Muddling through the Health System: Experiences of Three Groups of Black Women in Three Regions

PubMed Central

Gary, F; Still, C; Mickels, P; Hassan, M; Evans, E

2018-01-01

Health care disparities are a well-documented concern among patients and providers who care for minority groups in the United States. In this study, focus groups were created from an original sample of 606 Black women representing three regions in the United States: the South, the Midwest, and the Virgin Islands. Composed of 10 randomly selected members each (n = 30), the focus groups provided insights into the nature of these disparities, with some suggestions for viable solutions. Participants voiced concerns about cultural taboos about discussing menopause, financial concerns, and negative experiences with health care leading to distrust in medical systems. The primary solution proposed was an increase in Black health care professionals who would have increased rapport with, empathy for, and understanding of the concerns of Black women. PMID:26371357

Role of Patient Factors, Preferences, and Distrust in Health Care and Access to Liver Transplantation and Organ Donation

PubMed Central

Wilder, Julius M.; Oloruntoba, Omobonike O.; Muir, Andrew J.; Moylan, Cynthia A.

2017-01-01

Despite major improvements in access to liver transplantation (LT), disparities remain. Little is known about how distrust in medical care, patient preferences, and the origins shaping those preferences contribute to differences surrounding access. We performed a single-center, cross-sectional survey of adults with end-stage liver disease and compared responses between LT listed and nonlisted patients as well as by race. Questionnaires were administered to 109 patients (72 nonlisted; 37 listed) to assess demographics, health care system distrust (HCSD), religiosity, and factors influencing LT and organ donation (OD). We found that neither HCSD nor religiosity explained differences in access to LT in our population. Listed patients attained higher education levels and were more likely to be insured privately. This was also the case for white versus black patients. All patients reported wanting LT if recommended. However, nonlisted patients were significantly less likely to have discussed LT with their physician or to be referred to a transplant center. They were also much less likely to understand the process of LT. Fewer blacks were referred (44.4% versus 69.7%; P = 0.03) or went to the transplant center if referred (44.4% versus 71.1%; P = 0.02). Fewer black patients felt that minorities had as equal access to LT as whites (29.6% versus 57.3%; P < 0.001). For OD, there were more significant differences in preferences by race than listing status. More whites indicated OD status on their driver’s license, and more blacks were likely to become an organ donor if approached by someone of the same cultural or ethnic background (P < 0.01). In conclusion, our analysis demonstrates persistent barriers to LT and OD. With improved patient and provider education and communication, many of these disparities could be successfully overcome. PMID:27027394

Suspicious spirits, flexible minds: when distrust enhances creativity.

PubMed

Mayer, Jennifer; Mussweiler, Thomas

2011-12-01

Intuitively, as well as in light of prior research, distrust and creativity appear incompatible. The social consequences of distrust include reluctance to share information, a quality detrimental to creativity in social settings. At the same time, the cognitive concomitants of distrust bear resemblance to creative cognition: Distrust seems to foster thinking about nonobvious alternatives to potentially deceptive appearances. These cognitive underpinnings of distrust hold the provocative implication that distrust may foster creativity. Mirroring these contradictory findings, we suggest that the social versus cognitive consequences of distrust have diverging implications for creativity. We address this question in Study 1 by introducing private/public as a moderating variable for effects of distrust on creativity. Consistent with distrust's social consequences, subliminal distrust (vs. trust) priming had detrimental effects on creative generation presumed to be public. Consistent with distrust's cognitive consequences, though, an opposite tendency emerged in private. Study 2 confirmed a beneficial effect of distrust on private creative generation with a different priming method and pointed to cognitive flexibility as the mediating process. Studies 3 and 4 showed increased category inclusiveness versus increased remote semantic spread after distrust priming, consistent with enhanced cognitive flexibility as a consequence of distrust. Taken together, these results provide evidence for the creativity-enhancing potential of distrust and suggest cognitive flexibility as its underlying mechanism.

Vascularized Composite Allograft Donation and Transplantation: A Survey of Public Attitudes in the United States.

PubMed

Rodrigue, J R; Tomich, D; Fleishman, A; Glazier, A K

2017-10-01

Vascularized composite allograft (VCA) transplantation has emerged as a groundbreaking surgical intervention to return identity and function following traumatic injury, congenital deformity, or disfigurement. While public attitudes toward traditional organ/tissue donation are favorable, little is known about attitudes toward VCA donation and transplantation. A survey was conducted of 1485 U.S. residents in August 2016 to assess VCA donation attitudes. Participants also completed the Revised Health Care System Distrust Scale. Most respondents were willing to donate hands/forearms (67.4%) and legs (66.8%), and almost half (48.0%) were willing to donate the face. Three-quarters (74.4%) of women were willing to donate the uterus; 54.4% of men were willing to donate the penis. VCA donation willingness was more likely among whites and Hispanics (p < 0.001), registered organ/tissue donors (p < 0.001), and those with less health care system distrust (p < 0.001) and media exposure to VCA transplantation (p = 0.003). Many who opposed VCA donation expressed concerns about psychological discomfort, mutilation, identity loss, and the reaction of others to seeing familiar body parts on a stranger. Attitudes toward VCA donation are favorable overall, despite limited exposure to VCA messaging and confusion about how VCA donation occurs. These findings may help guide the development and implementation of VCA public education campaigns. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

The association of race, cultural factors, and health-related quality of life in persons with spinal cord injury.

PubMed

Myaskovsky, Larissa; Burkitt, Kelly H; Lichy, Alison M; Ljungberg, Inger H; Fyffe, Denise C; Ozawa, Haishin; Switzer, Galen E; Fine, Michael J; Boninger, Michael L

2011-03-01

To examine the association of race and cultural factors with quality-of-life factors (participation, life satisfaction, perceived health status) in people with spinal cord injury (SCI). Cross-sectional multisite study using structured questionnaires. Six National SCI Model Systems centers. People with SCI (N=275; age ≥16y; SCI with discernable neurologic impairments; used power or manual wheelchair for >1y as primary means of mobility; nonambulatory except for exercise purposes). None. Participation (Craig Handicap Assessment and Reporting Technique Short Form); satisfaction (Satisfaction With Life Scale); and perceived health status (2 items from 36-Item Short Form Health Survey). African American (n=96) with SCI reported more experiences of discrimination in health care, greater perceived racism, more health care system distrust, and lower health literacy than whites (n=156; P range, <.001-<.05). Participants who reported experiencing more discrimination in health care reported better occupational functioning (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.07-2.09; P<.05). Those who perceived more racism in health care settings reported better occupational functioning (OR, 1.65; 95% CI, 1.12-2.43; P<.05) and greater perceived health (β=.36; 95% CI, .05-.68; P<.05). Those who reported more distrust in the health care system reported better current health compared with 1 year ago (β=.38; 95% CI, .06-.69; P<.05). Those who reported better communication with their health care provider reported higher levels of mobility (OR, 1.5; 95% CI, 1.05-2.13; P<.05) and better general health (β=.27; 95% CI, .01-.53; P<.05). In this cross-sectional study of people with SCI, higher levels of perceived discrimination and racism and better communication with health care providers were associated with an increase in participation and functioning and improvements in perceptions of well-being. These associations are different from those reported in other study populations and warrant confirmation in future prospective studies. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Gut reactions: moral conviction, religiosity, and trust in authority.

PubMed

Wisneski, Daniel C; Lytle, Brad L; Skitka, Linda J

2009-09-01

Theory and research point to different ways moral conviction and religiosity connect to trust in political authorities to decide controversial issues of the day. Specifically, we predicted that stronger moral convictions would be associated with greater distrust in authorities such as the U.S. Supreme Court making the "right" decisions regarding controversial issues. Conversely, we predicted that stronger religiosity would be associated with greater trust in authorities. We tested these hypotheses using a survey of a nationally representative sample of Americans (N = 727) that assessed the degree to which people trusted the U.S. Supreme Court to rule on the legal status of physician-assisted suicide. Results indicated that greater religiosity was associated with greater trust in the U.S. Supreme Court to decide this issue, and that stronger moral convictions about physician-assisted suicide were associated with greater distrust in the U.S. Supreme Court to decide this issue. Also, the processes underlying religious trust and distrust based on moral convictions were more quick and visceral than slow and carefully considered.

When distrust frees your mind: the stereotype-reducing effects of distrust.

PubMed

Posten, Ann-Christin; Mussweiler, Thomas

2013-10-01

Trust and distrust are essential elements of human interaction, yet little is known about how trust and distrust shape how we perceive others. To close this gap, we examined how trust versus distrust influences stereotyping. Recent research has suggested that distrust fosters the use of cognitive nonroutine strategies. Building on these findings, we investigated the hypothesis that--contrary to intuition--it might be distrust rather than trust that reduces stereotyping. Supporting this hypothesis, engaging in an untrustworthy (vs. trustworthy vs. trust-unrelated) interaction resulted in less stereotypic evaluations in an unrelated person-judgment task (Experiment 1). Replicating the stereotype-reducing effect, 2 different distrust (vs. trust) priming manipulations led to less stereotypic person judgments in 2 different stereotyping paradigms (Experiments 2A and 2B). We hypothesized that a comparison focus on dissimilarities--a nonroutine mechanism that works against stereotyping--causes this stereotype-reducing effect. In line with this notion, distrust led to a more pronounced dissimilarity-focus (Experiment 3), and the stereotype-reducing effect of distrust diminished when this dissimilarity-focus was impaired (Experiment 4). Our findings suggest that distrust induces a dissimilarity-focus that in turn reduces stereotyping.

Distrust and the positive test heuristic: dispositional and situated social distrust improves performance on the Wason rule discovery task.

PubMed

Mayo, Ruth; Alfasi, Dana; Schwarz, Norbert

2014-06-01

Feelings of distrust alert people not to take information at face value, which may influence their reasoning strategy. Using the Wason (1960) rule identification task, we tested whether chronic and temporary distrust increase the use of negative hypothesis testing strategies suited to falsify one's own initial hunch. In Study 1, participants who were low in dispositional trust were more likely to engage in negative hypothesis testing than participants high in dispositional trust. In Study 2, trust and distrust were induced through an alleged person-memory task. Paralleling the effects of chronic distrust, participants exposed to a single distrust-eliciting face were 3 times as likely to engage in negative hypothesis testing as participants exposed to a trust-eliciting face. In both studies, distrust increased negative hypothesis testing, which was associated with better performance on the Wason task. In contrast, participants' initial rule generation was not consistently affected by distrust. These findings provide first evidence that distrust can influence which reasoning strategy people adopt. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Issues in healthcare services in Malaysia as experienced by Japanese retirees.

PubMed

Kohno, Ayako; Musa, Ghazali; Nik Farid, Nik Daliana; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-05-05

Worldwide, international retirement migration is growing in its popularity and Japanese retirees choose Malaysia as their most preferred destination. This study examines the pertinent issues related to healthcare services as experienced by Japanese retirees in this country. From January to March 2015, we conducted focus group discussions with 30 Japanese retirees who live in Kuala Lumpur and Ipoh. Guided by the social-ecological model, we discovered seven pertinent themes: 'language barriers','healthcare decisions', 'medical check-ups','healthcare insurance', 'nursing and palliative care', 'trust and distrust of healthcare services', and 'word-of-mouth information'. We identified seven pertinent issues related to healthcare services among Japanese retirees in Malaysia, of which four are especially important. These issues are explained as integrated themes within the social-ecological model. Language barriers prohibit them from having difficulty accessing to healthcare in Malaysia, but lack of will to improve their language skills exist among them. For that reason, they rely heavily on word-of-mouth information when seeking for healthcare. As a consequence, some develop feelings of trust and distrust of healthcare services. In addition, we have identified the needs for provide nursing and palliative care among Japanese retirees in Malaysia. Based on the magnitude of the discussion, we concluded that there are four crucial healthcare issues among Japanese retirees; 'language barriers', 'trust and distrust of healthcare services', 'word-of-mouth information' and 'nursing and palliative care'. We propose that further dialogue by healthcare stakeholders should be carried out to improve further the healthcare service provisions for Japanese retirees in Malaysia.

Ethical leadership.

PubMed

Keselman, David

2012-01-01

In today's climate and environment, the conventional relationship between caring, economic, and administrative practices no longer serves the interest of patients, clinicians, or systems. A shift toward human caring values and an ethic of authentic healing relationships is required as systems now have to value human resources and life purposes, inner meaning, and processes for providers and patients alike. The costs of unethical behavior can be even greater for followers. When we assume the benefits of leadership, we also assume ethical burdens. It is the assertion and experience of the author that the triangle of ethics and ethical behavior, followers, and patient's outcomes are closely interrelated and affect each other in a very intimate and direct way. Unethical leadership may lead to follower disappointment and distrust, leading to lack of interest and commitment, consequently negatively impacting patient outcomes and organizational effectiveness.

Considering the alternatives.

PubMed

Byrne, J

1999-01-01

Health care providers frequently talk about values and community care, and their mission statements often espouse a commitment to cooperative relationships with their patients. Good intentions aside, the reality is that some health care providers may be unable to accommodate patients who are unable to pay for services. Distrust is guaranteed when an industry's words and deeds don't match, but several caregivers are thinking outside the lines to find solutions to their patients' payment problems.

Trying to trust: Brain activity during interpersonal social attitude change.

PubMed

Filkowski, Megan M; Anderson, Ian W; Haas, Brian W

2016-04-01

Interpersonal trust and distrust are important components of human social interaction. Although several studies have shown that brain function is associated with either trusting or distrusting others, very little is known regarding brain function during the control of social attitudes, including trust and distrust. This study was designed to investigate the neural mechanisms involved when people attempt to control their attitudes of trust or distrust toward another person. We used a novel control-of-attitudes fMRI task, which involved explicit instructions to control attitudes of interpersonal trust and distrust. Control of trust or distrust was operationally defined as changes in trustworthiness evaluations of neutral faces before and after the control-of-attitudes fMRI task. Overall, participants (n = 60) evaluated faces paired with the distrust instruction as being less trustworthy than faces paired with the trust instruction following the control-of-distrust task. Within the brain, both the control-of-trust and control-of-distrust conditions were associated with increased temporoparietal junction, precuneus (PrC), inferior frontal gyrus (IFG), and medial prefrontal cortex activity. Individual differences in the control of trust were associated with PrC activity, and individual differences in the control of distrust were associated with IFG activity. Together, these findings identify a brain network involved in the explicit control of distrust and trust and indicate that the PrC and IFG may serve to consolidate interpersonal social attitudes.

[Trust and conflicts in care, legal elements].

PubMed

Decroix, Germain

2013-10-01

Trust is essential in all forms of medical care. It first appears when the patient chooses the professional, then when the latter suggests a treatment. This medical contract can be broken by both parties, if this trust disappears. The ultimate situation is the occurrence of complications, which can lead to a real distrust of the professional with a complaint made against him or her.

Effectiveness of U.S. Military Female Engagement Teams

DTIC Science & Technology

2012-09-01

way to curry favor with a potentially distrustful population. Medical care and education allow for measurable signs of progress to attract cooperation...increasing instances where military actions like Special Operations raids or drone strikes undertaken as a tactical response have a

High levels of cynical distrust partly predict premature mortality in middle-aged to ageing men.

PubMed

Šmigelskas, Kastytis; Joffė, Roza; Jonynienė, Jolita; Julkunen, Juhani; Kauhanen, Jussi

2017-08-01

The aim of this study was to evaluate the effect of cynical distrust on mortality in middle-aged and aging men. The analysis is based on Kuopio Ischemic Heart Disease study, follow-up from 1984 to 2011. Sample consisted of 2682 men, aged 42-61 years at baseline. Data on mortality was provided by the National Death Registry, causes of death were classified by the National Center of Statistics of Finland. Cynical distrust was measured at baseline using Cynical Distrust Scale. Survival analyses were conducted using Cox regression models. In crude estimates after 28 years of follow-up, high cynical distrust was associated with 1.5-1.7 higher hazards for earlier death compared to low cynical distrust. Adjusted for conventional risk factors, high cynical distrust was significantly associated regarding CVD-free men and CVD mortality, while non-CVD mortality in study sample was consistently but not significantly associated. The risk effects were more expressed after 12-20 years rather than in earlier or later follow-up. To conclude, high cynical distrust associates with increased risk of CVD mortality in CVD-free men. The associations with non-CVD mortality are weaker and not reach statistical significance.

Exploring the Combination of Dempster-Shafer Theory and Neural Network for Predicting Trust and Distrust

PubMed Central

Wang, Xin; Wang, Ying; Sun, Hongbin

2016-01-01

In social media, trust and distrust among users are important factors in helping users make decisions, dissect information, and receive recommendations. However, the sparsity and imbalance of social relations bring great difficulties and challenges in predicting trust and distrust. Meanwhile, there are numerous inducing factors to determine trust and distrust relations. The relationship among inducing factors may be dependency, independence, and conflicting. Dempster-Shafer theory and neural network are effective and efficient strategies to deal with these difficulties and challenges. In this paper, we study trust and distrust prediction based on the combination of Dempster-Shafer theory and neural network. We firstly analyze the inducing factors about trust and distrust, namely, homophily, status theory, and emotion tendency. Then, we quantify inducing factors of trust and distrust, take these features as evidences, and construct evidence prototype as input nodes of multilayer neural network. Finally, we propose a framework of predicting trust and distrust which uses multilayer neural network to model the implementing process of Dempster-Shafer theory in different hidden layers, aiming to overcome the disadvantage of Dempster-Shafer theory without optimization method. Experimental results on a real-world dataset demonstrate the effectiveness of the proposed framework. PMID:27034651

Using Word Clouds to Teach about Speaking Style

ERIC Educational Resources Information Center

Perry, Lisa

2012-01-01

Good public speaking style requires, among other skills, "effective management of the resources of language." Good speakers choose language carefully to create credibility, emotional impact, and logical appeal. If a speaker's language is wishy-washy, dull, vague, or long-winded, the speaker appears less trustworthy. Audience distrust of a speaker…

'Waiting for' and 'waiting in' public and private hospitals: a qualitative study of patient trust in South Australia.

PubMed

Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, A Simon; Meyer, Samantha

2017-05-05

Waiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012-13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation. Participants differentiated between experiences of 'waiting for' (e.g. for specialist appointments and surgery) and 'waiting in' (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst 'waiting for' public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter 'waiting for' hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer 'waiting in' public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy. Although public patients experienced longer 'waiting for' and 'waiting in' public hospitals, it did not lead to widespread distrust in public hospitals or healthcare professionals. Private patients recounted largely positive stories of reduced 'waiting for' and 'waiting in' private hospitals, and generally distrusted public hospitals. The continuing trust by public patients in the face of negative experiences may be understood as a form of exchange trust norm, in which institutional trust is based on base-level expectations of consistency and minimum standards of care and safety. The institutional trust by private patients may be understood as a form of communal trust norm, whereby trust is based on the additional and higher-level expectations of flexibility, reduced waiting and more time with healthcare professionals.

In regulation we trust.

PubMed

Wiig, Siri; Tharaldsen, Jorunn Elise

2012-01-01

The role of trust has been argued to play an increasingly important role in modern, complex, and ambivalent risk societies. Trust within organizational research is anticipated to have a general strategic impact on aspects such as organizational performance, communication and knowledge exchange, and learning from accidents. Trust is also an important aspect related to regulation of risk. Diverse regulatory regimes, their contexts and risks influence regulators use of trust and distrust in regulatory practice. The aim of this paper is to discuss the relationship between risk regulation and trust across diverse risk regulation regimes. By drawing from studies of risk regulation, risk perception, and trust the purpose is to discuss how regulation and trust are linked and used in practice to control risk across system levels in socio-technical systems in high risk industries. This paper provides new knowledge on 1) how functional and dysfunctional trust and distrust are grounded in the empirical realities of high risk industries, 2) how different perspectives on trust and distrust act together and bring new knowledge on how society control risk.

Do you believe in atheists? Distrust is central to anti-atheist prejudice.

PubMed

Gervais, Will M; Shariff, Azim F; Norenzayan, Ara

2011-12-01

Recent polls indicate that atheists are among the least liked people in areas with religious majorities (i.e., in most of the world). The sociofunctional approach to prejudice, combined with a cultural evolutionary theory of religion's effects on cooperation, suggest that anti-atheist prejudice is particularly motivated by distrust. Consistent with this theoretical framework, a broad sample of American adults revealed that distrust characterized anti-atheist prejudice but not anti-gay prejudice (Study 1). In subsequent studies, distrust of atheists generalized even to participants from more liberal, secular populations. A description of a criminally untrustworthy individual was seen as comparably representative of atheists and rapists but not representative of Christians, Muslims, Jewish people, feminists, or homosexuals (Studies 2-4). In addition, results were consistent with the hypothesis that the relationship between belief in God and atheist distrust was fully mediated by the belief that people behave better if they feel that God is watching them (Study 4). In implicit measures, participants strongly associated atheists with distrust, and belief in God was more strongly associated with implicit distrust of atheists than with implicit dislike of atheists (Study 5). Finally, atheists were systematically socially excluded only in high-trust domains; belief in God, but not authoritarianism, predicted this discriminatory decision-making against atheists in high trust domains (Study 6). These 6 studies are the first to systematically explore the social psychological underpinnings of anti-atheist prejudice, and converge to indicate the centrality of distrust in this phenomenon.

Diversity and Distrust: Civic Education in a Multicultural Democracy.

ERIC Educational Resources Information Center

Macedo, Stephen

This book contends that diversity is often to be highly valued, but not always. It should be remembered that many forms of social and religious diversity are at odds with basic commitments to liberty, equality, and civic ideals. The book argues that liberalism has an important but neglected civic dimension, and liberal democrats must take care to…

Hurdles to herd immunity: Distrust of government and vaccine refusal in the US, 2002-2003.

PubMed

Lee, Charlotte; Whetten, Kathryn; Omer, Saad; Pan, William; Salmon, Daniel

2016-07-25

High rates of nonmedical exemptions (NMEs) from required childhood vaccinations have contributed to outbreaks of vaccine-preventable diseases, such as measles and pertussis. Understanding the parental decision to obtain an NME could help health professionals and public health programs improve vaccination rates in areas with high vaccine refusal. Using a 2002-2003 multi-state survey of parents of school age children (​n=2445), this study found that parental distrust of the government and of healthcare providers is a significant factor related to a number of vaccine-related beliefs and behaviors. The odds that parents who distrust the government have seen a complementary/alternative medicine (CAM) provider were 2.11 times greater than those of parents who trust the government (70.1% vs 52.6%; OR, 2.11; 95% CI, 1.59-2.84; P<0.01). Parents who distrust the government had increased odds of trusting vaccine information from CAM providers compared to trusting parents (57.9% vs 46.3%; OR, 1.53; 95% CI, 1.16-2.01; P<0.01). Parents who distrust the government also had increased odds of distrusting vaccine information acquired at their healthcare providers' offices (12.6% vs 4.7%; OR, 2.64; 95% CI, 1.64-4.24; P<0.01). Distrustful parents had increased odds of thinking government sources of information about vaccines were unreliable, categorizing the CDC, the Food and Drug Administration (FDA), or local and state health departments as poor or very poor sources (distrust government vs trust government: 25.2% vs 11.7%; OR, 2.39; 95% CI, 1.70-3.36; P<0.01; distrust healthcare providers vs trust healthcare providers: 24.4% vs 11.4%; OR, 2.44; 95% CI, 1.75-3.38; P<0.01). These findings indicate that distrustful parent populations may need to be reached through modalities outside of traditional government and healthcare provider communications. Research into new and more effective techniques for delivering pro-vaccine messages is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

Diabetes: Christian worldview, medical distrust and self-management.

PubMed

Newlin Lew, Kelley; Arbauh, Nancy; Banach, Paul; Melkus, Gail

2015-06-01

To inform the development of a combined diabetes prevention and self-management intervention in partnership with church communities, this study sampled African American church leaders and members (N = 44) to qualitatively study religious beliefs and practices, diabetes prevention and self-management behaviors, and related community actions. Prior to commencing the study, internal review board approval was obtained. Although not required, community consent was officially provided by the church pastors. Individual consent was subsequently obtained from eligible community members who expressed an interest in participating in the study. Following a participatory action research approach, the inquiry group method was used. Qualitative data were analyzed with content analysis. Findings revealed Christian worldview, medical distrust and self-management as prominent themes. Findings suggest that diabetes providers address religious orientation in the provision of care with attention to rebuilding trust with the African-American community to improve health outcomes.

Institutional trust in the national social security and municipal healthcare systems for the elderly in Japan.

PubMed

Murayama, Hiroshi; Taguchi, Atsuko; Ryu, Shuhei; Nagata, Satoko; Murashima, Sachiyo

2012-09-01

Japanese social security systems and institutions for the elderly, as well as the general attitude toward elderly care services among the Japanese population, have been undergoing a dramatic change. By examining the association between institutional trust, which is a representative element of social capital, and anxiety regarding receiving elderly care, we can uncover clues toward building a more robust social security system for the elderly. This study examines the relationship between institutional trust, in the national social security and municipal healthcare systems for the elderly, and anxiety with respect to receiving elderly care among the general Japanese population. A cross-sectional survey was conducted using a self-administered questionnaire that was returned by mail in January and February 2005. The target population was 4735 community residents aged 20-75 years, who lived in the city of Koka, Shiga, Japan. A total of 2264 questionnaires were included in the analysis. A binominal logistic regression analysis showed that responses of 'trust' [odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.01-4.30] and 'strongly trust' (OR: 3.80, 95% CI: 1.55-9.31) for the national system were associated with not having anxiety regarding elderly care, compared with the reference category of feeling strongly distrust. However, trust in the municipal system showed no association with this anxiety. These results indicate the importance of developing strategies to increase a common trust in the national care services for the elderly to reduce the anxiety people feel regarding whether they will be able to receive elderly care when required.

Farmers' Cynicism toward Nature and Distrust of the Government: Where Does that Leave Conservation Buffer Programs?

ERIC Educational Resources Information Center

Gronewold, Katherine L.; Burnett, Ann; Meister, Mark

2012-01-01

Farmers are commonly regarded as stewards of the land. Farmers have, however, become cynical toward nature (Meister, Hest, & Burnett, 2009) and distrustful of the government (Cantrill, 2003). This study examines whether or not that cynicism and distrust is reflected in U.S. farmers' opinions of and future participation in conservation buffer…

Gender Distrust and Intimate Unions among Low-Income Hispanic and African American Women

ERIC Educational Resources Information Center

Estacion, Angela; Cherlin, Andrew

2010-01-01

This article investigates levels of generalized distrust of men among low-income non-Hispanic African American, Mexican, Puerto Rican, Dominican and non-Hispanic White women in a three-city survey. The results reveal substantial variation. Hispanics' overall levels of distrust are found to be higher than levels for either African Americans or…

Are hospital quality improvement and public accountability compatible?

PubMed

Panzer, R J

1994-07-01

The goals of public accountability and quality improvement are compatible in theory but not necessarily in practice. Both concepts emphasize the customer. However, those working toward these two goals design systems with quite different roles and relationships between the providers and consumers of health care. Superficial interactions obstruct meaningful dialogue about how to build a better system meeting both sets of goals. Current practices of public accountability and quality improvement have fundamentally different paradigms concerning the roles and responsibilities of those who provide and those who consume health care. There are at least three ways to improve the current relationship between public accountability and quality improvement. First, optimizing the design and performance of each effort would be an improvement since the goals are highly compatible. Neither ideal currently meets its own expectations, creating distrust among the proponents of each when reality falls short. Second, the two efforts could be coordinated through joint community-level planning and sharing. Finally and optimally, the two concepts could be made part of the same community-level cooperative system, an approach that offers the greatest opportunity for achieving shared goals.

Trust and distrust between patient and doctor.

PubMed

Hawley, Katherine

2015-10-01

To trust someone is to have expectations of their behaviour; distrust often involves disappointed expectations. But healthy trust and distrust require a good understanding of which expectations are reasonable, and which are not. In this paper, I discuss the limits of trustworthiness by drawing on recent studies of trust in the context of defensive medicine, biobanking and cardiopulmonary resuscitation decisions. © 2015 John Wiley & Sons, Ltd.

Fear and Loathing on the Campaign Trail: What the Election Means for U.S. Health Care, and the Health of American Democracy

PubMed Central

DOHERTY, ROBERT B.

2017-01-01

This paper analyzes four trends that are affecting the 2016 election: changing US demographics and the reaction to them, a growing distrust of government, increased polarization and government gridlock, and the rise of populism. It compares the views of candidates Hillary Rodham Clinton and Donald S. Trump on the Affordable Care Act, climate change, prescription drug pricing, prevention of injuries and deaths from firearms, and the opioids epidemic; and offers perspectives on the potential impact of the election not only on U.S. health care policy, but on the health of American democracy itself. PMID:28790510

The language of violence in mental health: shifting the paradigm to the language of peace.

PubMed

Alex, Marion; Whitty-Rogers, Joanne; Panagopoulos, Wendy

2013-01-01

Language used in health care, particularly with vulnerable populations such as those with mental illness, is often violent, rising from historical prejudices and politics of power over others. This creates disharmony and distrust between health care providers and patients and families. Peace involves relationships that nurture ongoing harmony, trust, and constructive solutions. In this descriptive philosophical article, we discuss connections between and among the concepts of peace, health, relational ethics, in relation to nurses' responsibilities, current health care realities, and the language of nursing. We propose a shift in discourse within nurse-patient relationships from oppressive and stigmatizing language to the discourse of peace.

Fear and Loathing on the Campaign Trail: What the Election Means for U.S. Health Care, and the Health of American Democracy.

PubMed

Doherty, Robert B

2017-01-01

This paper analyzes four trends that are affecting the 2016 election: changing US demographics and the reaction to them, a growing distrust of government, increased polarization and government gridlock, and the rise of populism. It compares the views of candidates Hillary Rodham Clinton and Donald S. Trump on the Affordable Care Act, climate change, prescription drug pricing, prevention of injuries and deaths from firearms, and the opioids epidemic; and offers perspectives on the potential impact of the election not only on U.S. health care policy, but on the health of American democracy itself.

Implicit Trust between the Uyghur and the Han in Xinjiang, China

PubMed Central

Li, Xueting; Fang, Huizhen; Yang, Shengmin; Liu, Jia

2013-01-01

Trust is a vital lubricant that increases the sense of security in social interactions. In this study, we investigated the intergroup trust between the Uyghur and the Han, the two largest ethnic groups in Xinjiang, China, with a Go/No-Go Association Task. Specifically, we instructed Uyghur and Han participants to respond to ethnic faces (Uyghur vs. Han) and trust/distrust words and measured the strength of the automatic associations between the faces and words for both in-group and out-group pairs. As expected, both ethnic groups showed implicit in-group trust and out-group distrust, but the Han group demonstrated stronger in-group trust and out-group distrust toward the Uyghur than the Uyghur group toward the Han. However, the magnitude of distrust of the Han toward the Uyghur was small to medium as compared with that reported by other intergroup relationship research. In addition, participant geographic location was associated with out-group distrust. These findings offer implications for developing effective strategies to encourage trust between conflicting groups. PMID:23977155

(Dis)-Trust in transitioning ventilator-dependent children from hospital to homecare.

PubMed

Manhas, Kiran Pohar; Mitchell, Ian

2015-12-01

Scholarly work is needed to develop the conceptual and theoretical understanding of trust to nursing practice. The transition from hospital care to complex pediatric homecare involves nurses in myriad roles, including management and care provision. Complex pediatric homecare transforms children, families, professionals, and communities, but its exact implications are unclear. To conduct an ethical inquiry into the role and responsibilities of nurses in the qualitative experience of adults involved in the hospital-to-home transition of young, ventilator-dependent children. We followed methods described by Franco Carnevale. We used a sociologically grounded theoretical orientation-trust-to re-interpret qualitative data for an ethical inquiry into a specific facet of that data. The participants included 26 adults, including 14 nurses, involved in the hospital-to-home transition in a Canadian province. Participants represented family, hospital, home, and government. The Conjoint Health Research Ethics Board at the University of Calgary approved this study. First, the concept and practice of trust was salient to the experience of transition. For example, responsibilities' allocation between hospital-based professionals to mothers, home-based nurses, and non-professionals necessitated reliance and vulnerability. Second, the consequences of distrust connected to recognized challenges. For example, tensions along rural-urban, medical-family, and professional-personal divide each revealed suspicion and uncertainty that led to isolation and anxiety for all involved. Third, recommendations to improve the experience and mitigate the challenges of transition can be grounded in trust promotion. For example, transition-specific education programs and codes of ethics would promote openness, recognize mutual vulnerability, and advance trust in transition. The challenges to transition evidenced distrust, while trust represents a powerful tool to counter these challenges and their implications. A climate of trust could bridge divides between mothers and professionals; rural and urban professionals; and professionals with differing relationships with the family. © The Author(s) 2014.

Distrust and patients in intercultural healthcare: A qualitative interview study.

PubMed

Alpers, Lise-Merete

2018-05-01

The importance of trust between patients and healthcare personnel is emphasised in nurses' and physicians' ethical codes. Trust is crucial for an effective healthcare personnel-patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of 'othering'. To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of 'othering'. Qualitative design, in-depth interviews and hermeneutic analysis. Participants and research context: The interviewees were 10 immigrant patients (six women and four men - eight Asians, two Africans - ages 32-85 years) recruited from a south-eastern Norwegian hospital. Ethical considerations: Study approval was obtained from the hospital's Privacy Ombudsman for Research and the hospital's leadership. Participation was voluntary and participants signed an informed consent form. Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient-healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust.

Interdisciplinary Team Collaboration during Discharge of Depressed Older Persons: A Norwegian Qualitative Implementation Study

PubMed Central

Holm, Anne Lise; Severinsson, Elisabeth

2013-01-01

In order to deliver effective care, it is necessary to organise interdisciplinary activities for older persons who suffer from depressive disorders. This paper evaluated the interdisciplinary team members' perceptions of cooperation in the discharge planning of depressed older persons based on the Chronic Care Model (CCM). A qualitative implementation design was used, data were collected by means of multistage focus groups, and a thematic analysis was performed. Three themes emerged: lack of effective team leadership in the community, the need to change the delivery system, and enhancing self-management support for depressed older persons as well as the participation of their families. It was concluded that nurse managers must find ways of supporting the depressed older persons by better structuring the care, increasing cooperation with organisational leadership, and creating an environment characterised by trust and mutual respect. Distrust can have serious implications for discharge planning collaboration. The development of a common vision of transparency in the organization is important as is a policy of change among leadership and in clinical practice. PMID:23766896

Beneficiaries of conflict: a qualitative study of people’s trust in the private health care system in Mogadishu, Somalia

PubMed Central

Gele, Abdi A; Ahmed, Mohamed Yusuf; Kour, Prabhjot; Moallim, Sadiyo Ali; Salad, Abdulwahab Moallim; Kumar, Bernadette

2017-01-01

Background In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as “access to adequate health care for all at an affordable price”. Despite this, an estimated 90% of Somalia’s largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people’s trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country. Methods A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis. Results Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country’s citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging – including the widespread practice of further appointments for follow-up – which inflates the costs. The study also found poor patient–provider relationship and widespread distrust of the private health care system. Conclusion The study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor–patient relationship has been – and remains – a keystone of care; thus, there is an urgent need for guidelines for private health care providers to treat their patients with dignity and respect. The education system, particularly the syllabus used by medical faculties, should be reviewed and improved to provide medical students with necessary knowledge, skills and attitudes to maintain patient dignity and rights. PMID:28831275

Beneficiaries of conflict: a qualitative study of people's trust in the private health care system in Mogadishu, Somalia.

PubMed

Gele, Abdi A; Ahmed, Mohamed Yusuf; Kour, Prabhjot; Moallim, Sadiyo Ali; Salad, Abdulwahab Moallim; Kumar, Bernadette

2017-01-01

In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as "access to adequate health care for all at an affordable price". Despite this, an estimated 90% of Somalia's largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people's trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country. A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis. Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country's citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging - including the widespread practice of further appointments for follow-up - which inflates the costs. The study also found poor patient-provider relationship and widespread distrust of the private health care system. The study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor-patient relationship has been - and remains - a keystone of care; thus, there is an urgent need for guidelines for private health care providers to treat their patients with dignity and respect. The education system, particularly the syllabus used by medical faculties, should be reviewed and improved to provide medical students with necessary knowledge, skills and attitudes to maintain patient dignity and rights.

Religious counseling in the penal context: strategies of trust and establishment of trusting relationships in a context of distrust.

PubMed

Brandner, Tobias

2013-06-01

The paper describes how distrust shapes the network of relationships between the different agents in the penal context, among inmates, between inmates and their family, between inmates and staff, between counselors and staff, and between inmates and counselors, and discusses how counseling strategies need to be adjusted to counter the effects of the institutional and biographical context of distrust. The paper is based on many years of participation and observation in the context of Hong Kong.

Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study.

PubMed

Abdou, Cleopatra M; Fingerhut, Adam W; Jackson, James S; Wheaton, Felicia

2016-02-01

Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care. Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use. Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine. The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups. Copyright © 2016. Published by Elsevier Inc.

A pilot analysis of the psychological themes found during the CARING at Columbia--Music Therapy program with refugee adolescents from North Korea.

