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PubMed2004

Attitudes and cultural self-efficacy levels of nurses caring for patients in army hospitals.

This descriptive, cross-sectional study was a convenience sample of 104 registered nurses (N = 104) from three Army hospitals who participated anonymously in this study. Participating in the study were 62 (n = 62) active-duty Army nurses and 41 civilian nurses (n = 41), and one nurse that did not specify status (n = 1). The purpose of the study was to investigate attitudes and cultural self-efficacy levels in caring for ethnically diverse patients. Three research questions were generated that included: (1) What are the attitudes and cultural self-efficacy levels of nurses caring for patients in Army hospitals? (2) Are there differences in attitudes and cultural self-efficacy levels based on the nurses' age, ethnic/racial group, sex, employment status, education, military experience, and nursing experience? And, (3) What relationship exists between nurses' attitudes and their cultural self-efficacy levels? The research instrument was an aggregated instrument consisting of three different instruments including: (1) the Updated Joseph Ethnic Attitude Assessment Survey (EAAS) based on Rooda's Cultural Fitness Survey; (2) a Cultural Self-Efficacy Scale (CSES) (Bernal & Froman, 1986; 1992), and (3) a Demographic Questionnaire. Analysis of the data suggested that there were significant differences among the nurses that were based on sex, ethnicity, and military status. For the attitudes section of the EAAS questionnaire, nurses were more positive toward patients of similar ethnic backgrounds Female nurses were more positive than male nurses, and civilian nurses were more positive than their military counterparts. For the Cultural Self-Efficacy Scale (CSES), nurses expressed a fairly high degree of confidence in their knowledge of cultural concepts They also expressed high confidence in their transcultural skills for African-Americans and Latino Americans and low confidence for Asian Americans Male nurses expressed higher confidence levels than female nurses, and military nurses expressed higher confidence levels than civilian nurses.

Adult↗

PubMed1997

Dental services utilization between 1977 and 1995 by Finnish adolescents of different socioeconomic levels.

Equal distribution of health care services has long been a major goal of health policy in the Nordic countries. According to these guidelines, every child is expected to have an examination and treatment at least every second year. The aim of this study was to analyze the trends and, in particular, the socioeconomic differences in dental visits between 1977 and 1995. The data were collected as part of a nationwide research program, the Adolescent Health and Lifestyle Survey, which began in 1977. Every second year a self-administered questionnaire was mailed to a representative sample of 14-, 16- and 18-year-old Finns. The sample sizes in the surveys varied from 2422 to 9556, making a total of 56,605 subjects in the whole study. The response rates in different years varied from 77% to 88%. The percentage of adolescents visiting a dentist increased between 1977 and 1981 and thereafter remained stable. Dental visits seemed to correlate with the occupational and educational status of the parents up to 1983, but not after that. The Finnish primary oral health care policy seems to have gained a major objective by eliminating social inequality in dental service utilization among adolescents.

Adolescent↗

PubMed1990

Reliability of subjective assessment of fever by mothers.

To evaluate reliability of mother's subjective assessment of fever, we measured actual body temperature of 301 children and correlated these with assessment of fever (presence or absence) by the mother. Mothers could identify 88.9% (104/117) of febrile children and 88.6% (163/184) afebrile children correctly (positive and negative predictive values 83.2 and 87.6%, respectively). Palpation of more than one anatomical site for subjective assessment had a sensitivity of 100% and a specificity of 92.2%. The accuracy of the assessment was maximum in infants, and was not influenced by sex of the child, mother's educational status and the use of thermometer at home. In the situation where accurate measurement of temperature by thermometer is not available, mother's assessment about presence or absence of fever in her child can be relied upon by health-workers and physicians.

Body Temperature↗

PubMed1994

HIV antibodies among intravenous drug users in Bahrain.

