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Physicians' changing attitudes about striking.

Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation.

Attitude of Health Personnel↗

Diet and stomach cancer: a case-control study in South India.

A prospective case-control study was conducted in Trivandrum, India, to evaluate the dietary risk factors for stomach cancer. One hundred and ninety-four patients with stomach cancer registered at the Regional Cancer Centre (RCC), Trivandrum, Kerala, India, during the period 1988-1991 were considered as cases. A minimum of one control (n = 305), matched for age (+/- 5 years), sex, religion and residential area was selected from the visitors to RCC during the same period. Interviews were carried out using a predetermined structured food frequency questionnaire. The information collected also included socio-demographic/economic background, tobacco chewing, tobacco smoking and alcohol habits. Data were analysed using a multiple logistic regression model. Odds ratios for all dietary variables were estimated. Increased risks were observed with higher consumption of rice (OR 3.9; 95% CI 1.6-10.0). Risk was high for those consuming spicy food (OR 2.3; 95% CI 1.1-5.0), high consumption of chilli (OR 7.4; 95% CI 4.0-13.5) and consumption of high-temperature food (OR 7.0; 95% CI 3.7-12.9). On multivariate analysis, high consumption of rice, high consumption of chilli and consumption of high-temperature food were found to be independent risk factors.

Adult↗

Nurses' acceptance of the decision support computer program for cancer pain management.

This article describes nurses' acceptance of a decision support computer program for cancer pain management and explores the relationships between the nurses' acceptance and their sociodemographic characteristics. A feminist perspective was used as a theoretical guide for the research process. This was an Internet intervention study among 122 nurses working with cancer patients. Nurses' acceptance of the decision support computer program was measured using the Questionnaire for User Interaction Satisfaction. The data were analyzed using descriptive and inferential statistics, including analysis of variance and correlation analyses. There were significant differences in the total scores of user satisfaction by sex, religion, ethnicity, job title, and specialty. The results suggest that nurses do welcome decision support systems and that nurses' sociodemographic and professional characteristics should be considered in the development of decision support systems.

Adult↗

Factors associated with the time nurses spend at the bedsides of seriously ill patients with poor prognoses.

BACKGROUND: Little is known about the time health professionals spend with inpatients that are close to the end of life. SUBJECTS AND METHODS: We asked day-shift nurses to use a standardized log sheet to record how much time they spent in various categories of activity for 146 seriously ill medical inpatients with poor prognoses at 2 teaching hospitals. RESULTS: The mean patient age was 68, and the mean APACHE-III physiology score 28; 59% were white, 56% were women, 41% had cancer or HIV, and 81% had do not resuscitate (DNR) orders. The mean amount of time nurses spent with patients per 12-hour day shift was 53 min. In bivariate analyses, sex, religion, diagnosis and insurance status were not associated with nursing bedside time. In an ANOVA model, patients with DNR orders received more time than those without DNR orders (56 vs. 39 min, P = 0.04), and white patients received more bedside time than nonwhites (57 vs. 46 min, P = 0.01), even after controlling for severity of illness and DNR status. Among the 47 mentally alert patients who could be interviewed, symptom severity, quality of care, and satisfaction ratings were not associated with nursing bedside time. CONCLUSIONS: In this population, nurses spent less time with nonwhite patients and more time with patients with DNR orders. That patients with DNR orders received more time may be reassuring. However, further investigation will be required to confirm these results, to understand why nonwhite patients appear to have received less bedside nursing time, and to investigate further the relationship between time, satisfaction, and quality of care.

Age Factors↗

The willingness of patients to accept an additional mortality risk in order to improve renal graft survival.

