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PubMed2005

Pain relief strategies used by older people with chronic pain: an exploratory survey for planning patient-centred intervention.

AIM: To explore pain relief interventions used by older people with chronic pain in Hong Kong. The frequency and perceived effectiveness of non-prescription measures were also explored. BACKGROUND: With increasing life expectancy, the incidence of chronic illness and chronic pain also increases. Chronic pain robs older people of their quality of life. DESIGN: This was a descriptive qualitative study. RESULTS: Forty-four older people (37 female and seven male) who were residents of a nursing home in Hong Kong took part in this study. Their ages ranged from 65 to 82 years, median age was 75 years. Almost 80% had experienced moderate to severe pain during the previous three months. The most common sites of pain were muscles and joints; 35% of subjects reported continuous pain, 27% reported pain associated with activities of daily living, and 38% reported pain during exercise but not at rest. Only a few of the study group had taken prescribed medication to relieve pain, and only two of the 44 subjects studied had used a combination of drug and non-prescription intervention for pain relief. The majority of participants used non-prescription intervention only and the most commonly used were topical analgesics with massage. The majority (58%) of the subjects perceived the used of non-prescription intervention to be very effective in pain relief. CONCLUSIONS: The prevalence of pain was found to be high among older people in this study. Yet, they were taking a pro-active and responsible role in treating their chronic pain by using non-pharmacological patient-initiated intervention; also older people perceive themselves to have control over their pain status. RELEVANCE TO CLINICAL PRACTICE: This active role of older people in their pain relief is likely to enhance the effect of education seminars and workshops aimed at novel, non-pharmacological pain relief strategies for older people with chronic pain.

Activities of Daily Living↗

PubMed2005

[People's interest in health information].

Well-informed citizens and patients regard health policy innovations as a key element when it comes to reforms in the health service--both in health economics and with regard to prevention issues. We evaluated the data provided by the 2003 Telephone Health Survey (GSTel03) to examine demographic and social distinctions in the use of different information sources. At the same time we examined whether there are any population-related differences in people's interest in health information depending on their levels of health awareness, attitudes to prevention and related modes of behaviour. The data generated by the survey show that there is considerable interest in health-related topics. Only 2% of the people questioned used no information sources for this purpose. In addition to more traditional media (books, newspapers, information from pharmacies), information provided by health insurance companies and via the Internet is becoming increasingly important. With the exception of the Internet, all other sources of information are used more frequently by women than by men, and demand for most of the information media increases with age. The frequency of information use and the number of different media used increase from the lower to the upper strata of society. As far as selected variables of health-related behaviour are concerned (smoking, sport, alcohol), the results show a link between a more positive attitude to health and a greater interest in information.

Adolescent↗

PubMed2004

Selection of a substance use disorder diagnostic instrument by the National Drug Abuse Treatment Clinical Trials Network.

Several instruments for diagnosing substance use disorders (SUD) have been developed, but to date none has emerged as the standard for community-based clinical studies. To select the most suitable SUD diagnostic instrument for its clinical trials, the National Drug Abuse Treatment Clinical Trials Network (CTN) implemented a procedure in which 36 university-based addiction researchers and 62 community-based addiction treatment providers evaluated and ranked five widely recognized diagnostic instruments: (1) the SUD section of the Structured Clinical Interview for DSM-IV (SCID); (2) the SUD section of the Composite International Diagnostic Interview, 2nd ed. (CIDI-2); (3) the SUD section of the Diagnostic Interview Schedule for DSM-IV Diagnosis (DIS-IV); (4) the Diagnostic Statistical Manual-IV Checklist (DSM-IV Checklist); and (5) the Substance Dependence Severity Scale (SDSS). To assist the evaluation and ranking process, key characteristics of each instrument were presented in tabular and narrative formats. Participants ranked each instrument from 1 (most preferred) to 5 (least preferred). The SCID received the best overall mean score (2.24) followed by the CIDI-2 (2.59), DIS (2.94), DSM Checklist (3.40) and the SDSS (3.83). After discussing the pragmatic and scientific advantages and disadvantages of each instrument, the CTN Steering Committee selected the CIDI-2. The selection of the CIDI-2 standardizes the collection of diagnostic data and provides a common diagnostic tool for practitioners and clinical researchers in the CTN. Implications for practice/research collaboration and initiatives are explored.