PubMed

Choi, Carolyn Mi Hwan

2010-01-01

The purpose of this study was to identify the psychological themes found during the modified CARING at Columbia-Music Therapy (CAC-MT) program with refugee adolescents from North Korea. Nine students attending an alternative school participated in this study. Academically, students belong to an equivalent middle school level. Students participated in a music therapy program comprised of 25 sessions. A multiple case analysis was conducted to gather qualitative results. Students were found to be exposed to various psychosocially stressful life situations such as lack of social support system, family separation, academic difficulty, and economic hardship throughout their adaptation process to their new country. There were 5 common psychological themes--avoidance, distrust, loneliness, feelings of loss, and fear--found among the refugee students over the course of the CAC-MT treatment. For future research, studies with a larger sample size and differing types of session structure should be conducted to closely examine the effects of this program on refugee adolescents.

The Reasons behind the (Non)Use of Feedback Reports for Quality Improvement in Physical Therapy: A Mixed-Method Study

PubMed Central

Scholte, Marijn; Neeleman-van der Steen, Catherina W. M.; van der Wees, Philip J.; Nijhuis-van der Sanden, Maria W. G.; Braspenning, Jozé

2016-01-01

Objectives To explain the use of feedback reports for quality improvements by the reasons to participate in quality measuring projects and to identify barriers and facilitators. Design Mixed methods design. Methods In 2009–2011 a national audit and feedback system for physical therapy (Qualiphy) was initiated in the Netherlands. After each data collection round, an evaluation survey was held amongst its participants. The evaluation survey data was used to explain the use of feedback reports by studying the reasons to participate with Qualiphy with correlation measures and logistic regression. Semi-structured interviews with PTs served to seek confirmation and disentangle barriers and facilitators. Results Analysis of 257 surveys (response rate: 42.8%) showed that therapists with only financial reasons were less likely to use feedback reports (OR = 0.24;95%CI = 0.11–0.52) compared to therapists with a mixture of reasons. PTs in 2009 and 2010 were more likely to use the feedback reports for quality improvement than PTs in 2011 (OR = 2.41;95%CI = 1.25–4.64 respectively OR = 3.28;95%CI = 1.51–7.10). Changing circumstances in 2011, i.e. using EHRs and financial incentives, had a negative effect on the use of feedback reports (OR = 0.40, 95%CI = 0.20–0.78). Interviews with 12 physical therapists showed that feedback reports could serve as a tool to support and structure quality improvement plans. Barriers were distrust and perceived self-reporting bias on indicator scores. Conclusions Implementing financial incentives that are not well-specified and well-targeted can have an adverse effect on using feedback reports to improve quality of care. Distrust is a major barrier to implementing quality systems. PMID:27518113

Medicalized addiction, self-medication, or nonmedical prescription drug use? How trust figures into incarcerated women's conceptualization of illicit prescription drug use.

PubMed

Smirnova, Michelle; Owens, Jennifer Gatewood

2017-06-01

Trust is crucial to optimal care. When trust is compromised, patients, doctors, and others involved in the provision of health care may not act in patients' best interests, particularly when dealing with prescription (Rx) drugs. Patients must trust that doctors are giving them the proper treatment, including access to Rx drugs only when medically necessary. They must also trust themselves to use these drugs properly. Likewise, doctors must trust the patient's ability to use medications appropriately. Given the recent rise in illicit Rx drug use in the U.S., we seek to understand how women articulate levels of trust in doctors and themselves and if different combinations of trust and distrust impact how they acquire, use, and articulate their experiences with Rx drugs. To this end, we identified and interviewed 40 women incarcerated in the U.S., who were deeply entrenched in illicit Rx drug use prior to prison. Based upon this research, we argue that illicit Rx drug use may be tied to different combinations of trust and distrust in individual doctors (interpersonal trust), the field of medicine (institutional trust), and the users themselves (self trust). How these women acquire Rx drugs: through doctors, friends, family, or the street market are influenced by combinations of interpersonal, institutional, and self trust. Copyright © 2017 Elsevier Ltd. All rights reserved.

Predictors of avoiding medical care and reasons for avoidance behavior.

PubMed

Kannan, Viji Diane; Veazie, Peter J

2014-04-01

Delayed medical care has negative health and economic consequences; interventions have focused on appraising symptoms, with limited success in reducing delay. To identify predictors of care avoidance and reasons for avoiding care. Using the Health Information National Trends Survey (2007), we conducted logistic regressions to identify predictors of avoiding medical visits deemed necessary by the respondents; and, we then conducted similar analyses on reasons given for avoidance behavior. Independent variables included geographic, demographic, socioeconomic, personal health, health behavior, health care system, and cognitive characteristics. Approximately one third of adults avoided doctor visits they had deemed necessary. Although unadjusted associations existed, avoiding needed care was not independently associated with geographic, demographic, and socioeconomic characteristics. Avoidance behavior is characterized by low health self-efficacy, less experience with both quality care and getting help with uncertainty about health, having your feelings attended to by your provider, no usual source of care, negative affect, smoking daily, and fatalistic attitude toward cancer. Reasons elicited for avoidance include preference for self-care or alternative care, dislike or distrust of doctors, fear or dislike of medical treatments, time, and money; respondents also endorsed discomfort with body examinations, fear of having a serious illness, and thoughts of dying. Distinct predictors distinguish each of these reasons. Interventions to reduce patient delay could be improved by addressing the health-related behavioral, belief, experiential, and emotional traits associated with delay. Attention should also be directed toward the interpersonal communications between patients and providers.

Automation trust and attention allocation in multitasking workspace.

PubMed

Karpinsky, Nicole D; Chancey, Eric T; Palmer, Dakota B; Yamani, Yusuke

2018-07-01

Previous research suggests that operators with high workload can distrust and then poorly monitor automation, which has been generally inferred from automation dependence behaviors. To test automation monitoring more directly, the current study measured operators' visual attention allocation, workload, and trust toward imperfect automation in a dynamic multitasking environment. Participants concurrently performed a manual tracking task with two levels of difficulty and a system monitoring task assisted by an unreliable signaling system. Eye movement data indicate that operators allocate less visual attention to monitor automation when the tracking task is more difficult. Participants reported reduced levels of trust toward the signaling system when the tracking task demanded more focused visual attention. Analyses revealed that trust mediated the relationship between the load of the tracking task and attention allocation in Experiment 1, an effect that was not replicated in Experiment 2. Results imply a complex process underlying task load, visual attention allocation, and automation trust during multitasking. Automation designers should consider operators' task load in multitasking workspaces to avoid reduced automation monitoring and distrust toward imperfect signaling systems. Copyright © 2018. Published by Elsevier Ltd.

Promoting organ donation to Hispanics: the role of the media and medicine.

PubMed

Frates, Janice; Bohrer, Gloria Garcia; Thomas, David

2006-01-01

This study assesses the impact of a paid media advertising campaign employing Spanish language, culturally sensitive television and radio spots airing on major Hispanic stations in southern California. An advertising tracking study with a baseline and three postintervention telephone surveys was conducted from 2001 through 2003 among 500 randomly selected self-identified, primarily Spanish language dominant adult Hispanics. Measures of organ donation attitudes and behaviors (decision and declared intent to donate organs) improved significantly (P < .05) in 2001 and 2002, then leveled off or declined in 2003. Among the reasons given for not making a decision to donate was fear that medical personnel might withhold care from identified organ donors, suggesting lack of knowledge and distrust of the health care system. Few respondents talked to health care professionals or contacted the organ procurement agency for information either before or after the campaign. Findings from this study indicate a need for ongoing public education in the Hispanic community about organ transplantation and donation. Health professionals need to become more engaged in encouraging Hispanic patients to learn about organ transplantation and donation, and to inform their families that they have made the personal decision to donate.

Interpersonal Dynamics in the Workplace.

ERIC Educational Resources Information Center

1999

The first of the four papers in this symposium, "Trust and Distrust at Work: Normative and Dyad-exchange Influences on Performance" (C. Ken Weidner, II), proposes a theoretical framework for exploring and understanding trust and distrust in organizations. "Work Culture Adjustment: A Critical Ingredient to Organizational Change"…

"They don't want anything to do with you": patient views of primary care management of chronic pain.

PubMed

Upshur, Carole C; Bacigalupe, Gonzalo; Luckmann, Roger

2010-12-01

Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and providers report low satisfaction with chronic pain care. This study was designed to explore the views held by a diverse sample of patients with chronic pain complaints about their care experiences to identify ways to improve care. Qualitative analysis of 17 patient focus groups (size 3-7 participants). Groups used structured questions and were tape recorded, transcribed, and coded using qualitative software. Eleven groups were conducted in English, six groups in Spanish. Convenience sample of 72 adult patients (68% female, 44% Latino, mean age=48.1 years) recruited from four diverse primary care practices in Central Massachusetts. Across all 17 groups, and all gender, ethnicity, and age groups, most patients reported suboptimal interactions with their providers when seeking care for chronic pain. Subjects acknowledged feeling disrespected and distrusted, suspected of drug-seeking, and having their symptoms dismissed as trivial and/or not warranting medical care. Patients reported more satisfaction when they felt a provider listened to them, trusted them, was accessible to address pain concerns between visits, and used patient-centered approaches to establish goals and treatment plans. Patients also recommended some management techniques related to the chronic disease management model to improve pain care. Implementing patient-centered approaches in caring for individuals with chronic pain and using principles drawn from the chronic disease management model to improve care systems may improve both patient and provider satisfaction with chronic pain care. Wiley Periodicals, Inc.

What's trust got to do with it? Revisiting opioid contracts.

PubMed

Buchman, Daniel Z; Ho, Anita

2014-10-01

Prescription opioid abuse (POA) is an escalating clinical and public health problem. Physician worries about iatrogenic addiction and whether patients are 'drug seeking', 'abusing' and 'diverting' prescription opioids exist against a backdrop of professional and legal consequences of prescribing that have created a climate of distrust in chronic pain management. One attempt to circumvent these worries is the use of opioid contracts that outline conditions patients must agree to in order to receive opioids. Opioid contracts have received some scholarly attention, with trust and trustworthiness identified as key values and virtues. However, few articles have provided a critical account of trust and trustworthiness in this context, particularly when there exists disagreement about their role in terms of enhancing or detracting from the patient-physician relationship. This paper argues that opioid contracts represent a misleading appeal to patient-physician trust. Assuming the patient is untrustworthy may wrongfully undermine the credibility of the patient's testimony, which may exacerbate certain vulnerabilities of the person in pain. However, misplaced trust in certain patients may render the physician vulnerable to the potential harms of POA. If patients distrust their physician, or feel distrusted by them, this may destabilise the therapeutic relationship and compromise care. A process of epistemic humility may help cultivate mutual patient-physician trust. Epistemic humility is a collaborative effort between physicians and patients that recognises the role of patients' subjective knowledge in enhancing physicians' self-understanding of their theoretical and practice frameworks, values and assumptions about the motivations of certain patients who report chronic pain. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Vaccine Rejecting Parents' Engagement With Expert Systems That Inform Vaccination Programs.

PubMed

Attwell, Katie; Leask, Julie; Meyer, Samantha B; Rokkas, Philippa; Ward, Paul

2017-03-01

In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and practice. Our data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and "the system" underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents-and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust-as arising from the internalization of countering views, which facilitates nuance.

Trust in the Internet as a Health Resource Among Older Adults: Analysis of Data from a Nationally Representative Survey

PubMed Central

Kirch, Matthias; Zheng, Kai; An, Lawrence C

2011-01-01

Background Distrust in the Internet as a source of health information remains common among older adults. The influence of this distrust on Internet use for health-related purposes, however, is unclear. Objective The objective of our study was to explore how older adults’ trust in the Internet influences their online health-related activities, and to identify potential targets for improving health-related Internet resources for older adults. Methods Data were obtained from a nationally representative, random digit-dial telephone survey of 1450 adults 50 years of age and older in the United States. A model was developed to conceptualize the hypothesized relationships among individual characteristics, distrust, and avoidance of the Internet as a health resource. Multivariate logistic regression analyses were conducted to examine the association between trust in online health information and use of the Internet for health-related purposes. Additional multivariate logistic regression analyses were conducted to identify the key characteristics associated with trust in online health information, adding sequentially the variables hypothesized to account for distrust among older adults: sociodemographic and health characteristics, inexperience and technical difficulties with the Internet, negative feelings toward the Internet, and lack of awareness about the sources providing the health information found online. Results The mean (SD) age of the study population was 63.7 (10.6) years. Of the 823 (56.8%) Internet users, 628 (76.3%) reported using the Internet as a health resource. Trust in the Internet as a source of health information was associated with using the Internet for a number of health activities, including searching for information about a specific health condition (adjusted OR 4.43, P < .001), purchasing prescription drugs (adjusted OR 2.61, P = .03), and talking with a health care provider about information found online (adjusted OR 2.54, P = .002). Older adults (age ≥65 years) were less likely to trust the Internet as a source of health information (OR 0.63, P = .04), even after adjusting for other sociodemographic characteristics and health and function. This age effect was only slightly attenuated (adjusted OR 0.69, P = .13) after adjusting for inexperience and technical difficulties with the Internet, but it disappeared entirely (adjusted OR 0.96, P = .91) after adjusting for other hypothesized contributors to distrust (including finding the Internet confusing because it provides “too much information,” and lacking awareness about the source providing health information found online). Conclusions Website design features that clearly identify the source and credibility of information and minimize confusion may build trust among older adults and offer an opportunity to increase the utility of the Internet as a health resource for this population. PMID:21324832

Trust in the internet as a health resource among older adults: analysis of data from a nationally representative survey.

PubMed

Zulman, Donna M; Kirch, Matthias; Zheng, Kai; An, Lawrence C

2011-02-16

Distrust in the Internet as a source of health information remains common among older adults. The influence of this distrust on Internet use for health-related purposes, however, is unclear. The objective of our study was to explore how older adults' trust in the Internet influences their online health-related activities, and to identify potential targets for improving health-related Internet resources for older adults. Data were obtained from a nationally representative, random digit-dial telephone survey of 1450 adults 50 years of age and older in the United States. A model was developed to conceptualize the hypothesized relationships among individual characteristics, distrust, and avoidance of the Internet as a health resource. Multivariate logistic regression analyses were conducted to examine the association between trust in online health information and use of the Internet for health-related purposes. Additional multivariate logistic regression analyses were conducted to identify the key characteristics associated with trust in online health information, adding sequentially the variables hypothesized to account for distrust among older adults: sociodemographic and health characteristics, inexperience and technical difficulties with the Internet, negative feelings toward the Internet, and lack of awareness about the sources providing the health information found online. The mean (SD) age of the study population was 63.7 (10.6) years. Of the 823 (56.8%) Internet users, 628 (76.3%) reported using the Internet as a health resource. Trust in the Internet as a source of health information was associated with using the Internet for a number of health activities, including searching for information about a specific health condition (adjusted OR 4.43, P < .001), purchasing prescription drugs (adjusted OR 2.61, P = .03), and talking with a health care provider about information found online (adjusted OR 2.54, P = .002). Older adults (age ≥ 65 years) were less likely to trust the Internet as a source of health information (OR 0.63, P = .04), even after adjusting for other sociodemographic characteristics and health and function. This age effect was only slightly attenuated (adjusted OR 0.69, P = .13) after adjusting for inexperience and technical difficulties with the Internet, but it disappeared entirely (adjusted OR 0.96, P = .91) after adjusting for other hypothesized contributors to distrust (including finding the Internet confusing because it provides "too much information," and lacking awareness about the source providing health information found online). Website design features that clearly identify the source and credibility of information and minimize confusion may build trust among older adults and offer an opportunity to increase the utility of the Internet as a health resource for this population.

Illuminating the Lived Experiences of Research with Indigenous Communities

ERIC Educational Resources Information Center

Burnette, Catherine E.; Sanders, Sara; Butcher, Howard K.; Salois, Emily Matt

2011-01-01

The historical exploitation experienced by indigenous people in the United States has left a number of negative legacies, including distrust toward research. This distrust poses a barrier to progress made through culturally sensitive research. Given the complex history of research with indigenous groups, the purpose of this descriptive…

Is the Process of Special Measures an Effective Tool for Bringing about Authentic School Improvement?

ERIC Educational Resources Information Center

Willis, Lynne

2010-01-01

Managing change in education is a complex process, but to do so under the pressure of a punishment-based measurement system (Fullan, 2008) makes sustainable and meaningful change increasingly difficult. Systems which produce high stakes accountability measures, which bring with it sanctions that create a greater sense of distrust, demoralization…

Trust in the Health Care System and the Use of Preventive Health Services by Older Black and White Adults

PubMed Central

Schulz, Richard; Harris, Roderick; Silverman, Myrna; Thomas, Stephen B.

2009-01-01

Objectives. We sought to find racial differences in the effects of trust in the health care system on preventive health service use among older adults. Methods. We conducted a telephone survey with 1681 Black and White older adults. Survey questions explored respondents' trust in physicians, medical research, and health information sources. We used logistic regression and controlled for covariates to assess effects of race and trust on the use of preventive health services. Results. We identified 4 types of trust through factor analysis: trust in one's own personal physician, trust in the competence of physicians' care, and trust in formal and informal health information sources. Blacks had significantly less trust in their own physicians and greater trust in informal health information sources than did Whites. Greater trust in one's own physician was associated with utilization of routine checkups, prostate-specific antigen tests, and mammograms, but not with flu shots. Greater trust in informal information sources was associated with utilization of mammograms. Conclusions. Trust in one's own personal physician is associated with utilization of preventive health services. Blacks' relatively high distrust of their physicians likely contributes to health disparities by causing reduced utilization of preventive services. Health information disseminated to Blacks through informal means is likely to increase Blacks' utilization of preventive health services. PMID:18923129

Organizational Silence and Hidden Threats to Patient Safety

PubMed Central

Henriksen, Kerm; Dayton, Elizabeth

2006-01-01

Organizational silence refers to a collective-level phenomenon of saying or doing very little in response to significant problems that face an organization. The paper focuses on some of the less obvious factors contributing to organizational silence that can serve as threats to patient safety. Converging areas of research from the cognitive, social, and organizational sciences and the study of sociotechnical systems help to identify some of the underlying factors that serve to shape and sustain organizational silence. These factors have been organized under three levels of analysis: (1) individual factors, including the availability heuristic, self-serving bias, and the status quo trap; (2) social factors, including conformity, diffusion of responsibility, and microclimates of distrust; and (3) organizational factors, including unchallenged beliefs, the good provider fallacy, and neglect of the interdependencies. Finally, a new role for health care leaders and managers is envisioned. It is one that places high value on understanding system complexity and does not take comfort in organizational silence. PMID:16898978

Organizational silence and hidden threats to patient safety.

PubMed

Henriksen, Kerm; Dayton, Elizabeth

2006-08-01

Organizational silence refers to a collective-level phenomenon of saying or doing very little in response to significant problems that face an organization. The paper focuses on some of the less obvious factors contributing to organizational silence that can serve as threats to patient safety. Converging areas of research from the cognitive, social, and organizational sciences and the study of sociotechnical systems help to identify some of the underlying factors that serve to shape and sustain organizational silence. These factors have been organized under three levels of analysis: (1) individual factors, including the availability heuristic, self-serving bias, and the status quo trap; (2) social factors, including conformity, diffusion of responsibility, and microclimates of distrust; and (3) organizational factors, including unchallenged beliefs, the good provider fallacy, and neglect of the interdependencies. Finally, a new role for health care leaders and managers is envisioned. It is one that places high value on understanding system complexity and does not take comfort in organizational silence.

[Meanings attributed by family members in pediatrics regarding their interactions with nursing professionals].

PubMed

Gomes, Giovana Calcagno; Xavier, Daiani Modernel; Pintanel, Aline Campelo; Farias, Dóris Helena Ribeiro; Lunardi, Valéria Lerch; Aquino, Deise Ribeiro

2015-12-01

Understanding the meanings attributed by family caregivers of children in hospital environments about their interactions with nursing professionals. This qualitative study used Symbolic Interactionism as a theoretical reference and Grounded Theory as the methodological framework. It was carried out in a Pediatrics Center in southern Brazil, in the first half of 2013. Participants were 15 family caregivers of hospitalized children. Data were collected through interviews and submitted to open and axial analysis. Interactions with the nursing team enable family to trust or distrust in the provided child care and to positively evaluate the care received. Interactions between family members and the nursing team contribute to the significance attributed by the family to the nursing care received by the child. Nurses should be aware of the attitudes of the nursing team regarding the child and their family, prioritizing humanized care.

Worldviews and trust of sources for health information on electronic nicotine delivery systems: Effects on risk perceptions and use.

PubMed

Weaver, Scott R; Jazwa, Amelia; Popova, Lucy; Slovic, Paul; Rothenberg, Richard B; Eriksen, Michael P

2017-12-01

Public health agencies, the news media, and the tobacco/vapor industry have issued contradictory statements about the health effects of electronic nicotine delivery systems (ENDS). We investigated the levels of trust that consumers place in different information sources and how trust is associated with cultural worldviews, risk perceptions, ENDS use, and sociodemographic characteristics using a nationally representative sample of 6051 U.S. adults in 2015. Seventeen percent of adults were uncertain about their trust for one or more potential sources. Among the rest, the Centers for Disease Control and Prevention (CDC), health experts, and the Food & Drug Administration (FDA) elicited the highest levels of trust. In contrast, tobacco and vapor manufacturers, vape shop employees, and, to a lesser extent, the news media were distrusted. Adults who had higher incomes and more education or espoused egalitarian and communitarian worldviews expressed more trust in health sources and the FDA, whereas those identifying as non-Hispanic Black or multiracial reported less trust. Current smokers, those who identified as non-Hispanic Black or other race, had lower incomes, and espoused hierarchy and individualism worldviews expressed less distrust toward the tobacco and vapor industry. Greater trust (or less distrust) toward the tobacco and vapor industry and an individualism worldview were associated with perceptions of lower risk of premature death from daily ENDS use, greater uncertainty about those risks, and greater odds of using ENDS. Public health and the FDA should consider consumer trust and worldviews in the design and regulation of public education campaigns regarding the potential health risks and benefits of ENDS.

Political Distrust and Social Capital in Europe and the USA

ERIC Educational Resources Information Center

Schyns, Peggy; Koop, Christel

2010-01-01

Levels of rising political distrust in the USA and parts of Europe attracted political scientists' attention in the 1990s, and urged them to look at possible consequences of this phenomenon for the functioning of democracies and social life. Approximately during the same period, from a sociological viewpoint, social capital theorists started…

Civic Media Literacies: Re-Imagining Engagement for Civic Intentionality

ERIC Educational Resources Information Center

Mihailidis, Paul

2018-01-01

This paper explores the structural constraints of contemporary approaches to media literacy in the face of increased partisanship, tribalism, and distrust. In the midst of a renewed call for media literacy initiatives that respond to the increasing levels of distrust in both legacy and grassroots media, this paper argues that media literacy…

On sanction-goal justifications: How and why deterrence justifications undermine rule compliance.

PubMed

Mooijman, Marlon; van Dijk, Wilco W; van Dijk, Eric; Ellemers, Naomi

2017-04-01

Authorities frequently justify their sanctions as attempts to deter people from rule breaking. Although providing a sanction justification seems appealing and harmless, we propose that a deterrence justification decreases the extent to which sanctions are effective in promoting rule compliance. We develop a theoretical model that specifies how and why this occurs. Consistent with our model, 5 experiments demonstrated that-compared with sanctions provided without a justification or sanctions provided with a just-deserts justification-sanction effectiveness decreased when sanctions were justified as attempts to deter people from rule breaking. This effect was mediated by people feeling distrusted by the authority. We further demonstrated that (a) the degree to which deterrence fostered distrust was attenuated when the sanction was targeted at others (instead of the participant) and (b) the degree to which distrust undermined rule compliance was attenuated when the authority was perceived as legitimate. We discuss the practical implications for authorities tasked with promoting rule compliance, and the theoretical implications for the literature on sanctions, distrust, and rule compliance. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Health care delivery and the training of surgeons.

PubMed Central

MacLean, L D

1993-01-01

Most countries have mastered the art of cost containment by global budgeting for public expenditure. It is not as yet clear whether the other option, managed care, or managed competition will accomplish cost control in America. Robert Evans, a Canadian health care expert, remains skeptical. He says, "HMO's are the future, always have been and always will be." With few exceptions, the amount spent on health care is not a function of the system but of the gross domestic product per person. Great Britain is below the line expected for expenditure, which may be due to truly impressive waiting lists. The United States is above the line, which is probably related to the overhead costs to administer the system and the strong demand by patients for prompt and highly sophisticated diagnostic measures and treatments. Canada is on the line, but no other country has subscribed to the Canadian veto on private insurance. Reform or changes are occurring in all countries and will continue to do so. For example, we are as terrified of managed care in Canada as you are of our brand of socialized insurance. We distrust practice by protocol just as you abhor waiting lists. From my perspective as a surgeon, I envision an ideal system that would cover all citizens, would maintain choice of surgeon by patients, would provide mechanisms for cost containment that would have the active and continuous participation of the medical profession, and would provide for research and development. Any alteration in health care delivery in the United States that compromises biomedical research and development will be a retrogressive, expensive step that could adversely affect the health of nations everywhere. Finally, a continuing priority of our training programs must be to ensure that the surgeon participating in this system continues to treat each patient as an individual with concern for his or her own needs. PMID:8373266

Ethics beyond borders: how health professionals experience ethics in humanitarian assistance and development work.

PubMed

Hunt, Matthew R

2008-08-01

Health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, clinic- and hospital-based care, rehabilitation and feeding programs. In the course of this work, clinicians are frequently exposed to complex ethical issues. This paper examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data, including: tension between respecting local customs and imposing values; obstacles to providing adequate care; differing understandings of health and illness; questions of identity for health workers; and issues of trust and distrust. Recommendations are made for organizational strategies that could help aid agencies support and equip their staff as they respond to ethical issues.

Young people's understanding of HIV: a qualitative study among school students in Mankweng, South Africa.

PubMed

Ragnarsson, Anders; Onya, Hans E; Aarø, Leif Edvard

2009-06-01

This article describes young people's interpretation of HIV, AIDS and sexually transmitted illness in a rural South African community in Mankweng, Limpopo Province. The study was based on 19 focus group discussions with adolescents aged 12-14 years. Our participants had limited knowledge about HIV from a biomedical perspective. Their understanding and interpretations of HIV and other sexually transmitted diseases were largely informed by traditional and religious belief systems that explain how and why people contract an illness via sexual intercourse. Based on these interpretations, they also expressed distrust towards the medical health system, and where to go for care, support and treatment. Local traditional healers were often mentioned as the only people who could cure several of the sexually transmitted diseases described by our informants. The ways of understanding HIV, AIDS and other sexually transmitted illnesses may weaken efforts of health education interventions based solely on a medical and modern notion of disease. The authors emphasise the importance of exploring traditional and religious belief systems and taking these into account when planning and designing behaviour change interventions.

DARPA ADAMS Project

DTIC Science & Technology

2015-05-11

it means that Mary distrusts John. We showed that it is possible to analyze such trust- distrust relationships within signed social networks in... relationship problems) − Professional Problems (negative changes at workplace, interpersonal conflicts) Furthermore, we encode in 2nd degree variables...a social media forum data. • Processed initial set of Vegas metrics data (clustering coefficient, # similar users, # skip levels) through time

Living with Layoffs.

ERIC Educational Resources Information Center

Hartzell, Gary N.

1992-01-01

Afterschool systems reduce the number of employees, the surviving staff members often experience low morale, distrust, and guilt. Administrators can help the survivors by answering questions about the layoff: whether it was necessary; whether it was conducted fairly; whether those who were laid off were treated humanely; and what is the status of…

Oregon School Finance Update.

ERIC Educational Resources Information Center

Lausberg, Clement H.

The Oregon educational system confronts a set of legislative challenges similar to, yet different from, the rest of the nation. Like the rest of the nation, distrust of government runs high, politicians are wary of raising or restructuring taxes, the economy is expanding, and the November 1994 state election shook up the political leadership of…

Explaining the relationship between insecure attachment and partner abuse: the role of personality characteristics.

PubMed

Buck, Nicole M L; Leenaars, Ellie P E M; Emmelkamp, Paul M G; van Marle, Hjalmar J C

2012-11-01

Studies have found that male batterers are more often insecurely attached as compared with nonbatterers. However, it is still not clear how insecure attachment is related to domestic violence. Many studies compared batterers and nonbatterers regarding pathological personality characteristics that are related to attachment (e.g., dependency, jealousy) and generally found that batterers report more personality characteristics. However, these studies did not investigate which role these characteristics played in the relationship between insecure attachment and battering. The first aim of this study is to test which personality characteristics are good candidates to explain the relationship between insecure attachment and domestic violence. The second aim is to test whether personality characteristics are predictive of battering over and above attachment. Seventy-two mainly court-mandated family-only males who were in group treatment for battering are allocated to a securely and an insecurely attached group and compared with 62 nonbatterers. Using questionnaires, self-esteem, dependency, general distrust, distrust in partner, jealousy, lack of empathy, separation anxiety, desire for control, and impulsivity were assessed. This was the first study that examined distrust, separation anxiety, and desire for control in relation to battering. The results show that the relationship between insecure attachment and domestic violence can be explained by separation anxiety and partner distrust. Moreover, only partner distrust increased the risk for battering over and above insecure attachment. The findings suggest the presence of two subtypes among batterers based on attachment style, which has similarities to the family-only and dysphoric-borderline subtypes suggested by Holtzworth-Munroe and Stuart. Implications of the present findings for therapy are discussed.

Quixotic medicine: physical and economic laws perilously disregarded in health care and medical education.

PubMed

Haburchak, David R; Mitchell, Bradford C; Boomer, Craig J

2008-12-01

Wise medical practice requires balancing the idealistic goals of medicine with the physical and economic realities of their application. Clinicians should know and employ the rules, maxims, and heuristics that summarize these goals and constraints. There has been little formal study of rules or laws pertaining to therapeutics and prognosis, so the authors postulate four physical and four economic laws that apply to health care: the laws of (1) finitude, (2) inertia, (3) entropy, and (4) the uncertainty principle; and the laws of (5) diminishing returns, (6) unintended consequences, (7) distribution, and (8) economizing. These laws manifest themselves in the absence of health, the pathogenesis of disease, prognosis, and the behaviors of participants in the health care enterprise. Physicians and the public perilously disregard these laws, frequently producing misdiagnoses, distraction, false expectations, unanticipated and undesirable outcomes, inequitable distribution of scarce resources, distrust, and cynicism: in short, quixotic medicine. The origins and public reinforcement of quixotic medicine make it deaf to calls for pragmatism. To achieve the Accreditation Council of Graduate Medical Education competency of systems-based practice, the authors recommend that premedical education return to a broader liberal arts curriculum and that medical education and training foster didactic and experiential knowledge of these eight laws.

Measuring physicians' trust: A scoping review with implications for public policy.

PubMed

Wilk, Adam S; Platt, Jodyn E

2016-09-01

Increasingly, physicians are expected to work in productive, trusting relationships with other health system stakeholders to improve patient and system outcomes. A better understanding of physicians' trust is greatly needed. This study assesses the state of the literature on physicians' trust in patients, other health care providers, institutions, and data systems or technology, and identifies key themes, dimensions of trust considered, quantitative measures used, and opportunities for further development via a scoping review. Peer-reviewed, English-language research articles were identified for inclusion in this study based on systematic searches of the Ovid/Medline, Pubmed, Proquest, Scopus, Elsevier, and Web of Science databases. Search terms included "trust" along with "physician," "doctor," "primary care provider," "family practitioner," "family practice," "generalist," "general practitioner," "general practice," "internist," "internal medicine," or "health professional," and plausible variants. Among the relevant articles identified (n = 446), the vast majority focused on patient trust in physicians (81.2%). Among articles examining physicians' trust, rigorous investigations of trust are rare, narrowly focused, and imprecise in their discussion of trust. Robust investigations of the effects of trust or distrust-as opposed to trust's determinants-and studies using validated quantitative trust measures are particularly rare. Studies typically measured trust using the language of confidence, effective communication, or cooperation, rarely or never capturing other important dimensions of trust, such as fidelity, the trustee's reputation, social capital, vulnerability, and acceptance. Research employing new, validated measures of physicians' trust, especially trust in institutions, may be highly informative to health system leaders and policymakers seeking to hone and enhance tools for improving the effectiveness and efficiency of the health care system. Copyright © 2016 Elsevier Ltd. All rights reserved.

The biometric imaginary: (Dis)trust in a policy vacuum.

PubMed

Gunnarsdóttir, Kristrún; Rommetveit, Kjetil

2017-02-01

The decision in Europe to implement biometric passports, visas and residence permits was made at the highest levels without much consultation, checks and balances. Council regulation came into force relatively unnoticed in January 2005, as part of wider securitization policies urging systems interoperability and data sharing across borders. This article examines the biometric imaginary that characterizes this European Union decision, dictated by executive powers in the policy vacuum after 9/11 - a depiction of mobility governance, technological necessity and whom/what to trust or distrust, calling upon phantom publics to justify decisions rather than test their grounding. We consult an online blog we operated in 2010 to unravel this imaginary years on. Drawing on Dewey's problem of the public, we discuss this temporary opening of a public space in which the imaginary could be reframed and contested, and how such activities may shape, if at all, relations between politics, publics, policy intervention and societal development.

The Swift Trust Partnership: A Project Management Exercise Investigating the Effects of Trust and Distrust in Outsourcing Relationships

ERIC Educational Resources Information Center

Adler, Terry R.

2005-01-01

The Swift Trust exercise provides instructors with the opportunity to discuss the issues of managing trust and distrust perceptions in a team-based design. Lewicki, McAllister, and Bies's (1998) framework is used to allow students to experience the difficulties of deriving a common set of contract requirements based on team dynamics and…

[Sharing and distrusting: street merchants' view of children in street situations].

PubMed

Sánchez-Suárez, Diana M; Giraldo-Puerta, Alexandra; Giraldo-Pineda, Álvaro; Forero-Pulido, Constanza

2016-06-01

Objective To understand the meanings, through the description of experiences that street merchants have of their interactions with children in a street situation in downtown of Medellin in 2013. Methodology Qualitative investigation with ethnographic approach. Observations were made in the zone at different times of the day. Twelve interviews with street merchants were held in their work places. Records were kept in a field journal. Results The street merchants and children in street situations share the same space. Both groups try to survive and their relationship is mediated by the trust-distrust that is established between them. The coexistence generates ambivalent feelings. For the street merchants, children in street situations are the result of abandonment by the family, the state and society. They live in a hard world in which they are exposed to a series of risks that they must face. Conclusion The interaction between street merchants and children in street situations is good to the extent that conflicts are avoided, establishing norms of coexistence. The element that determines this relationship is trust-distrust. In trust, strong affective ties are generated, considering each other family. Distrust generates a preventative attitude.

Using information communication technology to identify deficits in rural health care: a mixed-methods evaluation from Guatemala.

PubMed

Wahedi, Katharina; Flores, Walter; Beiersmann, Claudia; Bozorgmehr, Kayvan; Jahn, Albrecht

2018-01-01

In August 2014, the Centre for the Studies of Equity and Governance in Health Systems (CEGSS) in Guatemala launched an online platform, which facilitates complaints about health services via text messages. The aim is to collect, systemise and forward such complaints to relevant institutions, and to create a data pool on perceived deficits of health care in rural Guatemala. To evaluate if the online platform is an accepted, user-friendly and efficient medium to engage citizens in the reporting of health care deficiencies in Guatemala. The general study design of this research was a mixed-method approach including a quantitative analysis of complaints received and a qualitative exploration of the attitude of community leaders towards the platform. User statistics showed that a total of N = 228 messages were sent to the platform in the period August 2014-March 2015. The majority of complaints (n = 162, 71%) fell under the 'lack of drugs, equipment or supplies' category. The community leaders welcomed the platform, describing it as modern and progressive. Despite feedback mechanisms and methods to respond to complaints not yet being fully developed, many users showed a high intrinsic motivation to use the new tool. Others, however, were restrained by fear of personal consequences and distrust of the state's judicial system. Access to mobile phones, reception, and phone credit or battery life did not pose major obstacles, but the producing and sending of correctly formatted messages was observed to be difficult. The online platform paired with SMS technology appears to be a viable approach to collect citizens' complaints in health care and connect citizens with relevant institutions. Further studies should be conducted to quantify follow-up activities and the impact on local health care provision.

Health-care workers' perspectives on workplace safety, infection control, and drug-resistant tuberculosis in a high-burden HIV setting.

PubMed

Zelnick, Jennifer R; Gibbs, Andrew; Loveday, Marian; Padayatchi, Nesri; O'Donnell, Max R

2013-08-01

Drug-resistant tuberculosis (TB) is an occupational hazard for health-care workers (HCWs) in South Africa. We undertook this qualitative study to contextualize epidemiological findings suggesting that HCWs' elevated risk of drug-resistant TB is related to workplace exposure. A total of 55 HCWs and 7 hospital managers participated in focus groups and interviews about infection control (IC). Participants discussed caring for patients with drug-resistant TB, IC measures, occupational health programs, also stigma and support in the workplace. Key themes included: (i) lack of resources that hinders IC, (ii) distrust of IC efforts among HCWs, and (iii) disproportionate focus on individual-level personal protections, particularly N95 masks. IC programs should be evaluated, and the impact of new policies to rapidly diagnose drug-resistant TB and decentralize treatment should be assessed as part of the effort to control drug-resistant TB and create a safe workplace.

Old Pedagogies: ESL Students as Problems in the Composition Classroom.