BACKGROUND: This study was performed to assess renal transplant patient preferences with respect to the acceptance of an additional mortality risk induced by immunosuppressive therapy in order to prevent graft loss in case of acute rejection. METHODS: The two decision analysis tools standard gamble and time trade-off were used to interview 155 patients with a functioning renal graft, and 11 on dialysis awaiting transplantation. RESULTS: Defining the best possible outcome as being alive with a functioning graft (utility value = 1), and the worst outcome as dying (utility value = 0), median utility values of 0.68 (0.59 +/- 0.32, mean +/- SD) with standard gamble and of 0.65 (0.57 +/- 0.32) with time trade-off were obtained for the intermediate outcome (i.e., staying alive but returning to dialysis). Thirteen percent of the patients attributed a utility value of 0 to this intermediate outcome (i.e., they would rather die than return to dialysis), and 8% a utility value of 1 (i.e., they would take absolutely no risk from additional antirejection therapy). Individual utility values for returning to dialysis correlated with time on dialysis before transplantation (R= 0.76, P < 0.005), but no relationship was found between utility values and age, sex, religion, previous methods of dialysis, time with a functioning graft, number of transplantations, or time on the transplantation waiting list. CONCLUSION: The large interindividual variability of utility values precludes a prediction about the acceptance of a new therapeutic regimen by an individual patient. The assessment of the utility enables, however, a more objective judgment of the general acceptance of any possible risk/benefit ratio induced by a new immunosuppressive regimen in our patient population.

Adult↗

A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut.

A case-control study to elucidate the etiology of oral submucous fibrosis was conducted in Bhavnagar, Gujarat. Sixty consecutively arriving oral submucous fibrosis patients at a dental clinic were selected as cases. An equal number of controls matched for age, sex, religion and socioeconomic status were selected from individuals who did not exhibit any oral mucosal lesion or condition. Among cases, 98% chewed areca nut regularly in one form or the other whereas among controls 35% chewed areca nut, giving an overall relative risk of 109.6. Areca nut chewing was practiced most commonly in the form of mawa: a mixture containing mainly areca nut (over 90% by weight), some tobacco, and a few drops of lime. Mawa chewers and those who chewed mawa along with other chewing habits showed very high relative risks. The relative risks increased with increase in the frequency as well as the duration of chewing habits. In a bivariate analysis the effect of frequency and duration of chewing appeared to be multiplicative. The present findings confirm areca nut as the most important etiologic factor in oral submucous fibrosis.

Adolescent↗

Evaluations of political violence by English and Northern Irish schoolchildren.

In a study of attitudes to violence in English and Northern Irish schoolchildren, 178 children, 10-11-years-old, completed a questionnaire relating to eight examples of political and non-political violence. The children were distinguished by sex, religion and geographical location. The expected differences between religious groups in Northern Ireland did not emerge: significant differences arose only between English and Irish children and were apparent for only three of the questions. The implications of these findings are discussed.

Child↗

Who is willing to take the risk? Assessing the readiness for living liver donation in the general German population.

BACKGROUND: Shortage of donor organs is one of the major problems for liver transplant programmes. Living liver donation is a possible alternative, which could increase the amount of donor organs available in the short term. OBJECTIVE: To assess the attitude towards living organ donation in the general population to have an overview of the overall attitude within Germany. METHODS: A representative quota of people was evaluated by a mail questionnaire (n = 250). This questionnaire had 24 questions assessing the willingness to be a living liver donor for different potential recipients. Factors for and against living liver donation were assessed. RESULTS: Donating a part of the liver was almost as accepted as donating a kidney. The readiness to donate was highest when participants were asked to donate for children. In an urgent life-threatening situation the will to donate was especially high, whereas it was lower in the case of recipient substance misuse. More women than men expressed a higher disposition to donate for their children. Sex, religion, state of health and age of the donor, however, did not influence other questions on the readiness to consider living organ donation. The will for postmortem organ donation positively correlated with the will to be a living organ donor. CONCLUSIONS: The motivation in different demographic subgroups to participate in living liver transplantation is described. Differences in donation readiness resulting from the situation of every donor and recipient are thoroughly outlined. The acceptance for a living liver donation was found to be high - and comparable to that of living kidney donation.