Analysis of Variance↗

PubMed1994

The Autobiographical Memory Interview (AMI) in organic and psychogenic amnesia.

The Autobiographical Memory Interview (AMI) is a semi-structured interview, sampling a subject's recollections across three broad time-periods. In patients with organic amnesia or dementia, there is an impairment in recalling both autobiographical facts and incidents, and there is a temporal gradient such that early memories are relatively spared. Correlations with measures of anterograde memory are relatively low, and lesions affecting the frontal lobes, anterior temporal poles, the posterior-medial temporal lobes, or even projections from the occipital lobes, can impair retrieval of autobiographical memories. In schizophrenia, an impairment in retrieving autobiographical incidents, comparable with organic amnesia, has been reported in some patients. However a patient with delusional memories secondary to schizophrenia is cited, in whom AMI performance was normal. Finally, patients with psychogenic amnesia show a variable pattern of performance, but, in general, there is a disproportionate impairment of autobiographical memory, and often an anomalous temporal gradient, which can recover subsequently.

Alcohol Amnestic Disorder↗

PubMedDate not supplied

Youth-parent communication and youth sexual behavior: implications for physicians.

BACKGROUND AND OBJECTIVES: This study explores youth and parent agreement about conversations on specific topics related to sexual risk behavior and youth-parent relationship. The study's objective was to determine if the amount of agreement was associated with youth sexual behavior. METHODS: Data were collected using a computer-assisted data entry system from one parent and one youth in 1,350 randomly selected households in inner-city areas of two Midwestern cities. RESULTS: Youth-parent positive agreement scores about these conversations were significant after controlling for youth age, race, gender, family structure, and parental income and education. Scores were associated with youth abstinence and with the use of contraception if the youth had become sexually active. CONCLUSIONS: In this study, youth-parent agreement regarding their communication was associated with positive youth behaviors, including abstinence and the use of contraception if sexually active.

Adolescent↗

PubMed2001

Meta-analyses of prospective studies on coronary heart disease, type A personality, and hostility.

BACKGROUND: Several large-scale prospective studies have failed to find an association between Type A personality (TAP) or hostility and coronary heart disease (CHD). The existing meta-analyses on this topic have several shortcomings, such as a selective search of the literature, the failed use of effect sizes, and methodological flaws. METHODS: The present meta-analyses cover all prospective studies until the end of 1998. The correlation coefficient r is used as effect size to yield information on the population effect size R and variance. Several analyses have been carried out to stratify for disease endpoints, samples (healthy population, CHD patients), and methods used to determine TAP or hostility. RESULTS: The population effect size (weighted average of all correlation coefficients) for TAP and CHD is R=0.003 (n=74,326, P=0.213), and for hostility and CHD R=0.022 (n=15,038, P=0.003). CONCLUSIONS: The population effect size for TAP and CHD is not significant. Hostility yields a significant association with CHD; however, the effect size is so low that it has as yet no practical meaning for prediction and prevention.

Coronary Disease↗

PubMed1999

Community attitudes and mammography use: does it really matter what other people think?

This study examined whether community characteristics, particularly community attitudes regarding mammography use, are associated with women's use of mammography in rural communities. Forty communities in predominantly rural areas of Washington State were selected for inclusion in this study based on their size and distance from an urban center. Characteristics of the communities were assessed as were characteristics of women living in the communities. From each community, random samples of 352 women between 50 and 80 years old participated by completing a telephone survey that included questions on a variety of topics, including their use of mammography. Logistic regression analyses revealed community of residence to be a significant predictor of individual women's mammography use after adjusting for individual level predictors of mammography use including age, education, employment, marital status, financial situation, and ease of access to medical services. An examination of the influence of community characteristics revealed women living in communities with supportive community attitudes towards mammography use report higher levels of mammography use than do women living in communities with less supportive attitudes. The presence or absence of male or female physicians or of mammography facilities in a local community was not associated with statistically significant effects on women's mammography use. Community attitudes are associated with mammography use in rural communities. Public health interventions that change community attitudes may have effects that extend beyond the people directly contacted by these interventions.

Aged↗

PubMed2006

More than just a mouse click: research into work practices behind the assignment of medical trust marks on the World Wide Web.