ERIC Educational Resources Information Center

Agnew, Eleanor

Nonnative English speaking students have usually felt intense pressure and loss of self-esteem in the typical English classroom in the United States. This is a direct result of America's longstanding distrust of foreigners, and the condescension with which the educational system has sometimes treated nonnative speakers. According to C. B. Stein,…

Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

PubMed Central

Rööst, Mattias; Jonsson, Cecilia; Liljestrand, Jerker; Essén, Birgitta

2009-01-01

Background Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. Methods Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. Results The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. Conclusion The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia. PMID:19640286

The Relationship between Learners' Distrust of Scientific Models, Their Spatial Ability, and the Vividness of Their Mental Images

ERIC Educational Resources Information Center

Al-Balushi, Sulaiman M.

2013-01-01

The purpose of the current study was to examine the nature of the relationship between learners' distrust of scientific models that represent unseen entities and phenomena, their spatial ability, and the vividness of their mental images. The sample consisted of 302 tenth grade students in the Sultanate of Oman. Three measures were used for this…

Computing Distrust in Social Media

DTIC Science & Technology

2015-05-01

trusted friends and they are also likely to accept recommendations from trustworthy users. Therefore we proposed LOCABEL to exploit local and global... trustworthy [52]. To capture global information from trust/distrust, we can use user reputation scores to weight the im- portance of their recommendations...Transactions on, 22(10):1345–1359, 2010. [63] J. B. Rotter. Interpersonal trust, trustworthiness , and gullibility. American psychologist, 35(1):1

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

PubMed Central

Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

2016-01-01

Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders. PMID:27755558

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.

PubMed

Shan, Linghan; Li, Ye; Ding, Ding; Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

2016-01-01

Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

Under the shadow of Tuskegee: African Americans and health care.

PubMed

Gamble, V N

1997-11-01

The Tuskegee Syphilis Study continues to cast its long shadow on the contemporary relationship between African Americans and the biomedical community. Numerous reports have argued that the Tuskegee Syphilis Study is the most important reason why many African Americans distrust the institutions of medicine and public health. Such an interpretation neglects a critical historical point: the mistrust predated public revelations about the Tuskegee study. This paper places the syphilis study within a broader historical and social context to demonstrate that several factors have influenced--and continue to influence--African American's attitudes toward the biomedical community.

Perceived unsatisfactory care as a barrier to diabetes self-management for Coeur d'Alene tribal members with type 2 diabetes.

PubMed

Tiedt, Jane A; Sloan, Rebecca S

2015-05-01

The prevalence of diabetes and related complications are disproportionally higher in Native Americans. Diabetes self-management (DSM) is instrumental in preventing complications. The results presented here are a part of a larger hermeneutic phenomenology study to explore living with diabetes for one Pacific Northwest tribe. This study identified barriers to DSM within the worldview of the tribal people. Using purposive sampling, 10 Coeur d'Alene tribal members, ages 26 to 86 years, participated in in-depth interviews. Data interpretation used a three-step method leading to integrated themes across the transcripts. Perceived unsatisfactory care emerged as the major barrier to self-management, including communication barriers (distrust, misunderstanding, and educational methods) and organizational barriers (quality of care and access issues). Findings highlight the need to improve cross-cultural communication and calls for different approaches to diabetes education. Our profession is challenged to create new DSM and diabetes educational approaches for acceptable and compassionate cross-cultural nursing care. © The Author(s) 2014.

A Comparison Between Caucasians and African Americans in Willingness to Participate in Cancer Clinical Trials: The Roles of Knowledge, Distrust, Information Sources, and Religiosity.

PubMed

Meng, Jingbo; McLaughlin, Margaret; Pariera, Katrina; Murphy, Sheila

2016-06-01

This study aims to (a) examine the roles of knowledge, distrust in medical professionals, information sources, and 2 dimensions of religiosity (i.e., religious activity and religious belief) in influencing willingness to participate (WTP) in cancer clinical trials and to (b) compare the results for Caucasians and African Americans in order to inform future recruitment. An online survey was fielded via a Knowledge Networks panel with a nationally representative sample including 478 Caucasians and 173 African Americans. The results showed that distrust in medical professionals was a strong barrier to WTP for both ethnic groups, whereas factual knowledge about trial procedures was not associated with WTP for either ethnic group. Seeking trial information from doctors was positively associated with WTP for Caucasians; seeking trial information from hospitals was positively associated with WTP for African Americans. More interestingly, levels of religious activity negatively predicted WTP for Caucasians but positively predicted WTP for African Americans. Self-reported religious belief was not associated with WTP for either ethnic group. In sum, although distrust is a common barrier to WTP, the influence of preferred information sources and religious activity on WTP varies as a function of ethnicity.

The Naïve and the Distrustful: state dependency of hippocampal computations in manipulative memory distortion.

PubMed

Ludmer, Rachel; Edelson, Micah G; Dudai, Yadin

2015-02-01

Flexible mnemonic mechanisms that adjust to different internal mental states can provide a major adaptive advantage. However, little is known regarding how this flexibility is achieved in the human brain. We examined brain activity during retrieval of false memories of a movie, generated by exposing participants to misleading information. Half of the participants suspected the memory manipulation (Distrustful), whereas the other half did not (Naïve). Distrustful displayed more accurate memory performance and a brain signature different than that of Naïve. In Distrustful, the ability to differentiate true from false information was driven by a qualitatively distinct hippocampal activity for endorsed items, consistent with the view that hippocampal encoding allows recollection of a specific source. Conversely, in Naïve, BOLD differences between true and false memories were linearly correlated with accuracy across participants, suggesting that Naïve subjects needed to reinstate and evaluate stored information to discern true from false. We propose that our results lend support to models suggesting that hippocampal activity can exhibit different computational schemes, depending on memorandum attributes. Furthermore, we show that trust, considered as a subjective state of mind, may alter basic hippocampal strategies, influencing the ability to separate real from false memory. © 2014 Wiley Periodicals, Inc.

Health workers' views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children

PubMed Central

Nguyen, Thu Anh; Oosterhoff, Pauline; Pham, Yen Ngoc; Hardon, Anita; Wright, Pamela

2009-01-01

Background Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services. Methods Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes. Results Factors that lead to health workers' failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV/AIDS, is a major obstacle to providing a continuum of care. Conclusion Many hospital staff were not being able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of mother-to-child transmission service could be enhanced by improving communication and other skills of health workers, providing them with greater support and enhancing their motivation. Reduction of workload would also be important. Development of a practical strategy is needed to strengthen and adapt the referral system to meet the needs of patients. PMID:19439094

Study of Barrier to Help Seeking and its Relationships with Disability in Patients with Headache.

PubMed

John, Deepa; Ram, Dushad; Sundarmurthy, Harsha; Rathod, Harshal; Rathod, Snehal

2016-10-01

Headache is among the first three most prevalent disorders with a wide treatment gap due to barriers in help seeking. Headache has been associated with disability. However, the relationship of barriers to help-seeking and disability are unexplored. To find out the barriers to help seeking and its relationship with headache related disability in patients with headache. In this hospital based cross-sectional study, 200 consecutive subjects with headache attending a tertiary care centre were recruited as per selection criteria and assessed with Sociodemographic & Clinical Proforma, Mini International Neuropsychiatric Interview (MINI), Barriers to Help Seeking Scale (BHSS), The Henry Ford Hospital Headache Disability Inventory (HDI). High mean score was observed on BHSS subscale need for control and self reliance (19.45; SD ±9.66) and minimizing problem and resignation (10.02; SD ±6.98). Mean score on the HDI was 25.65 (SD ± 14.09). Socioeconomic status of the patient was statistically significant and positively associated with need for control and self reliance (p=0.035), concrete barriers and distrust of care givers (p=0.039), emotional control (p=0.005), and privacy (p=0.002). Occupational status had significant association with need for control and self-reliance (p=0.01), minimizing problem and resignation (p=0.033), and emotional control (p=0.006). Score on hospital headache disability inventory significantly predicted the value of score on concrete barriers and distrust of caregivers domain of HDI (p=0.001). Autonomy and under estimation of seriousness of headache are common barriers to help seeking. Pattern of help seeking barriers may vary with socio-economic status and occupational status, while disability varies with gender and severity of headache. Headache associated disability is positively associated with concrete barriers.

Improving palliative care outcomes for Aboriginal Australians: service providers' perspectives.

PubMed

Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine D; Aoun, Samar M; Thompson, Sandra C

2013-07-23

Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers' experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the 'cultural security' framework. Thematic analysis was carried out that identified patterns within data. Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people's willingness and ability to accept care and support from these services. This context needs to be understood and acknowledged at the system level. More cultural safety training was requested by care providers but it was not seen as replacing the need for an Aboriginal worker in the palliative care team.

Rasing the ivory tower: the production of knowledge and distrust of medicine among African Americans

PubMed Central

Wasserman, J; Flannery, M A; Clair, J M

2007-01-01

African American distrust of medicine has consequences for treatment seeking and healthcare behaviour. Much work has been done to examine acute events (eg, Tuskegee Syphilis Study) that have contributed to this phenomenon and a sophisticated bioethics discipline keeps watch on current practices by medicine. But physicians and clinicians are not the only actors in the medical arena, particularly when it comes to health beliefs and distrust of medicine. The purpose of this paper is to call attention not just to ethical shortcomings of the past, but to the structural contexts of those events and the contributions and responsibilities of popular media and academic disciplines in the production of (often mythic) knowledge. We argue that ignoring context and producing inaccurate work has real impacts on health and healthcare, particularly for African Americans, and thus engenders ethical obligations incumbent on disciplines traditionally recognised as purely academic. PMID:17329393

Why leaders punish: A power perspective.

PubMed

Mooijman, Marlon; van Dijk, Wilco W; Ellemers, Naomi; van Dijk, Eric

2015-07-01

We propose that power fundamentally changes why leaders punish and we develop a theoretical model that specifies how and why this occurs. Specifically, we argue that power increases the reliance on deterrence, but not just deserts, as a punishment motive and relate this to power fostering a distrustful mindset. We tested our model in 9 studies using different instantiations of power, different measurements and manipulations of distrust while measuring punishment motives and recommended punishments across a number of different situations. These 9 studies demonstrate that power fosters distrust and hereby increases both the reliance on deterrence as a punishment motive and the implementation of punishments aimed at deterrence (i.e., public punishments, public naming of rule breakers and punishments with a mandatory minimum). We discuss the practical implications for leaders, managers and policymakers and the theoretical implications for scholars interested in power, trust, and punishments. (c) 2015 APA, all rights reserved).

“First and foremost the evangelist”? Mission and government priorities for the treatment of leprosy in Uganda, 1927-1948

PubMed Central

Vongsathorn, Kathleen

2014-01-01

Early historiography on medicine in British colonial Africa suggests that colonial government and missionary medicine occupied two relatively distinct spheres, and that government officials viewed medical missionaries with suspicion and distrust. Contrary to this paradigm, this article suggests that missionaries and colonial government officials collaborated extensively and amicably in the treatment of leprosy in Uganda. Mission, medical, and government correspondence and reports are drawn upon in order to demonstrate that the suspicion and tension that characterised so many other interactions between British colonial government officials and missionaries was largely absent in the treatment of leprosy in Uganda. The mutual social and cultural priorities of missionaries and government administrators led to a system of isolated, in-patient leprosy care that was limited in scope and reflective not of a goal for the public health of Uganda, but rather a vision for the future of Uganda as a “civilised” and Christian country. PMID:24949084

Ebola Virus Diseases in Africa: a commentary on its history, local and global context.

PubMed

Awah, Paschal Kum; Boock, Alphonse Um; Kum, Kaiseuh Awah

2015-01-01

Ebola Virus Disease (EVD) started as a minor infection in Uganda in 1974 and has been frequent in Central Africa Region for the past 40 years. For over 40 years, Ebola was treated as an African disease, called a fever and known by other names where occurrences have been frequent. EVD has become a global public health threat following the most recent outbreak in West Africa. By December 31, 2014, Ebola has infected more than 23,500 people in West Africa and killed over 9,500, nearly all in the three worst-affected countries of Guinea, Liberia and Sierra Leone. It is transmitted through blood, vomit, diarrhea and other bodily fluids but cultural attributes associate its etiology to man-made and supernatural causes, hence stemming public health approaches to contain EVD difficult. Distrust and conflict between two healing systems are rife necessitating an African Model of EVD care and prevention. The African model remains indispensable to understand EVD and developing appropriate EVD containing approaches.

Citizens' distrust of government and their protest responses in a contingent valuation study of urban heritage trees in Guangzhou, China.

PubMed

Chen, Wendy Y; Hua, Junyi

2015-05-15

Protest response is a common aspect of contingent valuation (CV) studies, which has attracted growing attention from scholars worldwide. Distrust of government, understood as one of the major reasons for protest response, has been prevalent across transitional China experiencing dramatic changes in its economy, society and natural environment. Citizen distrust of government would significantly hinder the efficiency and validity of the contingent valuation method (CVM) application focusing on the provision of public environmental and ecological goods in China, as a large proportion of protest responses might be induced. Hitherto little has been done to link residents' trust in government to their environmental behaviors in developing and transitional economies like China where CVM has been increasingly applied to generate meaningful and reliable information for integrating both ecological and socioeconomic perspectives into policy decisions. This study aims to investigate the discrepancies between protest responses induced by distrust of government and non-protest responses, using the contingent valuation of heritage trees in Guangzhou as a case. The combination of a set of debriefing questions and several attitudinal questions is employed in the questionnaire. Based on logit analysis and discriminant analysis, it has been found that protestors who distrust government and non-protestors share similar salient values associated with urban heritage trees in Guangzhou, especially their distinctive historical and cultural values, in comparison with ordinary urban trees. Residents with low familiarity with heritage trees (who rarely visit sites with heritage trees, know little about management and conservation techniques, and consider present management to be ineffective) are likely to act as protesters with the "distrust of government" belief. Only if more opportunities are provided for residents to obtain access to urban heritage tree sites, more information (about urban heritage trees and other environmental and ecological goods) is disseminated, and more effective management is implemented, can better governmental trust be developed and stronger public participation and support secured. The results of this study can shed light on understanding protest responses in CV studies and improving the reliability and efficiency of CVM in China and other developing countries where a low level of trust in government prevails. Copyright © 2015 Elsevier Ltd. All rights reserved.

Relative Employment, Gender Beliefs, and Intimate Partner Coercion and Violence Against New Mothers Across Marital and Residential Contexts.

PubMed

Zito, Rena C

2017-06-01

This research builds on prior studies of intimate partner victimization by examining the impact of women's and men's relative employment, gender traditionalism, and gender distrust on coercive control and physical victimization among married, cohabiting, and noncohabiting couples with infants. It merges feminist approaches that emphasize the gendered meaning of work, power, and violence with prior insights regarding differences in levels of intimate violence across family forms. Specifically, this research recognizes that there is variation across married, cohabiting, and dating contexts in the symbolic meaning of work, the salience of traditionalism, and the tenuous status of relationships that may activate gender distrust in the production of compensatory violence and control. Logistic regression models using baseline and Year 1 Fragile Families and Child Well-Being data ( n = 2,337) indicate that the predictors of coercive control differ across couple types, with the relative odds of coercion higher among couples in which only the woman is employed, but only when cohabiting. Consistent with expectations, men's gender traditionalism increases coercive control, but only in the context of marriage. Relative employment and gender beliefs did not predict physical victimization among any couple types, but a moderating effect of men's gender distrust on women's sole employment was identified, such that status inconsistency in employment increases the relative odds of physical victimization only when the male partner is distrustful of women.

The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community.

ERIC Educational Resources Information Center

Thomas, Stephen B.; Quinn, Sandra Crouse

1991-01-01

The Tuskegee study of untreated syphilis in black males caused distrust by blacks of the public health system that has implications for Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) studies. AIDS prevention among blacks may require openness about the Tuskegee study to allay fears of repetition. (SLD)

Backstage Accounting in Preschool: Analysing Dealing with Complaints as 'Rehearsing Away' Professional Knowledge

ERIC Educational Resources Information Center

Aili, Carola; Nilsson, Lars-Erik

2018-01-01

Citizens of modern societies must trust a broad range of systems and professionals. When distrust arises, professionals are expected to be accountable. This paper draws on conversational material from a preschool team meeting. When a preschool work team prepares to meet a parent who has complained about their recurring neglect to change her…

Reforming America's health system through innovation and entrepreneurship.

PubMed

Reece, Richard L

2005-01-01

America's attempts for healthcare reform are gridlocked. Healthcare special interests are reluctant to abandon profitable activities, and American culture-distrust of centralized federal power, belief in self-improvement, desire for choice, and belief in equal access to medical technologies-is slow to change. Physician entrepreneurship and innovation, coupled with consumer-driven healthcare and public-private partnerships, may break the present gridlock.

Qualitative research in critical care: Has its time finally come?

PubMed Central

A Foëx, Bernard

2015-01-01

As clinicians, we are well acquainted with using randomised controlled trials, case–control studies and cohort studies together with p-values, odds ratios and confidence intervals to understand and improve the way in which we care for our patients. We have a degree of familiarity, trust and confidence with well-performed scientific quantitative studies in critical care and we make a judgment about our practice based on their recommendations. The same cannot be said of qualitative research, and its use accounts for only a small proportion of published studies in critical care. There are many research questions in our environment that lend themselves to a qualitative research design. Our positivistic education as doctors potentially incites distrust towards such studies and, as such, they are seldom undertaken in our units. We aim to describe and discuss the differences between quantitative and qualitative research with focus being given to common misunderstandings and misconceptions. An overview of the methods of data collection and analysis is provided with references towards published qualitative studies in critical care. Finally, we provide pragmatic and practical instruction and guidance for those wishing to undertake their own qualitative study in critical care. PMID:28979479

Bring an axe and your wildest dreams: Post-apocalyptic desires, science distrust, and the de(con)struction of a zombie story

NASA Astrophysics Data System (ADS)

Long, Samantha Jo

Observing the current popularity of the zombie narrative in American culture, this thesis explores the questions "why zombie?" and "why now?" through a combination of research and the creation of an original zombie story. Moving beyond existing criticism which argues that the zombie transforms to fit each generation's specific fears, I argue that zombie movies, novels, and video games from George A. Romero-onwards continually speak to a distrust of science and scientific progress while additionally romanticizing the post-apocalyptic landscape. Consequently, the zombie's unprecedented mainstream popularity over the last fifteen years could be read as symptomatic of this distrust intensifying, paralleling an increasing politicization of science and a rise in apocalyptic thinking within the public sphere. Through the deconstruction of my own zombie story, I uncover not only what these timely narratives tell us about our perceptions of the future, but also how they can help us change them.

Prenatal care of African American women in selected USA urban and rural cultural contexts.

PubMed

Morgan, M

1996-01-01

The purpose of this ethnonursing research was to systematically discover, describe, and analyze the beliefs, practices, and values of African American women related to prenatal care. The domain of inquiry was prenatal care of African American women within their familiar cultural contexts. The study was conceptualized within Leininger's Theory of Culture Care Diversity and Universality which enabled the researcher to study professional and generic care as influenced by the worldview, social structural factors, cultural values and beliefs, ethnohistory, and environmental context. The goal of the study was to discover knowledge that could be used by health professionals to provide culturally congruent prenatal care that would increase the health and well being of the people. The rationale for the study was based on studies that showed the lack of prenatal care in the African American cultural group leads to low birth weights and high infant mortality rates. Four major themes that focused on the domain of inquiry were identified: 1) Cultural care meant protection, presence, and sharing; 2) social structural factors that greatly influenced the health and well being were spirituality, kinship, and economics; 3) professional prenatal care was seen by the women as necessary and essential but there was distrust of noncaring professionals, and barriers to such care; and 4) folk health beliefs, practices, and indigenous health care providers were widely used by women in the African American community.

Using information communication technology to identify deficits in rural health care: a mixed-methods evaluation from Guatemala

PubMed Central

Wahedi, Katharina; Flores, Walter; Beiersmann, Claudia; Bozorgmehr, Kayvan; Jahn, Albrecht

2018-01-01

ABSTRACT Background: In August 2014, the Centre for the Studies of Equity and Governance in Health Systems (CEGSS) in Guatemala launched an online platform, which facilitates complaints about health services via text messages. The aim is to collect, systemise and forward such complaints to relevant institutions, and to create a data pool on perceived deficits of health care in rural Guatemala. Objective: To evaluate if the online platform is an accepted, user-friendly and efficient medium to engage citizens in the reporting of health care deficiencies in Guatemala. Methods: The general study design of this research was a mixed-method approach including a quantitative analysis of complaints received and a qualitative exploration of the attitude of community leaders towards the platform. Results: User statistics showed that a total of N = 228 messages were sent to the platform in the period August 2014–March 2015. The majority of complaints (n = 162, 71%) fell under the ‘lack of drugs, equipment or supplies’ category. The community leaders welcomed the platform, describing it as modern and progressive. Despite feedback mechanisms and methods to respond to complaints not yet being fully developed, many users showed a high intrinsic motivation to use the new tool. Others, however, were restrained by fear of personal consequences and distrust of the state’s judicial system. Access to mobile phones, reception, and phone credit or battery life did not pose major obstacles, but the producing and sending of correctly formatted messages was observed to be difficult. Conclusion: The online platform paired with SMS technology appears to be a viable approach to collect citizens’ complaints in health care and connect citizens with relevant institutions. Further studies should be conducted to quantify follow-up activities and the impact on local health care provision. PMID:29661072

Utah obstetricians' opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study.

PubMed

Rainey, Emily; Simonsen, Sara; Stanford, Joseph; Shoaf, Kimberley; Baayd, Jami

2017-06-01

The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines. Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines. Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting. Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth. © 2017 Wiley Periodicals, Inc.

Implementation of a Multidisciplinary Guideline for Low Back Pain: Process-Evaluation Among Health Care Professionals.

PubMed

Suman, Arnela; Schaafsma, Frederieke G; Buchbinder, Rachelle; van Tulder, Maurits W; Anema, Johannes R

2017-09-01

Background To reduce the burden of low back pain (LBP) in the Netherlands, a multidisciplinary guideline for LBP has been implemented in Dutch primary care using a multifaceted implementation strategy targeted at health care professionals (HCPs) and patients. The current paper describes the process evaluation of the implementation among HCPs. Methods The strategy aimed to improve multidisciplinary collaboration and communication, and consisted of 7 components. This process evaluation was performed using the Linnan and Steckler framework. Data were collected using a mixed methods approach of quantitative and qualitative data. Results 128 HCPs participated in the implementation study, of which 96 participated in quantitative and 21 participated in qualitative evaluation. Overall dose delivered for this study was 89 %, and the participants were satisfied with the strategy, mostly with the multidisciplinary approach, which contributed to the mutual understanding of each other's disciplines and perspectives. While the training sessions did not yield any new information, the strategy created awareness of the guideline and its recommendations, contributing to positively changing attitudes and aiding in improving guideline adherent behaviour. However, many barriers to implementation still exist, including personal and practical factors, confidence, dependence and distrust issues among the HCPs, as well as policy factors (e.g. reimbursement systems). Conclusions The data presented in this paper have shown that the strategy that was used to implement the guideline in a Dutch primary care setting was feasible, especially when using a multidisciplinary approach. However, identified barriers for implementation have been identified and should be addressed in future implementation.

Adolescent trust and primary care: Help-seeking for emotional and psychological difficulties.

PubMed

Corry, Dagmar Anna S; Leavey, Gerard

2017-01-01

Although a quarter of adolescents are likely to experience emotional and psychological difficulties, only a third of them will seek professional help. In this exploratory study we undertook focus groups with 54 adolescents between the ages of 13 and 16 in eight post-primary schools in Northern Ireland. Young people do not trust their GPs, perceiving them as strangers, impersonal and uncaring. The basis of distrust is different among males and females. The findings are discussed in light of adolescents' developmental challenges of identity formation and the consequent demand to be respected and taken seriously by adults. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Personal characteristics associated with resident physicians' self perceptions of preparedness to deliver cross-cultural care.

PubMed

Lopez, Lenny; Vranceanu, Ana-Maria; Cohen, Amy P; Betancourt, Joseph; Weissman, Joel S

2008-12-01

Recent reports from the Institute of Medicine emphasize patient-centered care and cross-cultural training as a means of improving the quality of medical care and eliminating racial and ethnic disparities. To determine whether, controlling for training received in medical school or during residency, resident physician socio-cultural characteristics influence self-perceived preparedness and skill in delivering cross-cultural care. National survey of resident physicians. A probability sample of residents in seven specialties in their final year of training at US academic health centers. Nine resident characteristics were analyzed. Differences in preparedness and skill were assessed using the chi(2) statistic and multivariate logistic regression. Fifty-eight percent (2047/3500) of residents responded. The most important factor associated with improved perceived skill level in performing selected tasks or services believed to be useful in treating culturally diverse patients was having received cross-cultural skills training during residency (OR range 1.71-4.22). Compared with white residents, African American physicians felt more prepared to deal with patients with distrust in the US healthcare system (OR 1.63) and with racial or ethnic minorities (OR 1.61), Latinos reported feeling more prepared to deal with new immigrants (OR 1.88) and Asians reported feeling more prepared to deal with patients with health beliefs at odds with Western medicine (1.43). Cross-cultural care skills training is associated with increased self-perceived preparedness to care for diverse patient populations providing support for the importance of such training in graduate medical education. In addition, selected resident characteristics are associated with being more or less prepared for different aspects of cross-cultural care. This underscores the need to both include medical residents from diverse backgrounds in all training programs and tailor such programs to individual resident needs in order to maximize the chances that such training is likely to have an impact on the quality of care.

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan

PubMed Central

Chang, Hsin Hsin; Chang, Ching Sheng

2008-01-01

Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. Methods This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. Results The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. Conclusion It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust. PMID:18419820

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan.

PubMed

Chang, Hsin Hsin; Chang, Ching Sheng

2008-04-17

Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust.

Between government policy, clinical autonomy, and market demands: a qualitative study of the impact of the Prescribing Analysis System on behavior of physicians in South Korea.

PubMed

Kim, Dong-Sook; Bae, Green; Yoo, Soo Yeon; Kang, Minah

2015-09-21

In South Korea, the Health Insurance Review and Assessment Service manages the Prescribing Analysis System (PAS) to evaluate the appropriate use of medication. To achieve the system's goal of changing prescribing behavior, it is critical to understand how physicians respond to the PAS. This study analyzes the opinions of South Korean physicians about the PAS, the way it is used, and factors affecting prescribing behavior. A qualitative, exploratory approach was used, with four focus groups of physicians from different specialties. A semi-structured guide was used to explore their opinions. Transcripts of the discussions were analyzed by the authors, who independently considered content using uniform categories. Common themes were extracted and used to gather results and draw conclusions. Physicians acknowledged some positive aspects of the PAS but, overall, had mainly negative impressions of the system, and particularly, the evaluation reports that it generates. They reported that their prescribing behavior was affected by predisposing factors, including experiential, environmental and psychological factors. Physicians reported that their negative perceptions regarding the regulations were primarily influenced by concerns about maintaining their autonomy and expertise. However, their strong resistance to these perceived infringements on their independence may be considered inconsistent in relation to their professional autonomy as there was an equally strong concern about market competition. Physicians' objections to the PAS are more likely to have been caused by deeply rooted distrust of the government agency in charge of the system. Interestingly, we found that physicians' strong resistance to perceived violations of their autonomy seems somewhat inconsistent and contradictory. While they are very positive about new information or printed materials provided by pharmaceutical representatives, they are less enthusiastic when it comes to governmental guidelines or standards. Similarly, they appear to willingly accept situations in which they believe they should comply with patients' demands as a means of surviving in a competitive market. It is notable that physicians' negative perceptions of PAS seemed to be aggravated by suspicion and distrust regarding the purpose of this program. Because of widespread beliefs in professional autonomy, market competition, and a deep-seated distrust of the system, it would be difficult for the government to persuade physicians to change their prescribing behaviors using only the PAS. Successful implementation of the PAS will not only require its improvement as a policy tool, but also the creation of a social consensus regarding the PAS.

Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives

PubMed Central

2013-01-01

Background Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the ‘cultural security’ framework. Thematic analysis was carried out that identified patterns within data. Results Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Conclusion Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people’s willingness and ability to accept care and support from these services. This context needs to be understood and acknowledged at the system level. More cultural safety training was requested by care providers but it was not seen as replacing the need for an Aboriginal worker in the palliative care team. PMID:23875957

Perspectives of Patients With Cancer on the Ethics of Rapid-Learning Health Systems.

PubMed

Jagsi, Reshma; Griffith, Kent A; Sabolch, Aaron; Jones, Rochelle; Spence, Rebecca; De Vries, Raymond; Grande, David; Bradbury, Angela R

2017-07-10

Purpose To inform the evolving implementation of CancerLinQ and other rapid-learning systems for oncology care, we sought to evaluate perspectives of patients with cancer regarding ethical issues. Methods Using the GfK Group online research panel, representative of the US population, we surveyed 875 patients with cancer; 621 (71%) responded. We evaluated perceptions of appropriateness (scored from 1 to 10; 10, very appropriate) using scenarios and compared responses by age, race, and education. We constructed a scaled measure of comfort with secondary use of deidentified medical information and evaluated its correlates in a multivariable model. Results Of the sample, 9% were black and 9% Hispanic; 38% had completed high school or less, and 59% were age ≥ 65 years. Perceptions of appropriateness were highest when consent was obtained and university researchers used data to publish a research study (weighted mean appropriateness, 8.47) and lowest when consent was not obtained and a pharmaceutical company used data for marketing (weighted mean appropriateness, 2.7). Most respondents (72%) thought secondary use of data for research was very important, although those with lower education were less likely to endorse this (62% v 78%; P < .001). Overall, 35% believed it was necessary to obtain consent each time such research was to be performed; this proportion was higher among blacks/Hispanics than others (48% v 33%; P = .02). Comfort with the use of deidentified information from medical records varied by scenario and overall was associated with distrust in the health care system. Conclusion Perceptions of patients with cancer regarding secondary data use depend on the user and the specific use of the data, while also frequently differing by patient sociodemographic factors. Such information is critical to inform ongoing efforts to implement oncology learning systems.

Attitudes and Beliefs of African Americans Toward Participation in Medical Research

PubMed Central

Corbie-Smith, Giselle; Thomas, Stephen B; Williams, Mark V; Moody-Ayers, Sandra

1999-01-01

OBJECTIVE To describe barriers to participation of African Americans in research. DESIGN Focus group interviews conducted in 1997. PATIENTS Thirty-three African-American adults presenting to an urban public hospital for outpatient medical care participated in one of five focus groups. MEASUREMENTS AND MAIN RESULTS African-American patients' attitudes toward medical research were measured. Mistrust of doctors, scientists, and the government was reported consistently by the participants. Many participants described concerns about the ethical conduct of clinicians and investigators when poor or minority patients are involved and cited examples of exploitation as supporting evidence for their mistrust of the medical establishment. While participants were clear about the violation of human rights in the Tuskegee Syphilis Study, all were misinformed of the historical facts of the study. Few participants understood the concept of informed consent. Participants saw signing the document as relinquishing their autonomy and as a legal protection for physicians. Despite these concerns, participants gave recommendations to improve minority participation in research. CONCLUSIONS African-American participants in this study described distrust of the medical community as a prominent barrier to participation in clinical research. Participants described real and perceived examples of exploitation to support their distrust of researchers. The goal of the consent process, to inform patients of risks and benefits so as to facilitate self-determination, was misinterpreted by these participants. Understanding the importance of interpersonal trust within the clinical relationship may prove to be a significant factor in enhancing participation in clinical trials. PMID:10491242

Study of Barrier to Help Seeking and its Relationships with Disability in Patients with Headache

PubMed Central

John, Deepa; Sundarmurthy, Harsha; Rathod, Harshal; Rathod, Snehal

2016-01-01

Introduction Headache is among the first three most prevalent disorders with a wide treatment gap due to barriers in help seeking. Headache has been associated with disability. However, the relationship of barriers to help-seeking and disability are unexplored. Aim To find out the barriers to help seeking and its relationship with headache related disability in patients with headache. Materials and Methods In this hospital based cross-sectional study, 200 consecutive subjects with headache attending a tertiary care centre were recruited as per selection criteria and assessed with Sociodemographic & Clinical Proforma, Mini International Neuropsychiatric Interview (MINI), Barriers to Help Seeking Scale (BHSS), The Henry Ford Hospital Headache Disability Inventory (HDI). Results High mean score was observed on BHSS subscale need for control and self reliance (19.45; SD ±9.66) and minimizing problem and resignation (10.02; SD ±6.98). Mean score on the HDI was 25.65 (SD ± 14.09). Socioeconomic status of the patient was statistically significant and positively associated with need for control and self reliance (p=0.035), concrete barriers and distrust of care givers (p=0.039), emotional control (p=0.005), and privacy (p=0.002). Occupational status had significant association with need for control and self-reliance (p=0.01), minimizing problem and resignation (p=0.033), and emotional control (p=0.006). Score on hospital headache disability inventory significantly predicted the value of score on concrete barriers and distrust of caregivers domain of HDI (p=0.001). Conclusion Autonomy and under estimation of seriousness of headache are common barriers to help seeking. Pattern of help seeking barriers may vary with socio-economic status and occupational status, while disability varies with gender and severity of headache. Headache associated disability is positively associated with concrete barriers. PMID:27891430

JPRS Report, East Europe

DTIC Science & Technology

1988-03-31

gmina’s inhabitants. Subsequently in April ofthat year a group of local PRON activists toured Swierk [Polish nuclear research institute] to familiarize...this country. And yet, the tragic death of the young girl scout in the MFR [Miedzyrzec Fortified Region] bunkers which occurred last spring did not...distrust and disbelief in public sentiment." Report on page 4. 2776 The reform system is sick. Its health is broken. In all this there is too little

Quantifying Trust, Distrust, and Suspicion in Human-System Interactions

DTIC Science & Technology

2015-10-26

devices which require subjects to lie in restricted positions ( fMRI ), or to drink hazardous materials (PET), EEG and fNIRS can non-invasively measure... fMRI . Since fNIRS and fMRI both measure elements of the Blood Oxygen Level Dependent (BOLD) signal. Researchers have recently explored the...response inhibition load, verbal working memory load, and spatial working memory load [1, 7]. We have also successfully localized brain regions such as

Can we trust what parents tell us? A systematic review.

PubMed

Brand, Paul L P; van Dulmen, Sandra

2017-09-01

Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations. Copyright © 2017. Published by Elsevier Ltd.

"Always paracetamol, they give them paracetamol for everything": a qualitative study examining Eastern European migrants' experiences of the UK health service.

PubMed

Madden, Hannah; Harris, Jane; Blickem, Christian; Harrison, Rebecca; Timpson, Hannah

2017-08-29

The enlargement of the European Union since 2004 has led to an increase in the number of Eastern European migrants living in the UK. The health of this group is under-researched though some mixed evidence shows they are at higher risk of certain physical health conditions such as heart attacks, strokes, HIV and alcohol use and have poorer mental health. This is compounded by poor or insecure housing, low pay, isolation and prejudice. We aimed to understand the health needs and health service experiences of the Eastern European population in a town in Northern England. Five semi structured one-to-one and small group interviews and five focus groups were conducted with 42 Eastern European participants between June and September 2014. The majority of participants were Polish and other participants were from Belarus, Hungary, Latvia, Russia, Slovakia and Ukraine. The data were analysed using thematic framework analysis. Key findings included a good understanding the UK health service structure and high registration and use of general practice/primary care services. However, overall, there were high levels of dissatisfaction, frustration and distrust in General Practitioners (GP). The majority of participants viewed the GP as unhelpful and dismissive; a barrier to secondary/acute care; reluctant to prescribe antibiotics; and that GPs too often advised them to take paracetamol (acetaminophen) and rest. Overwhelmingly participants had strong opinions about access to primary care and the role of the general practitioners. Although the design of the UK health service was well understood, participants were unhappy with the system of GP as gatekeeper and felt it inferior to the consumer-focused health systems in their country of origin. More work is needed to promote the importance of self-care, reduce antibiotic and medication use, and to increase trust in the GP.

A Study on the Knowledge, Perception, and Use of Breast Cancer Screening Methods and Quality of Care Among Women from Central Mexico.

PubMed

Cruz-Castillo, Andrea B; Hernández-Valero, María A; Hovick, Shelly R; Campuzano-González, Martha Elva; Karam-Calderón, Miguel Angel; Bustamante-Montes, L Patricia

2015-09-01

Studies on health behaviors have observed several barriers to breast cancer screening, including lack of breast cancer knowledge, distrust of health care providers, and long waiting times to be screened or to receive screening results. We conducted a nested case-control study among a subsample of 200 women 21 years of age and older [100 patients (cases)], who had been diagnosed with breast cancer, and 100 controls, who were screened and found to be free of breast cancer), all residing in the Toluca metropolitan area in central Mexico. We examined how knowledge of breast cancer screening guidelines, perceptions of screening methods, and quality of health care influenced the use of breast cancer screening among study participants. Our study found that the most important factor associated with the decision to have breast cancer screenings was having a positive perception of the quality of care provided by the local health care centers, such as having competent clinic personnel, sufficient screening equipment, and reasonable waiting times to receive screening and to receive the screening results. Therefore, individual health care centers need to focus on the patients' perception of the services received by optimizing the care provided and, in so doing, increase the rates of early diagnosis and reduce the rate of mortality from breast cancer as well as its associated treatment costs.