Attitude to Health↗

Social factors and mental illness: an analysis of first admissions to a psychiatric hospital.

The authors have investigated all first admissions to a psychiatric hospital during a five year period (1972-1976) to determine the diagnostic socio-economic and demographic variables among these patients. Variables of age, sex, religion, education, occupation, income, domicile, family structure and size, and sibling position have been studied. A comparison of these variables has been made between neuroses and psychoses; and between schizophrenia and affective disorders. The significant variables are discussed in the context of socio-cultural practices in India.

Adolescent↗

OCD in Bahrain: a phenomenological profile.

Fifty patients with a primary diagnosis of Obsessive-Compulsive Disorder (OCD) were studied during the course of the year 1994 from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to highlight the frequency with which the different forms and contents occur. Six types of obsessions were identified: doubts, thoughts, fear (phobia), images, impulses and miscellaneous. Compulsive acts were classified into two types: yielding and controlling. The contents of obsessions could be classified into eight broad categories as relating to: dirt and contamination, germs, aggression, sex, religion, blasphemy, illness and indecisiveness. Thirty eight percent of the patients displayed obsessional thoughts related to dirt and contamination, while forty per cent showed religious and blasphemous obsessional thoughts and doubts. Fifty six percent of the patients had compulsions of which 36% were multiple, while 20% displayed only a single compulsion. The paper discusses these findings and emphasizes the role played by sociocultural and religious factors in shaping the character of an obsessional thought content.

Adolescent↗

Seroprevalence of anti-cysticercus antibodies among the children living in the urban environs of Maputo, Mozambique.

Blood and faecal samples were collected from 269 children (aged 0-15 years) who lived in the urban environs of Maputo, the capital city of Mozambique. Antibodies against Cysticercus cellulosae were detected, at a titre of at least 1:100, in 56 (20.8%) of the blood samples. When the stool samples were checked for Taenia solium and other helminths, both as direct smears and after formalin-ether concentration, 180 (67.0%) were found to contain at least one helminth species. The parasites most commonly detected in the faecal samples were Trichurus trichiura (36.0%) and Ascaris lumbricoides (35.7%). Only in one sample (0.4%) were gravid proglottids of Ta. solium detected, but Hymenolepis nana (1.1%) and H. diminuta (0.4%) were also found. A positive correlation between seropositivity for anti-cysticercus antibodies and subject age, and positive associations between such seropositivity and infection with A. lumbricoides and infection with Tr. trichiura were observed. None of the other demographic and environmental factors investigated--the child's sex, religion and access to toilets and/or piped water, the type of house in which he or she lived, the number of individuals in the household to which he or she belonged, and whether that household had pets or raised livestock--showed any apparent association with either the seroprevalence of anti-cysticercus antibodies or infection with any intestinal helminth. The use of water from the common sewage-drainage system for agricultural irrigation in the study area probably causes most of the contamination with intestinal parasites.

Adolescent↗

Childhood correlates of blood lead levels in Mumbai and Delhi.

BACKGROUND: Lead exposure has previously been associated with intellectual impairment in children in a number of international studies. In India, it has been reported that nearly half of the children have elevated blood lead levels (BLLs). However, little is known about risk factors for these elevated BLLs. METHODS: We conducted a retrospective cross-sectional analysis of data from the Indian National Family Health Survey, a population-based study conducted in 1998-1999. We assessed potential correlates of BLLs in 1,081 children who were < 3 years of age and living in Mumbai or Delhi, India. We examined factors such as age, sex, religion, caste, mother's education, standard of living, breast-feeding, and weight/height percentile. RESULTS: Most children (76%) had BLLs between 5 and 20 microg/dL. Age, standard of living, weight/height percentile, and total number of children ever born to the mother were significantly associated with BLLs (log transformed) in multivariate regression models. Compared with children < or = 3 months of age, children 4-11 and 12-23 month of age had 84 and 146% higher BLLs, respectively (p < 0.001). A low standard of living correlated with a 32.3% increase in BLLs (p = 0.02). Children greater than the 95th percentile for their weight/height had 31% (p = 0.03) higher BLLs compared with those who were below the 5th percentile for their weight/height. CONCLUSIONS: Our study found various factors correlated with elevated BLLs in children. The correlation between greater than the 95th percentile weight/height and higher BLL may reflect an impact of lead exposure on body habitus. Our study may help in targeting susceptible populations and identifying correctable factors for elevated BLLs in Mumbai and Delhi.

