the health status of adolescents, little is known about adolescents' perception of their own health. The purpose of this article is to describe the health concerns of rural adolescents. Two national studies, the Youth Risk Behavior Survey and the National Longitudinal Study of Adolescent Health (Add Health Project), are used as comparisons. Data from the rural survey represent 624 community adolescents attending 4 rural Pennsylvania schools. The students were in the 9th, 10th, and 11th grades. The Adolescent Health Inventory was used to report concerns related to general health, psychosocial issues, and risk behaviors. Overall, rural adolescents in the study reported an average of 6.5 (SD = 3.2) health concerns with frequencies of occurrence being always or often and reported an average involvement in 1 (SD = 1.3) risk behavior. Psychosocial issues were reported by 28%, and 23% worried about their general health. Frequently reported risk behaviors included alcohol use, drug use, and a lack of exercise. There was minimal concern expressed regarding venereal disease or AIDS, whereas 12% expressed concern about the possibility of pregnancy. These results suggest the likelihood that adolescents perceive health from a holistic perspective and that health promotion programs should consider involving adolescents in planning, both (a) to ensure congruence of the plan of care with adolescents' concerns and (b) to clarify the interpretation and meaning of their concerns. We present implications for the community health nurse.

Adolescent↗
PubMedDate not supplied

Attitudes of African American premedical students toward genetic testing and screening.

PURPOSE: Genetic research is progressing at a rapid rate. While most view genetic advances favorably, concerns regarding eugenics and discrimination based on genetic test results have been raised. These concerns have been found among all groups studied; however, they have particular relevance for members of the African American community. Studies have shown that because of a long history of negative experiences, African Americans have a general mistrust of the medical establishment. It is unclear whether these negative attitudes encompass genetic advances. Because there is little empiric data in the literature, it is not known whether African Americans have a positive view of genetic advances or whether they have the same level of mistrust as is seen in their attitudes toward other forms of biomedical research. METHODS: This study was conducted as an initial effort to examine the attitudes of African Americans toward recent genetic advances and, specifically, genetic testing. A cohort of 97 college-age minority students, including 78 African Americans, participating in the Health Career Enhancement for Minorities Program (HCEM) at Case Western Reserve University were surveyed. Surveys were made available before and after the summer long course, which included five lectures on basic genetic principles and medical genetics. RESULTS: Both African American students and other minority students initially (questionnaire prior to HCEM course) had an overall positive view of genetic testing. The vast majority supported genetic testing for preventive care (95%) and presymptomatic detection of disease (88%) and agreed that it should be easily available (83%). However, several concerns were expressed as well, including fears about discrimination (68%), privacy (68%), that abortions will become more common (51%), and eugenics (37%). It is interesting that in the postcourse questionnaire, the percentages of positive views remained similar to those of the precourse survey, but the number of respondents expressing concerns increased. DISCUSSION: These results suggest that the minority students surveyed view many aspects of genetic testing and other advances favorably. However, these students expressed concerns about discrimination, privacy, and eugenics. These concerns were increased, not lessened, by exposure to genetics education. One possible explanation for this observation is that the students had a greater understanding of the issues regarding genetic testing after the HCEM lectures and discussion. Of note, there was a greater negative response toward genetic screening programs among the African American students compared with the non-African American minority students. This suggests that the negative attitudes of African Americans toward biomedical research do extend to some aspects of genetics and that educational programs must be designed and implemented if this community is going to receive the maximum benefits of this advancing technology.

Adult↗
PubMed2005

When and by whom is concern first expressed for children with neuromotor problems?

OBJECTIVE: To describe when and by whom concern is first expressed for children referred to rehabilitation because of neuromotor problems. STUDY DESIGN AND SETTING: We conducted a survey of parents of 92 children (aged 0-6 years) who were on the waiting list for physical or occupational therapy services at rehabilitation centers in Montréal, Québec. We compared age of child at initial concern with who first expressed concern for children who were considered at risk due to their perinatal history of prematurity and those who were not born prematurely but were later diagnosed as having neuromotor problems. INTERVENTION: Parents were interviewed regarding their child's medical history and utilization of health care services. RESULTS: Parents were concerned later than physicians were regarding their child's development (mean difference, 8.2 months; 95% confidence interval [CI], 3.7-12.6 months). There was no significant difference in time of recognition of problems between the premature (10.2 months) and full-term (11.9 months) groups. Even after controlling for risk group, parental concern occurred later than physician concern (beta coefficient, 7.3; 95% CI, 2.5-12.2). The child's age at the time of initial concern was associated with the child's age at referral to rehabilitation (beta coefficient, 0.04; 95% CI, 0.01-0.06). CONCLUSIONS: Early recognition is important if a child is to benefit from early rehabilitation. It may be important to improve primary care screening of children for neuromotor problems and to increase parental awareness regarding normal motor development of their children. Prompt, simultaneous referral to medical evaluation and rehabilitation resources may decrease delays in rehabilitation.

Age Factors↗
PubMed2006

Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues.

BACKGROUND: Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues. METHODS: This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536) who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger). Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis. RESULTS: Approximately 3/100 (3%) answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1). Increasing age reduced likelihood of gambling concerns - logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99) p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p < 0.0001) to have concerns about their smoking, use of recreational drugs, and alcohol. Similarly there were more likely to indicate problems with depression, anxiety and anger control. No significant relationship with gambling worries was found for abuse, physical inactivity or weight concerns. Patients expressing concerns about gambling were significantly more likely to want help with smoking, other drug use, depression and anxiety. CONCLUSION: Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.

Adult↗
PubMed2001

What do master surgeons think of surgical competence and revalidation?

BACKGROUND: There has been on-going debate and public interest in surgical competence in recent years. METHODS: A Delphi reiterative opinion survey was conducted among master surgeons on selection of surgical trainees, methods of assessment of progress of surgical trainees, and revalidation of established consultant surgeons. RESULTS: Selection-the current methods of trainee selection were considered inadequate and in need of revision. The important attributes recognized by group are cognitive factors, innate dexterity, and personality. Important aspects of personality include decision-making ability, insight, team spirit, and emotional stability. Assessment during training-the majority view was that this should be based on clinical judgement/skills, operative skills, and cognitive ability. Assessment of technical ability should be based on standardized checklists. Research within training programs was encouraged but academic achievement does not reflect surgical competence. There was a majority verdict for an exit clinical examination. Revalidation-the group agreed on the need for competence checks during the professional career of surgeons. These should cover knowledge, clinical, operative, and humanistic skills; but expressed concern on the feasibility of a revalidation system that can reliably assess the range of skills needed for surgical competence. There was a majority vote against an internal appraisal system. External assessment by nationally appointed 'assessors' was considered preferable. CONCLUSIONS: Both selection and assessment of surgical trainees require changes and standardization. Although revalidation is necessary, concern was expressed on the reliability and validity of existing and proposed systems.

Clinical Competence↗