A Study on the knowledge, perception and use of breast cancer screening methods and quality of care among women from central Mexico

PubMed Central

Cruz-Castillo, Andrea B.; Hernández-Valero, María A.; Hovick, Shelly R.; Campuzano-González, Martha Elva; Karam-Calderón, Miguel Angel; Bustamante-Montes, L. Patricia

2014-01-01

Studies on health behaviors have observed several barriers to breast cancer screening, including lack of breast cancer knowledge, distrust of health care providers, long waiting times to be screened or to receive screening results. We conducted a nested case-control study among a subsample of 200 women 21 years of age and older (100 cases, who had been diagnosed with breast cancer, and 100 controls, who were screened and found to be free of breast cancer), all residing in the Toluca metropolitan area in central Mexico. We examined how knowledge of breast cancer screening guidelines, perceptions of screening methods, and quality of health care influenced the use of breast cancer screening among study participants. Our study found that the most important factors associated with the decision to have breast cancer screenings was having a positive perception of the quality of care provided by the local health care centers, such as having competent clinic personnel, sufficient screening equipment, and reasonable waiting times to receive screening and to receive the screening results. Therefore, individual health care centers need to focus on the patients’ perception of the services received by optimizing the care provided, and in so doing increase the rates of early diagnosis, reduce the rate of mortality from breast cancer as well as its associated treatment costs. PMID:25182506

The experiences of midwives and nurses collaborating to provide birthing care: a systematic review.

PubMed

Macdonald, Danielle; Snelgrove-Clarke, Erna; Campbell-Yeo, Marsha; Aston, Megan; Helwig, Melissa; Baker, Kathy A

2015-11-01

Collaboration has been associated with improved health outcomes in maternity care. Collaborative relationships between midwives and physicians have been a focus of literature regarding collaboration in maternity care. However despite the front line role of nurses in the provision of maternity care, there has not yet been a systematic review conducted about the experiences of midwives and nurses collaborating to provide birthing care. The objective of this review was to identify, appraise and synthesize qualitative evidence on the experiences of midwives and nurses collaborating to provide birthing care.Specifically, the review question was: what are the experiences of midwives and nurses collaborating to provide birthing care? This review considered studies that included educated and licensed midwives and nurses with any length of practice. Nurses who work in labor and delivery, postpartum care, prenatal care, public health and community health were included in this systematic review.This review considered studies that investigated the experiences of midwives and nurses collaborating during the provision of birthing care. Experiences, of any duration, included any interactions between midwives and nurses working in collaboration to provide birthing care.Birthing care referred to: (a) supportive care throughout the pregnancy, labor, delivery and postpartum, (b) administrative tasks throughout the pregnancy, labor, delivery and postpartum, and (c) clinical skills throughout the pregnancy, labor, delivery and postpartum. The postpartum period included the six weeks after delivery.The review considered English language studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.This review considered qualitative studies that explored the experiences of collaboration in areas where midwives and nurses work together. Examples of these areas included: hospitals, birth centers, client homes, health clinics and other public or community health settings. These settings were located in any country, cultural context, or geographical location. A three-step search strategy was used to identify relevant published and unpublished studies. English papers from 1981 onwards were considered. The following databases were searched: Anthrosource, CENTRAL (The Cochrane Library), CINAHL, EMBASE, PsycINFO, PubMed, Social Services Abstracts and Sociological Abstracts. In addition to the databases, several grey literature sources were searched. Papers that were selected for retrieval were independently assessed for inclusion in the review by two JBI-trained reviewers. The two reviewers used a standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Once qualitative studies were assessed using the the Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool, findings of the included studies were extracted. These findings were aggregated into categories according to their similarity in meaning. These categories were then subjected to a meta-synthesis to produce a comprehensive set of synthesized findings. Five studies were included in the review. Thirty-eight findings were extracted from the included studies and were aggregated into five categories. The five categories were synthesized into two synthesized findings. The two synthesized findings were:Synthesized finding1: Negative experiences of collaboration between nurses and midwives may be influenced by distrust, lack of clear roles, or unprofessional or inconsiderate behavior.Synthesized finding 2: If midwives and nurses have positive experiences collaborating thenthere is hope that the challenges of collaboration can be overcome. Qualitative evidence about the experiences of midwives and nurses collaborating to provide birthing care was identified, appraised and synthesized. Two synthesized findings were created from the findings of the five included studies. Midwives and nurses had negative experiences of collaboration which may be influenced by: distrust, unclear roles, or a lack of professionalism or consideration. Midwives and nurses had positive experiences of teamwork which can be a source of hope for overcoming the challenges of sharing care.There is clearly a gap in the literature about the collaborative experiences of midwives and nurses, given that only five studies were located for inclusion in the systematic review. More qualitative research exploring collaboration as a process and the interactional dynamics of midwives and nurses in a variety of practice and professional contexts is required.Distrust, unclear roles, and lack of professionalism and consideration must all be addressed. Strategies that address and minimize the occurrences of these three elements need to be developed and implemented in an effort to reduce negative collaborative experiences for midwives and nurses. Postive experiences of teamwork must be acknowleged and celebrated, and the challenges that sharing care present must be understood as a part of the collaborative process.More qualitative research is required to explore the collaborative process between midwives and nurses. Further exploration of their interactional dynamics, their relationship between power and collaboration, and the experiences of collaboration in a variety of professional and practice contexts is recommended.

A paradigm for the study of paranoia in the general population: the Prisoner's Dilemma Game.

PubMed

Ellett, Lyn; Allen-Crooks, Rhani; Stevens, Adele; Wildschut, Tim; Chadwick, Paul

2013-01-01

A growing body of research shows that paranoia is common in the general population. We report three studies that examined the Prisoner's Dilemma Game (PDG) as a paradigm for evaluation of non-clinical paranoia. The PDG captures three key qualities that are at the heart of paranoia--it is interpersonal, it concerns threat, and it concerns the perception of others' intentions towards the self. Study 1 (n=175) found that state paranoia was positively associated with selection of the competitive PDG choice. Study 2 (n=111) found that this association was significant only when participants believed they were playing the PDG against another person, and not when playing against a computer. This finding underscores the interpersonal nature of paranoia and the concomitant necessity of studying paranoia in interpersonal context. In Study 3 (n=152), we assessed both trait and state paranoia, and differentiated between distrust- and greed-based competition. Both trait and state paranoia were positively associated with distrust-based competition (but not with greed-based competition). Crucially, we found that the association between trait paranoia and distrust-based competition was fully mediated by state paranoia. The PDG is a promising paradigm for the study of non-clinical paranoia.

Mobile healthcare informatics.

PubMed

Siau, Keng; Shen, Zixing

2006-06-01

Advances in wireless technology give pace to the rapid development of mobile applications. The coming mobile revolution will bring dramatic and fundamental changes to our daily life. It will influence the way we live, the way we do things, and the way we take care of our health. For the healthcare industry, mobile applications provide a new frontier in offering better care and services to patients, and a more flexible and mobile way of communicating with suppliers and patients. Mobile applications will provide important real time data for patients, physicians, insurers, and suppliers. In addition, it will revolutionalize the way information is managed in the healthcare industry and redefine the doctor - patient communication. This paper discusses different aspects of mobile healthcare. Specifically, it presents mobile applications in healthcare, and discusses possible challenges facing the development of mobile applications. Obstacles in developing mobile healthcare applications include mobile device limitations, wireless networking problems, infrastructure constraints, security concerns, and user distrust. Research issues in resolving or alleviating these problems are also discussed in the paper.

The meaning of a poor childbirth experience - A qualitative phenomenological study with women in Rwanda.

PubMed

Mukamurigo, Judith; Dencker, Anna; Ntaganira, Joseph; Berg, Marie

2017-01-01

Being pregnant and giving birth is a pivotal life event and one that a woman ordinarily remembers for most of her life. A negative childbirth experience can affect a woman's health well beyond the episode of the labour and birth itself. This study explored the meaning of a poor childbirth experience, as expressed by women who had given birth in Rwanda. In a cross-sectional household study conducted in Northern Province and in Kigali City, the capital of Rwanda, a structured questionnaire was answered by women who had given birth one to 13 months earlier. One question, answered by 898 women, asked them to rate their overall experience of childbirth from 0 (very bad) to 10 (very good). Of these, 28 women (3.1%) who had rated their childbirth experience as bad (≤ 4) were contacted for individual interviews. Seventeen of these women agreed to participate in individual in-depth interviews. The texts were analysed with a reflective lifeworld approach. The essential meaning of a "poor" childbirth experience was that the women had been exposed to disrespectful care, constituted by neglect, verbal or physical abuse, insufficient information, and denial of their husband as a companion. The actions of carers included abandonment, humiliation, shaming and insult, creating feelings of insecurity, fear and distrust in the women. Two of the women did not report any experience of poor care; their low rating was related to having suffered from medical complications. It is challenging that the main finding is that women are exposed to disrespectful care. In an effort to provide an equitable and high quality maternal health care system in Rwanda, there is a need to focus on activities to implement respectful, evidence-based care for all. One such activity is to develop and provide education programmes for midwives and nurses about professional behaviour when caring for and working with women during labour and birth.

Perceptions of cancer clinical research among African American men in North Carolina

PubMed Central

Trantham, Laurel C.; Carpenter, William R; DiMartino, Lisa D.; White, Brandolyn; Green, Melissa; Teal, Randall; Corbie-Smith, Giselle; Godley, Paul A.

2015-01-01

Objective The problem of cancer health disparities is substantial. Clinical trials are widely advocated as a means of reducing disparities and bringing state-of-the-art care to the broader community, where most cancer care is delivered. This study sought to develop a better understanding of why disproportionately few African American men enroll in clinical trials given their substantial cancer burden. Design This study applied community-based participatory research (CBPR) methods to design and conduct four focus groups of African American male cancer survivors and their caregivers in North Carolina. Results Among major themes, participants expressed confusion about the relationship between clinical trials, treatment, and research, signifying patient confusion and misinterpretation of common clinical trial terminology. Social norms including gender barriers and generational differences remain problematic; participants often reported that men do not talk about health issues, are unwilling to go to the doctor, and exhibit misapprehension and distrust regarding trials. Participants perceived this as detrimental to community health and expressed the need for more clarity in clinical trials information and a more fundamental social openness and communication about cancer detection and treatment. Conclusion Findings indicate the importance of clinical trials education in both traditional provider referral to trials and also in general patient navigation. To dispel pervasive misapprehension regarding placebos, clinical trials information should emphasize the role of standard care in modern cancer treatment trials. Many participants described willingness to participate in a trial upon physician recommendation, suggesting merit in improving patient-physician communication through culturally competent terminology and trial referral systems. PMID:26113749

Erosion of Trust in the Medical Profession in India: Time for Doctors to Act

PubMed Central

Kane, Sumit; Calnan, Michael

2017-01-01

In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction. PMID:28005537

Social acceptability of Satellite Power Systems (SPS): the near-term outlook

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klineberg, S L

1980-05-01

It is important, at this early stage in the concept development and evaluation of Satellite Power Systems, to explore aspects of contemporary social change that may be expected to complicate the process of achieving the necessary support of the American public for this new technological venture. Current public attitudes make it appear unlikely that a consensus will evolve during the 1980s favoring costly efforts to develop vast new supplies of conventional energy. Opinion polls reveal a pervasive worry over inflation, a broadening of aspirations to encompass quality-of-life concerns, a growing distrust of central governments, large corporations, big science and technology,more » and a continuing commitment to environmental protection - all of which suggests a social environment that is likely to resist the development of a major new high-technology energy system such as the SPS. Opposition to satellite power will focus on the high front-end development costs, on environmental and technical uncertainties, and on a generalized distrust of large bureaucracies and esoteric technologies. The SPS concept is also likely to be viewed with skepticism by those with vested interests in the long-run uses of coal, shale, fission, fusion, or on-site solar technologies. The growing commitment to energy conservation and the spreading deployment of dispersed renewable-energy systems strongly suggest that the unmet US demand for centrally generated electricity is unlikely to grow sufficiently over the next twenty years to convince a reluctant public of the need for so large an investment of scarce resources in the SPS program. Satellite Power Systems will have a problem in the area of public acceptability.« less

Differences between Roma and non-Roma in how social support from family and friends helps to overcome health care accessibility problems.

PubMed

Bobakova, Daniela; Dankulincova Veselska, Zuzana; Babinska, Ingrid; Klein, Daniel; Madarasova Geckova, Andrea; Cislakova, Lydia

2015-04-14

Roma are the most deprived ethnic minority in Slovakia, suffering from discrimination, poverty and social exclusion. Problematic access to good quality health care as result of institutional and interpersonal discrimination affects their health; therefore, factors which affect health care accessibility of Roma are of high importance for public health and policy makers. The aim of this study was to explore the association between health care accessibility problems and ethnicity and how different levels of social support from family and friends affect this association. We used data from the cross-sectional HepaMeta study conducted in 2011 in Slovakia. The final sample comprised 452 Roma (mean age = 34.7; 35.2% men) and 403 (mean age = 33.5; 45.9% men) non-Roma respondents. Roma in comparison with non-Roma have a more than 3-times higher chance of reporting health care accessibility problems. Social support from family and friends significantly decreases the likelihood of reporting health care accessibility problems in both Roma and non-Roma, while the family seems to be the more important factor. The worse access to health care of Roma living in so-called settlements seems to be partially mediated by social support. Interventions should focus on Roma health mediators and community workers who can identify influential individuals who are able to change a community's fear and distrust and persuade and teach Roma to seek and appropriately use health care services.

The search for safety, control, and voice for mothers living with the legacy of childhood violence experiences: a critical feminist narrative inquiry.

PubMed

Pitre, Nicole Y; Kushner, Kaysi E; Hegadoren, Kathy M

2011-01-01

We explored the experiences of 12 women who mothered their children while they encountered challenges stemming from the legacy of childhood violence experiences. We examined the participants' narratives through critical, feminist, and symbolic interaction lenses to locate the forces and conditions facilitating and constraining women's mothering choices and decisions. Women's stories revealed their agency in the face of enduring distrust experiences. Women were determined to "change the story." They met pervasive self-doubt with a "search for anchors" and "constant comparisons." Persistent distrust of others meant women relied on "hypervigilance" and "gatekeeping." Implications for knowledge development, research, and practice are discussed.

Rational choice(s)? Rethinking decision-making on breast cancer risk and screening mammography.

PubMed

Vahabi, Mandana; Gastaldo, Denise

2003-12-01

Women who refrain from undergoing breast cancer screening are believed to be uninformed about risks and usually labeled as irrational. Our purpose in writing this paper is to challenge the traditional notion of rational behaviour, illustrating with qualitative data that people's rationality is influenced by their socio-cultural and political identities. We explore three major themes: (1) cultural explanations regarding intention to use screening mammography (2) (dis)trust in science and expert opinion, and (3) self-responsibility and self-surveillance in caring for one's body. Understanding that women rely on different risk discourses to make decisions about their health should aide researchers, health professionals, and the community in better understanding alternative ways of conceptualizing people's health-related behaviours when they do not coincide with health authorities recommendations.

Latino Beliefs about Biomedical Research Participation: A Qualitative Study on the US-Mexico Border

PubMed Central

Ceballos, Rachel; Knerr, Sarah; Scott, Mary Alice; Hohl, Sarah; Malen, Rachel; Vilchis, Hugo; Thompson, Beti

2015-01-01

Latinos are under-represented in biomedical research conducted in the United States (US), impeding disease prevention and treatment efforts for this growing demographic group. We gathered perceptions of biomedical research and gauged willingness to participate through elicitation interviews and focus groups with Latinos living on the US-Mexico border. Themes that emerged included a strong willingness to participate in biomedical studies and suggested that Latinos may be under-represented due to limited formal education and access to health information, not distrust. The conflation of research and clinical care was common and motivated participation. Outreach efforts and educational interventions to inform Latinos of participation opportunities and clarify harms and benefits associated with biomedical research participation will be essential to maintain trust within Latino communities. PMID:25747293

A focus group study of DES daughters: implications for health care providers.

PubMed

Duke, S S; McGraw, S A; Avis, N E; Sherman, A

2000-01-01

A focus group study of women exposed to diethylstilbestrol (DES) in utero (DES daughters) was conducted to gain understanding about exposure to this drug from a patient perspective. Focus group participants reported that learning about their DES exposure was devastating; they experienced strains in their family relationships, emotional shock, a feeling that their health concerns were not appreciated by others and, to some degree, a sense of social isolation. Although many were aware of the need for special gynecological exams and high-risk prenatal care, they were frustrated by what they felt was a lack of reliable and clear information about the effects of DES exposure. Most expressed questions and anxiety about their health. Many found their communication with physicians about their DES exposure unsatisfying. They felt that physicians lacked information about the long-term health effects of DES exposure and as a result did not give them accurate information. Furthermore, they felt that physicians were dismissive of their concerns and often gave what they felt to be false reassurances. Consequently, the women developed an enduring distrust of the medical profession. The results of the study suggest implications for the delivery of health care to DES daughters. Copyright 2000 John Wiley & Sons, Ltd.

The Price of Distrust: Trust, Anxious Attachment, Jealousy, and Partner Abuse.

PubMed

Rodriguez, Lindsey M; DiBello, Angelo M; Øverup, Camilla S; Neighbors, Clayton

2015-07-01

Trust is essential to the development of healthy, secure, and satisfying relationships (Simpson, 2007a). Attachment styles provide a theoretical framework for understanding how individuals respond to partner behaviors that either confirm or violate trust (Hazan & Shaver, 1994). The current research aimed to identify how trust and attachment anxiety might interact to predict different types of jealousy and physical and psychological abuse. We expected that when experiencing lower levels of trust, anxiously attached individuals would report higher levels of both cognitive and behavioral jealousy as well as partner abuse perpetration. Participants in committed romantic relationships ( N = 261) completed measures of trust, attachment anxiety and avoidance, jealousy, and physical and psychological partner abuse in a cross-sectional study. Moderation results largely supported the hypotheses: Attachment anxiety moderated the association between trust and jealousy, such that anxious individuals experienced much higher levels of cognitive and behavioral jealousy when reporting lower levels of trust. Moreover, attachment anxiety moderated the association between trust and nonphysical violence. These results suggest that upon experiencing distrust in one's partner, anxiously attached individuals are more likely to become jealous, snoop through a partner's belongings, and become psychologically abusive. The present research illustrates that particularly for anxiously attached individuals, distrust has cascading effects on relationship cognitions and behavior, and this should be a key area of discussion during therapy.

Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers

PubMed Central

2013-01-01

Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs, cancer education for Aboriginal stakeholders, continuity of care, avoiding use of medical jargon, accommodating patients’ psychosocial and logistical needs, and in-service coordination. Conclusion Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. PMID:24188503

Viewpoint: Cultural competence and the African American experience with health care: The case for specific content in cross-cultural education.

PubMed

Eiser, Arnold R; Ellis, Glenn

2007-02-01

Achieving cultural competence in the care of a patient who is a member of an ethnic or racial minority is a multifaceted project involving specific cultural knowledge as well as more general skills and attitude adjustments to advance cross-cultural communication in the clinical encounter. Using the important example of the African American patient, the authors examine relevant historical and cultural information as it relates to providing culturally competent health care. The authors identify key influences, including the legacy of slavery, Jim Crow discrimination, the Tuskegee syphilis study, religion's interaction with health care, the use of home remedies, distrust, racial concordance and discordance, and health literacy. The authors propose that the awareness of specific information pertaining to ethnicity and race enhances cross-cultural communication and ways to improve the cultural competence of physicians and other health care providers by providing a historical and social context for illness in another culture. Cultural education, modular in nature, can be geared to the specific populations served by groups of physicians and provider organizations. Educational methods should include both information about relevant social group history as well as some experiential component to emotively communicate particular cultural needs. The authors describe particular techniques that help bridge the cross-cultural clinical communication gaps that are created by patients' mistrust, lack of cultural understanding, differing paradigms for illness, and health illiteracy.

Evaluating a bilingual patient navigation program for uninsured women with abnormal screening tests for breast and cervical cancer: implications for future navigator research.

PubMed

Simon, Melissa A; Tom, Laura S; Nonzee, Narissa J; Murphy, Kara R; Endress, Richard; Dong, XinQi; Feinglass, Joe

2015-05-01

The DuPage Patient Navigation Collaborative evaluated the Patient Navigation Research Program (PNRP) model for uninsured women receiving free breast or cervical cancer screening through the Illinois Breast and Cervical Cancer Program in DuPage County, Illinois. We used medical records review and patient surveys of 477 women to compare median follow-up times with external Illinois Breast and Cervical Cancer Program and Chicago PNRP benchmarks of performance. We examined the extent to which we mitigated community-defined timeliness risk factors for delayed follow-up, with a focus on Spanish-speaking participants. Median follow-up time (29.0 days for breast and 56.5 days for cervical screening abnormalities) compared favorably to external benchmarks. Spanish-speaking patients had lower health literacy, lower patient activation, and more health care system distrust than did English-speaking patients, but despite the prevalence of timeliness risk factors, we observed no differences in likelihood of delayed (> 60 days) follow-up by language. Our successful replication and scaling of the PNRP navigation model to DuPage County illustrates a promising approach for future navigator research.

Evaluating a Bilingual Patient Navigation Program for Uninsured Women With Abnormal Screening Tests for Breast and Cervical Cancer: Implications for Future Navigator Research

PubMed Central

Tom, Laura S.; Nonzee, Narissa J.; Murphy, Kara R.; Endress, Richard; Dong, XinQi; Feinglass, Joe

2015-01-01

Objectives. The DuPage Patient Navigation Collaborative evaluated the Patient Navigation Research Program (PNRP) model for uninsured women receiving free breast or cervical cancer screening through the Illinois Breast and Cervical Cancer Program in DuPage County, Illinois. Methods. We used medical records review and patient surveys of 477 women to compare median follow-up times with external Illinois Breast and Cervical Cancer Program and Chicago PNRP benchmarks of performance. We examined the extent to which we mitigated community-defined timeliness risk factors for delayed follow-up, with a focus on Spanish-speaking participants. Results. Median follow-up time (29.0 days for breast and 56.5 days for cervical screening abnormalities) compared favorably to external benchmarks. Spanish-speaking patients had lower health literacy, lower patient activation, and more health care system distrust than did English-speaking patients, but despite the prevalence of timeliness risk factors, we observed no differences in likelihood of delayed (> 60 days) follow-up by language. Conclusions. Our successful replication and scaling of the PNRP navigation model to DuPage County illustrates a promising approach for future navigator research. PMID:25713942

Nuclear weapons and NATO-Russia relations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cornwell, G.C.

1998-12-01

Despite the development of positive institutional arrangements such as Russian participation in the NATO-led peacekeeping force in Bosnia and the NATO- Russia Permanent Joint Council, the strategic culture of Russia has not changed in any fundamental sense. Russian strategic culture has not evolved in ways that would make Russian policies compatible with those of NATO countries in the necessary economic, social, technological, and military spheres. On the domestic side, Russia has yet to establish a stable democracy and the necessary legal, judicial, and regulatory institutions for a free-market economy. Russia evidently lacks the necessary cultural traditions, including concepts of accountabilitymore » and transparency, to make these adaptations in the short-term. Owing in part to its institutional shortcomings, severe socioeconomic setbacks have afflicted Russia. Russian conventional military strength has been weakened, and a concomitant reliance by the Russians on nuclear weapons as their ultimate line of defense has increased. The breakdown in the infrastructure that supports Russian early warning and surveillance systems and nuclear weapons stewardship defense, coupled with a tendency towards has exacerbated Russian anxiety and distrust toward NATO. Russia`s reliance on nuclear weapons as the ultimate line of defense, coupled with a tendency toward suspicion and distrust toward NATO, could lead to dangerous strategic miscalculation and nuclear catastrophe.« less

Struggling for confirmation--patients' experiences of dissatisfaction with hospital care.

PubMed

Eriksson, Ulrika; Svedlund, Marianne

2007-03-01

The aim of the study was to illuminate patients' experiences of dissatisfaction with hospital care. During the last decade, interest in measuring patient satisfaction has become an important indicator of the quality of care. Researchers have, however, criticized the concept theoretically and methodologically. Subsequently, researchers have increasingly argued that the focus of attention should shift to explore patient dissatisfaction. A qualitative approach. Narrative interviews were conducted with six people who had experienced dissatisfaction during a hospital care episode. The interview text was analysed using qualitative content analysis. The results show the patients' struggle for confirmation, the feeling of distrust in health care and what they have been forced to sacrifice because of lack of treatment. A feeling of being a troublesome patient is also apparent. At the same time a positive encounter is described, as well as situations of confirmation from caregivers. The results also show hope and a will to get on with life. Dissatisfaction relating to aspects of encounter is a common problem in health care and conceivable causes and possible solutions are discussed from different perspectives. RELEVANCE TO CLINICAL: Caregivers as well as patients are in need of confirmation. If management were to take notice of and confirm caregivers this could consequently help them to gain the strength and energy necessary to provide care permeated with confirmation. A veritable, trustworthy care can be established through personal presence. To take notice of, confirm and listen to patients, creates opportunities for providing them with a positive experience of human encounter, which in the long run is rewarding from all perspectives.

Enhancing the role of private practitioners in tuberculosis prevention and care activities in India.

PubMed

Anand, Tanu; Babu, Ranjith; Jacob, Anil G; Sagili, Karuna; Chadha, Sarabjit S

2017-01-01

India accounts for the highest number of incident tuberculosis (TB) cases globally. Hence, to impact the TB incidence world over, there is an urgent need to address and accelerate TB control activities in the country. Nearly, half of the TB patients first seek TB care in private sector. However, the participation of private practitioners (PPs) has been patchy in TB prevention and care and distrust exists between public and private sector. PPs usually have varied diagnostic and treatment practices that are inadequate and amplify the risk of drug resistance. Hence, their regulation and involvement as key stakeholders are important in TB prevention and care in India if we are to achieve TB control at global level. However, there remain certain barriers and gaps, which are preventing their upscaling. The current paper aims to discuss the status of private sector involvement in TB prevention and care in India. The paper also discusses the strategies and initiatives taken by the government in this regard as evidence shows that the involvement of private sector in co-opting directly observed treatment short-course (DOTS) helps to enhance case finding and treatment outcomes; it improves the accessibility of quality TB care with greater geographic coverage. Besides public-private mix, DOTS has been found more cost-effective and reduces financial burden of patients. The paper also offers to present some more solutions both at policy and program level for upscaling the engagement of PPs in the national TB control program.

Enhancing the role of private practitioners in tuberculosis prevention and care activities in India

PubMed Central

Anand, Tanu; Babu, Ranjith; Jacob, Anil G.; Sagili, Karuna; Chadha, Sarabjit S.

2017-01-01

India accounts for the highest number of incident tuberculosis (TB) cases globally. Hence, to impact the TB incidence world over, there is an urgent need to address and accelerate TB control activities in the country. Nearly, half of the TB patients first seek TB care in private sector. However, the participation of private practitioners (PPs) has been patchy in TB prevention and care and distrust exists between public and private sector. PPs usually have varied diagnostic and treatment practices that are inadequate and amplify the risk of drug resistance. Hence, their regulation and involvement as key stakeholders are important in TB prevention and care in India if we are to achieve TB control at global level. However, there remain certain barriers and gaps, which are preventing their upscaling. The current paper aims to discuss the status of private sector involvement in TB prevention and care in India. The paper also discusses the strategies and initiatives taken by the government in this regard as evidence shows that the involvement of private sector in co-opting directly observed treatment short-course (DOTS) helps to enhance case finding and treatment outcomes; it improves the accessibility of quality TB care with greater geographic coverage. Besides public-private mix, DOTS has been found more cost-effective and reduces financial burden of patients. The paper also offers to present some more solutions both at policy and program level for upscaling the engagement of PPs in the national TB control program. PMID:29099000

'It's easier to talk to a woman'. Aspects of gender in Swedish telenursing.

PubMed

Höglund, Anna T; Holmström, Inger

2008-11-01

To describe and explore gender aspects in telenursing as experienced by Swedish telenurses. Telenurses at call centres in Sweden offer triage recommendations and self-care advice to the general public over the telephone, on a wide range of health problems. The demands on telenurses are multifaceted and competence is needed in many fields such as nursing, pharmacology, psychology and communication. Previous studies have shown that telenurses encounter many ethical dilemmas and that some of these are to do with gender related issues. Most telenurses, as well as most callers, are women. It is, therefore, reasonable to believe that gender plays an important role in the work of telenurses. Descriptive and explorative qualitative design. A purposive sample of 12 female telenurses in Sweden participated in in-depth interviews twice during 2004-2005. The transcribed interviews were analysed inductively with a stepwise thematic method. Five themes emerged from the interviews, namely: female subordination in the family, disrespect in dialogue with female nurses, distrust in fathers' competence, reluctant male callers and woman-to-woman connection. Gender construction and cultural gender norms seem to be at work in the encounter between Swedish telenurses and callers. Questions of power relations, the picture of the mother/woman as the primary carer for small children and distrusting men in their parental role were particularly highlighted. Telenurses should be aware of the risk of stereotyping their dialogues with callers in a way that seems to fit better with female callers' ways of communicating. Clinical supervision based on reflective practice and peer reviews of calls might diminish this risk. Telenurses also need more training in handling overt or covert power messages based on male superiority.

The Price of Distrust: Trust, Anxious Attachment, Jealousy, and Partner Abuse

PubMed Central

Rodriguez, Lindsey M.; DiBello, Angelo M.; Øverup, Camilla S.; Neighbors, Clayton

2017-01-01

Trust is essential to the development of healthy, secure, and satisfying relationships (Simpson, 2007a). Attachment styles provide a theoretical framework for understanding how individuals respond to partner behaviors that either confirm or violate trust (Hazan & Shaver, 1994). The current research aimed to identify how trust and attachment anxiety might interact to predict different types of jealousy and physical and psychological abuse. We expected that when experiencing lower levels of trust, anxiously attached individuals would report higher levels of both cognitive and behavioral jealousy as well as partner abuse perpetration. Participants in committed romantic relationships (N = 261) completed measures of trust, attachment anxiety and avoidance, jealousy, and physical and psychological partner abuse in a cross-sectional study. Moderation results largely supported the hypotheses: Attachment anxiety moderated the association between trust and jealousy, such that anxious individuals experienced much higher levels of cognitive and behavioral jealousy when reporting lower levels of trust. Moreover, attachment anxiety moderated the association between trust and nonphysical violence. These results suggest that upon experiencing distrust in one’s partner, anxiously attached individuals are more likely to become jealous, snoop through a partner’s belongings, and become psychologically abusive. The present research illustrates that particularly for anxiously attached individuals, distrust has cascading effects on relationship cognitions and behavior, and this should be a key area of discussion during therapy. PMID:28386379

[The Role of Distinctiveness of Stimulus in Memory Distrust as a Function of Repeated Checking].

PubMed

Demirsöz, Talat; Ayvaşık, H Belgin

2017-01-01

Recent literature proposes that repeated checking increases familiarity with the material, making recollections less vivid and detailed and promoting distrust in memory. The aim of the current study is to investigate the possible underlying mechanisms of low confidence in memory. The Padua Inventory-Washington State University Revision (PI-WSUR) was applied in a cohort of university students. Among the students who completed the PI-WSUR, 84 participants were selected and assigned to low Obsessive-Compulsive Symptomatology (OCS) group or high OCS group according to their PI-WSUR scores. An interactive computer animation was developed to test repeated checking behavior. Participants were randomly assigned to two experimental conditions: "Feedback condition" and "no feedback condition". The participants were all asked to carry out checking rituals on a virtual gas ring. However, half of the participants were given feedback indicating that checking activity was successful and complete and half of the participants were not. While there was no significant difference in terms of memory accuracy, memory detail and memory vividness between feedback condition and no feedback condition, there was a significant difference in terms of memory confidence between two experimental groups. Results are discussed in the light of a different explanation offering that the level of distinctiveness of recollections plays crucial role in memory distrust rather than the explanation of low confidence hypothesis.

Experiences of health care in women with Peripartum Cardiomyopathy in Sweden: a qualitative interview study.

PubMed

Patel, Harshida; Schaufelberger, Maria; Begley, Cecily; Berg, Marie

2016-12-08

Peripartum cardiomyopathy is often associated with severe heart failure occurring towards the end of pregnancy or in the months following birth with debilitating, exhausting and frightening symptoms requiring person-centered care. The aim of this study was to explore women's experiences of health care while being diagnosed with peripartum cardiomyopathy. Qualitative interviews were conducted with 19 women with peripartum cardiomyopathy in Sweden, following consent. Data were analysed using qualitative content analysis. Confirmability was ensured by peer-debriefing, and an audit trail was kept to establish the credibility of the study. The main theme in the experience of health care was, 'Exacerbated Suffering', expressed in three subthemes; 'not being cared about', 'not being cared for' and 'not feeling secure.' The suffering was present in relation to the illness with failing health symptoms, but most of all in relation to not being taken seriously and adequately cared for by healthcare professionals. Women felt they were on an assembly line in midwives' routine work where knowledge about peripartum cardiomyopathy was lacking and they showed distrust and dissatisfaction with care related to negligence and indifference experienced from healthcare professionals. Feelings of being alone and lost were prominent and related to a sense of insecurity, distress and uneasiness. This study shows a knowledge gap of peripartum cardiomyopathy in maternity care personnel. This is alarming as the deprecation of symptoms and missed diagnosis of peripartum cardiomyopathy can lead to life-threatening consequences. To prompt timely diagnosis and avoid unnecessary suffering it is important to listen seriously to, and respect, women's narratives and act on expressions of symptoms of peripartum cardiomyopathy, even those overlapping normal pregnancy symptoms.

The CRADLE vital signs alert: qualitative evaluation of a novel device designed for use in pregnancy by healthcare workers in low-resource settings.

PubMed

Nathan, Hannah L; Boene, Helena; Munguambe, Khatia; Sevene, Esperança; Akeju, David; Adetoro, Olalekan O; Charanthimath, Umesh; Bellad, Mrutyunjaya B; de Greeff, Annemarie; Anthony, John; Hall, David R; Steyn, Wilhelm; Vidler, Marianne; von Dadelszen, Peter; Chappell, Lucy C; Sandall, Jane; Shennan, Andrew H

2018-01-05

Vital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Its traffic light early warning system alerts healthcare workers to the need for escalation of care for women with hypertension, haemorrhage or sepsis. This study evaluated the usability and acceptability of the CRADLE VSA device. Evaluation was conducted in community and primary care settings in India, Mozambique and Nigeria and tertiary hospitals in South Africa. Purposeful sampling was used to convene 155 interviews and six focus groups with healthcare workers using the device (n = 205) and pregnant women and their family members (n = 41). Interviews and focus groups were conducted in the local language and audio-recorded, transcribed and translated into English for analysis. Thematic analysis was undertaken using an a priori thematic framework, as well as an inductive approach. Most healthcare workers perceived the CRADLE device to be easy to use and accurate. The traffic lights early warning system was unanimously reported positively, giving healthcare workers confidence with decision-making and a sense of professionalism. However, a minority in South Africa described manual inflation as tiring, particularly when measuring vital signs in obese and hypertensive women (n = 4) and a few South African healthcare workers distrusted the device's accuracy (n = 7). Unanimously, pregnant women liked the CRADLE device. The traffic light early warning system gave women and their families a better understanding of the importance of vital signs in pregnancy and during the postpartum period. The CRADLE device was well accepted by healthcare workers from a range of countries and levels of facility, including those with no previous vital signs measurement experience. The device motivated women to attend primary care and encouraged them to accept treatment and referral.

Conduct Disorder

MedlinePlus

... the challenge of treatment are the child's uncooperative attitude, fear and distrust of adults. In developing a ... depression . Treatment is rarely brief since establishing new attitudes and behavior patterns takes time. However, early treatment ...

Comparing the epidemic in U.S. and Britain.

PubMed

Harmon, K S

1999-01-01

Cultural differences between the United States and Britain influence how the AIDS/HIV epidemic is being addressed and why AIDS rates are smaller in the United Kingdom. The author proposes that highly diverse and racist societies, like in the United States, may cause distrust among different groups in the effort to challenge the spread of HIV/AIDS, leaving people to fend for themselves. Because of racism and distrust between ethnic and racial groups, as well as differences in financial resources between groups, the AIDS epidemic in the United States is being fought on too many fronts without the benefit of a uniform response. Ironically, this problem has also spurred a greater ability among US AIDS service providers to work with diverse communities during the course of the epidemic.

Farming or seasonal migration? - Potential futures of reindeer husbandry in Fennoscandia studied with Social-Ecological System (SES) approach, co-production of knowledge, and scenarios

NASA Astrophysics Data System (ADS)

Käyhkö, Jukka; Horstkotte, Tim; Vehmas, Jarmo; Forbes, Bruce

2017-04-01

The area allocated for reindeer husbandry in Finland, Sweden and Norway covers approximately 40 % of each country. As the livelihood requires large, relatively unfragmented territories while being marginal in terms of direct income, land-use conflicts between various livelihoods and activities, such as forestry, agriculture, mining, energy production, tourism, and nature protection are common phenomena in the region. Simultaneously, rapid societal change, urban exodus and fading traditions as well as climate warming and subsequent ecosystem change may put the livelihood at stake. We have probed potential futures of reindeer husbandry in Northern Fennoscandia using the Social-Ecological System (SES) approach, knowledge co-production in stakeholder-scientist workshops in all three countries, and scenario building based on quantitative data and narratives. Regarding the future of the livelihood, we have identified some crucial components in the SES that are influential in determining the direction of development. We produced four potential pathways of future development and demonstrate that important factors controlling the direction of development include governance and actor relations. Governance is often considered distant and opaque by local stakeholders, fostering conflicts in land allocation, while unclear regulations at local level reinforce emerging conflict situations leading to distrust and restrained communication between the actors. Regionally, these conflicts may lead to decreased resilience and threaten the future of the livelihood altogether. Therefore, research should focus on supporting the reform process of institutional arrangements and governance mechanisms, and fostering co-design and co-production processes that ease distrust and improve resilience of the livelihood in multifunctional landscapes.