Body Size↗

Gallbladder carcinoma: experience of 116 cases.

BACKGROUND: Aggressive surgical treatment is now being advocated even for advanced carcinoma gall bladder (GBC). We reviewed our data of GBC over the last 5 years to analyse patient and survival characteristics in our patients. PATIENTS AND METHODS: Case records of all cases of GBC admitted to surgical wards in our hospital between 1994 to 1998 were reviewed for details such as age, sex, religion, symptoms, signs, investigations, treatment and survival. World literature was reviewed by using Medline search of the subject. RESULTS: A total of 116 patients with confirmed GBC were admitted during these five years. Their mean age was 54 +/- 11 years. Females greatly outnumbered males. The commonest symptom was abdominal pain (95%) followed by GB mass (78%). Associated gallstones were present in 67% cases. Adenocarcinoma was the commonest variety (79%). CT scan and USG were helpful in 78% and 89% cases respectively. Maximum patients (67%) presented with Nevins' stage V and most of these were treated with supportive therapy only. CONCLUSIONS: Our patients were at least a decade younger than patients in other series and presented at an advanced stage. Radiological investigations (USG and CT scan) played a vital role in diagnosing or suspecting the disease. Curative resections were performed in few cases. Our own results, though limited favour an aggressive surgical approach. Based on our observations we have recommended certain cancer preventive steps and future treatment strategies.

Adult↗

[Medical oath and the notion of human dignity].

Considering the recent commemoration of the 50th anniversary of the Proclamation of Human Rights, the author attempts to establish a parallel between the notion of human dignity as we read in the Hippocratic Oath, and the prevailing concept within the societies that either preceded, were contemporary or succeeded it. With that goal in mind, three ancient civilizations are focussed--Egypt, Mesopotamia and Greece--showing the differences in behaviour towards the human being, far different from the perspective of the Oath. The new view of human dignity and its due respect, in any circumstance, was only completely understood with the appearance and acceptance of Christianity. The author then draws attention to what may be viewed as the main feature of this century, as it approaches its end: the urge to lead the international community to accept, in a clear way, what Hippocrates defined in Medicine--the dignity of the human person, regardless of race, religion, sex or social class.

Hippocratic Oath↗

Epidemiology of Japanese encephalitis.

Seven hundred and sixty-two cases of Japanese Encephalitis (JE) were studied during the last 5 years (1985-1989) in relation to age, sex, religion, nutritional status, living habits, exposure to domestic animals and mosquitos, clinical profile, seasonal variation and mortality pattern. The maximum occurrence was in 1987-1988 and it showed a preponderance in males (51-82%). The disease is progressively decreasing in Muslims (3-7%) and gradually increasing in tribes (25-60%). Children in the age-group of 6-7 years (19-25%) were maximally affected and the disease was rare in infancy. The common features were coma, convulsions, neck rigidity and fever (88-97%). Gastrointestinal manifestations were rare (3.6%) but were associated with the highest mortality. About 80-95% had exposure to domestic animals directly or indirectly and 95% of the patients were not using mosquito nets. The CSF protein and sugar content were normal, with or without slight leucocytosis while the lymphocyte count was variable. The CSF and blood picture had no significant relation with clinical presentation and prognosis.