A 12-month study was conducted to identify risk factors for human immunodeficiency virus (HIV) infections among intravenous drug users (IDU) attending drug rehabilitation clinic of the Psychiatric Hospital, Manama, Bahrain. Patients provided demographic and behavioural information based on a questionnaire. Two hundred and forty male IDUs participated in the study on voluntary basis. The seroprevalence of HIV was 21.1 per cent. The presence of HIV antibody was associated with educational status, frequency of injecting drugs and needle sharing.

Adult↗

PubMed2006

Factors motivating dyspepsia patients to enter clinical research.

One of the most influential factors in science and medicine has been the development of placebo-controlled clinical trials. However, recruitment of patients for clinical trials is sometimes a major problem in clinical research. Successful patient recruitment may be enhanced with a clear understanding of the motivating factors that determine a patient's decision to enter a study. We have developed the Patients' Expectations, Attitudes and Knowledge (PEAK) Program consisting of questionnaires designed to study the factors motivating patients to enter a clinical trial, as well as capturing the experiences of research participants. A total of 247 female patients with dyspepsia (mean age: 43.9; range: 18.0-78.0 years) who entered either of two prospective double-blind, randomized, placebo-controlled multicenter trials in the USA completed PEAK Entry questionnaires during the first study visit. Based on their responses, the top three factors motivating patients to join the clinical trial were: interest in receiving investigational treatment with average score (AS) of 4.33 +/- 0.08 (M +/- SEM) on a 5-point scale, possibility of getting skilled professional care (AS = 4.07 +/- 0.09), and altruism expressed as an intention to help develop a new drug for the sake of other people (AS = 3.89 +/- 0.09). Age, ethnicity, and educational status significantly affected motivational factors of patients. These results indicate that recruitment can be enhanced by targeting these motivations in physician/patient communications, informed consent process and advertising for study participants.

Adolescent↗

PubMed1990

Mainstreaming and postsecondary educational and employment status of a rubella cohort.

The postsecondary education and work status of 46 rubella deaf young adults was described and evaluated as an outcome of ethnicity, socioeconomic status, preschool attendance, early parent involvement, and degree of prior mainstreaming. With regard to postsecondary education attendance, 24 had two or more years, 11 had one year or less, and 11 had none. At time of interview, 19 were still attending school, 22 were working and five were neither working nor attending an educational program. Ethnic minority young adults were underrepresented in the group with two or more years of postsecondary education, and overrepresented in the group neither working nor in school at time of interview. Prior mainstreaming was a determinant of postsecondary education attendance over and above the effects of demographic and background characteristics. Implications of these findings are discussed.

Adult↗

PubMed2004

[The development of obesity in Germany in the period from 1985 until 2000].

Due to the great increase in the prevalence of obesity in the industrialised countries during the last two decades we examined the development of this prevalence in Germany between 1985 and 2002. Data sources are four national health surveys conducted between 1985 and 1998 and three surveys of the "Bertelsmann Health Monitor" in 2002 and 2003. Included in these representative cross-sectional surveys were all persons aged 25-69 years. The total number of study participants was 12 984 males and 13 630 females. Based on recommendations of the WHO, moderate obesity is defined as body-mass-index > or = 30 and pronounced obesity as body-mass-index > or = 35. From 1985 to 2002, there was an increase in the prevalence of moderate obesity in males from 16.2 to 22.5 % and in females from 16.2 % to 23.5 %, whereas the increase in the prevalence of pronounced obesity in males was from 1.5 to 5.2 % and in females from 4.5 to 7.5 %. The most important social characteristics related to pronounced obesity prevalences are low educational status, low occupational status and low household income. Thus, the quality of future preventive measures aiming at reducing obesity prevalence among the general population should be evaluated inter alia in respect of their ability to cope with the social origins of obesity.

Adult↗

PubMed2002

Individualized drug use assessment in the elderly.