Pastoral Care Use among Post-9/11 Veterans who Screen Positive for Mental Health Problems

PubMed Central

Nieuwsma, Jason A.; Fortune-Greeley, Alice K.; Jackson, George L.; Meador, Keith G.; Beckham, Jean C.; Elbogen, Eric B.

2014-01-01

As a result of their military experience, veterans with mental health problems may have unique motivations for seeking help from clergy. Patterns and correlates of seeking pastoral care were examined using a nationwide representative survey that was conducted among veterans of post-9/11 conflicts (adjusted N = 1,068; 56% response rate). Separate multivariate logistic regression models were used to examine veteran characteristics associated with seeking pastoral care and seeking mental health services. Among post-9/11 veterans with a probable mental disorder (n = 461) – defined as a positive screen for posttraumatic stress disorder, major depressive disorder, or alcohol misuse – 20.2% reported talking to a “pastoral counselor” in the preceding year, 44.7% reported talking to a mental health professional, and 46.6% reported talking to neither. In a multivariate analysis for veterans with a probable mental disorder, seeing a pastoral counselor was associated with an increased likelihood of seeing a mental health professional in the past year (OR: 2.16; 95% CI: [1.28, 3.65]). In a separate bivariate analysis, pastoral counselors were more likely to be seen by veterans who indicated concerns about stigma or distrust of mental health care. These results suggest that pastoral and mental health care services may complement one another and underscore the importance of enhancing understanding and collaboration between these disciplines so as to meet the needs of the veterans they serve. PMID:24933105

Suffering caused by care—Patients’ experiences from hospital settings

PubMed Central

Berglund, Mia; Westin, Lars; Svanström, Rune

2012-01-01

Suffering and well-being are significant aspects of human existence; in particular, suffering and well-being are important aspects of patients’ experiences following diseases. Increased knowledge about existential dimensions of illness and healthcare experiences may be needed in order to improve care and reduce unnecessary suffering. Therefore, the aim of this paper is to illuminate the phenomenon of suffering experienced in relation to healthcare needs among patients in hospital settings in Sweden. In this study, we used a reflective lifeworld approach. The data were analysed with a focus on meanings. The results describe the essential meaning of the phenomenon of suffering in relation to healthcare needs. The patients were suffering during care-giving when they felt distrusted or mistreated and when their perspective on illness and health was overlooked. Suffering was found to arise due to healthcare actions that neglected a holistic and patient-centred approach to care. Unfortunately, healthcare experiences that cause patients to suffer seem to be something one needs to endure without being critical. The phenomenon can be described as having four constituents: to be mistreated; to struggle for one's healthcare needs and autonomy; to feel powerless; and to feel fragmented and objectified. The study concludes that there are problems associated with patients experiencing suffering at the hands of healthcare providers, even if this suffering may not have been caused deliberately to the patient. Consequently, conscious improvements are needed to lessen the suffering caused by care-giving, as are strategies that promote more patient-centred care and patient participation. PMID:22943888

Recruiting, Linking, and Retaining High-risk Transgender Women into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned

PubMed Central

Reback, Cathy J.; Ferlito, Dahlia; Kisler, Kimberly A.; Fletcher, Jesse B.

2016-01-01

Despite disproportionately high HIV prevalence rates and high risk for HIV acquisition and transmission, trans women in the United States are less likely than other high-risk populations to be aware of their HIV status or to perceive HIV infection as a serious health threat. Furthermore, concurrently high rates of unstable housing, few legal employment opportunities, lack of social support, and distrust of social service providers limit trans women's interest or ability to be recruited by, retained within, or linked into HIV prevention and care services. This article provides an overview of the barriers that prevent many high-risk trans women from being recruited, linked, and retained within HIV prevention and care services as well as accessing HIV testing services, and discusses several strategies for overcoming these barriers. Best practices in working with high-risk trans women include hiring trans women indigenous to the local trans communities, designing culturally specific recruitment and retention strategies including the creation of living “community maps” to ensure successful community outreach, the construction of a trans women-specific CAB to create dialogue with community stakeholders including consumers, and extensive cultural sensitivity training for staff and community collaborators to sensitize them to the specific needs of high-risk trans women participants. PMID:27110227

Communication Between Professionals During Volcanic Emergencies

NASA Astrophysics Data System (ADS)

Solana, Carmen; Spiller, Claire

2007-07-01

Successful communication between scientists, officials, media, and the public is imperative during a volcanic crisis. Misunderstanding can lead to confusion and distrust, and it ultimately can transform an emergency into a disaster.

Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

PubMed Central

van Heerden, Alastair; Harris, Danielle M.; van Rooyen, Heidi; Barnabas, Ruanne V.; Ramanathan, Nithya; Ngcobo, Nkosinathi; Mpiyakhe, Zukiswa; Comulada, W. Scott

2017-01-01

mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such systems are critical to the successful extension of the health system from health facilities into people’s homes. PMID:28475904

Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa.

PubMed

van Heerden, Alastair; Harris, Danielle M; van Rooyen, Heidi; Barnabas, Ruanne V; Ramanathan, Nithya; Ngcobo, Nkosinathi; Mpiyakhe, Zukiswa; Comulada, W Scott

2017-06-01

mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such systems are critical to the successful extension of the health system from health facilities into people's homes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Increasing EHR system usability through standards: Conformance criteria in the HL7 EHR-system functional model.

PubMed

Meehan, Rebecca A; Mon, Donald T; Kelly, Kandace M; Rocca, Mitra; Dickinson, Gary; Ritter, John; Johnson, Constance M

2016-10-01

Though substantial work has been done on the usability of health information technology, improvements in electronic health record system (EHR) usability have been slow, creating frustration, distrust of EHRs and the use of potentially unsafe work-arounds. Usability standards could be part of the solution for improving EHR usability. EHR system functional requirements and standards have been used successfully in the past to specify system behavior, the criteria of which have been gradually implemented in EHR systems through certification programs and other national health IT strategies. Similarly, functional requirements and standards for usability can help address the multitude of sequelae associated with poor usability. This paper describes the evidence-based functional requirements for usability contained in the Health Level Seven (HL7) EHR System Functional Model, and the benefits of open and voluntary EHR system usability standards. Copyright © 2016 Elsevier Inc. All rights reserved.

Tripartite counterfactual quantum cryptography

NASA Astrophysics Data System (ADS)

Salih, Hatim

2014-07-01

We show how two distrustful parties, "Bob" and "Charlie," can share a secret key with the help of a mutually trusted "Alice" counterfactually; that is, with no information-carrying particles traveling between any of the three.

Scientific Citizenship and good governance: implications for biotechnology.

PubMed

Davies, Keith G; Wolf-Phillips, Jonathan

2006-02-01

In the wake of public distrust regarding biotechnology, it has been suggested that the debate should be moved "upstream", whereby the public help to set research priorities. Although many scientists see this as an illogical reaction to a loss of faith in science, we argue that the boundaries between science and its technological applications have become blurred and this produces conflicts of interests that have led to this crisis of trust. Furthermore, this distrust is also a crisis in governance that calls for a new open and democratic approach to scientific research. We propose that the concept of Scientific Citizenship, based on good governance, will help to restore public trust and bridge the gap between science and the society that it serves. Integral to this is the suggestion that the governance of science forms part of the training for scientists.

Finding the faithless: perceived atheist prevalence reduces anti-atheist prejudice.

PubMed

Gervais, Will M

2011-04-01

Although prejudice is typically positively related to relative outgroup size, four studies found converging evidence that perceived atheist prevalence reduces anti-atheist prejudice. Study 1 demonstrated that anti-atheist prejudice among religious believers is reduced in countries in which atheists are especially prevalent. Study 2 demonstrated that perceived atheist prevalence is negatively associated with anti-atheist prejudice. Study 3 demonstrated a causal relationship: Reminders of atheist prevalence reduced explicit distrust of atheists. These results appeared distinct from intergroup contact effects. Study 4 demonstrated that prevalence information decreased implicit atheist distrust. The latter two experiments provide the first evidence that mere prevalence information can reduce prejudice against any outgroup. These findings offer insights about anti-atheist prejudice, a poorly understood phenomenon. Furthermore, they suggest both novel directions for future prejudice research and potential interventions that could reduce a variety of prejudices.

Involvement of the Ventrolateral Prefrontal Cortex in Learning Others' Bad Reputations and Indelible Distrust.

PubMed

Suzuki, Atsunobu; Ito, Yuichi; Kiyama, Sachiko; Kunimi, Mitsunobu; Ohira, Hideki; Kawaguchi, Jun; Tanabe, Hiroki C; Nakai, Toshiharu

2016-01-01

A bad reputation can persistently affect judgments of an individual even when it turns out to be invalid and ought to be disregarded. Such indelible distrust may reflect that the negative evaluation elicited by a bad reputation transfers to a person. Consequently, the person him/herself may come to activate this negative evaluation irrespective of the accuracy of the reputation. If this theoretical model is correct, an evaluation-related brain region will be activated when witnessing a person whose bad reputation one has learned about, regardless of whether the reputation is deemed valid or not. Here, we tested this neural hypothesis with functional magnetic resonance imaging (fMRI). Participants memorized faces paired with either a good or a bad reputation. Next, they viewed the faces alone and inferred whether each person was likely to cooperate, first while retrieving the reputations, and then while trying to disregard them as false. A region of the left ventrolateral prefrontal cortex (vlPFC), which may be involved in negative evaluation, was activated by faces previously paired with bad reputations, irrespective of whether participants attempted to retrieve or disregard these reputations. Furthermore, participants showing greater activity of the left ventrolateral prefrontal region in response to the faces with bad reputations were more likely to infer that these individuals would not cooperate. Thus, once associated with a bad reputation, a person may elicit evaluation-related brain responses on their own, thereby evoking distrust independently of their reputation.

Lost trust: a yellow fever patient response.

PubMed

Runge, John S

2013-12-13

In the 19th century, yellow fever thrived in the tropical, urban trade centers along the American Gulf Coast. Industrializing and populated, New Orleans and Memphis made excellent habitats for the yellow fever-carrying Aedes aegypti mosquitoes and the virulence they imparted on their victims. Known for its jaundice and black, blood-filled vomit, the malady terrorized the region for decades, sometimes claiming tens of thousands of lives during the near annual summertime outbreaks. In response to the failing medical community, a small, pronounced population of sick and healthy laypeople openly criticized the efforts to rid the Gulf region of yellow jack. Utilizing newspapers and cartoons to vocalize their opinions, these critics doubted and mocked the medical community, contributing to the regional and seasonal dilemma yellow fever posed for the American South. These sentient expressions prove to be an early example of patient distrust toward caregivers, a current problem in clinical heath care.

Spanish students' use of the Internet for mental health information and support seeking.

PubMed

Montagni, Ilaria; Parizot, Isabelle; Horgan, Aine; Gonzalez-Caballero, Juan-Luis; Almenara-Barrios, José; Lagares-Franco, Carolina; Peralta-Sáez, Juan-Luis; Chauvin, Pierre; Amaddeo, Francesco

2016-06-01

The Internet is a growing source of information for health in general, with university student being online almost daily. Evaluating their use of the Internet for mental health information and support can help understanding if online tools and websites should be used for mental health promotion and, to some extent, care. A survey was conducted with more than 600 students of Law, Nursing and Computer Science of the University of Cadiz in Spain to determine their general use of the Internet and their perceptions and trust in using this medium for mental health information. Data were collected using a 25-item-questionnaire and findings indicated that students had a strong distrust in online mental health information, notwithstanding their daily use of the Internet. The frequency and methods of their research on the Internet correlated with their health status, their medical consultations and with certain socio-demographic characteristics. © The Author(s) 2014.

Lost Trust: A Yellow Fever Patient Response

PubMed Central

Runge, John S.

2013-01-01

In the 19th century, yellow fever thrived in the tropical, urban trade centers along the American Gulf Coast. Industrializing and populated, New Orleans and Memphis made excellent habitats for the yellow fever-carrying Aedes aegypti mosquitoes and the virulence they imparted on their victims. Known for its jaundice and black, blood-filled vomit, the malady terrorized the region for decades, sometimes claiming tens of thousands of lives during the near annual summertime outbreaks. In response to the failing medical community, a small, pronounced population of sick and healthy laypeople openly criticized the efforts to rid the Gulf region of yellow jack. Utilizing newspapers and cartoons to vocalize their opinions, these critics doubted and mocked the medical community, contributing to the regional and seasonal dilemma yellow fever posed for the American South. These sentient expressions prove to be an early example of patient distrust toward caregivers, a current problem in clinical heath care. PMID:24348220

From breakthrough to bust: the brief life of Norplant, the contraceptive implant.

PubMed

Watkins, Elizabeth Siegel

2010-01-01

This essay examines the history of Norplant from its development in the 1960s, to its approval by the FDA in 1990, through its tumultuous reception in American society, to its removal from the market in 2000. The rejection of Norplant by women was influenced by the social and political climate of the 1990s, in which a feminist health agenda, a consumerist ideology in health care, a growing tendency toward class action litigation, and increasing distrust of the pharmaceutical industry worked together to empower women to take charge of their reproductive decision making. The rhetoric of population control in the 1960s, when the pill and IUD were introduced, was very different from the language of individual choice that dominated in the 1990s, the era of Norplant. This investigation of Norplant extends the historical analysis of reproductive politics to the very end of the twentieth century.

Digital Partnerships for Health: Steps to develop a community-specific health portal aimed at promoting health and well-being

PubMed Central

Kukafka, Rita; Khan, Sharib A.; Hutchinson, Carly; McFarlane, Delano J.; Li, Jianhua; Ancker, Jessica S.; Cohall, Alwyn

2007-01-01

We describe the steps taken by the Harlem Health Promotion Center to develop a community-specific health web portal aimed at promoting health and well-being in Harlem. Methods and results that begin with data collection and move onto elucidating requirements for the web portal are discussed. Sentiments of distrust in medical institutions, and the desire for community specific content and resources were among the needs emanating from our data analysis. These findings guided our decision to customize social software designed to foster connections, collaborations, flexibility, and interactivity; an “architecture of participation”. While we maintain that the leveraging of social software may indeed be the way to build healthy communities and support learning and engagement in underserved communities, our conclusion calls for careful thinking, testing and evaluation research to establish best practice models for leveraging these emerging technologies to support health improvements in the community. PMID:18693872

Diabetes: Christian Worldview, Medical Distrust & Self-Management

PubMed Central

Newlin Lew, Kelley; Arbuah, Nancy; Banach, Paul; Melkus, Gail

2015-01-01

To inform development of a combined diabetes prevention and self-management intervention in partnership with church communities, this study sampled African American church leaders and members (N=44) to qualitatively study religious beliefs and practices, diabetes prevention and self-management behaviors, and related community actions. Prior to commencing the study, internal review board approval was obtained. Although not required, community consent was officially provided by the church pastors. Individual consent was subsequently obtained from eligible community members who expressed an interest in participating in the study. Following a participatory action research approach, the inquiry group method was used. Qualitative data were analyzed with content analysis. Findings revealed Christian worldview, medical mistrust, and self-management as prominent themes. Findings suggest diabetes providers address religious orientation in the provision of care with attention to rebuilding trust with the African American community to improve health outcomes. PMID:25735754

Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision making.

PubMed

Goggins, Kathryn M; Wallston, Kenneth A; Nwosu, Samuel; Schildcrout, Jonathan S; Castel, Liana; Kripalani, Sunil

2014-01-01

Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making Scale. Using multivariable modeling, we determined the relationship of health literacy, subjective numeracy, and other patient characteristics with preferences for involvement in decisions, and how this differed by scenario. The authors found that patients with higher levels of health literacy desired more participation in the problem-solving and decision-making process, as did patients with higher subjective numeracy skills, greater educational attainment, female gender, less perceived social support, or greater health care system distrust (p<.05 for each predictor in multivariable models). Patients also preferred to participate more in the decision-making process when the hypothetical symptom they were experiencing was less severe (i.e., they deferred more to their physician when the hypothetical symptom was more severe). These findings underscore the role that patient characteristics, especially health literacy and numeracy, play in decisional preferences among hospitalized patients.

The importance of context in early autism intervention: A qualitative South African study.

PubMed

Guler, Jessy; de Vries, Petrus J; Seris, Noleen; Shabalala, Nokuthula; Franz, Lauren

2017-09-01

The majority of individuals with autism spectrum disorder live in low- and middle-income countries and receive little or no services from health or social care systems. The development and validation of autism spectrum disorder interventions has almost exclusively occurred in high-income countries, leaving many unanswered questions regarding what contextual factors would need to be considered to ensure the effectiveness of interventions in low- and middle-income countries. This study qualitatively explored contextual factors relevant to the adaptation of a caregiver-mediated early autism spectrum disorder intervention in a low-resource South African setting. We conducted four focus groups and four in-depth interviews with 28 caregivers of young children with autism spectrum disorder and used thematic analysis to identify key themes. Eight contextual factors including culture, language, location of treatment, cost of treatment, type of service provider, support, parenting practices, and stigma emerged as important. Caregivers reported a preference for an affordable, in-home, individualized early autism spectrum disorder intervention, where they have an active voice in shaping treatment goals. Distrust of community-based health workers and challenges associated with autism spectrum disorder-related stigma were identified. Recommendations that integrate caregiver preferences with the development of a low-cost and scalable caregiver-mediated early autism spectrum disorder intervention are included.

Contemporary Criticism and the Return of Zeno.

ERIC Educational Resources Information Center

Harris, Wendell V.

1983-01-01

Suggests that contemporary critical literary theories such as hermaneutics, reader-response, speech-act, structuralism, and deconstructionism share with pre-Platonic Eleatic thought a distrust of cause-and-effect reasoning and an emphasis on paradox. (MM)

An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

PubMed Central

Khan, Rasheda; Sultana, Marzia; Bilkis, Sayeda; Koblinsky, Marge

2012-01-01

Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008–August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health systems need to be strengthened to ensure that all women in clinical need of lifesaving obstetric surgery access quality EmOC services rapidly and, once in a facility, can obtain a caesarean section promptly, if needed. While greater access to surgical interventions may be lifesaving, policy-makers need to institute mechanisms to discourage the over-medicalization of childbirth in a context where the use of caesarean section is rapidly rising. PMID:22838158

Public views towards community health and hospital-based outpatient services and their utilisation in Zhejiang, China: a mixed methods study

PubMed Central

Wu, Dan; Lam, Tai Pong; Lam, Kwok Fai; Zhou, Xu Dong; Sun, Kai Sing

2017-01-01

Objective China is engaged in promoting community health services (CHS) nationwide. This study examines the public’s views towards CHS and their utilisation of community-based and hospital-based outpatient services. Design A mixed methods study using qualitative interviews and a cross-sectional survey. Study setting and participants The study was conducted among the public between September 2014 and September 2015 in Zhejiang province, China. Six focus groups and 13 individuals were interviewed. The questionnaire was completed by 1248 respondents (response rate: 83%). Primary outcome measures Utilisation of community-based and hospital-based outpatient services. Results Functions of CHS perceived by the public included provision of minor illness management, coordination, drug dispensing, follow-up care and patient education. However, many also showed a distrust in primary care providers’ (PCPs) competence for confirming the initial diagnosis and management plan. As coordinators, PCPs’ integrity was challenged, and PCPs were thought to be potential ‘tuo er’ (cunning agents who tried to lead patients to some notorious hospitals to make money). Survey results showed that 800 (64.1%) respondents visited hospital-based clinics and 688 (55.1%) visited CHS at least once in the past year. Compared with the uninsured group, those covered by Urban Resident Medical Insurance (adjusted OR (AOR)=1.95, 95% CI 1.24 to 3.07) and Urban Employee Medical Insurance (AOR=2.59, 95% CI 1.59 to 4.24) were more likely to use hospital-based services. Respondents who had a chronic condition were more likely than their counterparts to use both hospital-based services (AOR=1.72, 95% CI 1.18 to 2.49) and CHS (AOR=1.66, 95% CI 1.19 to 2.32). Income levels were positively associated with the likelihood of visiting hospital-based clinics (AOR=1.67, 95% CI 1.15 to 2.42) but negatively associated with the likelihood of using CHS (AOR=0.68, 95% CI 0.48 to 0.96). Conclusions Demand of hospital-based outpatient services is much higher than the community-based outpatient services. Policy reformers need to take further actions to address the public distrust in PCPs to facilitate their gatekeeping role. PMID:29101139

Perspectives on polio and immunization in Northern Nigeria.

PubMed

Renne, Elisha

2006-10-01

Through the efforts of the global campaign to eradicate poliomyelitis, polio cases have declined worldwide, from 35,251 cases in 1988, to 1449 cases as of 28 October 2005. However, confirmed cases of wild polio virus continue to be reported from Northern Nigeria. This paper examines the reasons for the difficulties in eradicating polio in Northern Nigeria from the perspective of residents of one town, Zaria, in northern Kaduna State. Research methods included participant observation, open-ended interviews and the collection of polio-related documents. While some people believed that the vaccine was contaminated by anti-fertility substances, others questioned the focus on polio when measles and malaria were considered more harmful. Some also distrusted claims about the safety of Western biomedicine. These concerns relate to questions about the appropriateness of vertical health interventions, where levels of routine immunization are low. While the Polio Eradication Initiative was considered to be cost-effective by Western donors, from the perspective of some people in Zaria it was seen as undermining primary health care, suggesting that a collaborative, community-based framework for primary health care, which includes routine immunization, would be a more acceptable approach.

Challenges of Implementing a Communication-and-Resolution Program Where Multiple Organizations Must Cooperate.

PubMed

Mello, Michelle M; Armstrong, Sarah J; Greenberg, Yelena; McCotter, Patricia I; Gallagher, Thomas H

2016-12-01

To implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians. Six hospitals and clinics and a liability insurer in Washington State. Sites designed and implemented CRPs and contributed information about cases and operational challenges over 20 months. Data were qualitatively analyzed. Data from interviews with personnel responsible for CRP implementation were triangulated with data on program cases collected by sites and notes recorded during meetings with sites and among project team members. Sites experienced small victories in resolving particular cases and streamlining some working relationships, but they were unable to successfully implement a collaborative CRP. Barriers included the insurer's distance from the point of care, passive rather than active support from top leaders, coordinating across departments and organizations, workload, nonparticipation by some physicians, and overcoming distrust. Operating CRPs where multiple organizations must collaborate can be highly challenging. Success likely requires several preconditions, including preexisting trust among organizations, active leadership engagement, physicians' commitment to participate, mechanisms for quickly transmitting information to insurers, tolerance for missteps, and clear protocols for joint investigations and resolutions. © Health Research and Educational Trust.

Values conflicts in professional-community collaborations.

PubMed

Sabin, James E

2010-01-01

GAP/I and INP+ represent markedly divergent cultures and therefore highlight the opportunities and strains associated with professional-community collaborations. I believe, however, that the factors that emerge from studying GAP/I-INP+ are not idiosyncratic and are relevant for other professional-community dyads. Every such partnership is likely to require some form of bridging mechanism to serve the same purposes as Mr Varghese's role did. The task of creating a zone of optimal tension may be less familiar than the need to build bridges but it is no less important. Tension between partners with significantly different cultural backgrounds has tremendous potential for generating misunderstanding and distrust. Avoiding tension-laden issues is likely to entail significant cost, whether in the form of resentment, distrust, withdrawal, or settling for a lesser outcome than could be achieved. Finally, creating and sustaining the potential for constructive tension typically requires the humble virtues associated with servant-leadership: patience, persistence and understanding.

"A Somali girl is Muslim and does not have premarital sex. Is vaccination really necessary?" A qualitative study into the perceptions of Somali women in the Netherlands about the prevention of cervical cancer.

PubMed

Salad, Jihan; Verdonk, Petra; de Boer, Fijgje; Abma, Tineke A

2015-08-21

Participation in Human Papillomavirus (HPV) vaccination and Papanicolaou Screening (Pap smears) is low among ethnic minorities in the Netherlands and hardly any information is available about the cervical cancer prevention methods of Somali women living in the diaspora. This qualitative study, based on the Health Belief Model (HBM) and an intersectionality-based framework, explores the perceptions of Somali women living in the Netherlands regarding measures to prevent cervical cancer. Semi-structured interviews have been conducted with young Somali women aged 17-21 years (n = 14) and Somali mothers aged 30-46 years (n = 6). Two natural group discussions have been conducted with 12 and 14 Somali mothers aged 23-66 years. The collected data has been analyzed thematically for content. In this study, we have identified perceived barriers to the use of preventive measures across three major themes: (1) Somali women and preventive healthcare; (2) Language, knowledge, and negotiating decisions; and (3) Sexual standards, culture, and religion. Many issues have been identified across these themes, e.g., distrust of the Dutch health care system or being embarrassed to get Pap smears due to Female Genital Mutilation (FGM) and having a Dutch, male practitioner; or a perceived low susceptibility to HPV and cancer because of the religious norms that prohibit sex before marriage. Current measures in the Netherlands to prevent women from developing cervical cancer hardly reach Somali women because these women perceive these kinds of preventative measures as not personally relevant. Dutch education strategies about cervical cancer deviate from ways of exchanging information within the Somali community. Teachers can provide culturally sensitive information to young Somali women in schools. For Somali mothers, oral education (e.g., poetry or theater) about the Dutch health care system and men's roles in HPV transmission may be useful. An intersectional approach, grounded in the HBM, is recommended to promote equal access to preventive health care for Somali women.

Books, Baths, and Burials: Notes on Certain Nineteenth Century Adoptive Acts

ERIC Educational Resources Information Center

Whiteman, Philip M.

1973-01-01

Early legislation relating to street lighting, baths and washhouses, burial of the dead, public libraries and public improvements in England and Wales, reflected Parliament's suspicion of local democracy and distrust of local authorities. (9 references) (Author)

Trust in climate scientists

NASA Astrophysics Data System (ADS)

Gauchat, Gordon

2018-06-01

Those who distrust climate scientists are more likely to be skeptical of climate change and reluctant to support mitigation policies. Now research shows that scientific interest in early adolescence is associated with increased trust in climate scientists in adulthood irrespective of political ideology.

Public perception: Distrust for fracking

NASA Astrophysics Data System (ADS)

MacNaghten, Philip

2017-04-01

Oil and gas extraction via hydraulic fracturing is controversial, with government support but mixed public opinion. Deliberative research shows that securing public support may be difficult because citizens in the United States and United Kingdom are sceptical of government and industry motives.

Liking Health Reform But Turned Off By Toxic Politics.

PubMed

Jacobs, Lawrence R; Mettler, Suzanne

2016-05-01

Six years after the Affordable Care Act (ACA) became law, the number of nonelderly Americans with health insurance has expanded by twenty million, and the uninsurance rate has declined nearly 9 percentage points. Nevertheless, public opinion about the law remains deeply divided. We investigated how individuals may be experiencing and responding to health reform implementation by analyzing three waves of a panel study we conducted in 2010, 2012, and 2014. While public opinion about the ACA remains split (45.6 percent unfavorable and 36.2 percent favorable), there have been several detectable shifts. The share of respondents believing that reform had little or no impact on access to health insurance or medical care diminished by 18 percentage points from 2010 to 2014, while those considering reform to have some or a great impact increased by 19 percentage points. Among individuals who held unfavorable views toward the law in 2010, the percentage who supported repeal-while still high, at 72 percent-shrank by 9 percentage points from 2010 to 2014. We found that party affiliation and distrust in government were influential factors in explaining the continuing divide over the law. The ACA has delivered discernible benefits, and some Americans are increasingly recognizing that it is improving access to health insurance and medical care. Project HOPE—The People-to-People Health Foundation, Inc.

Work resumption at the price of distrust: a qualitative study on return to work legislation in the Netherlands

PubMed Central

2013-01-01

Background Return to work (RTW) after sick leave is considered necessary to support the employees’ health. Cooperation between employees and employers may encourage employees’ RTW, but is hampered by bottlenecks that we do not completely understand. Dutch legislation means to support this cooperation and allows trying RTW during two years. The Resource Dependence Institutional Cooperation (RDIC) model has been developed for studying cooperation in public health. Study aims were to get insight into the degree of cooperation between Dutch sick-listed employees and employers, how this (lack of) cooperation can be understood, and how valid the RDIC model is for understanding this (lack of) cooperation. Methods This qualitative study was based on in-depth interviews with 8 employees and 8 employers. Employees reported sick for 1.5-20 months for various reasons. Interviews were analysed using an interpretative approach and pattern matching. Results Cooperation was lacking early during sick leave. Later on there were regular meetings, but employers decided about RTW without consulting the employees. Particularly employers were motivated to cooperate during the first year, while employees were especially motivated during the second. This could be understood by experienced dependence; employees (first year) and employers (second year) did not consider cooperation to be important for achieving medical recovery (employees) or RTW (employers). These divergent goals may be understood by personal norms about the timing of medical recovery and RTW. Legislation was particularly effective regarding employer behaviour in year 1 and employee behaviour in year 2. Employees distrusted their employers during the first year, while employers reported to distrust the employees during the second year. Besides, employees and employers experienced a moderate ability to cooperate. This could be understood particularly by having moderate knowledge about legislation. The RDIC model appeared to be valid to understand the cases studied, but the additional factor distrust also played a role. Conclusions Legislation appeared to support cooperation, but awareness of a mutual dependence, trust, knowledge about the legislation and personal norms regarding recovery and RTW are also important. Professionals such as occupational physicians should support this to attain a degree of cooperation that is necessary for effective RTW. PMID:23421974

Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia.

PubMed

Siekmans, Kendra; Sohani, Salim; Boima, Tamba; Koffa, Florence; Basil, Luay; Laaziz, Saïd

2017-01-17

Trained community health workers (CHW) enhance access to essential primary health care services in contexts where the health system lacks capacity to adequately deliver them. In Liberia, the Ebola outbreak further disrupted health system function. The objective of this study is to examine the value of a community-based health system in ensuring continued treatment of child illnesses during the outbreak and the role that CHWs had in Ebola prevention activities. A descriptive observational study design used mixed methods to collect data from CHWs (structured survey, n = 60; focus group discussions, n = 16), government health facility workers and project staff. Monthly data on child diarrhea and pneumonia treatment were gathered from CHW case registers and local health facility records. Coverage for community-based treatment of child diarrhea and pneumonia continued throughout the outbreak in project areas. A slight decrease in cases treated during the height of the outbreak, from 50 to 28% of registers with at least one treatment per month, was attributed to directives not to touch others, lack of essential medicines and fear of contracting Ebola. In a climate of distrust, where health workers were reluctant to treat patients, sick people were afraid to self-identify and caregivers were afraid to take children to the clinic, CHWs were a trusted source of advice and Ebola prevention education. These findings reaffirm the value of recruiting and training local workers who are trusted by the community and understand the social and cultural complexities of this relationship. "No touch" integrated community case management (iCCM) guidelines distributed at the height of the outbreak gave CHWs renewed confidence in assessing and treating sick children. Investments in community-based health service delivery contributed to continued access to lifesaving treatment for child pneumonia and diarrhea during the Ebola outbreak, making communities more resilient when facility-based health services were impacted by the crisis. To maximize the effectiveness of these interventions during a crisis, proactive training of CHWs in infection prevention and "no touch" iCCM guidelines, strengthening drug supply chain management and finding alternative ways to provide supportive supervision when movements are restricted are recommended.

Barriers to prompt and effective malaria treatment among the poorest population in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Molyneux, Catherine

2010-05-27

Prompt access to effective malaria treatment is central to the success of malaria control worldwide, but few fevers are treated with effective anti-malarials within 24 hours of symptoms onset. The last two decades saw an upsurge of initiatives to improve access to effective malaria treatment in many parts of sub-Saharan Africa. Evidence suggests that the poorest populations remain least likely to seek prompt and effective treatment, but the factors that prevent them from accessing interventions are not well understood. With plans under way to subsidize ACT heavily in Kenya and other parts of Africa, there is urgent need to identify policy actions to promote access among the poor. This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey (n=708 households); 24 focus group discussions; semi-structured interviews with health workers (n=34); and patient exit interviews (n=359). Multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40 percent of individuals who self-treated using shop-bought drugs and 42 percent who visited a formal health facility reported not having enough money to pay for treatment, and having to adopt coping strategies including borrowing money and getting treatment on credit in order to access care. Other factors influencing affordability were seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organization of health care services, drug and staff shortages. Ensuring that all individuals suffering from malaria have prompt access to effective treatment remains a challenge for resource constrained health systems. Policy actions to address the multiple barriers of access should be designed around access dimensions, and should include broad interventions to revitalize the public health care system. Unless additional efforts are directed towards addressing access barriers among the poor and vulnerable, malaria will remain a major cause of morbidity and mortality in sub-Saharan Africa.

[The science of communication in the patient-physician relationship].

PubMed

Moroianu Zlatescu, Irina; Popescu, Octav

2007-09-01

The authors dedicate their work to the improvement of inter-human communication within the healthcare system, mainly in the sub-system of the patient-physician relationship, with the aim of respecting human rights in general and in particular, of respecting patient rights. The combined usage of elements of medical ethics, acquired throughout professional training - university and post-university studies - and the knowledge assimilated following some last minute information relative to the science of communication is a permanent responsibility of all healthcare practitioners with the goal of improving their relationships with patients. The authors believe that this is the only way of increasing the degree of trust and satisfaction of the population towards healthcare providers. The authors are in favor of the implementation, in common medical practice, of this motto of communication: "If you do not communicate, you do not exist. If you do not know, you are at fault", as a founding principle of ethics and of the medical professional ethics, applicable equally in private and public medical practice. Effective patient-physician communication generates reciprocal trust. Its absence or poor communication can lead to distrust, suspicion, animosity and even conflicts which can cause physicians to be called before the College of Physicians of Romania or lead to legal repercussions for both physicians and patients. If it is true that, during medical assistance procedures, patients wish their right to be cared for and treated as dignified humans to be respected, it is also fair for those who care for them to evoke in turn their right to respect and dignity from the side of their patients. National legislation dedicated to issues relating to the professional patient-physician relationship contains provisions strictly in agreement with the regulations of the European Union. Once ethical and legal standards are introduced into national legislation, the next step should be towards the implementation and control of the procedure in which these desiderata are applied to life in Romanian society.

Why has the Ebola outbreak in West Africa been so challenging to control?

PubMed Central

Semalulu, T; Wong, G; Kobinger, G; Huston, P

2014-01-01

West Africa is in the midst of the largest Ebola outbreak ever; there have been over 1000 deaths and many new cases are reported each day. The World Health Organization (WHO) declared it an outbreak in March 2014 and on August 6, 2014 the WHO declared the outbreak a public health emergency of international concern. Based on the number of deaths and total number of cases reported to the WHO as of August 11, 2014, the current outbreak has an overall mortality rate of 55%. Outbreak control measures against Ebola virus disease are effective. Why then, has this outbreak been so challenging to control? Ebola is transmitted through bodily fluids and immediately attacks the immune system, then progressively attacks the major organs and the lining of blood vessels. Sierra Leone, Guinea and Liberia are small countries that have limited resources to respond to prolonged outbreaks, especially in rural areas. This has been made more challenging by the fact that health care workers are at risk of contracting Ebola virus disease. Treatment to date has been supportive, not curative and outbreak control strategies have been met with distrust due to fear and misinformation. However, important progress is being made. The international response to Ebola is gaining momentum, communication strategies have been developed to address the fear and mistrust, and promising treatments are under development, including a combination of three monoclonal antibodies that has been administered to two American Ebola infected health care workers. The National Microbiology Laboratory of the Public Health Agency of Canada (PHAC) has been supporting laboratory diagnostic efforts in West Africa and PHAC has been working with the provinces and territories and key stakeholders to ensure Canada is prepared for a potential Ebola importation. PMID:29769855

Women's experiences with healthcare professionals after suffering from gender-based violence: An interview study.

PubMed

Wallin Lundell, Inger; Eulau, Louise; Bjarneby, Frida; Westerbotn, Margareta

2018-03-01

This study sought to describe how women in Mexico who have suffered from gender-based violence experience their encounters with healthcare professionals. Gender-based violence is a worldwide problem. Previous studies have described that women feel they are not being cared for appropriately during their encounters with healthcare professionals. This study was conducted in Mexico, which has a high rate of gender inequality. A descriptive, qualitative study was conducted. Face-to-face interviews were conducted with seven women. An inductive content analysis was used to analyse the interviews. The analyses resulted in four categories: Feelings of guilt about being abused, Feelings of being unimportant, Feelings of taking time and Feelings of being insecure/secure. The women emphasised the importance of healthcare professionals taking time out of their busy schedules for them. When they treated the women with respect and genuine interest, the women felt secure. When the healthcare professionals did not meet these expectations, feelings of frustration and mistrust were elicited. Feelings of being listened to and safety were considered important aspects in a positive encounter, whereas feeling a lack of time or interest often led to negative experiences such as frustration with and distrust of the healthcare system. These results imply that healthcare professionals may have deficiencies with regard to how these women are treated because these women do not feel that they receive the proper support. Education regarding how to approach women who have suffered from gender-based violence is essential for healthcare professionals to establish respectful encounters. The findings of this study stress that relatively simple efforts such as listening to these women's stories and providing them with genuine attention might substantially improve care. © 2017 John Wiley & Sons Ltd.