Hyperlinked web trust marks have been a popular topic of discussion during the past 10 years. However, the discussion has focused mostly on what these trust marks are not doing in terms of helping patients (or other lay end users) find reliable medical information on the web. In this paper, we discuss how this focus on patients and their actions with respect to trust marks, has overshadowed, if not rendered invisible, what trust marks are doing to educate medical site/information providers. We draw on data from ethnographic research conducted at the Health on the Net Foundation in 2002 and 2003 in order to explore an alternate definition of what it means to be a 'user' of a trust mark and the importance of the review process in educating site providers. We argue that understanding the work involved in the process of assigning a seal is crucial to understanding the role that the seal plays as part of the medical internet.

Humans↗

PubMed2003

Do quality improvement strategies for Medicaid enrollees differ in Medicaid-dominant versus commercial managed care organizations?

OBJECTIVE: To examine whether it matters, in terms of quality improvement initiatives and access to commercial networks, whether states contract with Medicaid-dominant or commercial managed care plans. STUDY DESIGN: A 2001 telephone survey of Medicaid managed care plans in 11 states that together account for about half of the national Medicaid managed care enrollment. METHODS: The survey was developed in consultation with a panel of individuals knowledgeable about Medicaid managed care. Information on plan characteristics and network design was obtained from the plan CEO or person most knowledgeable about the topics. The rest of the data were obtained from the person the CEO named as most knowledgeable about quality improvement initiatives. RESULTS: Surveyed plans reported an extensive array of quality improvement initiatives. Programs are in many ways similar across Medicaid-dominant and commercial plans. Medicaid-dominant plans tend to specialize more in conditions of greatest priority to Medicaid beneficiaries. Commercial plans tend to develop programs for accreditation by the National Committee for Quality Assurance, and to limit measurement specific to the Medicaid population. They draw on their commercial networks to support the Medicaid product line, but how much they expand provider access is not clear. Both types of programs face barriers that limit the effectiveness of the plans' initiatives. CONCLUSION: This study shows extensive development of quality initiatives in Medicaid managed care plans, with limited differences across Medicaid-dominant and commercial plans.

Accreditation↗

PubMed2006

Structured practice opportunities with a mnemonic affect medical student interviewing skills for intimate partner violence.

BACKGROUND: Low rates of partner violence inquiry and detection are reported in the medical setting. PURPOSE: To determine if a teaching module with a mnemonic improves interviewing skills. METHOD: Prospective randomized trial. A total of 43 medical students were assigned to either the intervention group (teaching module with guided discussion and practice highlighting use of a mnemonic) or the control group (general discussion and provision of the mnemonic at the end of the session). These students subsequently interviewed simulated patients. RESULTS: A total of 75% of the intervention group and 62% of the control group reported the mnemonic was helpful. A total of 68% of the intervention group and 45% of the control group asked a direct question about partner violence. Students who obtained a history of abuse consistently asked direct, nonjudgmental question(s). CONCLUSIONS: Students learn to perform desired interviewing skills more frequently when they have the benefit of guided discussion, practice, and memory aids.

Abbreviations as Topic↗

PubMedDate not supplied

[Health related self-help groups--participation and information level in Germany. Results of the German telephone health survey 2003].

Using the data provided by the German Telephone Health Survey 2003 that gathered health related information from 8,318 adult residents, statements concerning the participation in health related self-help groups and the level of information about self-help groups were analysed. According to the survey 8.9 % of sample have already participated in a health related self-help group, 13 % stated to be informed about this topic but have not taken part in such a group. Women are more often informed about self-help groups and have more frequently reported on participation experience than men. In comparison the level of information and participation in former East Germany is slightly smaller than in West Germany. Further, the frequency of participation experience reported as well as the level of information increased with socioeconomic status; the differences between the social stratums were smaller for participation level than for information level. People reporting to suffer from chronic health conditions or to have severe handicaps, stated approximately twice as often to be informed about self-help groups as people who did not so. Compared to estimates for the beginning of the eighties the results indicate an increased part of German population stating experiences with health related self-help groups. Especially persons affected by chronic illnesses and severe handicaps reported to be or have been active in self-help groups. However, apparently a considerable unused self-help potential still exists.

Community Participation↗

PubMed2006

Beneficiary knowledge of original Medicare and Medicare managed care.