STUDY OBJECTIVE: To quantify how seniors' ability to take oral prescription drugs safely may correlate with age, sex, socioeconomic status, education, cognitive impairment, depression, and drug self-management. DESIGN: Cross-sectional study SETTING: Three retirement communities and an adult day care center. PATIENTS: Fifty-seven elderly individuals (mean age 79.49 +/- 7.26 yrs; mean education 11.33 +/- 3.8 yrs; 72% women). INTERVENTION: After completing a comprehensive medical history, and with drug vials and pillboxes available for consultation, each subject described how he or she was taking prescribed oral drugs. MEASUREMENTS AND MAIN RESULTS: The MedTake test evaluated dosage, indication, food or water coingestion, and regimen. For each agent, the test was scored as percentage of correct actions, equally weighted, and compared with label directions or self-expressed physician changes. A composite MedTake test score (0-100%) summarized a subject's overall ability to take their drug(s) safely A follow-up qualitative assessment by a single pharmacist assigned each agent to one of four potential risk categories: correct use, partial correct use without potential clinical significance, partial correct use with potential clinical significance, or incorrect use with high potential of clinical significance. Most subjects (80%) managed their own drug therapy; 70% used reminder systems (calendar, pillbox). The number of medical conditions and prescription drugs was 6.11 +/- 4.2 and 5.88 +/- 3.44, respectively. Of 325 agents, correct dosage was reported for 94% (306), correct indication for 95% (309), correct coingestion with food or water for 97% (314), and correct regimen for 89% (288). The composite MedTake test score was 88.5 +/- 21.3%. The multivariate model, with that score as the dependent variable, adjusted for age and sex, used Mini-Mental State Examination (p = 0.002) and Medicaid assistance within 10 years (p = 0.021) as significant factors. The most frequent problem was underdosing of cardiovascular drugs. CONCLUSION: Seniors' ability to take oral prescription drugs safely was affected by cognitive function and socioeconomic status. Although the MedTake test helped identify some problems with therapy adherence, a pharmacist's follow-up evaluation of comprehensive medical and drug histories identified additional potentially clinically significant problems in 20% of subjects.

Administration, Oral↗

PubMedDate not supplied

Variations in risk attitude across race, gender, and education.

BACKGROUND: Significant disparities in health care utilization exist across gender and race. Little is known about the patient-specific factors that may contribute to this variation. This study examined variations in risk attitude across major sociodemographic groups. METHODS: A survey elicited utility measures for health states under risk-insensitive and risk-sensitive conditions (time tradeoff and standard gamble methods, respectively). Risk attitude was modeled assuming constant proportional risk posture, thus the utility function used was a power function. A multivariable linear regression model was used to examine the relationship between risk attitude and sociodemographic factors. RESULTS: Of the 62 study subjects, the mean age was 47.6 years, 47% were female, and 33% were African American. Overall, 37% of respondents were decidedly risk averse, 37% moderately risk averse, 15% moderately risk seeking, and 11% decidedly risk seeking. Significant predictors of increasing risk aversion in multivariate modeling were white race (P < 0.01) and lower education (P < 0.05). Women also tended to be more risk averse (P = 0.07). CONCLUSIONS: This study found significant differences in risk attitude across race and educational status, with a smaller difference across gender. Further research is needed to validate these findings and clarify their contribution to racial and gender variations in health care utilization and their future role in decision and cost-effectiveness analyses.

Adult↗

PubMed1990

Subsequent pregnancies: who has them and who wants them? Observations from an urban center in southern Brazil.

Subsequent pregnancies in mothers of a birth cohort from Pelotas, Southern Brazil, were studied in relation to maternal and socio-economic factors. Within about 3 1/2 years of the cohort child's birth, 39% of mothers had experienced at least one further pregnancy. This proportion decreased with increasing maternal age, years of schooling and family income. A U-shaped trend was observed with respect to parity. Mothers who had delivered the cohort child by caesarean section were also less likely to have another pregnancy within that time. Logistic regression analysis showed that each of these factors remained significantly associated with further pregnancies after controlling for the remaining variables. Analysis of the first subsequent pregnancy showed that a high proportion of mothers had not wanted the pregnancy. Unwanted pregnancies were also significantly associated with older women, low educational status, higher parity and low family income.