Overview, Control Strategies, and Lessons Learned in the CDC Response to the 2014-2016 Ebola Epidemic.

PubMed

Bell, Beth P; Damon, Inger K; Jernigan, Daniel B; Kenyon, Thomas A; Nichol, Stuart T; O'Connor, John P; Tappero, Jordan W

2016-07-08

During 2014-2016, CDC, working with U.S. and international partners, mounted a concerted response to end the unprecedented epidemic of Ebola virus disease (Ebola) in West Africa. CDC's response, which was the largest in the agency's history, was directed simultaneously at controlling the epidemic in West Africa and strengthening preparedness for Ebola in the United States. Although experience in responding to approximately 20 Ebola outbreaks since 1976 had provided CDC and other international responders an understanding of the disease and how to stop its spread, the epidemic in West Africa presented new and formidable challenges. The initial response was slow and complicated for several reasons, including wide geographic spread of cases, poor public health and societal infrastructure, sociodemographic factors, local unfamiliarity with Ebola, and distrust of government and health care workers. In the United States, widespread public alarm erupted after Ebola cases were diagnosed in Dallas, Texas, and New York City, New York. CDC, in collaboration with its U.S. and international counterparts, applied proven public health strategies as well as innovative new approaches to help control the Ebola epidemic in West Africa and strengthen public health readiness in the United States. Lessons learned include the recognition that West African and other countries need effective systems to detect and stop infectious disease threats, the need for stronger international surge capacity for times when countries are overwhelmed by an outbreak, and the importance of improving infection prevention and control in health care settings. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Why has the Ebola outbreak in West Africa been so challenging to control?

PubMed

Semalulu, T; Wong, G; Kobinger, G; Huston, P

2014-08-14

West Africa is in the midst of the largest Ebola outbreak ever; there have been over 1000 deaths and many new cases are reported each day. The World Health Organization (WHO) declared it an outbreak in March 2014 and on August 6, 2014 the WHO declared the outbreak a public health emergency of international concern. Based on the number of deaths and total number of cases reported to the WHO as of August 11, 2014, the current outbreak has an overall mortality rate of 55%. Outbreak control measures against Ebola virus disease are effective. Why then, has this outbreak been so challenging to control? Ebola is transmitted through bodily fluids and immediately attacks the immune system, then progressively attacks the major organs and the lining of blood vessels. Sierra Leone, Guinea and Liberia are small countries that have limited resources to respond to prolonged outbreaks, especially in rural areas. This has been made more challenging by the fact that health care workers are at risk of contracting Ebola virus disease. Treatment to date has been supportive, not curative and outbreak control strategies have been met with distrust due to fear and misinformation. However, important progress is being made. The international response to Ebola is gaining momentum, communication strategies have been developed to address the fear and mistrust, and promising treatments are under development, including a combination of three monoclonal antibodies that has been administered to two American Ebola infected health care workers. The National Microbiology Laboratory of the Public Health Agency of Canada (PHAC) has been supporting laboratory diagnostic efforts in West Africa and PHAC has been working with the provinces and territories and key stakeholders to ensure Canada is prepared for a potential Ebola importation.

How to end the nuclear nightmare

DOE Office of Scientific and Technical Information (OSTI.GOV)

Speiser, S.M.

1984-01-01

An international lawyer examines the underlying causes of and ways to remove the Soviet-US enmity. He traces the history of distrust between the superpowers to differences in ideology and political systems, expansionism based on nationalism, and the human drive for power, and concludes that these tensions compel us to be enemies. Ideology is the only difference between the superpowers that can be removed. Capitalism could be made compatible with communism by distributing corporate stock to everyone. Eliminating poverty and exploitation would remove the ideological barrier to world peace and nuclear disarmament, making it worthwhile for the Soviet self-interest to cooperatemore » with the US. The capitalistic system and Western freedoms would be preserved, and religious leaders could solve the dilemma of liberation theology. 61 references, 3 figures.« less

Ethics and transparent risk communication start with proper risk assessment methodologies

NASA Astrophysics Data System (ADS)

Oboni, Franco; Oboni, Cesar

2014-05-01

We will use throught this paper a "dialogue" between two professionals. One is aware of the misleading character of many risk assessments and wants to foster better approaches. A discomforting set of statements sets the background of the "story": public reactions to risk assessments are generally negative, the developer find it difficult to understand the reasons for general public negative reactions, many projects get often rejected without valid reasons by the public, anywhere in the world. Common practice approaches in Risk Assessment are discussed from the angle of public rejection, taking into account various studies that explicitly expose common practices limitations and voids. The hiatus between rational and well-balanced risk assessments and common practices is explored. Finally solutions to overcome the limitations of common practices and deliver to the public more realistic risk assessment on which to build a widespread consensus are reviewed. The paper conclusions relate to the need of: properly communicating risk throughout the life of a project, from cradle to grave, avoiding conflict of interest, having estimates that are understandable to foster good understanding of what a risk assessment can bring to better Human existence, in an ethical and fair way. The paper delivers a list of possible remedies and shows that "Common Practices" do not equate to "Best Practices": common practices are not to be proposed/used any longer if we want to avoid public distrust and misrepresentations. Many of the "modern" issues ranging from public distrust to insurance denial could be relieved or mitigated ahead of time if misrepresentation was kept at bay using five simple rules. Common practice Risk Assessments, especially those developed under conflict of interest situations, generally misrepresent risks and fail to give the "big picture", hence do not help taking valid decision and are prone to generating/fostering public distrust.

Association between violence exposure and condom non-use among transgender sex workers in the Dominican Republic: the mediating role of trust.

PubMed

Budhwani, Henna; Turan, Bulent; Hasbun, Julia; Rosario, Santo; Tillotson, Louise; McGlaughlin, Elaine; Waters, John

2017-05-01

Transgender women are a high-risk population, and transgender female sex workers are one of the most vulnerable populations globally. Transgender female sex workers have high rates of sexually transmitted infections, HIV, and exposure to violence compared to cisgender sex workers; these negative exposures are associated with an increase in HIV risk behaviors. Thus, the aim of this study is to examine the relationship between exposure to violence and condom non-use in transgender female sex workers residing in the Dominican Republic. We hypothesize that mediation exists wherein the effects of violence on condom non-use are mediated by distrust. Facilitated interview data ( N = 78) were used. Primary outcome was condom non-use with coercive partner. Four logistic regression models and a mediation analysis were employed. Respondents' mean age was 23.0 years (SD = 4.8) with an average level education attainment of 10.1 years (SD = 2.6); 35% reported experiencing violence; 17% believed that a person who asks a partner to use a condom does not trust that partner. Exploratory mediation analyses yielded a significant indirect effect of experience with violence on condom non-use through distrust (b = 0.64, SE = 0.33, p = .05). Results suggest that distrust mediates the association between experienced violence and condom use with coercive partners. It was concluded that developing interventions on increasing resilience and perceived self-worth, plus provision of screening for violence and referral services may reduce maladaptive attributions and cognitions about condom use. Furthermore, by implementing policies that protect vulnerable populations, and subsequently enforcing them, the Dominican Republic has the opportunity to improve overall population health and protect their most disadvantaged citizens.

Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study.

PubMed

Tieu, Lina; Sarkar, Urmimala; Schillinger, Dean; Ralston, James D; Ratanawongsa, Neda; Pasick, Rena; Lyles, Courtney R

2015-12-03

Patient portals have the potential to support self-management for chronic diseases and improve health outcomes. With the rapid rise in adoption of patient portals spurred by meaningful use incentives among safety net health systems (a health system or hospital providing a significant level of care to low-income, uninsured, and vulnerable populations), it is important to understand the readiness and willingness of patients and caregivers in safety net settings to access their personal health records online. To explore patient and caregiver perspectives on online patient portal use before its implementation at San Francisco General Hospital, a safety net hospital. We conducted 16 in-depth interviews with chronic disease patients and caregivers who expressed interest in using the Internet to manage their health. Discussions focused on health care experiences, technology use, and interest in using an online portal to manage health tasks. We used open coding to categorize all the barriers and facilitators to portal use, followed by a second round of coding that compared the categories to previously published findings. In secondary analyses, we also examined specific barriers among 2 subgroups: those with limited health literacy and caregivers. We interviewed 11 patients and 5 caregivers. Patients were predominantly male (82%, 9/11) and African American (45%, 5/11). All patients had been diagnosed with diabetes and the majority had limited health literacy (73%, 8/11). The majority of caregivers were female (80%, 4/5), African American (60%, 3/5), caregivers of individuals with diabetes (60%, 3/5), and had adequate health literacy (60%, 3/5). A total of 88% (14/16) of participants reported interest in using the portal after viewing a prototype. Major perceived barriers included security concerns, lack of technical skills/interest, and preference for in-person communication. Facilitators to portal use included convenience, health monitoring, and improvements in patient-provider communication. Participants with limited health literacy discussed more fundamental barriers to portal use, including challenges with reading and typing, personal experience with online security breaches/viruses, and distrust of potential security measures. Caregivers expressed high interest in portal use to support their roles in interpreting health information, advocating for quality care, and managing health behaviors and medical care. Despite concerns about security, difficulty understanding medical information, and satisfaction with current communication processes, respondents generally expressed enthusiasm about portal use. Our findings suggest a strong need for training and support to assist vulnerable patients with portal registration and use, particularly those with limited health literacy. Efforts to encourage portal use among vulnerable patients should directly address health literacy and security/privacy issues and support access for caregivers.

Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study

PubMed Central

Sarkar, Urmimala; Schillinger, Dean; Ralston, James D; Ratanawongsa, Neda; Pasick, Rena; Lyles, Courtney R

2015-01-01

Background Patient portals have the potential to support self-management for chronic diseases and improve health outcomes. With the rapid rise in adoption of patient portals spurred by meaningful use incentives among safety net health systems (a health system or hospital providing a significant level of care to low-income, uninsured, and vulnerable populations), it is important to understand the readiness and willingness of patients and caregivers in safety net settings to access their personal health records online. Objective To explore patient and caregiver perspectives on online patient portal use before its implementation at San Francisco General Hospital, a safety net hospital. Methods We conducted 16 in-depth interviews with chronic disease patients and caregivers who expressed interest in using the Internet to manage their health. Discussions focused on health care experiences, technology use, and interest in using an online portal to manage health tasks. We used open coding to categorize all the barriers and facilitators to portal use, followed by a second round of coding that compared the categories to previously published findings. In secondary analyses, we also examined specific barriers among 2 subgroups: those with limited health literacy and caregivers. Results We interviewed 11 patients and 5 caregivers. Patients were predominantly male (82%, 9/11) and African American (45%, 5/11). All patients had been diagnosed with diabetes and the majority had limited health literacy (73%, 8/11). The majority of caregivers were female (80%, 4/5), African American (60%, 3/5), caregivers of individuals with diabetes (60%, 3/5), and had adequate health literacy (60%, 3/5). A total of 88% (14/16) of participants reported interest in using the portal after viewing a prototype. Major perceived barriers included security concerns, lack of technical skills/interest, and preference for in-person communication. Facilitators to portal use included convenience, health monitoring, and improvements in patient-provider communication. Participants with limited health literacy discussed more fundamental barriers to portal use, including challenges with reading and typing, personal experience with online security breaches/viruses, and distrust of potential security measures. Caregivers expressed high interest in portal use to support their roles in interpreting health information, advocating for quality care, and managing health behaviors and medical care. Conclusions Despite concerns about security, difficulty understanding medical information, and satisfaction with current communication processes, respondents generally expressed enthusiasm about portal use. Our findings suggest a strong need for training and support to assist vulnerable patients with portal registration and use, particularly those with limited health literacy. Efforts to encourage portal use among vulnerable patients should directly address health literacy and security/privacy issues and support access for caregivers. PMID:26681155

Parents' perspectives on physician-parent communication near the time of a child's death in the pediatric intensive care unit.

PubMed

Meert, Kathleen L; Eggly, Susan; Pollack, Murray; Anand, K J S; Zimmerman, Jerry; Carcillo, Joseph; Newth, Christopher J L; Dean, J Michael; Willson, Douglas F; Nicholson, Carol

2008-01-01

Communicating bad news about a child's illness is a difficult task commonly faced by intensive care physicians. Greater understanding of parents' scope of experiences with bad news during their child's hospitalization will help physicians communicate more effectively. Our objective is to describe parents' perceptions of their conversations with physicians regarding their child's terminal illness and death in the pediatric intensive care unit (PICU). A secondary analysis of a qualitative interview study. Six children's hospitals in the National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Fifty-six parents of 48 children who died in the PICU 3-12 months before the study. Parents participated in audio recorded semistructured telephone interviews. Interviews were analyzed using established qualitative methods. Of the 56 parents interviewed, 40 (71%) wanted to provide feedback on the way information about their child's terminal illness and death was communicated by PICU physicians. The most common communication issue identified by parents was the physicians' availability and attentiveness to their informational needs. Other communication issues included honesty and comprehensiveness of information, affect with which information was provided, withholding of information, provision of false hope, complexity of vocabulary, pace of providing information, contradictory information, and physicians' body language. The way bad news is discussed by physicians is extremely important to most parents. Parents want physicians to be accessible and to provide honest and complete information with a caring affect, using lay language, and at a pace in accordance with their ability to comprehend. Withholding prognostic information from parents often leads to false hopes and feelings of anger, betrayal, and distrust. Future research is needed to investigate whether the way bad news is discussed influences psychological adjustment and family functioning among bereaved parents.

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study.

PubMed

Marshall, Martin N; Hiscock, Julia; Sibbald, Bonnie

2002-11-30

To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care. Qualitative focus group study using mock quality report cards as prompts for discussion. 12 focus groups held in an urban area in north west England and a semirural area in the south of England. 35 service users, 24 general practitioners, and 18 clinical governance leads. There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectors-for example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection. Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

Emotional Disturbance and Chronic Low Back Pain.

ERIC Educational Resources Information Center

McCreary, Charles P.; And Others

1980-01-01

Patients high in alientation and distrust may be poor compliers. Because only the somatic concern dimension predicted outcome, a single scale that measures this characteristic may be sufficient for effective identification of the potential good v poor responders to conservative treatment of low back pain. (Author)

In Defense of Teacher Professionalism as a Policy Choice.

ERIC Educational Resources Information Center

Sykes, Gary

1991-01-01

Whereas democracy institutionalizes distrust, professionalism relies on trust. Responding to Berbules and Densmore, this article identifies strong normative reasons, grounded in the interests of children, for promoting teacher professionalism. Exorcising the evils of classic professionalism will eliminate neither equity nor quality problems.…

An item response theory analysis of Harter's Self-Perception Profile for children or why strong clinical scales should be distrusted.

PubMed

Egberink, Iris J L; Meijer, Rob R

2011-06-01

The authors investigated the psychometric properties of the subscales of the Self-Perception Profile for Children with item response theory (IRT) models using a sample of 611 children. Results from a nonparametric Mokken analysis and a parametric IRT approach for boys (n = 268) and girls (n = 343) were compared. The authors found that most scales formed weak scales and that measurement precision was relatively low and only present for latent trait values indicating low self-perception. The subscales Physical Appearance and Global Self-Worth formed one strong scale. Children seem to interpret Global Self-Worth items as if they measure Physical Appearance. Furthermore, the authors found that strong Mokken scales (such as Global Self-Worth) consisted mostly of items that repeat the same item content. They conclude that researchers should be very careful in interpreting the total scores on the different Self-Perception Profile for Children scales. Finally, implications for further research are discussed.

Rosacea Patient Perspectives on Homeopathic and Over-the-counter Therapies

PubMed Central

Lan, Lucy; Kuo, Sandy; Huang, Karen E.; Taylor, Sarah L.; Feldman, Steven R.

2015-01-01

Background: Rosacea patients commonly employ nonprescription therapies. The authors’ aim was to understand rosacea patients’ perceptions of over-the-counter products, complementary and alternative medicine, and homeopathic therapies. Method: A public, online discussion forum comprising 3,350 members and 27,051 posts provided a source of 346 posts on patient perceptions on alternative rosacea treatments. Results: Three major themes of nonprescription treatment were identified—motivation for use, patient-provider discussions, and experience with these treatments. Perceived medication failure, barriers to treatment, and distrust of physicians drive patients to seek nonprescription therapies. Still, patients prefer to consult a physician on incorporating nonprescription therapies into treatment. Complementary and alternative medicine natural products (19.4% of posts), complementary and alternative medicine practices (16.5%), and homeopathic medicine (3.8%) were commonly discussed. Conclusion: Physicians have an opportunity to be a trusted source of information on the strengths and weaknesses of skin care products and other complementary treatments for rosacea. PMID:26557217

'No one to trust': the cultural embedding of atomism in financial markets.

PubMed

Ailon, Galit

2018-05-13

The paper ethnographically explores the cultural embedding of atomistic indifference in online, global financial markets: arenas that have been digitally designed according to economic ideals and that demand an extreme form of relational and social dissociation from the partners to exchange and from those affected by the transactions. Its case-study is lay financial-trading in Israel, a country undergoing extensive neoliberalization. The study shows that dissociation is embedded in an economic culture marked by constant, multi-sited declarations that economic-Others are cold, uncaring and manipulative. It takes shape as traders convert the distrust towards Others into distrust towards portions of the Self that represent links to these Others, namely their own social-psychology and social concern. Acting atomistically and selfishly in the market thus entails considerable reflexive work. The paper contributes to an ongoing debate on the moral and cultural embeddedness of markets in general and of the expanding financial markets in particular. © London School of Economics and Political Science 2018.

The enduring effect of scientific interest on trust in climate scientists in the United States

NASA Astrophysics Data System (ADS)

Motta, Matthew

2018-06-01

People who distrust scientists are more likely to reject scientific consensus, and are more likely to support politicians who are sceptical of scientific research1. Consequently, boosting Americans' trust in scientists is a central goal of science communication2. However, while previous research has identified several correlates of distrust in climate scientists3 and scientists more broadly4, far less is known about potential long-term influences taking root in young adulthood. This omission is notable, as previous research suggests that attitudes towards science formulated in pre-teenage years play a key role in shaping attitudes in adulthood5. Using data from the Longitudinal Study of American Youth, I find that interest in science at age 12-14 years is associated with increased trust in climate scientists in adulthood (mid thirties), irrespective of Americans' political ideology. The enduring and bipartisan effects of scientific interest at young ages suggest a potential direction for future efforts to boost mass trust in climate scientists.

A science confidence gap: Education, trust in scientific methods, and trust in scientific institutions in the United States, 2014.

PubMed

Achterberg, Peter; de Koster, Willem; van der Waal, Jeroen

2017-08-01

Following up on suggestions that attitudes toward science are multi-dimensional, we analyze nationally representative survey data collected in the United States in 2014 ( N = 2006), and demonstrate the existence of a science confidence gap: some people place great trust in scientific methods and principles, but simultaneously distrust scientific institutions. This science confidence gap is strongly associated with level of education: it is larger among the less educated than among the more educated. We investigate explanations for these educational differences. Whereas hypotheses deduced from reflexive-modernization theory do not pass the test, those derived from theorizing on the role of anomie are corroborated. The less educated are more anomic (they have more modernity-induced cultural discontents), which not only underlies their distrust in scientific institutions, but also fuels their trust in scientific methods and principles. This explains why this science confidence gap is most pronounced among the less educated.

Continuous-variable protocol for oblivious transfer in the noisy-storage model.

PubMed

Furrer, Fabian; Gehring, Tobias; Schaffner, Christian; Pacher, Christoph; Schnabel, Roman; Wehner, Stephanie

2018-04-13

Cryptographic protocols are the backbone of our information society. This includes two-party protocols which offer protection against distrustful players. Such protocols can be built from a basic primitive called oblivious transfer. We present and experimentally demonstrate here a quantum protocol for oblivious transfer for optical continuous-variable systems, and prove its security in the noisy-storage model. This model allows us to establish security by sending more quantum signals than an attacker can reliably store during the protocol. The security proof is based on uncertainty relations which we derive for continuous-variable systems, that differ from the ones used in quantum key distribution. We experimentally demonstrate in a proof-of-principle experiment the proposed oblivious transfer protocol for various channel losses by using entangled two-mode squeezed states measured with balanced homodyne detection. Our work enables the implementation of arbitrary two-party quantum cryptographic protocols with continuous-variable communication systems.

Erosion of Trust in the Medical Profession in India: Time for Doctors to Act.

PubMed

Kane, Sumit; Calnan, Michael

2016-11-02

In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Is advising food allergic patients to avoid food with precautionary allergen labelling out of date?

PubMed

Zurzolo, Giovanni A; de Courten, Maximilian; Koplin, Jennifer; Mathai, Michael L; Allen, Katrina J

2016-06-01

Precautionary allergen labelling (PAL) continues to be used by the food manufacturing industry to alert the food allergic consumer that cross-contact may have occurred during the supply chain for ingredients or the manufacturing process. This review will summarize recent evidence regarding use and interpretation of precautionary labels by industry, healthcare professionals, and food allergic consumers. Consumers find precautionary labels difficult to interpret and often distrust them as disclaimers of product liability. It is unclear from a clinician's perspective how healthcare professionals should advise their patients regarding these statements. Recent studies suggest that consumers do not always read food labels and that these labels are difficult to interpret and are often distrusted by consumers as disclaimers of liability. There is evidence to suggest that this behaviour occurs in all countries assessed that use PAL. The healthcare professional remains confused about the interpretation and value of the current PAL system as it is unclear whether foods that contain no advisory labels are safe to consume. There is a need for improvement in the value and use of precautionary labelling for allergen risk assessment for allergic consumers. New studies have shown the confusion that currently exists in regard to PAL for the healthcare professional and the consumer alike. The studies have also highlighted certain gaps in the literature that, once addressed, will improve the uniformity of PAL and provide the healthcare professional with appropriate advice which they can in turn relay to the allergic consumer. Because of the global supply of food products there is a need for an international approach in improving PAL.

When paranoia makes sense.

PubMed

Kramer, Roderick M

2002-07-01

On September 11, 2001, in the space of a few horrific minutes, Americans realized the fragility of trust. The country's evident vulnerability to deadly terrorism rocked our faith in the systems we rely on for security. Our trust was shaken again only a few months later with the stunning collapse of Enron, forcing us to question many of the methods and assumptions underpinning the way we work. These two crises are obviously very different, yet both serve as reminders of the perils of trusting too much. The abiding belief that trust is a strength now seems dangerously naive. This new doubtfulness runs contrary to most management literature, which has traditionally touted trust as an organizational asset. It's an easy case to make. When there are high levels of trust, employees can fully commit themselves to the organization because they can be confident that their efforts will be recognized and rewarded. Trust also means that leaders don't have to worry so much about putting the right spin on things. They can act and speak forthrightly and focus on essentials. In short, trust is an organizational superglue. Nevertheless, two decades of research on trust and cooperation in organizations have convinced social psychologist Roderick Kramer that--despite its costs--distrust can be beneficial in the workplace. Kramer has observed that a moderate form of suspicion, which he calls prudent paranoia, can in many cases prove highly beneficial to the distrustful individual or organization. In this article, he describes situations in which prudent paranoia makes sense and shows how, when properly deployed, it can serve as a powerful morale booster--even a competitive weapon--for organizations.

The Influence of Western Radio on the Democratization of Soviet Youth.

ERIC Educational Resources Information Center

Manaev, Oleg

1991-01-01

Finds that the openness toward broadcasts from Radio Liberty and other Western stations during perestroika has only increased the level of distrust of the Soviet media by those teenagers who tend to be poorly adapted to the established social activities of their peers. (PRA)

Order Up

ERIC Educational Resources Information Center

Gibeault, Michael

2005-01-01

Change orders. The words can turn the stomachs of administrators. Horror stories about change orders create fear and distrust among school officials, designers and builders. Can change orders be avoided? If car manufacturers can produce millions of intricately designed vehicles, why can't the same quality control be achieved on a construction…

Incest Victims: Inadequate Help by Professionals.

ERIC Educational Resources Information Center

Frenken, Jos; Van Stolk, Bram

1990-01-01

Interviews with 130 Dutch professionals helping incest victims and 50 adult women who were incest victims as children found that assistance was hampered by institutional distrust, inability of professionals to stop ongoing incest, frequent breaking off of contact by the young girls, professionals' shortcomings in knowledge and skills, and…

Review of "What's Trust Got to Do with It?"

ERIC Educational Resources Information Center

Mathis, William J.

2012-01-01

This report offers recommendations for building community support for federal school turnaround approaches, particularly in communities that oppose these approaches. Parents, the report concludes, want improvement but cherish their local schools and distrust the turnaround options mandated from above by higher levels of government. Thus,…

Rust in Peace: Finding Hope for the Future in the Graveyards of Technology.

ERIC Educational Resources Information Center

Jungk, Robert

1984-01-01

When a form of high technology becomes obsolete, many people acquire a fear and distrust of the future--a neurosis called the ruins complex. But humanity can respond positively to the ghosts of dead technology and invent a hopeful future. (Author/RM)

Feasibility of a patient decision aid regarding disclosure of personal health information: qualitative evaluation of the Health Care Information Directive

PubMed Central

Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross EG

2004-01-01

Background Concerns regarding the privacy of health information are escalating owing both to the growing use of information technology to store and exchange data and to the increasing demand on the part of patients to control the use of their medical records. The objective of this study was to evaluate the Health Care Information Directive (HCID), a recently-developed patient decision aid that aims to delineate the level of health information an individual is willing to share. Methods We convened a series of four focus group meetings with several communities in a large Canadian city. A total of 28 men and women participated, representing health care consumer advocates, urban professionals, senior citizens, and immigrants who speak English as a second language. Data were analysed using qualitative methods. Results Participants lacked substantial knowledge regarding the fate and uses of personal health information. They expressed mistrust concerning how their information will be used and protected. Several suggestions were made towards customizing the use of data according to specific needs rather than broad and full access to their charts. Furthermore, despite concern regarding the implementation of a tool like the HCID, participants were hopeful that a refined instrument could contribute to the improved regulation of health information. Conclusion This study indicated poor knowledge concerning the uses of personal health information, distrust concerning security provisions, and cautious support for a patient decision aid such as the HCID to improve control over health data. PMID:15361257

Feasibility of a patient decision aid regarding disclosure of personal health information: qualitative evaluation of the Health Care Information Directive.

PubMed

Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G

2004-09-10

Concerns regarding the privacy of health information are escalating owing both to the growing use of information technology to store and exchange data and to the increasing demand on the part of patients to control the use of their medical records. The objective of this study was to evaluate the Health Care Information Directive (HCID), a recently-developed patient decision aid that aims to delineate the level of health information an individual is willing to share. We convened a series of four focus group meetings with several communities in a large Canadian city. A total of 28 men and women participated, representing health care consumer advocates, urban professionals, senior citizens, and immigrants who speak English as a second language. Data were analysed using qualitative methods. Participants lacked substantial knowledge regarding the fate and uses of personal health information. They expressed mistrust concerning how their information will be used and protected. Several suggestions were made towards customizing the use of data according to specific needs rather than broad and full access to their charts. Furthermore, despite concern regarding the implementation of a tool like the HCID, participants were hopeful that a refined instrument could contribute to the improved regulation of health information. This study indicated poor knowledge concerning the uses of personal health information, distrust concerning security provisions, and cautious support for a patient decision aid such as the HCID to improve control over health data.

Dietary Supplements in American Children: Scientific vs Marketing Justifications.

PubMed

Grivetti, Louis E.

2002-01-01

The American public receives conflicting messages from dietitians, nutritionists, physicians, and manufacturers regarding food supplements. Consumers commonly distrust scientists and justify supplement use based upon word of mouth and friendship patterns. Scientific-based education regarding supplement use is vital in the present atmosphere where consumer misinformation is rampant.

The Paradox of Educational Testing.

ERIC Educational Resources Information Center

Ebel, Robert L.

1976-01-01

There is currently a conflict between educational accountability and the distrust of standardized testing. Concern for the quality of education is based on evidence of students' academic dificiencies, the decline in test scores, and increasing education costs and school taxes. As a result of criticism, states have mandated, or are considering,…

The Development of Distrust

ERIC Educational Resources Information Center

Vanderbilt, Kimberly E.; Liu, David; Heyman, Gail D.

2011-01-01

Preschool-age children's reasoning about the reliability of deceptive sources was investigated. Ninety 3- to 5-year-olds watched several trials in which an informant gave advice about the location of a hidden sticker. Informants were either "helpers" who were happy to give correct advice, or "trickers" who were happy to give incorrect advice.…

Employers Often Distrust Online Degrees

ERIC Educational Resources Information Center

Carnevale, Dan

2007-01-01

This article explains why employers are reluctant to accept potential employees with online degrees. The results of several surveys of those who evaluate potential employees and make hiring decisions indicate a bias against online degrees, even as more and more colleges are offering programs online. To those officials, the words "online…

Democratizing Academic Professionalism Inside and Out

ERIC Educational Resources Information Center

Dzur, Albert W.

2010-01-01

American higher education is afflicted by a condition of successful failure. In terms of academic knowledge production, America's colleges and universities are success stories, yet there is a disturbing neglect of the civic life eroding all around Americans. At a time of widespread public distrust of politics, institutions, and officials, a time…

Affirmative Action: A Personal View.

ERIC Educational Resources Information Center

Hayashi, Patrick

1992-01-01

An Asian-American college admissions director discusses affirmative action based on his own experiences and the comments of Shelby Steele, an African-American critic of affirmative action. He argues that affirmative action promotes distrust and self-doubt. He proposes that honest self-assessment is more productive and affirmative action should not…

Standard Oil and Big Business. Lesson Plan One.

ERIC Educational Resources Information Center

Dicke, Thomas S.

1996-01-01

Presents a lesson plan that aims to show students why individuals admire and distrust the great size and power of the firms that dominate the economy. Activities include student research and presentations on conflicts and competition within the oil industry, as well as within Microsoft, Wal-Mart, and other companies. (MJP)

Vocational Education and CETA--A Growing Partnership

ERIC Educational Resources Information Center

Lund, Duane R.

1976-01-01

The history of distrust between vocational education and the Department of Labor manpower programs and the results of a national survey of CETA programs are reviewed. It is recommended that lines of communication be kept open, that differences and similarities between the programs be recognized, and that coordination be improved. (AJ)

Hope, for the Dry Side.

ERIC Educational Resources Information Center

Husted, Bette Lynch

2001-01-01

Describes the experiences of the author as she tries to transfigure her students enrolled in freshman writing and college preparatory writing classes at Blue Mountain Community College in Pendleton, Oregon (located in the "dry side" of the state). Addresses students' racism, homophobia, and distrust of their own skills in writing. (RS)

Going Public: A Message for the Measurement Community.

ERIC Educational Resources Information Center

Anderson, Scarvia B.

Measurement and evaluation have become major public issues in the legislatures and the courts. Testing legislation represents two extremes: (1) confidence in external objective measurement for high school teacher and occupational certification; and (2) distrust of the results. Since 1978, truth-in-testing bills for admissions or other standardized…

Assistant Principal Dilemma: Walking the Line between Compliance and Leadership

ERIC Educational Resources Information Center

Baker, A. Minor; Guerra, Patricia L.; Baray, Sarah

2018-01-01

Inspired by real-life events, this case describes the start of a seemingly solid working relationship between two elementary campus administrators and its demise as the result of inadequate communication and distrust. Initially, these two leaders benefit from differing supervision styles, but these differences eventually lead to increased tension…

Catholic Theological Education in a Religiously Pluralistic Age

ERIC Educational Resources Information Center

Lefebure, Leo D.

2006-01-01

This article describes the transformation of Catholic theological education over the last fifty years from a highly defensive posture vis-a-vis other religions toward dialogical engagement with members of other religions and all persons of good will. Until Vatican II, most Catholic theologians and officials distrusted exploration of other…

Co-Ordinating Education during Emergencies and Reconstruction: Challenges and Responsibilities

ERIC Educational Resources Information Center

Sommers, Marc

2004-01-01

While co-ordination is essentially a method of getting institutions to work together, it is clearly not synonymous with togetherness. Undercurrents of suspicion and distrust between individuals and institutional actors can affect important relationships and give rise to enduring misunderstandings and perplexing challenges. Turf battles involving…

The Globalisation of Fear and the Construction of the Intercultural Imagination

ERIC Educational Resources Information Center

Bash, Leslie

2014-01-01

Intercultural education concerns the destruction of boundaries between people and their replacement by what Jurgen Habermas has called communicative action. It is a difficult task that raises various forms of existential fear: consciousness of individual mortality, communal insecurity, collective anxiety and distrust. In order to confront this…

The Army and Academic Culture

ERIC Educational Resources Information Center

Bateman, Robert L.

2008-01-01

America has always felt ambivalent towards its armed forces. During national emergencies it has shown them support, but during longer eras of calm this has often turned to distrust and scorn. LTC Robert Bateman examines the underpinnings of this uneasy and complex relationship, which has been mirrored and expressed most intensely (sometimes in…

A Semiprofessional Conception of Teaching.

ERIC Educational Resources Information Center

Tom, Alan R.

1987-01-01

Examines the Carnegie report in terms of three themes: (1) distrust of teachers; (2) commitment to teacher autonomy that is conditional on achieved results; and (3) a conception of teacher accountability focusing on student performance rather than professional practice. Concludes that the implicit view of the teacher is one of an assembly-line…

On Certain Aspects of Acts of Corruption Countermeasures

ERIC Educational Resources Information Center

Mamitova, Zhanat A.; Kumarbekkyzy, Zhaniya; Tapenova, Asem R.; Mahanov, Talgat G.

2016-01-01

One of the biggest problems of developing countries, including Kazakhstan, is corruption. Corruption significantly decelerates the development of economic and social institutions, which may cause distrust in the authorities and a social crisis. Therefore, fighting corruption is a top-priority task of the government of Kazakhstan; this task…

Faculty and Administrators Collaborating for E-Learning Courseware

ERIC Educational Resources Information Center

Donohue, Brian C.; Howe-Steiger, Linda

2005-01-01

To soothe faculty distrust and encourage engagement, or reengagement, in exploring applications of digital technology for teaching, the authors believe it is necessary to do three things: (1) create incentives for faculty that balance public service goals with professional and entrepreneurial rewards; (2) clarify ownership and usage rights of…

Getting cold feet?: Why health care mergers are abandoned.

PubMed

Roos, Anne-Fleur; Postma, Jeroen

2016-01-01

Despite the frequent occurrence and sizeable consequences of merger abandonment in other sectors, there is no thorough understanding of merger abandonment in health care. The purpose of this study is to improve the understanding of determinants of health care merger abandonment. On the basis of the literature on merger abandonment, we formulated a framework on potential determinants of health care merger abandonment. We then constructed a survey that was sent to 70% of all executives of Dutch health care organizations (response rate = 35%, n = 291). We provide descriptive overviews of open, multiple-response, and multiple-choice questions on merger abandonment and use chi-square tests and Fisher's exact tests to test whether abandoned and completed merger processes differ. About 62% of the respondents were involved in at least one merger process during the period of 2005-2012. Thirty-eight percent of these respondents reported that their last merger case ended prematurely (n = 53). The most frequently mentioned determinants of merger abandonment are changing insights on the desirability and feasibility during merger processes, incompatibilities between executives, and insufficient support for the merger from internal stakeholders. We did not find significant relationships between merger abandonment and executives' previous merger experience, degree of organizational diversification, health care sector, size differences, or other organizational differences. Our findings partially confirm results from previous studies, especially with regard to the importance of changing insights and incompatibilities between the involved executives in merger abandonment. We also find that pressure from internal stakeholders, particularly nonexecutive directors, and distrust, fear, and animosity play an important role in merger abandonment. To minimize the organizational and societal costs of abandoned mergers, we advise executives who engage in mergers to construct backup plans with alternative strategies in case the merger is abandoned and to conduct a thorough analysis of pros and cons before the merger.

Sensitivity Training and Group Encounter, an Introduction.

ERIC Educational Resources Information Center

Siroka, Robert W., Ed.; And Others

"Sensitivity Training and Group Encounter" attempts to explore group interaction on many levels--verbal, sensory, and physical. It can be utilized as a model for dealing with various forms of interpersonal relations, from ongoing social issues to the isolation, alienation, and distrust felt by the members of a group. Presented as a guide to this…

Is it Time to Take a Courageous Leap?

ERIC Educational Resources Information Center

Dickmeyer, Nathan

2006-01-01

In this article, the author observes that while university officials believe that strategic planning will help them look past the day-to-day housekeeping and meet the challenges of a volatile environment, much of such planning appears mired in competitive self-replication and is vulnerable to distrust from the public and government. Too often, the…

Group Skills and Reality Therapy: A Pragmatic Process for Humanizing Education.

ERIC Educational Resources Information Center

Supple, Robert V.