BACKGROUND: Previous research on beneficiary knowledge of the Medicare program has shown that the beneficiary population is not well informed about Medicare. The Centers for Medicare & Medicaid Services (CMS) implemented the National Medicare Education Program in 1998 to educate Medicare beneficiaries about program benefits; choices, rights, responsibilities and protections, and health behaviors. OBJECTIVES: We sought to measure beneficiary knowledge of the Medicare program and to assess how knowledge varies by beneficiary subgroups and topic areas. RESEARCH DESIGN: We conducted psychometric analyses of survey data from Round 36 of the Medicare Current Beneficiary Survey to construct knowledge indices and estimated regression models with each knowledge index as the dependent variable, controlling for sociodemographic characteristics, self-reported health status, and insurance. SUBJECTS: The study sample included 2634 noninstitutionalized Medicare beneficiaries. MEASURES: There were 2 separate knowledge indices representing the 2 primary avenues for receiving Medicare benefits: Original Medicare and Medicare managed care. RESULTS: Beneficiaries ages 75 or older, nonwhite, with lower incomes, lower education levels, and public insurance had lower levels of knowledge on both indices. Enrollment in Medicare managed care was positively associated with knowledge about Medicare managed care but negatively associated with knowledge about Original Medicare. Areas of low program knowledge included coverage and benefits, enrollment/disenrollment, and plan choice. CONCLUSIONS: Our findings suggest the need to develop educational campaigns targeting vulnerable beneficiaries who have continued to demonstrate low levels of Medicare program knowledge.

Aged↗

PubMed2001

[Child or career? Desire for a child in East and West Berlin].

OBJECTIVE: In the Federal Republic of Germany the rate of the childless women rises. While the topic of unwanted childlessness among gynecologists receives broad attention among gynecologists, the question of (temporaryly?) intended renouncement of pregnancy and birth is of little interest. For the former GDR a low age with the firstborn and a high mother rate were typically. After the "turn" serious modifications of the birth rate in East Germany happened. MATERIAL AND METHODS: The available study examined 1996 motives for and against a child with 554 up-to-date wanted childless women in East- and West-Berlin (population-referred sample). In the questionnaire, besides sociodemographic data, information was raised to own childhood, partnership, occupation, satisfaction with life and for child desire motivation. RESULTS: Apart from the school and vocational termination conceptions on the age with the firstborn, disadvantages for a life with child and value hierarchies for partnership and family were important for the description of the dilemma of compatibility of occupation and family. Eastsocialized women consider a compatibility rather possible. CONCLUSIONS: Targets for vocational development and responsible parenthood for young women come into conflict. Temporal delaying of the child desire leads to an increase of intended and unwanted childlessness with various (psychosomatic) effects on obstetrics and gynecology.

Adult↗

PubMed2005

[Continuity of care by Pflegeüberleitung? Results of participant observation].

Continuity of care between health care institutions is of increasing importance. In a two-year research project on this topic extensive participant observation was carried out for data gathering in three hospitals in Düsseldorf (Germany). In each institution four patients were observed until their discharge and all interactions between them and health care professionals were documented using a semi-structured data-gathering instrument. Furthermore, the researchers questioned the involved professionals after each situation. Altogether a total of 980 situations were documented during 100 shifts, thus professional activities aiming at continuity of care can be regarded as extensively covered. The results show that care professionals (nurses, physicians, social workers etc.) in the three participating hospitals only incompletely assess individual needs or even fail to do so at all. In addition, there is no regular interprofessional collaboration and the professionals' horizon is essentially limited to their own institution. Patients and their relatives are not systematically involved and their views rarely considered. Two cases are used as examples to illustrate these aspects. A third example shows that also successful processes were observed. In most cases, however, the implicit logic of the hospital system dominates over individual needs and therefore a successful continuity of care processes cannot be assumed. Finally, the necessity for a fundamental change of this counterproductive systems logic is briefly discussed.

Continuity of Patient Care↗

PubMed1990

Continuing professional education needs of clinical dietitians in Pennsylvania.

