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Computer-based and live interviews on problem drinking: users' attitudes.

Some studies of computerized interviews particularly those that deal with personally sensitive topics demonstrate that people have a preference for automated interviews versus live interviews. To explore this phenomenon, we administered four open-ended questions after participants were screened for problem drinking by both an automated and a human telephone interviewer. Both interviews administered AUDIT (Alcohol Use Disorders Identification Test) for assessing problem drinking. Individuals were recruited into the study who responded to ads in daily papers. Sixty-two percent of the participants preferred the human interviewer and only 3% among these expressed a concern about confidentiality of the interview. Among the 22% who preferred the automated interview, 32% indicated confidentiality as a reason for their preference.

Alcohol Drinking↗

Patient-controlled epidural analgesia in labor does not always improve maternal satisfaction.

BACKGROUND: We investigated whether patient-controlled epidural analgesia in labor with bupivacaine and fentanyl provides more satisfaction to mothers than intermittent bolus epidural analgesia or patient-controlled epidural analgesia with plain bupivacaine. METHODS: Ninety mothers with term, uncomplicated pregnancies were randomized to receive intermittent bolus epidural analgesia (bupivacaine + fentanyl), patient-controlled epidural analgesia (bupivacaine + fentanyl), or patient-controlled epidural analgesia (bupivacaine). Pain during labor was evaluated with a visual analog scale. Obstetric and neonatal outcomes were recorded. After delivery, the mothers were given a questionnaire covering the following themes: experience of labor pain, feeling of control, fears and expectations associated with pregnancy/with delivery/with becoming a mother, as well as pain, physical condition and emotions after delivery. To elaborate on these answers, 30 mothers were further randomized to a semistructured interview, in which the same topics were discussed. The main outcome measure was maternal satisfaction. RESULTS: The intermittent bolus epidural analgesia group felt they could influence labor most (p = 0.03), and in the interview they expressed most satisfaction. In this group, the total drug utilization was smallest (bupivacaine: p <0.0001 comparing all groups, fentanyl: p = 0.03 comparing the two fentanyl-receiving groups). No differences in pain occurred. Vomiting (p = 0.04) and pruritus (p <0.0001) were more common or more severe in the groups receiving fentanyl. CONCLUSIONS: We found no advantages for patient-controlled epidural analgesia over intermittent bolus epidural analgesia in terms of maternal satisfaction.

Adult↗

African American adolescents' experiences with unplanned pregnancy and elective abortion.

Abortion is a controversial topic in American society, yet abortion experiences have not been studied in great detail. We used a focused ethnographic method to interview 12 adolescents (ages 15-18 years) as they awaited elective abortion. Two follow-up interviews were conducted 6 and 8 months after the elective abortion. Major domains included relationships with partners, confiding in others and finding support, unselfish decision for self, and resolution of the crises. Empowerment was the integrating theme that unified the four domains.

Abortion, Induced↗

An application of actuarial methods in psychiatric diagnosis.

An actuarial program for psychiatric diagnosis is evaluated for agreement with final clinical diagnosis in a series of 288 patients. The acturial program provides a probability differential diagnosis based on an analysis of history and background data, symptom rating profiles, and MMPI clinical scale profiles. The observed agreement with final clinical diagnosis is approximately 50% higher than previously reported for psychological testing in this same setting. The results emphasize the importance for psychologists of clinical interview and observation skills.

Brief Psychiatric Rating Scale↗

Cognitive aspects of health surveys for public information and policy.

Health survey data are an important and efficient source of information for policy makers and administrators. But caution is warranted: surveys do not show cause-and-effect relations, and they are no substitute for randomized controlled experimentation in predicting behavior. The variety of surveys--governmental and private--is increasing, and both methodology employed and interpretation of results can be improved in suggested ways.

Adult↗

Can a brief video intervention improve breast cancer clinical trial knowledge and beliefs?

A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a video vignette using modeling in which a physician discussed the concept of a clinical trial (CT) with a woman who was in the process of making a treatment decision. A pretest-post-test design was used and improvements in clinical trial knowledge and beliefs were assessed. Results indicate that video modeling is a powerful tool for increasing CT knowledge (pretest mean=41.5% correct, post-test mean=77.5% correct) but not for improving CT beliefs. Increased clinical trial knowledge, as measured by change scores, was associated with white race, lower levels of education and pretest breast cancer knowledge, more negative pretest CT beliefs, and a higher estimate of the lifetime probability that a woman will have breast cancer. When pretest CT knowledge was added to the analysis using hierarchical multiple regression, all variables except white race became nonsignificant; an increase in CT knowledge was associated with having lower pretest CT knowledge. Results indicate that the effects of low education, low breast cancer knowledge, and biased probability assessment were mediated through the pretest score. An increase in post-test positive CT beliefs was associated with older age, thinking about breast cancer less often, and having lower pretest CT knowledge in the total sample. When pretest CT beliefs was added to the analysis using hierarchical multiple regression, all other variables became nonsignificant; an increase in CT beliefs was associated with having lower pretest CT beliefs, again indicating mediation of the effects of other variables.