Age Factors↗

Collective bargaining and organized nurses: correlation of support and participation.

The objective of this article was to list identified personal characteristics which are intrinsic to the respondents, irrespective of their profession or employment, and which influence their viewpoints and participation in collective bargaining. Little information is reported in the nursing literature which points out the similarities of nurses to other subsets of society. The belief systems of various sub-group affiliations can have greater influence on one's opinions than one's socialization to professional values or exposure to particular environments. The current investigation was of an explorative nature. Moreover, as with many surveys, the applicability of findings is limited to the respondent population. No significant correlations were identified for nurses who are financially dependent on the income from their position, union membership of a family member, hospital size, shift worked or full-time/part-time employment status. The identified correlates of participation in collective bargaining as seniority in bargaining units and employment, hierarchical employment position and involvement in the organizing campaign were consistent with findings regarding blue collar unionists. Perception and militance correlates of age, seniority in the profession and the bargaining unit, race, religion, sex, employment position, membership in the professional association prior to collective bargaining, involvement in the initial organizing campaign and geographic location are also supportive of previous findings. The major finding of this investigation was that a tendency toward negative perceptions was associated with a proclivity toward militance. This was particularly true for the professional model of collective bargaining.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗

Incidence of isoniazid acetylation phenotypes in North Indians.

Isoniazid acetylation phenotypes were determined in 110 cases (55 of pulmonary tuberculosis and 55 of nontubercular chest diseases) by sulphadimidine acetylation test (Bratton and Marshall method). Cases with more than 65% of acetylated sulphadimidine in urine at 6th h were classified as fast acetylators, those with less than 50% as slow acetylators and others with values between 50-65% as intermediate acetylators. There were 39.09% fast, 46.36% intermediate and 14.55% slow acetylators. Possible factors for difference in results from other Indian studies have been discussed. Sulphadimidine acetylation showed no variation due to presence of disease, age, sex, religion, place of origin, height, weight and smoking habits. However, 79% of those who took alcohol regularly turned out to be fast acetylators.

Acetylation↗

Preemployment physical evaluation.

There is a growing trend toward using preemployment tests to select employees for physically demanding jobs. Women are, in increasing numbers, entering physically demanding occupations that were traditionally dominated by men. Under current Federal employment law, it is illegal to disqualify an employee for a job because of race, color, religion, sex, national origin, and with the recent passage of the American Disabilities Act (ADA), handicap. Because of gender differences in strength, body composition, and VO2max, preemployment tests for physically demanding jobs tend to screen out more females than males. Employers are using preemployment tests not only to enhance worker productivity, but also to minimize the threat of litigation for discriminatory hiring practices and to reduce the risk of musculoskeletal injuries. The primary ergonomic methods used in industry to reduce the risk of back injuries are preemployment testing and job redesign. When a test results in adverse impact, the validity of the test must be established. Validity in this context means that the test represents or predicts the applicant's capacity to perform the job. Criterion-related, content, and construct validation studies are the means used to establish validity. The validity of preemployment hiring practices for physically demanding jobs has been decided in the courts. The most common reason for ruling an employment practice invalid is the failure to show that the test measured important job behaviors. Much of this litigation has involved height and weight requirements for public safety jobs. The courts have generally ruled that using height and weight standards as a criteria for employment is illegal because they were not job related. If fitness tests comprise part or all of the preemployment test, it is essential to demonstrate that the fitness component is related to job performance. Although there are many factors to consider when establishing a cut score, there is a growing trend toward establishing the cut score on the basis of the job's physical demands, defined by VO2max and strength. This literature is limited because most validation studies are not published. They more typically take the form of a technical report to the governmental agency or company that funded the project. There are published preemployment validation studies for outdoor telephone craft jobs involving pole-climbing tasks; firefighters; highway patrol officers; steel workers; underground coal miners; chemical plant workers; electrical transmission lineworkers; and various military jobs.

Employment↗