Birth Rate↗

PubMed1978

[Social class and mental disorders (an empirical study in Zurich canton)].

The correlation of social class and diagnosis, therapy, mode of admission, frequency of hospitalization was tested in a population of 2103 inpatients of the two governmental and of two private mental hospitals of the Canton Zurich. The results fit to the correlations expected from the literature. The therapeutic procedures as far as reported in the case histories are mainly determined by the hospital type, not so clearly by the subject's social class. High educational status and psychotherapy are correlated. The correlation between social class and therapy is resulting of the class specific admission to one of the two hospital types. There was no sign that within one hospital patients of lower social class were placed at a disadvantage in regard to therapeutic procedures.

Educational Status↗

PubMed2000

Determinants of health-promoting behavior among women ages 65 and above living in the community.

This study utilized Pender's Health Promotion Model to investigate through canonical correlation analysis the role that select cognitive-perceptual factors (health self-determinism, learned helplessness, self-esteem, and perceived health) and modifying factors (age, race, marital status, education, and income) play in understanding participation of community-living older adult women (age > or = 65) in the health-promoting behaviors of health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. These were measured by the Health-Promoting Lifestyle Profile II in a convenience sample of 107 community-living older adult women (mean age 76.7 years). Gender-specific benefits and barriers to participating in health-promoting behaviors were also explored using open-ended questions. Two significant canonical variates were demonstrated. These indicated that age, marital status, race, education, and self-esteem and the two health-related factors of perceived health and health self-determinism made statistically significant contributions to the health-promoting behaviors of physical activity, nutrition, spiritual growth, and interpersonal relations. Benefits identified included better psychological well-being, coping with the general issues of aging, social interaction, improved function, and management of existing health problems. Internal barriers focused on perceived physical difficulties with all types of health-promoting behaviors; external barriers included aspects of the activity itself, lack of support from others and structural barriers. Study results suggest that older adult women (age > or = 65) participate in health-promoting behaviors for both health enhancement and health management reasons and that barriers may be a more important determinant of older women's health-promoting lifestyle behaviors than previously described in the model.

Aged↗

PubMed1983

Interpersonal tactics and communicative strategies of Anglo-American and Mexican-American mildly mentally retarded and nonretarded students.

In this investigation, we compared the preferred interpersonal tactics of mildly mentally retarded Mexican-American and Anglo-American children in an experimental social problem-solving situation. Sixty subjects were divided into four equal groups based upon ethnicity (Mexican-American or Anglo-American) and educational status (mildly mentally retarded or nonretarded). Results indicated that although there were no ethnic group differences, differences in preferred problem solving strategies were demonstrated by mentally retarded and nonretarded children. Overall, nonretarded children tended to utilize strategies such as cooperation and temporary withdrawal more often than mentally retarded children.

Child↗

PubMedDate not supplied

The relations between Griffiths scales assessments in the pre-school period and educational outcomes at 7+ years.

This paper reports an administrative follow-up of 107 children at least 7 years old who were assessed on the Griffiths scales of mental development for clinical purposes when they were aged 4-4.11 years. When Griffiths scale scores are compared with educational status at follow-up, the analyses show that groups of children in settings requiring different levels of learning capacity scored differently on the scales and in line with expectation. There is also evidence of this trend in earlier years. The clinical use of this trend is illustrated.

Achievement↗

PubMed2002

Inter-relationships between lifestyle and diabetes mellitus, overweight/obesity and hypertension in Nigeria.

This study of inter-relationship between life styles and diabetes mellitus, overweight/obesity and hypertension was carried out to determine the life styles of the bank workers and the nutritional related diseases. A total sample of 570 was systematically drawn from workers of the United Bank for Africa Plc in Lagos for this study, with the following results. Not surprisingly the level of education influenced life style (P<0.05). There was also a statistically significant relationship between life style and the consumption of alcohol and diabetes, but no relationship was found between smoking and diabetes. There was a significant correlation with their consumption of fatty foods and vegetables. A relationship between increased protein intake and an increase in educational status (P<0.05) was found. There was association between obesity and hypertension (P<0.05), and between increase in frequency of clinic visitation and hypertension which was statistically significant (Chi square P<.05).