Anxiety↗

Searching for a normal life: personal accounts of adults with schizophrenia, their parents and well-siblings.

Using a life course perspective, the research examines personal accounts of adults with schizophrenia, and their parents and well-siblings from six families. Accounts of multiple members of the same family, including the family member with schizophrenia, are used to describe how families understand and accommodate life changes that result from the illness. Families describe the loss of a "normal life" as one of the most devastating aspects of schizophrenia. We present the personal and social losses described by adults with schizophrenia and their well family members, and document families' search for ways that their ill family member can achieve or maintain valued social roles. The concerns of well family members for the future of the ill family member and ways families contemplate transfer of care issues are described. Implications of the study for community research and action are discussed.

Adaptation, Psychological↗

Research fundamentals: follow-up of subjects in clinical trials: addressing subject attrition.

Many published clinical trials have less than adequate follow-up. When conducting a clinical trial, researchers attempt to minimize data loss; however, some data may not be collected, particularly when subjects are lost to follow-up. Careful planning of research protocols, including comprehensive initial data collection, identification of locators, flexible scheduling, systematic subject tracking, monitoring subject loss, and systematically approaching problem cases can ensure high follow-up rates. This article presents a compendium of techniques and procedures that researchers can use to enhance follow-up and address attrition in their studies. Finally, this article outlines statistical techniques that can be used to address the effects of missing data, particularly when patients are lost to follow-up.

Appointments and Schedules↗

Caregiver role appraisal and caregiver tasks as factors in ending caregiving.

This study focuses on factors related to why people with primary responsibility for providing care to ADL-impaired elderly persons ended their caregiving roles. Data are from the 1982 National Long-Term Care Survey and the Informal Caregiver Survey. Variables reflecting characteristics of care recipients and caregivers, caregiver role responsibilities, and appraisal of the caregiver role are investigated. Of particular interest is the influence of role responsibilities, such as number of ADL tasks, relative to appraisal of the caregiving role. The results indicate that factors other than role responsibilities are important in understanding who ends caregiving, and that risk factor profiles may prove a useful means of targeting caregivers at greatest risk of ending caregiving.

Activities of Daily Living↗

Women's work: volunteer AIDS care giving in northern Thailand.

Because persons with AIDS in Thailand usually are cared for by their families, and because government AIDS policy relies upon this assistance for the care of the country's sick, the research reported here addressed the questions: Who are the home and community care givers for PWA? What kind of care do they give? And, What is the impact of care giving on the care giver(s)? Informants were drawn in 1998-99 from a long-term birth cohort study of a non-clinical urban population in the country's province of highest AIDS mortality, ChiangMai. The study was part of a larger, exploratory ethnographic study of the interplay among health, reproduction and development among persons born in 1964 and their mothers that I began in 1973. Findings include that among care-givers, parents, overwhelmingly mothers, and wives considered it their place, duty and moral benefit to care for adult children or husbands sick with AIDS.

Acquired Immunodeficiency Syndrome↗

Procedural misconceptions and informed consent: insights from empirical research on the clinical trials industry.

This paper provides a simultaneously reflexive and analytical framework to think about obstacles to truly informed consent in social science and biomedical research. To do so, it argues that informed consent often goes awry due to procedural misconceptions built into the research context. The concept of procedural misconception is introduced to describe how individuals respond to what is familiar in research settings and overlook what is different. In the context of biomedical research, procedural misconceptions can be seen to function as root causes of therapeutic misconceptions.

Behavioral Research↗

Credibility and creativity: a conversation with Kaiser Permanente's George C. Halvorson.

In 2002 Kaiser Permanente's board surprised the industry by reaching outside its organization and selecting a nonphysician leader, George C. Halvorson, then CEO of HealthPartners of Minneapolis. In this interview Halvorson talks about returning to Kaiser's strengths--its sixty-year-plus history of integrated health care organization and its power base along the Pacific Coast--and about how he and his physician colleagues intend to leverage clinical information technology to improve their subscribers' health. Halvorson also discusses the new Medicare prescription drug legislation, the sources of the current run-up in health costs, and how he intends to position Kaiser for future growth.

Administrative Personnel↗