A multimethod needs assessment generated both qualitative and quantitative data about continuing professional education needs and interests of Pennsylvania clinical dietitians. The study also evaluated three different needs assessment procedures. First, data were obtained from 22 clinical dietitians invited to participate in focus group interviews. The dietitians suggested continuing education topics representing four aspects of practice: clinical, procedural, professional development, and management skills. With the data obtained, two needs assessment instruments subsequently were prepared and distributed at a statewide conference. Fourteen percent of 650 attending dietitians volunteered to participate in the needs assessment process. Forty-four completed a survey using an electronic preference recording device, and 50 completed printed questionnaires. Although not directly comparable, responses to both questionnaire formats generally confirmed suggestions obtained from focus groups. Topics such as computer applications, patient education, staff development, and time management led the wide variety of choices selected. Respondents favored live, affordable, conveniently located programs delivered effectively by experts using a participatory format. Of the three assessment procedures used, focus group interviews provided the most detailed information for planning continuing education. Surveys based on focus group results are useful for contributing quantitative data. We conclude that a comprehensive plan for dietitians' professional development through continuing professional education should include structured needs assessments. The assessments are necessary to determine the diverse and changing concerns, needs, and preferences of dietitians and the organizations employing them.

Dietetics↗

PubMed2007

Cognitive plasticity in people at risk for dementia: optimising the testing-the-limits-approach.

A topic of great interest in gerontology research is the prediction of cognitive deterioration which marks the transition from mild cognitive impairment (MCI) to dementia. In this area, the term cognitive plasticity can be of great interest. We examined the utility of the Adaptive Figure Series Learning Test (ADAFI) to evoke cognitive plasticity and to show whether reduced plasticity can be found in people with MCI. In a pre-test-intervention-post-test design, intervention with the ADAFI was compared to an unspecific brain jogging task in MCI participants and healthy controls. A total of 42 subjects were included. Independent of mental health status only using the ADAFI led to pronounced improvements in post-test performances, but MCI participants profited less from the intervention with the ADAFI than healthy controls, that is, showed lower cognitive plasticity. Thus, the overlap in performance distributions between healthy participants and MCI individuals at pre-test was reduced at the time of post-test once the ADAFI had been given as intervention. The findings of the present article indicate that plasticity oriented information can be gained when the ADAFI is given as an intervention in a pre-test-training-post-test-design. The cognitive plasticity approach seems potentially useful for purposes of early identification of dementia.

Aged↗

PubMed2006

'Sex for life'? Men's counter-stories on 'erectile dysfunction', male sexuality and ageing.

Discourse on male sexuality in mid-to-later life has exploded in recent years (Gullette 1998). Attention to this topic has been spurred by the advent of (highly profitable) sexuopharmaceutical 'solutions' to erectile changes affecting older men. 'Success' stories abound in the media and in medical literature related to the restoration of faulty erections and ailing sex lives through drugs such as Viagra (sildenafil citrate), Uprima (apomorphine) and Cialis (tadalafil). In this paper we explore some of the ways in which notions about ageing and male sexuality are changing in popular cultural and medical texts in response to the advent of Viagra and the increasing authority of biomedicine in this area. We also demonstrate how the recent biomedical endorsement of 'sex for life' (the imperative to maintain an active youthful masculine [hetero]sexuality - defined in terms of male orgasm through penetrative sex) may be challenged by the very accounts of older men who are, or have been, affected by erectile difficulties and have used drugs like Viagra themselves. We present the perspectives of mid-to-late life heterosexual men in New Zealand whose stories question the contemporary biomedical privileging of erections and intercourse 'at any cost and at any age'. We argue that the current push to identify and treat so-called erectile dysfunction (and restore erections and penetrative sex to relationships) neglects some men's own experiences of alternative modes of relating sexually that they identify as 'normal', 'healthy', 'enjoyable' and 'satisfying' for them and their partners; and undermines their understanding of such changes as positive outcomes of ageing, experience and maturity.

Aged↗

PubMed1992

Language sample collection and analysis: interview compared to freeplay assessment contexts.

Spontaneous language samples elicited during freeplay and interview contexts were compared for 10 children who were specifically language impaired (SLI). Clinician-child videotaped interactions were analyzed for both structural and conversational behaviors. The results indicated that the interview was a reliable and valid assessment context, eliciting the same profile of behaviors as the freeplay context without altering diagnostic classifications. Most behaviors occurred significantly more often during the interview than during the freeplay context, indicating further that interviews are an efficient language sampling alternative for assessment purposes with elementary school-aged children with language disorders.

Child↗