While elementary school teachers are concerned for and involved in the affective world of children, some elementary educators fear or distrust group affective approaches. It may be the case that they lack understanding and skills in the use of affective curricula. William Glasser's guides for classroom meetings, designed to increase and promote…

The DREAMS Team: Creating Community Partnerships through Research Advocacy Training for Diverse Older Adults

ERIC Educational Resources Information Center

Hart, Ariel R.; Dillard, Rebecca; Perkins, Molly M.; Vaughan, Camille P.; Kinlaw, Kathy; McKay, J. Lucas; Waldrop-Valverde, Drenna; Hagen, Kimberley; Wincek, Ron C.; Hackney, Madeleine E.

2017-01-01

The DREAMS Team research advocacy training program helps clinical faculty and health students introduce basic clinical research concepts to diverse older adults to galvanize their active involvement in the research process. Older adults are frequently underrepresented in clinical research, due to barriers to participation including distrust,…

Offering African Americans Opportunities to Participate in Clinical Trials Research: How Social Workers Can Help

ERIC Educational Resources Information Center

Mason, Susan E.

2005-01-01

Historically, African Americans have resisted participation in clinical trials and other research projects because of distrust of the mostly white research establishment. Although there are legitimate reasons for refusing to join clinical trials, most notably the abuses of the Tuskegee Syphilis Study, African Americans may be passing up…

College Students' Perceptions of Community-Oriented Policing at a Mid-Size Public University

ERIC Educational Resources Information Center

Cooper, Joseph J.

2017-01-01

Campus crime and distrust of campus police are significant problems for institutions of higher education. Utilizing the Broken Windows Theory (Kelling & Wilson, 1982) as the theoretical framework, the purpose of this qualitative study was to explore students' attitudes toward community-oriented policing and their perceptions of crime, safety,…

The Dimensionality of Trust

DTIC Science & Technology

2005-06-30

others. Erikson (1968) has described the first stage of psychosocial development (occurring at about 1 to 2 years of age) as requiring resolution of...relationship are critical, particularly at the early stages (before distrust develops ). Humansystems...7747-20 On behalf of DEPARTMENT OF NATIONAL DEFENCE as represented by Defence Research and Development Canada Toronto 1133 Sheppard Avenue West

Student Leadership in a Residential College: From Dysfunction to Effective Collaboration

ERIC Educational Resources Information Center

Bloomdahl, Susana Contreras; Navan, Joy

2013-01-01

This article depicts the intervention strategy of two faculty members on a dysfunctional student council in a residential college setting. The council demonstrated poor collaboration and productivity, which indicated signs of distrust. The group intervention helped to expose the students' lack of organization and need to learn more about each…

Meeting the Social and Legal Needs of Urban Indians: An Experimental Program.

ERIC Educational Resources Information Center

Halverson, Lowell K.; Garrow, Tom

Approximately 40 percent of America's Indians live in urban environments; of these, about 12,000 live in Seattle, Washington. With no representation in local government, and lacking the power and cultural sophistication to make the political process work for them, many Indian emigres have developed an almost institutionalized distrust of and…

Collaboration, Communities, and Covey: A Model for Personal and Professional Change.

ERIC Educational Resources Information Center

Birrell, James R.; Ostlund, Margaret R.; Eagan, M. Winston; Young, James R.; Cook, Paul F.; DeWitt, Paul F.; Tibbitts, Cathy B.

1998-01-01

Reports on one school-university partnership that used S. Covey's "The 7 Habits of Highly Effective People" as a framework for initiating and sustaining teacher-education reform in an elementary school. Discusses how the collaboration overcame a difficult start involving distrust of the university. Shows how the project illuminates three…

Negotiated Communities: A Stakeholder Approach to Understanding Town-Gown Relations during Periods of Campus Expansion

ERIC Educational Resources Information Center

Lawrence-Hughes, Dorine Lynelle

2014-01-01

More colleges and universities are expanding to attract more students, to increase their academic standing and to generate revenue. Recent court decisions and negative publicity concerning large university real estate development projects, coupled with the entrenched ambivalence and even distrust that may characterize town-gown relationships,…

Situated Self-Esteem

ERIC Educational Resources Information Center

Cigman, Ruth

2004-01-01

Pervasive though it is in modern life, the concept of self-esteem is often viewed with distrust. This paper departs from an idea that was recently aired by Richard Smith: that we might be better off without this concept. The meaning of self-esteem is explored within four homes: the self-help industry, social science, therapy and education. It is…

Millennials in Adulthood: Detached from Institutions, Networked with Friends

ERIC Educational Resources Information Center

Pew Research Center, 2014

2014-01-01

The Millennial generation is forging a distinctive path into adulthood. Now ranging in age from 18 to 331, they are relatively unattached to organized politics and religion, linked by social media, burdened by debt, distrustful of people, in no rush to marry--and optimistic about the future. They are also America's most racially diverse…

Gender Bias in Families and Its Clinical Implications for Women.

ERIC Educational Resources Information Center

Atwood, Nancy C.

2001-01-01

Women (N=45) were surveyed about the gender bias evidenced in their mothers' and brothers' relationships and how this influenced their lives. Several legacies from the girlhood experience of gender bias were identified that may be associated with depression, such as involvement in demeaning relationships and an isolating distrust of relationships.…

Understanding and (Dis)trusting Food Assurance Schemes: Consumer Confidence and the "Knowledge Fix"

ERIC Educational Resources Information Center

Eden, Sally; Bear, Christopher; Walker, Gordon

2008-01-01

This paper uses evidence from focus groups with consumers in England to consider how consumers understand and evaluate a range of proxies or intermediary organisations that offer assurance about food and consumer products, particularly voluntary certification schemes. This addresses the current concern in developed economies about providing…

Considering a Voice of the Body for Adult Transformative Learning Theory

ERIC Educational Resources Information Center

Boleyn, Elizabeth C.

2013-01-01

Unknowingly, much of the population of the Western World are thinking machines who live and learn isolated from somatic experiences. They distrust their bodies in the learning process and are stuck living out unquestioned realities of embodied socioculturalism and rationalism which guide decision making, learning and ways of being. Considering a…

A Youth-Friendly Intervention for Homeless and Street-Involved Youth.

ERIC Educational Resources Information Center

O'Connor, Barbara Virley; MacDonald, Brian J.

1999-01-01

Describes a community intervention for a population of youth who are often distrustful of mainstream mental health services. Program focuses on not viewing youth as patients but as experts in working with adults to design youth-friendly interventions. Outlines the development and implementation of a support-group model tailored specifically to the…

Assess and enhance public trust

Treesearch

Patricia Winter; James Absher; Alan Watson

2007-01-01

Trust is a form of social capital, facilitating effective land management, communication and collaboration. Although trust in the Forest Service is at least moderately high for most publics, evidence of a lack of trust and outright distrust has been found in some communities. However, the amount, types, and conditions of trust necessary for effective management to...

The Effective Supervision, Coordination and Improvement of the Instructional Activities of Professional Colleagues.

ERIC Educational Resources Information Center

Schonberger, Vincent L.

1982-01-01

Focuses upon general improvement of classroom instruction, advocating a more personal and analytical supervisory approach. Advocates a change from the present supervisory practices of fear and distrust, in which power stifles creativity and innovative thought, to that of consultation and collaboration based on social management principles of…

Interrogating the dynamics between power, knowledge and pregnant bodies in amniocentesis decision making.

PubMed

Markens, Susan; Browner, Carole H; Mabel Preloran, H

2010-01-01

A common assumption is that women who decline prenatal testing distrust biomedicine and trust embodied/experiential knowledge sources, while women who accept testing trust biomedicine and distrust embodied/experiential sources. Another major assumption about prenatal testing utilisation is that women who are open to abortion will undergo prenatal testing while those who are opposed to abortion will decline testing. Yet, previous research has produced inconsistent findings as to what, if anything, distinguishes women who accept or decline the offer of prenatal diagnosis. Analysing interviews with 147 pregnant women, this paper questions these assumptions about the role of abortion views and pregnant women's relative trust in various knowledge sources on their decisions to accept or decline an amniocentesis offer after a positive result on an initial diagnostic screening. We found that pregnant women's attitudes toward different knowledge sources were equally, if not more, important factors than abortion views in affecting whether individual women accepted or declined amniocentesis. At the same time, our data reveal that the relationship between 'expert' and 'lay' knowledge sources is often complex and synergistic.

Science, Politics, and Watershed Management: Another Task for Hydrologists

NASA Astrophysics Data System (ADS)

Wise, W. R.

2002-05-01

The lowest common denominator in hydrology should be "common" sense. The basic concepts that need to be addressed during watershed management are tractable by the general public when presented effectively. Of course the details should be left to the professionals. An uninformed public will feel disenfranchised when "experts" pummel it with technical content beyond its comfort level. To be effective, the hydrologic professional needs to be competent to perform the required analyses and prepared to win the trust of all concerned parties. In the adversarial roles played by developers and growth opponents, distrust reigns supreme. Usually this distrust is fed first and foremost by a lack of communication between the parties. In today's litigious environment, the results can be maddening. The author's experience in high profile hydrologic projects have infused him with the knowledge that effective communication is a critical lubricant to the watershed management process. It is the hydrologic community's duty to facilitate the policy makers' genuine education on watershed processes. The former must act now, if previous problems are not to be repeated.

Declining conventional cancer treatment and using complementary and alternative medicine: a problem or a challenge?

PubMed

Verhoef, M J; Rose, M S; White, M; Balneaves, L G

2008-08-01

Several studies have shown that a small but significant percentage of cancer patients decline one or more conventional cancer treatments and use complementary and alternative medicine (CAM) instead. Here, drawing on the literature and on our own ongoing research, we describe why cancer patients decide to decline conventional cancer treatments, who those patients are, and the response by physicians to patients who make such decisions. Poor doctor-patient communication, the emotional impact of the cancer diagnosis, perceived severity of conventional treatment side effects, a high need for decision-making control, and strong beliefs in holistic healing appear to affect the decision by patients to decline some or all conventional cancer treatments. Many patients indicate that they value ongoing follow-up care from their oncologists provided that the oncologists respect their beliefs. Patients declining conventional treatments have a strong sense of internal control and prefer to make the final treatment decisions after considering the opinions of their doctors. Few studies have looked at the response by physicians to patients making such a decision. Where research has been done, it found that a tendency by doctors to dichotomize patient decisions as rational or irrational may interfere with the ability of the doctors to respond with sensitivity and understanding. Declining conventional treatment is not necessarily an indicator of distrust of the medical system, but rather a reflection of many personal factors. Accepting and respecting such decisions may be instrumental in "keeping the door open."

Reported Racial Discrimination, Trust in Physicians, and Medication Adherence Among Inner-City African Americans With Hypertension

PubMed Central

Hargraves, J. Lee; Rosal, Milagros; Briesacher, Becky A.; Schoenthaler, Antoinette; Person, Sharina; Hullett, Sandral; Allison, Jeroan

2013-01-01

Objectives. We sought to determine if reported racial discrimination was associated with medication nonadherence among African Americans with hypertension and if distrust of physicians was a contributing factor. Methods. Data were obtained from the TRUST project conducted in Birmingham, Alabama, 2006 to 2008. All participants were African Americans diagnosed with hypertension and receiving care at an inner city, safety net setting. Three categories of increasing adherence were defined based on the Morisky Medication Adherence Scale. Trust in physicians was measured with the Hall General Trust Scale, and discrimination was measured with the Experiences of Discrimination Scale. Associations were quantified by ordinal logistic regression, adjusting for gender, age, education, and income. Results. The analytic sample consisted of 227 African American men and 553 African American women, with a mean age of 53.7 ±9.9 years. Mean discrimination scores decreased monotonically across increasing category of medication adherence (4.1, 3.6, 2.9; P = .025), though the opposite was found for trust scores (36.5, 38.5, 40.8; P < .001). Trust mediated 39% (95% confidence interval = 17%, 100%) of the association between discrimination and medication adherence. Conclusions. Within our sample of inner city African Americans with hypertension, racial discrimination was associated with lower medication adherence, and this association was partially mediated by trust in physicians. Patient, physician and system approaches to increase “earned” trust may enhance existing interventions for promoting medication adherence. PMID:24028222

Beliefs in Chemotherapy and Knowledge of Cancer and Treatment Among African American Women With Newly Diagnosed Breast Cancer.

PubMed

Jiang, Yun; Sereika, Susan M; Bender, Catherine M; Brufsky, Adam M; Rosenzweig, Margaret Q

2016-03-01

To examine beliefs regarding the necessity of chemotherapy and knowledge of breast cancer and its treatment in African American women with newly diagnosed breast cancer, and to explore factors associated with women's beliefs and knowledge.
. Descriptive, cross-sectional study.
. Six urban cancer centers in Western Pennsylvania and Eastern Ohio.
. 101 African American women with newly diagnosed breast cancer. 
. Secondary analysis using baseline data collected from participants in a randomized, controlled trial at their first medical oncology visit before the first cycle of chemotherapy.
. Belief in chemotherapy, knowledge of cancer and recommended treatment, self-efficacy, healthcare system distrust, interpersonal processes of care, symptom distress, and quality of life.
. African American women endorsed the necessity of chemotherapy. Most women did not know their tumor size, hormone receptors, specific therapy, or why chemotherapy was recommended to them. Women who perceived better interpersonal communication with physicians, less self-efficacy, or were less involved in their own treatment decision making held stronger beliefs about the necessity of chemotherapy. Women without financial difficulty or having stronger social functioning had more knowledge of their cancer and recommended chemotherapy. 
. African American women with newly diagnosed breast cancer generally agreed with the necessity of chemotherapy. Knowledge of breast cancer, treatment, and risk reduction through adjuvant therapy was limited.
. Oncology nurses could help advocate for tailored educational programs to support informed decision making regarding chemotherapy acceptance for African American women.

Environmental mediation: A method for protecting environmental sciences and scientists

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vigerstad, T.J.; Berdt Romilly, G. de; MacKeigan, P.

1995-12-31

The primary role for scientific analysis of environmental and human risks has been to support decisions that have arisen out of a regulatory decision-making model called ``Command and Control`` or ``Decide and Defend``. A project or a policy is proposed and permission for its implementation is sought. Permission-gaining sometimes requires a number of technical documents: Environmental Impact Statements, Public Health Risk Evaluations, policy analysis documents. Usually, little of this analysis is used to make any real decisions. This is a fact that has lead to enormous frustration and an atmosphere of distrust of government, industry and consulting scientists. There havemore » been a number of responses by governmental and industrial managers, some scientists, and even the legal system, to mitigate the frustration and distrust. One response has been to develop methods of packaging information using language which is considered more ``understandable`` to the public: Ecosystem Health, Social Risk Assessment, Economic Risk Management, Enviro-hazard Communication, Risk Focus Analysis, etc. A second is to develop more sophisticated persuasion techniques-a potential misuse of Risk Communication. A third is proposing to change the practice of science itself: e.g., ``post-normal science`` and ``popular epidemiology``. A fourth has been to challenge the definition of ``expert`` in legal proceedings. All of these approaches do not appear to address the underlying issue: lack of trust and credibility. To address this issue requires an understanding of the nature of environmental disputes and the development of an atmosphere of trust and credibility. The authors propose Environmental Mediation as a response to the dilemma faced by professional environmental scientists, engineers, and managers that protects the professionals and their disciplines.« less

Systematic Poisoning Attacks on and Defenses for Machine Learning in Healthcare.

PubMed

Mozaffari-Kermani, Mehran; Sur-Kolay, Susmita; Raghunathan, Anand; Jha, Niraj K

2015-11-01

Machine learning is being used in a wide range of application domains to discover patterns in large datasets. Increasingly, the results of machine learning drive critical decisions in applications related to healthcare and biomedicine. Such health-related applications are often sensitive, and thus, any security breach would be catastrophic. Naturally, the integrity of the results computed by machine learning is of great importance. Recent research has shown that some machine-learning algorithms can be compromised by augmenting their training datasets with malicious data, leading to a new class of attacks called poisoning attacks. Hindrance of a diagnosis may have life-threatening consequences and could cause distrust. On the other hand, not only may a false diagnosis prompt users to distrust the machine-learning algorithm and even abandon the entire system but also such a false positive classification may cause patient distress. In this paper, we present a systematic, algorithm-independent approach for mounting poisoning attacks across a wide range of machine-learning algorithms and healthcare datasets. The proposed attack procedure generates input data, which, when added to the training set, can either cause the results of machine learning to have targeted errors (e.g., increase the likelihood of classification into a specific class), or simply introduce arbitrary errors (incorrect classification). These attacks may be applied to both fixed and evolving datasets. They can be applied even when only statistics of the training dataset are available or, in some cases, even without access to the training dataset, although at a lower efficacy. We establish the effectiveness of the proposed attacks using a suite of six machine-learning algorithms and five healthcare datasets. Finally, we present countermeasures against the proposed generic attacks that are based on tracking and detecting deviations in various accuracy metrics, and benchmark their effectiveness.

Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia.

PubMed

Blair, Robert A; Morse, Benjamin S; Tsai, Lily L

2017-01-01

Trust in government has long been viewed as an important determinant of citizens' compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014-15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as "safe burial" of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD's symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD's spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future public health crises. Copyright © 2016 Elsevier Ltd. All rights reserved.

When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services.

PubMed

Moore, Megan; Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

2017-04-01

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED. Copyright © 2017 Elsevier Ltd. All rights reserved.

How did rapid scale-up of HIV services impact on workplace and interpersonal trust in Zambian primary health centres: a case-based health systems analysis

PubMed Central

Topp, Stephanie M; Chipukuma, Julien M

2016-01-01

Background In sub-Saharan Africa, large amounts of funding continue to be directed towards HIV-specific care and treatment, often with claims of ‘health system strengthening’ effect. Such claims rarely account for the impact on human relationships and decisions that are core to functional health systems. This research examined how establishment of externally funded HIV services influenced trusting relationships in Zambian health centres. Methods An in-depth, multicase study included four health centres selected for urban, peri-urban and rural characteristics. Case data included healthcare worker (HCW) interviews (60); patient interviews (180); direct observation of facility operations (2 weeks/centre) and key informant interviews (14) which were recorded and transcribed verbatim. Thematic analysis adopted inductive and deductive coding guided by a framework incorporating concepts of workplace trust, patient–provider trust, intrinsic and extrinsic motivation. Results HIV service scale-up impacted trust in positive and negative ways. Investment in HIV-specific infrastructure, supplies and quality assurance mechanisms strengthened workplace trust, HCW motivation and patient–provider trust in HIV departments in the short-term. In the health centres more broadly and over time, however, non-governmental organisation-led investment and support of HIV departments reinforced HCW's perceptions of the government as uninterested or unable to provide a quality work environment. Exacerbating existing perceptions of systemic workplace inequity and nepotism, uneven distribution of personal and professional opportunities related to HIV service establishment contributed to interdepartmental antagonism and reinforced workplace practices designed to protect individual HCW's interests. Conclusions Findings illustrate long-term negative effects of the vertical HIV resourcing and support structures which failed to address and sometimes exacerbated HCW (dis)trust with their own government and supervisors. The short-term and long-term effects of weakened workplace trust on HCWs' motivation and performance signal the importance of understanding how such relationships play a role in generating virtuous or perverse cycles of actor interactions, with implications for service outcomes. PMID:28588985

When high pressure, system constraints, and a social justice mission collide: a socio-structural analysis of emergency department social work services

PubMed Central

Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

2017-01-01

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N=1,509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N=10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED. PMID:28214722

Knowledge and Attitudes Toward Organ Donation in Health Care Undergraduate Students in Italy.

PubMed

Fontana, F; Massari, M; Giovannini, L; Alfano, G; Cappelli, G

2017-11-01

The number of organ donors in Italy is increasing, but with still disappointing living donation activity and relatively frequent objection by potential deceased donors' relatives to organ recovery. Few studies have assessed health care students' knowledge and attitude on donation. We administered a questionnaire to medical (MS) and nursing students (NS) at University of Modena and Reggio Emilia, Italy, and 749 students (406 MS and 343 NS) completed the questionnaire. Although 95% of students were in favor of donation, only 21.9% of NS and 24.9% of MS were registered as donors. One quarter of students reported family disagreement. MS appeared more confident with personnel involved in donation. Overall, 60% of students knew the term donation after brain death but only 40% were aware of the criteria used to define it. Barely 27.1% of NS and 15.3% of MS believed they had received sufficient information in lessons. Backward logistic regression demonstrated that students whose families agree with them and who knew the definition of donation after brain death were more likely to express the disposition of registering, and those who showed distrust in the declaration of brain death were half as likely to register as donors. Students expressed a lack of knowledge, controversial attitudes on donation, and strong need for education; increased awareness may help increase donation rates. The majority of educational institutions in Italy do not directly address training on organ donation and transplantation for health care students; an integrated curriculum favoring interpersonal discussion including practical aspects is urgently required. Copyright © 2017 Elsevier Inc. All rights reserved.

Community stakeholders' perceptions of barriers to childhood obesity prevention in low-income families, Massachusetts 2012-2013.

PubMed

Ganter, Claudia; Chuang, Emmeline; Aftosmes-Tobio, Alyssa; Blaine, Rachel E; Giannetti, Mary; Land, Thomas; Davison, Kirsten K

2015-03-26

The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social-ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity.

Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study

PubMed Central

Wakewich, Pamela; Wood, Brianne; Davey, Crystal; Laframboise, Ashlie; Zehbe, Ingeborg

2016-01-01

Regular Papanicolaou (Pap) screening has dramatically reduced cervical cancer incidence in Canada since the 1950s. However, Indigenous women’s rates of cervical cancer remain disproportionately high, a factor which is not acknowledged in national media or in educational materials reporting Canada’s new cervical cancer screening guidelines. Here, we present findings from a cervical cancer screening initiative in Northwestern Ontario. Based on participatory action research, we worked with 10 First Nations communities in the Robinson Superior Treaty area to increase awareness of cervical cancer risk, develop culturally sensitive tools for screening and education and test the efficacy of human papillomavirus (HPV) self-sampling as an alternative to Pap cytology. We conducted 16 interviews with health care professionals and 9 focus groups with 69 women from the communities. A central theme for both health care providers (HCPs) and community members was the colonial legacy and its influence on women’s experiences of cervical cancer screening. This was evidenced by a strong sense of body shyness, including shame related to sexuality and sexually transmitted infections, concerns about confidentiality in clinical encounters and distrust or caution around HCPs. Reaffirming women’s traditional caregiving and educational roles, enhancing mother and daughter communication, improving cultural sensitivity in health care and education and adoption of HPV self-sampling to increase women’s privacy and control of the cervical cancer screening experience were endorsed. We argue that education and screening initiatives must reflect the cultural preferences of Indigenous women, empowering them to take control of their experiences of health and body in cervical cancer screening. PMID:27867262

Effect of hygric and thermal properties of connecting layers on the performance of interior thermal insulation systems

NASA Astrophysics Data System (ADS)

Kočí, Václav; Jerman, Miloš; Fiala, Lukáš; Černý, Robert

2017-11-01

Interior thermal insulation systems represent often the only way of thermal protection, especially when historical buildings are taken into account. Since these systems face distrust due to frequent moisture failures, alternative solutions substituting the common water vapor barrier are being sought. In this paper, an assessment of hygrothermal performance of interior thermal insulation systems with purposely developed connecting layers is presented. Two types of mineral wools are connected to a sandstone masonry using two different connecting materials. The hygrothermal performance of the wall is obtained as a result of computational modelling with experimentally determined material parameters. Dynamic boundary conditions in the form of climatic data for Prague are used. The results indicate that the combination of permeable thermal insulation materials with investigated connecting layers have a positive influence on hygrothermal performance of the system as the moisture content is kept on very low level during a reference year. On the other hand, an increased attention should be paid to the protection of the masonry against excessive weather straining due to the absence of exterior thermal insulation.

A study of so-called hypochondriasis.

PubMed

von Scheele, C; Nordgren, L; Kempi, V; Hetta, J; Hallborg, A

1990-01-01

Twenty-four patients with unexplained somatic complaints were subjected to a thorough somatic examination. Only when the examination proved negative was the patient entered into the study. The patients were clinically appraised according to criteria given in DSM-III. Generalized anxiety disorder (GAD) was diagnosed in 12, somatization disorder (SD) in 8, and hypochondriasis in 4 patients. Seventeen of the 24 patients agreed to participate in biochemical investigations including a TRH load, a dexamethasone test, and a determination of the monoamine metabolites 5-HIAA and HVA in cerebrospinal fluid (CSF). A normal TSH increase and a normal suppression of cortisol were registered. The HVA values correlated significantly with the 5-HIAA values as well as with the alexithymia scores. Concerning alexithymia and maturity level, no difference as to social class was found. The patients filled in a Zung depression chart. The Zung scale and the 5-HIAA values were both inconsistent with depressive illness. In so-called hypochondriasis a long-term relationship, including selected somatic and biochemical examinations and thorough information, was crucial in abating the patient's distrust and thus the need for health care.

Why are 'hard-to-reach' women not engaging in a breastfeeding peer support programme?

PubMed

Islam, May Patricia

2016-02-01

ABSTRACT Increasing breastfeeding rates is one way of reducing health inequality and breastfeeding peer support is seen an effective method to improve breastfeeding rates in low-income areas. Local quantitative data indicated a poor uptake of breastfeeding peer support in two deprived areas in a south-east London borough. This evaluation set out to investigate in more depth why the uptake was poor. Using semi-structured interviews, 11 women were interviewed, eight of whom declined the support and three embraced it. The findings indicate insurmountable barriers for the respondents in initiating and sustaining breastfeeding in a sometimes undermining formula-feeding community. They also show that early support and a good start were crucial for women to be able to withstand these barriers, with many women surreptitiously breastfeeding unbeknown to those caring for them. The respondents were wary of asking for help, knew little of the peer support programme, were distrustful as to what a peer supporter did and what she could do for them, and consequently some endured pain without recourse to support.

The woman patient after WHI.

PubMed

Graziottin, Alessandra

2005-05-16

An epidemic of fear and distrust has infected women (and physicians) after publication of the Women's Health Initiative (WHI). The overinflated negative data emerging from the oestroprogestinic arm of WHI have frightened women and gave rise to the most difficult emotions to cope with. Keywords such as cancer, death and hormones combined together, have potentiated an avoidant attitude towards hormonal therapy (HT) driven more emotionally than rationally. This negative aura has not been dissipated by the positive data from the oestrogen-only arm of WHI. This paper will discuss: women's different emotional reactions to and coping strategies for HT-related fear after WHI; the communication skills physicians should use in focusing on positive messages emerging from WHI; predictors of current HT use; the meaning of the higher use of HT in postmenopausal highly-educated women and women gynaecologists; the importance of increasing healthy life-styles as a taking of responsibility towards aging by every woman; shifting from passivity to active sharing of the decision making process with the caring physician; and the use of an individually tailored HT, when appropriate, as part of an active strategy in the pursuit of a longer health expectancy.

Confronting health disparities: Latin American social medicine in Venezuela.

PubMed

Briggs, Charles L; Mantini-Briggs, Clara

2009-03-01

We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, "Inside the Neighborhood Mission," a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician-patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians' lives and clinical practices but heightened the program's visibility. Top-down and bottom-up efforts are less effective than "horizontal" collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas.

Muslim Pupils' Lives Changed after Sept. 11

ERIC Educational Resources Information Center

Shah, Nirvi

2011-01-01

Since 9/11, the lives of some Muslim students, and those perceived to be Muslim, have changed across the country, shaped in part by the distrust and harassment Muslims have endured from fellow Americans. In the months immediately following the attacks, accounts of harassment of Muslim students mounted in the news media, as did efforts by Muslim…

It Takes Two (or More) to Tango: Partnerships within the Education Sector in Timor-Leste

ERIC Educational Resources Information Center

Shah, Ritesh

2011-01-01

Recent international declarations stress the importance of partnerships between and amongst donors, the state and civil society, in order to improve service delivery and promote qualities of good governance, particularly in key sectors such as education. However, in conditions of state fragility--where high levels of distrust between and amongst…

Crossing into Uncharted Territory: Developing Thoughtful, Ethical School Administrators

ERIC Educational Resources Information Center

Surface, Jeanne L.

2009-01-01

In this distrustful, unstable, and ethically polarized era, there is a need to prepare school administrators to resolve a myriad of moral dilemmas. As professors of school administration, how can we make sure that our future leaders have the capacity to make thoughtful, ethical decisions? How do we prepare these leaders to develop, foster and lead…

Computer Fear and Anxiety in the United States Army

DTIC Science & Technology

1991-03-01

number) FIELD I GROUP SUBGROUP Computer Fear, Computer Anxiety, Computerphobia, Cyberphobia, Technostress , Computer Aversion, Corn puterphrenia 19...physiological and psychological disorders that impact not only on individuals, but on organizations as well. " Technostress " is a related term which is...computers, technostress , computer anxious, computer resistance, terminal phobia, fear of technology, computer distrust, and computer aversion. Whatever

Communication/Culture Study for Victor Valley College, Victorville, California, November 1991-April 1992.

ERIC Educational Resources Information Center

Caldwell, Patricia F.

In November 1991, a study was conducted to assess the corporate culture and state of communication at Victor Valley College (VVC), in Victorville, California. The study was designed to determine the extent to which "trust" or "distrust" existed at VVC, and whether the lack of communication on campus was real or perceived. Study…

All Roads Lead to Rust: How Acculturation Erodes Latino Immigrant Trust in Government

ERIC Educational Resources Information Center

Michelson, Melissa R.

2007-01-01

Political trust is an important determinant of individual political behavior and government effectiveness and an indication of the health of civil society. Declining trust among Americans is well documented. Surveys of Latino immigrants indicate that they are also cynical about government, but it is not clear whether this distrust takes the same…

The Legacy of the U. S. Public Health Services Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years After President Clinton’s Apology

PubMed Central

Mays, Vickie M.

2013-01-01

This special issue addresses the legacy of the United States Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act (ACA). The 12 manuscripts cover the history and current practices of ethical abuses affecting American Indians, Latinos, Asian Americans and African Americans in the United States and in one case, internationally. Commentaries and essays include the voice of a daughter of one of the study participants in which we learn of the stigma and maltreatment some of the families experienced and how the study has impacted generations within the families. Consideration is given in one essay to utilizing narrative storytelling with the families to help promote healing. This article provides the reader a roadmap to the themes that emerged from the collection of articles. These themes include population versus individual consent issues, need for better government oversight in research and health care, the need for overhauling our bioethics training to develop a population level, culturally driven approach to research bioethics. The articles challenge and inform us that some of our assumptions about how the consent process best works to protect racial/ethnic minorities may be merely assumptions and not proven facts. Articles challenge the belief that low participation rates seen in biomedical studies have resulted from the legacy of the USPHS Syphilis Study rather than a confluence of factors rooted in racism, bias and negative treatment. Articles in this special issue challenge the “cultural paranoia” of mistrust and provide insights into how the distrust may serve to lengthen rather than shorten the lives of racial/ethnic minorities who have been used as guinea pigs on more than one occasion. We hope that the guidance offered on the importance of developing a new framework to bioethics can be integrated into the foundation of health care reform. PMID:23630410

The Legacy of the U. S. Public Health Services Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years After President Clinton's Apology.

PubMed

Mays, Vickie M

2012-11-01

This special issue addresses the legacy of the United States Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act (ACA). The 12 manuscripts cover the history and current practices of ethical abuses affecting American Indians, Latinos, Asian Americans and African Americans in the United States and in one case, internationally. Commentaries and essays include the voice of a daughter of one of the study participants in which we learn of the stigma and maltreatment some of the families experienced and how the study has impacted generations within the families. Consideration is given in one essay to utilizing narrative storytelling with the families to help promote healing. This article provides the reader a roadmap to the themes that emerged from the collection of articles. These themes include population versus individual consent issues, need for better government oversight in research and health care, the need for overhauling our bioethics training to develop a population level, culturally driven approach to research bioethics. The articles challenge and inform us that some of our assumptions about how the consent process best works to protect racial/ethnic minorities may be merely assumptions and not proven facts. Articles challenge the belief that low participation rates seen in biomedical studies have resulted from the legacy of the USPHS Syphilis Study rather than a confluence of factors rooted in racism, bias and negative treatment. Articles in this special issue challenge the "cultural paranoia" of mistrust and provide insights into how the distrust may serve to lengthen rather than shorten the lives of racial/ethnic minorities who have been used as guinea pigs on more than one occasion. We hope that the guidance offered on the importance of developing a new framework to bioethics can be integrated into the foundation of health care reform.

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients.

PubMed

DeMeester, Rachel H; Lopez, Fanny Y; Moore, Jennifer E; Cook, Scott C; Chin, Marshall H

2016-06-01

Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dual-minority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender ("LGBT") racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

Self-treatment of acute exacerbations of chronic obstructive pulmonary disease requires more than symptom recognition - a qualitative study of COPD patients' perspectives on self-treatment.

PubMed

Laue, Johanna; Melbye, Hasse; Risør, Mette Bech

2017-01-25

Self-treatment of acute exacerbations of COPD with antibiotics and/or oral corticosteroids has emerged as a promising strategy to reduce hospitalization rates, mortality and health costs. However, for reasons little understood, the effect of self-treatment, particularly when not part of comprehensive self-management programs, remains unclear. Therefore, this study aims to get insight into the patients' perspective on self-treatment of acute exacerbations of COPD, focusing specifically on how patients decide for the right moment to start treatment with antibiotics and/or oral corticosteroids, what they consider important when making this decision and aspects which might interfere with successful implementation. We interviewed 19 patients with chronic obstructive pulmonary disease using qualitative semi-structured interviews, and applied thematic analysis for data analysis. Patients were well equipped with experiential knowledge to recognize and promptly respond to worsening COPD symptoms. Worries regarding potential adverse effects of antibiotics and oral corticosteroids played an important role in the decision to start treatment and could result in hesitation to start treatment. Although self-treatment represented a practical and appreciated option for some patients with predictable symptom patterns and treatment effect, all patients favoured assistance from a medical professional when their perceived competence reached its limits. However, a feeling of obligation to succeed with self-treatment or distrust in their doctors or the health care system could keep patients from timely help seeking. COPD patients regard self-treatment of exacerbations with antibiotics and/or oral corticosteroids as a valuable alternative. How they engage in self-treatment depends on their concerns regarding the medications' adverse effects as well as on their understanding of and preferences for self-treatment as a means of health care. Caregivers should address these perspectives in a collaborative approach when offering COPD patients the opportunity for self-treatment of exacerbations.

'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital.

PubMed

Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han

2015-01-01

This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place. Additionally promoting communication and interaction among health workers can foster team spirit. Also resolving conflicts using the collaborating response may help to create a conducive work environment that will promote healthy work relations, which can facilitate the delivery of quality maternal and neonatal health care. However, such an approach requires that unequal power relations, which is a root cause of the conflicts is addressed.

Ethics and quality care in nursing homes: Relatives' experiences.

PubMed

Jakobsen, Rita; Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Sørlie, Venke

2017-01-01

A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. The results are discussed considering the concepts of trust, power and asymmetry. When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim.

The effects of customers' mobile experience and technical support on the intention to use mobile banking.

PubMed

Chung, Namho; Kwon, Soon Jae

2009-10-01

While mobile banking has become an integral part of banking activities, it has also caused systems-related stress and consequent distrust among mobile banking users. This study looks into the phenomenon of technology adoption for mobile banking users and identifies potential factors that nurture positive intentions toward mobile banking usage. It examines the effects of a customer's mobile experience and technical support on mobile banking acceptance and explains how some variables affect this intention. After a literature review, the method of empirical analysis using a structured questionnaire is developed. Hierarchical Moderated Regression Analyses (HMRA) is used to examine the model. We find that mobile experience and technical support tend to strengthen the relationship between technological characteristics and a customer's intention to use the mobile technology.

It’s a Process: Reactions to HIV Diagnosis and Engagement in HIV Care among High-Risk Heterosexuals

PubMed Central

Kutnick, Alexandra H.; Gwadz, Marya Viorst; Cleland, Charles M.; Leonard, Noelle R.; Freeman, Robert; Ritchie, Amanda S.; McCright-Gill, Talaya; Ha, Kathy; Martinez, Belkis Y.; Banfield, Angela

2017-01-01

After HIV diagnosis, heterosexuals in high-poverty urban areas evidence delays in linkage to care and antiretroviral therapy initiation compared to other groups. Yet barriers to/facilitators of HIV care among these high-risk heterosexuals are understudied. Under the theory of triadic influence, putative barriers to HIV care engagement include individual/attitudinal-level (e.g., fear, medical distrust), social-level (e.g., stigma), and structural-level influences (e.g., poor access). Participants were African-American/Black and Hispanic adults found newly diagnosed with HIV (N = 25) as part of a community-based HIV testing study with heterosexuals in a high-poverty, high-HIV-incidence urban area. A sequential explanatory mixed-methods design was used. We described linkage to HIV care and clinical outcomes [CD4 counts, viral load (VL) levels] over 1 year, and then addressed qualitative research questions about the experience of receiving a new HIV diagnosis, its effects on timely engagement in HIV care, and other barriers and facilitators. Participants were assessed five times, receiving a structured interview battery, laboratory tests, data extraction from the medical record, a post-test counseling session, and in-person/phone contacts to foster linkage to care. Participants were randomly selected for qualitative interviews (N = 15/25) that were recorded and transcribed, then analyzed using systematic content analysis. Participants were 50 years old, on average (SD = 7.2 years), mostly male (80%), primarily African-American/Black (88%), and low socioeconomic status. At the first follow-up, rates of engagement in care were high (78%), but viral suppression was modest (39%). Rates improved by the final follow-up (96% engaged, 62% virally suppressed). Two-thirds (69%) were adequately retained in care over 1 year. Qualitative results revealed multi-faceted responses to receiving an HIV diagnosis. Problems accepting and internalizing one’s HIV status were common. Reaching acceptance of one’s HIV-infected status was frequently a protracted and circuitous process, but acceptance is vital for engagement in HIV care. Fear of stigma and loss of important relationships were potent barriers to acceptance. Thus, partially as a result of difficulties accepting HIV status, delays in achieving an undetectable VL are common in this population, with serious potential negative consequences for individual and public health. Interventions to foster acceptance of HIV status are needed. PMID:28540287

Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration.