Adult↗

PubMed1995

Investigation of the personality structure in patients with vitiligo and a possible association with impaired catecholamine metabolism.

BACKGROUND: Patients with vitiligo show an increased beta 2-adrenoceptor density in differentiating vitiliginous keratinocytes correlating with a defective extracellular calcium uptake. Thirty-one percent of the patients present increased norepinephrine levels in their urine and 98% in their plasma. OBJECTIVE: The aim of this study was to find out whether these patients may: (a) have a characteristic personality structure and/or (b) show an increased stress sensitivity towards physical/environmental/hormonal changes in association with a defective catecholamine metabolism. METHODS AND RESULTS: The investigation included a randomized group of 117 patients with vitiligo (89 female, 28 male). Catecholamines were determined in plasma in a random sample of the total group (n = 30, M/F = 10/20). Norepinephrine levels in plasma were significantly higher compared to controls, whereas epinephrine was within the normal range. No specific personality pattern was found although divergencies from the normal healthy control were observed in 5 out of 12 personality dimensions. Moderate to intolerable disfigurement and psychological disturbance were stated by 75% of the patients. Evaluation of the educational status revealed that 26.5% of the patients graduated successfully from university compared to 8.4% in the normal population. CONCLUSION: The results of this study suggest a possible link between catecholamine-based stress and a genetic susceptibility to the onset/progression of this depigmentation disorder.

Adolescent↗

PubMed1996

Variables associated with cognitive function in elderly California Seventh-day Adventists.

From a cohort of white, non-Hispanic California Seventh-day Adventists, 99 subjects over age 75 years in 1991 were randomly selected. Dietary habits and educational status had been measured in 1976. Subjects completed the Mini-Mental State Examination (MMSE) in 1991, and at that time, they or caregivers also gave information on current medical problems and drug therapy. Those who ate more calories in 1976 had lower MMSE scores in 1991 (p = 0.03), an association strengthened by excluding those with previous stroke or Parkinson's disease by 1991. This raises the possibility that higher consumption of calories in middle age may accelerate the decline in cognitive function seen with aging, as apparently occurs in some animals. Less-educated subjects had lower MMSE scores, especially among the very elderly. The statistical model predicts that the negative association between use of psychotropic drugs and MMSE score (p = 0.004) is particularly potent in those cognitively impaired for other reasons. If causal, this suggests that physicians should use these agents very cautiously in such subjects.

Aged↗

PubMed1990

Stature and the risk of myocardial infarction in women.

An inverse association between height and coronary heart disease has been observed in several prospective studies of men, but the reasons for the association have not been established. The relation of stature to the risk of first nonfatal myocardial infarction in women was evaluated in data from a hospital-based case-control study of women under 65 years of age carried out in 1985-1988; 910 cases were compared with 1,140 controls. The risks of myocardial infarction for tall and short women relative to women of average height (63-64 inches (160-163 cm] were estimated, with control for body mass index (weight (kg)/height (m)2), years of education, religion, and the major known risk factors. There was a significant inverse relation of height to myocardial infarction risk (p = 0.003). The relative risk estimate for women greater than or equal to 69 inches (175 cm) tall was 0.5 (95% confidence interval (CI) 0.2-0.8); for women less than or equal to 59 inches (less than or equal to 150 cm) tall, it was 1.5 (95% CI 0.9-2.6). The results were consistent within strata of age, body mass index, educational status, and religion, and they suggest that among women, as among men, those of tall stature have a lower risk of myocardial infarction than shorter individuals. Factors which might explain the association, such as early nutrition, genetic endowment, and artery size, could not be directly evaluated.

Body Composition↗