PubMed

Freeman, Robert; Gwadz, Marya Viorst; Silverman, Elizabeth; Kutnick, Alexandra; Leonard, Noelle R; Ritchie, Amanda S; Reed, Jennifer; Martinez, Belkis Y

2017-03-24

African American/Black and Hispanic persons living with HIV (AABH-PLWH) in the U.S. evidence insufficient engagement in HIV care and low uptake of HIV antiretroviral therapy, leading to suboptimal clinical outcomes. The present qualitative study used critical race theory, and incorporated intersectionality theory, to understand AABH-PLWH's perspectives on the mechanisms by which structural racism; that is, the macro-level systems that reinforce inequities among racial/ethnic groups, influence health decisions and behaviors. Participants were adult AABH-PLWH in New York City who were not taking antiretroviral therapy nor well engaged in HIV care (N = 37). Participants were purposively sampled for maximum variation from a larger study, and engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach. We found AABH-PLWH experienced HIV care and medication decisions through a historical and cultural lens incorporating knowledge of past and present structural racism. This contextual knowledge included awareness of past maltreatment of people of color in medical research. Further, these understandings were linked to the history of HIV antiretroviral therapy itself, including awareness of the first HIV antiretroviral regimen; namely, AZT (zidovudine) mono-therapy, which was initially prescribed in unacceptably high doses, causing serious side effects, but with only modest efficacy. In this historical/cultural context, aspects of structural racism negatively influenced health care decisions and behavior in four main ways: 1) via the extent to which healthcare settings were experienced as overly institutionalized and, therefore, dehumanizing; 2) distrust of medical institutions and healthcare providers, which led AABH-PLWH to feel pressured to take HIV antiretroviral therapy when it was offered; 3) perceptions that patients are excluded from the health decision-making process; and 4) an over-emphasis on antiretroviral therapy compared to other non-HIV related priorities. We found that although participants were located at the intersection of multiple social categories (e.g., gender, social class, AABH race/ethnicity), race/ethnicity and social class were described as primary factors. Critical race theory proved useful in uncovering how macro-level structural racism affects individual-level health decisions and behaviors. HIV clinical settings can counter-balance the effects of structural racism by building "structural competency," and interventions fostering core self-determination needs including autonomy may prove culturally appropriate and beneficial for AABH-PLWH.

Remarks: "What Parents Ought to Know/Be Told About Our Schools".

ERIC Educational Resources Information Center

Oxender, Vernon L.

Public distrust in schools should not be attributed to poorer schools or less able students; it exists because we have a different kind of parent and a different world ahead. Parents of today's children were trained not to accept the status quo, but to question; furthermore, underlying parents' concern about the schools is a fear that their…

Indelible Distrust: Memory Bias toward Cheaters Revealed as High Persistence against Extinction

ERIC Educational Resources Information Center

Suzuki, Atsunobu; Honma, Yoshiko; Suga, Sayaka

2013-01-01

Our ability to learn about the reputations of others--that is, who is likely to cooperate versus cheat--contributes greatly to cooperativeness in society. There has been recent debate whether humans employ memory bias favoring cheaters (i.e., there is an evolved module for the detection of cheaters) or whether no such bias exists (i.e., reputation…

Because of the Kids: Facing Racial and Cultural Differences in Schools. The Practitioner Inquiry Series.

ERIC Educational Resources Information Center

Obidah, Jennifer E.; Teel, Karen Manheim

This book presents the story of two teachers, one black and one white, who confronted the boundaries of race, describing their journey through distrust, anger, and fear as they grappled with race in classroom teaching. It explains how the white teacher, guided by her African American mentor, learned to effectively teach African American students.…

The Neglected Majority: Mass Communications and the Working Person.

ERIC Educational Resources Information Center

Mendelsohn, Harold

Studies have shown that members of the working class are often overworked, underpaid, overtaxed, and unhappy. They tend to be distrustful of new ideas and methods and to rely on their extended families to meet their needs for human contact. One way in which the working class person may have a chance to widen the character of his interactions with…

Targets, Threats and (dis)Trust: The Managerial Troika for Public School Principals in Chile

ERIC Educational Resources Information Center

Montecinos, Carmen; Ahumada, Luis; Galdames, Sergio; Campos, Fabián; Leiva, Maria Verónica

2015-01-01

Public education in Chile has been steadily losing students as a result of the implementation, for the last 35 years, of a market model. In this paper we exemplify how a structural problem (public schools' declining enrollment) created by neoliberal educational policies is transformed into an individual problem to be managed by the public school…

Patterns of Sophistication and Naivety: Some Features of Anthropological Approaches to the Study of Education. Occasional Paper No. 22.

ERIC Educational Resources Information Center

Erickson, Frederick

The limits and boundaries of anthropology are briefly discussed, along with a general description of lay attitudes towards the field. A research case is given to illustrate the way in which anthropological study methods can contribute to educational research. Noted among these contributions is an informed distrust that anthropologists exhibit…

Training in Supervision: A Limited Inservice Approach. Teacher Education Forum; Volume 4, Number 20.

ERIC Educational Resources Information Center

Hedley, R. L.; And Others

Although it has been the practice of the University of Manitoba to place the majority of student teachers in metropolitan schools, recently there has been increasing pressure to place students in rural school divisions as well. One rural school division, however, has given some evidence of distrust in the university faculty and in its methods of…

Voices of Canadian and Mexican Youth Surrounded by Violence: Learning Experiences for Peace-Building Citizenship

ERIC Educational Resources Information Center

Bickmore, Kathy; Awad, Yomna; Radjenovic, Angelica

2017-01-01

How do young people living in high-violence contexts express a sense of democratic agency and hope, and/or frustration and hopelessness, for handling various kinds of social and political conflict problems? The management of conflict is a core challenge and purpose of democracy, severely impeded by the isolation and distrust caused by violence.…

Somewhere between Distrust and Dependence: Young People, the Police and Anti-Social Behaviour Management within Marginalised Communities

ERIC Educational Resources Information Center

Gormally, Sinead; Deuchar, Ross

2012-01-01

Recent concerns in the UK about youth disaffection, anti-social behaviour and gang culture have led to an increase in pre-emptive intervention strategies focused on the policing of groups of young people. This article explores the literature on youth/police relationships and the evidence that suggests that preventive police strategies may have…

Managing distrust-induced risk with deposit in supply chain contract decisions.

PubMed

Han, Guanghua; Dong, Ming; Sun, Qi

2014-01-01

This paper studies the trust issue in a two-echelon supply chain information sharing process. In a supply chain, the retailer reports the forecasted demand to the supplier. Traditionally, the supplier's trust in the retailer's reported information is based on the retailer's reputation. However, this paper considers that trust is random and is also affected by the reputation and the demand gap. The supplier and retailer have been shown to have different evaluations regarding the degree of trust. Furthermore, distrust is inherently linked to perceived risk. To mitigate perceived risk, a two-stage decision process with an unpayback deposit contract is proposed. At the first stage, the supplier and the retailer negotiate the deposit contract. At the second stage, a Stackelberg game is used to determine the retailer's reported demand and the supplier's production quantity. We show that the deposits from the retailer's and supplier's perspectives are different. When the retailer's reported demand is equal to the supplier's forecasted demand, the retailer's evaluation of the deposit is more than that of supplier's. When the retailer's reported demand is equal to the retailer's forecasted demand, the deposit from the retailer's perspective is at the lowest level.

Kidneys for sale: who disapproves, and why?

PubMed

Leider, S; Roth, A E

2010-05-01

The shortage of transplant kidneys has spurred debate about legalizing monetary payments to donors to increase the number of available kidneys. However, buying and selling organs faces widespread disapproval. We survey a representative sample of Americans to assess disapproval for several forms of kidney market, and to understand why individuals disapprove by identifying factors that predict disapproval, including disapproval of markets for other body parts, dislike of increased scope for markets and distrust of markets generally. Our results suggest that while the public is potentially receptive to compensating kidney donors, among those who oppose it, general disapproval toward certain kinds of transactions is at least as important as concern about specific policy details. Between 51% and 63% of respondents approve of the various potential kidney markets we investigate, and between 42% and 58% want such markets to be legal. A total of 38% of respondents disapprove of at least one market. Respondents who distrust markets generally are not more disapproving of kidney markets; however we find significant correlations between kidney market disapproval and attitudes reflecting disapproval toward certain transactions-including both other body markets and market encroachment into traditionally nonmarket exchanges, such as food preparation.

Managing Distrust-Induced Risk with Deposit in Supply Chain Contract Decisions

PubMed Central

Han, Guanghua; Dong, Ming; Sun, Qi

2014-01-01

This paper studies the trust issue in a two-echelon supply chain information sharing process. In a supply chain, the retailer reports the forecasted demand to the supplier. Traditionally, the supplier's trust in the retailer's reported information is based on the retailer's reputation. However, this paper considers that trust is random and is also affected by the reputation and the demand gap. The supplier and retailer have been shown to have different evaluations regarding the degree of trust. Furthermore, distrust is inherently linked to perceived risk. To mitigate perceived risk, a two-stage decision process with an unpayback deposit contract is proposed. At the first stage, the supplier and the retailer negotiate the deposit contract. At the second stage, a Stackelberg game is used to determine the retailer's reported demand and the supplier's production quantity. We show that the deposits from the retailer's and supplier's perspectives are different. When the retailer's reported demand is equal to the supplier's forecasted demand, the retailer's evaluation of the deposit is more than that of supplier's. When the retailer's reported demand is equal to the retailer's forecasted demand, the deposit from the retailer's perspective is at the lowest level. PMID:25054190

How do we trust strangers? The neural correlates of decision making and outcome evaluation of generalized trust

PubMed Central

Wang, Yiwen; Zhang, Zhen; Jing, Yiming; Valadez, Emilio A.

2016-01-01

This study investigates the brain correlates of decision making and outcome evaluation of generalized trust (i.e. trust in unfamiliar social agents)—a core component of social capital which facilitates civic cooperation and economic exchange. We measured 18 (9 male) Chinese participants’ event-related potentials while they played the role of the trustor in a one-shot trust game with unspecified social agents (trustees) allegedly selected from a large representative sample. At the decision-making phase, greater N2 amplitudes were found for trustors’ distrusting decisions compared to trusting decisions, which may reflect greater cognitive control exerted to distrust. Source localization identified the precentral gyrus as one possible neuronal generator of this N2 component. At the outcome evaluation phase, principal components analysis revealed that the so called feedback-related negativity was in fact driven by a reward positivity, which was greater in response to gain feedback compared to loss feedback. This reduced reward positivity following loss feedback may indicate that the absence of reward for trusting decisions was unexpected by the trustor. In addition, we found preliminary evidence suggesting that the decision-making processes may differ between high trustors and low trustors. PMID:27317927

Community Stakeholders’ Perceptions of Barriers to Childhood Obesity Prevention in Low-Income Families, Massachusetts 2012–2013

PubMed Central

Chuang, Emmeline; Aftosmes-Tobio, Alyssa; Blaine, Rachel E.; Giannetti, Mary; Land, Thomas; Davison, Kirsten K.

2015-01-01

Introduction The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social–ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). Methods From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. Results Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. Conclusion The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity. PMID:25811497

Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

PubMed

Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

2015-11-01

Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.

Japan-U.S. Relations: Issues for Congress

DTIC Science & Technology

2008-12-30

aggression in the World War II period. Despite underlying distrust, Tokyo’s relationships with Beijing and, until recently, Seoul appear to be on a solid...the release of government documents. # In concert with the leadership in Beijing , which has been keen to shore up its foreign relations...Sichuan province, the first foreign team that Beijing accepted. The official reconciliation, however, may be challenged by sentiment among the

Creating Defense Excellence: Defense Addendum to Road Map for National Security

DTIC Science & Technology

2001-05-15

occasionally distrust political appointees—many of whom can be young , inexperienced academics—as “interlopers” who can severely damage well-established...centralization, lost managerial competence, and the loss of Service esprit de corps. The centralized approach may instill greater efficiency toward a...This is necessary because the evolution of joint warfighting and defense economics has shifted many past roles and responsibilities to joint and

Environmental Microbiology: Bacteria & Fungi on the Foods We Eat

ERIC Educational Resources Information Center

Segner, Suzanne; Scholthof, Karen-Beth G.

2007-01-01

The near daily news reports on food-borne diseases caused by contaminated produce, dairy, or meats suggests to the public that the safety of the U.S. food supply is in jeopardy. These reports, as well as a general distrust in federal agencies due in part to mad cow disease and toxigenic forms of "E. coli" in ground beef, have resulted in an…

Successful Aging Among African American Older Adults With Type 2 Diabetes.

PubMed

Chard, Sarah; Harris-Wallace, Brandy; Roth, Erin G; Girling, Laura M; Rubinstein, Robert; Reese, Ashanté M; Quinn, Charlene C; Eckert, J Kevin

2017-03-01

Rowe and Kahn's concept of successful aging remains an important model of well-being; additional research is needed, however, to identify how economically and socially disadvantaged older adults experience well-being, including the role of life events. The findings presented here help address this gap by examining the subjective construction of well-being among urban African American adults (age ≥ 50) with Type 2 diabetes. As part of the National Institute on Aging-funded Subjective Experience of Diabetes among Urban Older Adults study, ethnographers interviewed African American older adults with diabetes (n = 41) using an adaptation of the McGill Illness Narrative Interview. Data were coded using an inductively derived codebook. Codes related to aging, disease prognosis, and "worldview" were thematically analyzed to identify constructions of well-being. Participants evaluate their well-being through comparisons to the past and to the illnesses of friends and family. Diabetes self-care motivates social engagement and care of others. At times, distrust of medical institutions means well-being also is established through nonadherence to suggested biomedical treatment. Hardship and illness in participants' lives frame their diabetes experience and notions of well-being. Providers need to be aware of the social, economic, and political lenses shaping diabetes self-management and subjective well-being. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis

PubMed Central

Morciano, Cristina; Basevi, Vittorio; Faralli, Carla; Hilton Boon, Michele; Tonon, Sabina; Taruscio, Domenica

2016-01-01

Objective To assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies. Methods Survey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards. Results The survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed. Conclusions The finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy. PMID:27846255

Practical secure quantum communications

NASA Astrophysics Data System (ADS)

Diamanti, Eleni

2015-05-01

We review recent advances in the field of quantum cryptography, focusing in particular on practical implementations of two central protocols for quantum network applications, namely key distribution and coin flipping. The former allows two parties to share secret messages with information-theoretic security, even in the presence of a malicious eavesdropper in the communication channel, which is impossible with classical resources alone. The latter enables two distrustful parties to agree on a random bit, again with information-theoretic security, and with a cheating probability lower than the one that can be reached in a classical scenario. Our implementations rely on continuous-variable technology for quantum key distribution and on a plug and play discrete-variable system for coin flipping, and necessitate a rigorous security analysis adapted to the experimental schemes and their imperfections. In both cases, we demonstrate the protocols with provable security over record long distances in optical fibers and assess the performance of our systems as well as their limitations. The reported advances offer a powerful toolbox for practical applications of secure communications within future quantum networks.

Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study.

PubMed

Wee, Liang En; Cher, Wen Qi; Sin, David; Li, Zong Chen; Koh, Gerald Choon-Huat

2016-02-06

In Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to determine whether proximity to primary care, subsidised primary care, or having regular primary care associated with health screening participation in a low socioeconomic-status public rental-flat community in Singapore. From 2009-2014, residents in five public rental-flat enclaves (N = 936) and neighboring owner-occupied precincts (N = 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved adherence to health screening. We also investigated attitudes to health screening using qualitative methodology. In the rental flat population, for cardiovascular screening, regular primary care was independently associated with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12-2.26, p = 0.009) and hyperlipidemia screening (aOR = 1.82, CI = 1.10-3.04, p = 0.023). In the owner-occupied flats, regular primary care was independently associated with regular hypertension screening (aOR = 9.34 (1.82-47.85, p = 0.007), while subsidized primary care was associated with regular diabetes screening (aOR = 2.94, CI = 1.04-8.31, p = 0.042). For cancer screening, in the rental flat population, proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42, CI = 0.17-0.99, p = 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10-0.84, p = 0.023). In the owner-occupied flat population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01-0.75, p = 0.025). On qualitative analysis, patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in particular, patients were discouraged by potential embarrassment. Regular primary care was independently associated with regular participation in cardiovascular screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES community, proximity to primary care was associated with less participation in regular screening, while in the higher-SES community, regular primary care was associated with lower screening participation; possibly due to embarrassment regarding screening modalities.

Introduction of a guide to enhance risk communication among low-income and minority populations: a grassroots community engagement approach.

PubMed

Rowel, Randy; Sheikhattari, Payam; Barber, Tanyka M; Evans-Holland, Myrtle

2012-01-01

Low-income populations, especially those belonging to minority groups, are among the most vulnerable groups before, during, and after a natural disaster. One of the factors that can be attributed to their vulnerability is the ineffectiveness of traditional risk communication systems in reaching this population. Many low-income populations are distrustful of government agencies and those who typically communicate risk messages. Consequently, traditional systems are not as effective in reaching these communities. Furthermore, traditional systems have been based on the social media that the general population uses and not based on social networks of disadvantaged populations which are more important than formal channels in these communities for dissemination of information. To bridge the gap, an approach is needed that relies on trusted agencies and leaders to educate and warn low-income communities about possible public health threats. A grassroots approach can enhance the capacity of the risk communication systems to more effectively reach vulnerable populations by engaging grassroots organizations in risk communication activities. The Guide to Enhance Grassroots Risk Communication Among Low-Income Populations provides strategies and guidance that can assist agencies in upgrading their systems for risk communication by building partnerships with local community stakeholders.

Using transformational change to improve organizational culture and climate in a school of nursing.

PubMed

Springer, Pamela J; Clark, Cynthia M; Strohfus, Pamela; Belcheir, Marcia

2012-02-01

A positive organizational culture and climate is closely associated with an affirming workplace and job satisfaction. Especially during a time of faculty shortages, academic leaders need to be cognizant of the culture and climate in schools of nursing. The culture of an organization affects employees, systems, and processes, and if the culture becomes problematic, transformational leadership is essential to create change. The purpose of this article is to describe an 8-year journey to change the culture and climate of a school of nursing from one of dissatisfaction and distrust to one of high employee satisfaction and trust. Kotter's model for transformational change was used to frame a longitudinal study using the Cultural and Climate Assessment Scale to transform the organizational culture and climate of a school of nursing. Copyright 2012, SLACK Incorporated.

Developing research in partnership with Aboriginal communities - strategies for improving recruitment and retention.

PubMed

Rae, K; Weatherall, L; Hollebone, K; Apen, K; McLean, M; Blackwell, C; Eades, S; Boulton, J; Lumbers, E; Smith, R

2013-01-01

Australian Aboriginal communities in urban, rural and remote areas are continuing to suffer high rates of perinatal mortality and morbidity that will impact on the future health of the community. It has been well documented that Aboriginal women have extreme distrust of mainstream pregnancy-related health care and suggested that late entry into antenatal care is as high as 50% in the Aboriginal population. Although medical and midwifery staff have long discussed strategies to improve uptake of antenatal health care for Aboriginal women, researchers in many areas have found the recruitment of Aboriginal people into scientific studies almost impossible. This article seeks to share the strategies that have been developed over a period of time by the authors that have proved useful for recruitment and retention into research. It is anticipated that these strategies would also apply for health practitioners in maintaining their patients for clinical care management. Although each research location (regional, rural and remote) has had to spend time determining what approach is best for meeting the research outcomes, many of these suggestions become applicable to clinicians seeking to develop better connections with Aboriginal patients in their clinics. With the management of ongoing chronic health conditions for Aboriginal people a priority in 'Closing the Gap', a number of these suggestions could easily be implemented by clinicians. Remembering that each community has specific needs that must be addressed, priorities for assistance for that community will be easily identifiable after community consultation (eg transport, or ability to access medical testing). Opportunities for the use of new social media (eg Facebook) as communication tools for researchers and clinicians will have increasing applicability as further software updates are created. With open and trusting dialogues between researchers, clinicians and Aboriginal communities, we can go a long way towards understanding the needs of individual communities and working in partnerships to close the gap.

'I thought they were going to handle me like a queen but they didn't': A qualitative study exploring the quality of care provided to women at the time of birth.

PubMed

Lambert, Jaki; Etsane, Elsie; Bergh, Anne-Marie; Pattinson, Robert; van den Broek, Nynke

2018-07-01

To explore experiences of care during labour and birth from the perspectives of both the healthcare provider and women receiving care, to inform recommendations for how the quality of care can be improved and monitored, and, to identify the main aspects of care that are important to women. A descriptive phenomenological approach. 53 interviews and 10KII as per table 1 took place including in-depth interviews (IDI), focus group discussions (FGD) and key informant interviews (KII) conducted with women, healthcare providers, managers and policy makers. Following verbatim transcription thematic framework analysis was used to describe the lived experience of those interviewed. 11 public healthcare facilities providing maternity care in urban Tshwane District, Gauteng Province (n = 4) and rural Waterberg District, Limpopo Province (n = 7), South Africa. Women who had given birth in the preceding 12 weeks (49 women, 7 FGD and 23 IDI); healthcare providers working in the labour wards (33 healthcare providers; nurses, midwives, medical staff, 5 FGD, 18 IDI; managers and policy makers (10 KII). Both women and healthcare providers largely feel alone and unsupported. There is mutual distrust between women and healthcare providers exacerbated by word of mouth and the media. A lack of belief in women's ability to make appropriate choices negates principles of choice and consent. Procedure- rather than patient-centred care is prioritised by healthcare providers. Although healthcare providers know the principles of good quality care, this was not reflected in the care women described as having received. Beliefs and attitudes as well as structural and organisational problems make it difficult to provide good quality care. Caring behaviour and environment as well as companionship are the most important needs highlighted by women. Professional hierarchy is rarely seen as supportive by healthcare providers but when present, good leadership changes the culture and experience of women and care providers. The use of mobile phones to provide feedback regarding care was positively viewed by women. Clarity regarding what a healthcare facility can (or cannot provide) is important in order to separate practice issues from structural and organisational constraints. Improvements in quality that focus on caring as well as competence should be prioritised. Increased dialogue between healthcare providers and users should be encouraged and prioritised. A renewed focus is needed to ensure companionship during labour and birth is facilitated. Training in respectful maternity care needs to prioritise caring behaviour and supportive leadership. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Policies and perceptions on generic drugs: The case of Greece.

PubMed

Xanthopoulou, Sofia-Sotiria; Katsaliaki, Korina

2018-01-01

The increase in the consumption of generic drugs to reduce pharmaceutical expenditure is a challenge for many countries, especially during the economic crisis. The purpose of the present study is to review the Greek market of generic drugs and the decisions that shape it, to determine the factors that affect Greek patients' and doctors' attitudes about generic substitution and present a set of measures for all stakeholders based on the findings of the secondary and primary analysis. The study includes (a) an analysis of international and national reports and legislation on drugs policies and (b) a questionnaire survey of 242 hospital patients and 85 doctors regarding their perceptions on generics. A small increase in the volume of generics is recorded, yet not followed by sales value, over the recent years that the measures for promoting generics prescription took effect. Distrust from both patients and doctors was observed toward generics' effectiveness and toward the appropriateness of the regulatory authorities' quality controls. The study presents a structured set of viable measures, applicable to many countries, for promoting generic drug consumption that can lead to economic efficiency without degrading the health care quality.

Early-Life Stressors, Personality Development, and Fast Life Strategies: An Evolutionary Perspective on Malevolent Personality Features.

PubMed

Csathó, Árpád; Birkás, Béla

2018-01-01

Life history theory posits that behavioral adaptation to various environmental (ecological and/or social) conditions encountered during childhood is regulated by a wide variety of different traits resulting in various behavioral strategies. Unpredictable and harsh conditions tend to produce fast life history strategies, characterized by early maturation, a higher number of sexual partners to whom one is less attached, and less parenting of offspring. Unpredictability and harshness not only affects dispositional social and emotional functioning, but may also promote the development of personality traits linked to higher rates of instability in social relationships or more self-interested behavior. Similarly, detrimental childhood experiences, such as poor parental care or high parent-child conflict, affect personality development and may create a more distrustful, malicious interpersonal style. The aim of this brief review is to survey and summarize findings on the impact of negative early-life experiences on the development of personality and fast life history strategies. By demonstrating that there are parallels in adaptations to adversity in these two domains, we hope to lend weight to current and future attempts to provide a comprehensive insight of personality traits and functions at the ultimate and proximate levels.

Patients' reflections on communication in the second-opinion hematology-oncology consultation.

PubMed

Goldman, Roberta E; Sullivan, Amy; Back, Anthony L; Alexander, Stewart C; Matsuyama, Robin K; Lee, Stephanie J

2009-07-01

The nature of communication between patients and their second-opinion hematology consultants may be very different in these one-time consultations than for those that are within long-term relationships. This study explored patients' perceptions of their second-opinion hematology-oncology consultation to investigate physician-patient communication in malignant disease at a critical juncture in cancer patients' care and decision-making. In-depth telephone interviews with a subset of 20 patients from a larger study, following their subspecialty hematology consultations. Most patients wanted to contribute to the consultation agenda, but were unable to do so. Patients sought expert and honest advice delivered with empathy, though most did not expect the consultant to directly address their emotions. They wanted the physician to apply his/her knowledge to the specifics of their individual cases, and were disappointed and distrustful when physicians cited only general prognostic statistics. In contrast, physicians' consideration of the unique elements of patients' cases, and demonstrations of empathy and respect made patients' feel positively about the encounter, regardless of the prognosis. Patients provided concrete recommendations for physician and patient behaviors to enhance the consultation. Consideration of these recommendations may result in more effective communication and increased patient satisfaction with medical visits.

'I have only little English': language anxiety of Filipino migrants with chronic disease.

PubMed

Maneze, Della; Everett, Bronwyn; Kirby, Sue; DiGiacomo, Michelle; Davidson, Patricia M; Salamonson, Yenna

2016-12-01

This study investigates communication challenges faced by Filipino patients with chronic diseases when engaging with healthcare professionals (HCPs). Nine focus groups were conducted between November 2010 and June 2011. Two main categories of themes were identified: patient-related and HCP-related factors. Patient-related factors included three subthemes: (1) lack of confidence in their English language abilities in clinical situations; (2) cultural attitudes; and (3) strategies used to improve communication. Older Filipinos with chronic disease were anxious about their lack of ability to explain their symptoms in English and were concerned that asking questions was conveying distrust in the HCPs. Most of the elderly simply nodded their head to indicate they understood even if they did not, for fear of being thought 'stupid'. Many participants preferred Filipino GPs or have a relative interpret for them. Two subthemes were related to HCPs including (1) not being listened to and (2) assumptions of understanding. HCPs were thought to assume English language skills in Filipino patients and therefore were not careful about ensuring understanding. These findings highlighted the need for HCPs to be more aware of 'grey areas' in English-language proficiency and the cultural lens through which migrants understand health.

Confronting Health Disparities: Latin American Social Medicine in Venezuela

PubMed Central

Mantini-Briggs, Clara

2009-01-01

Objectives. We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, “Inside the Neighborhood Mission,” a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. Methods. We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. Results. Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician–patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians’ lives and clinical practices but heightened the program's visibility. Conclusions. Top-down and bottom-up efforts are less effective than “horizontal” collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas. PMID:19150916

Patient Perspectives of Medical Confidentiality

PubMed Central

Sankar, Pamela; Mora, Susan; Merz, Jon F; Jones, Nora L

2003-01-01

OBJECTIVE To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included. MAIN RESULTS Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information. CONCLUSIONS Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients. PMID:12911650

PRISM. Volume 2, Number 3, June 2011

DTIC Science & Technology

2011-06-01

Institute (SIPRI) Background Paper (Stockholm: SIPRI, April 2009), 3, available at <http://books.sipri.org/files/misc/ SIPRIBP0904a.pdf>. 41 Martin ...Conflict (Washington, DC: CNA, 2010), 28. 46 Nenad Dimitrijevic and Petra Kovacs, “Managing Hatred and Distrust: Changes from the Bottom and the Top...Dimitrijevic and Petra Kovacs (Hungary: Open Society Institute, 2004), xxiv. 47 Simonsen, “Addressing Ethnic Divisions in Post-Conflict Institution-Building

Japan-U.S. Relations: Issues for Congress

DTIC Science & Technology

2013-02-15

million Japanese were displaced. Damage to several reactors at the Fukushima Dai-ichi nuclear power plant complex led the government to declare a state of...the March 11, 2011, natural disasters and meltdowns at the Fukushima Daiichi nuclear power plant. Public trust in the safety of nuclear power...aircraft’s safety record may be connected to widespread distrust of the government stemming from the nuclear disaster at the Fukushima Daichi

Japan-U.S. Relations: Issues for Congress

DTIC Science & Technology

2009-06-03

resentful of Japan’s occupation policies and aggression in the World War II period. Despite underlying distrust, Tokyo’s relationships with Beijing and...prisoners during World War II, a charge that was later confirmed by the release of government documents. China In concert with the leadership in Beijing ...earthquake rescue experts then were dispatched to the hard-hit Sichuan province, the first foreign team that Beijing accepted. The official

Building a Better Legacy: Contrasting the British and American Experiences in Iraq

DTIC Science & Technology

2008-12-01

U.S. finds itself constrained by distrust abroad and doubt and war weariness at home . It is indisputable that despite the tenuous success of the ...ability of the occupied to rule themselves. This philosophy and cultural imperialism derived from the schools of thought espoused by John Stuart Mills...14. 36 Ibid., 14. 14 early Mesopotamian empires generated numerous cultural , scientific and literary contributions. The institutions and

The Evolution of Instrument Flying in the U.S. Army.

DTIC Science & Technology

1988-04-01

had learned to fly in World War One without instruments. They either distrusted instruments and avoided clouds, or were "seat-of- the-pants" flyers...hooded flight training, Basic students received six hours, and Advanced students received fifteen. Primary and Basic students learned aircraft control and...instrument maneuvers while Advanced students learned radio-navigation.;’ The twenty-seven hours of instrument 23 flying represented 11 percent of the

Secure Design Patterns

DTIC Science & Technology

2009-03-01

the Distrustful Decomposition pattern: • a number of separate programs, each running in a separate process . For more complete sepa- ration, each...be used in place of fork(). For example, under various versions of Windows, the CreateProcess() func- tion is used to spawn a child process . Figure...list contains the SIDs of the client processes that are allowed to connect to the server, that is, the Windows service. For more information about

The Carrier Strike Group: Examining Approaches to Forward Presence

DTIC Science & Technology

2016-09-01

capped at 8 months. This distrust represented in the study may continue to adversely affect retention rates especially if the current O-FRP exceeds...the 8 month proposed deployment cap .22 Another disadvantage of longer deployments is the increase in maintenance periods and the associated costs...establishing the requisite support facilities to maintain a nuclear powered aircraft carrier.31 For example, a port that is not nuclear carrier

Patient Race and Outcome Preferences as Predictors of Urologists’ Treatment Recommendations and Referral Patterns in Early-Stage Prostate Cancer

DTIC Science & Technology

2007-11-01

African Americans are more likely to fear surgery and distrust physicians than members of other racial/ethnic groups [13,18] – and may therefore refuse...disadvantaged patients are less appropriate for surgery . Such patients might be more likely to experience postoperative complications and require...recurrence, survival, and long-term erectile dysfunction and incontinence. KEYWORDS surgery , prostatectomy, surgical volume, postoperative

An Approach to Forward Presence in a Resource-Constrained Environment

DTIC Science & Technology

2013-03-01

working quietly to coordinate cooperation between Indonesia, Malaysia , and Singapore , who were historically distrustful of each other. Through...freedom of action. Non-state actors will likely seek to capitalize on these weakening and corrupt failing states as potential safe havens. The low...11 Figure 1. 2011 Defense Spending: United States vs . 16 Next Leading Spenders44 Department of Defense can feel like it is hard pressed for

Risk communication, risk perception, and public health.

PubMed

Aakko, Eric

2004-01-01

Risk communication is about building trust while deploying an interactive and ongoing communication process in which audience members are active participants. This interactive participation may not solve a public health crisis, but it will help reduce unwarranted fear, anxiety and distrust. Consequently, if a government agency fails to understand how to effectively communicate about health risks, their trustworthiness and credibility may suffer, and a crisis event may go from bad to worse.

Intentions to donate to a biobank in a national sample of African Americans.

PubMed

McDonald, Jasmine A; Vadaparampil, Susan; Bowen, Deborah; Magwood, Gayenell; Obeid, Jihad S; Jefferson, Melanie; Drake, Richard; Gebregziabher, Mulugeta; Hughes Halbert, Chanita

2014-01-01

Despite the investments being made to develop biobanks, African Americans are under-represented in genomic studies. We identified factors having significant independent associations with intentions to donate personal health information and blood and/or tissue samples to a biobank in a national random sample of African Americans (n = 1,033). We conducted a national survey from October 2010 through February 2011. Twenty-three percent of respondents reported that it was not at all likely that they would donate to a biobank, 18% reported it was a little likely, 36% reported it was somewhat likely, and 23% reported it was very likely. Respondents who were likely to donate to a biobank had greater positive expectations about participating in cancer genetics research and reported more participation facilitators relative to barriers. Respondents who were distrustful of researchers had a significantly lower likelihood of being willing to donate to a biobank compared to those who were less distrustful. African Americans have diverse attitudes about participating in genetics research, and many are likely to donate to a biobank based on expectations of positive outcomes. It may be important to address attitudes about genetics research as part of recruitment to enhance the quality of informed consent for participation in biobanks among African Americans. © 2014 S. Karger AG, Basel.

Intentions to Donate to a Biobank in a National Sample of African Americans

PubMed Central

McDonald, Jasmine A.; Vadaparampil, Susan; Bowen, Deborah; Magwood, Gayenell; Obeid, Jihad S.; Jefferson, Melanie; Drake, Richard; Gebregziabher, Mulugeta; Halbert, Chanita Hughes

2015-01-01

Background/Aims Despite the investments being made to develop biobanks, African Americans are under-represented in genomic studies. We identified factors having significant independent associations with intentions to donate personal health information and blood and/or tissue samples to a biobank in a national, random sample of African Americans (n=1,033). Methods National survey conducted from October 2010 through February 2011. Results 23% of respondents reported that it was not at all likely that they would donate to a biobank, 18% reported a little likely, 36% reported somewhat likely, and 23% reported very likely. Respondents who were likely to donate to a biobank had greater positive expectations about participating in cancer genetics research and reported more participation facilitators relative to barriers. Respondents who were distrustful of researchers had a significantly lower likelihood of being willing to donate to a biobank compared to those who were less distrustful. Conclusions African Americans have diverse attitudes about participating in genetics research and many are likely to donate to a biobank based on expectations of positive outcomes. It may be important to address attitudes about genetics research as part of recruitment to enhance the quality of informed consent for participation in biobanks among African Americans. PMID:24942180

The spiral of distrust: (Non-)cooperation in a repeated trust game is predicted by anger and individual differences in negative reciprocity orientation.

PubMed

Harth, Nicole S; Regner, Tobias

2017-12-01

This study investigated state anger and individual differences in negative reciprocity orientation as predictors of individuals' willingness to cooperate with strangers. In order to observe real behaviour, we used a trust game that was played over six periods. In the trust game, a first player (sender) determines how much of a certain endowment she/he wants to share with a second player (trustee), who then can give something back. We varied whether participants received feedback [feedback (yes, no)] about the trustee's behavioural decision (amount sent back). Supporting our hypotheses, the results suggest that feedback compared with no feedback about the trustee's behaviour increased anger. Specifically, information about low back transfers triggered anger and non-cooperation in return. Importantly, participants with a strong negative reciprocity orientation reported higher levels of anger and were less willing to cooperate with the trustee compared with those with low negative reciprocity orientation. Moreover, even when anger was low, individuals with a strong negative reciprocity orientation were less willing to cooperate compared with those with a low negative reciprocity orientation. Thus, negative reciprocity orientation seems to arouse a spiral of distrust. Theoretical and practical implications of these findings are discussed. © 2016 International Union of Psychological Science.

Trust and doubt, an examination of children's decision to believe what they are told about food

PubMed Central

Nguyen, Simone P.; Gordon, Cameron L.; Chevalier, Tess; Girgis, Helena

2016-01-01

The domain of food is one that is highly relevant and vital to the everyday lives of children. However, children's reasoning about this domain is poorly understood within the field of developmental psychology. Because children's learning about food, including its evaluative components (e.g., health, taste) is so heavily dependent upon information conveyed by other people, a major developmental challenge that children face is determining who to distrust regarding food. In three studies, this investigation examined how 3- to 4-year-olds and adults (N = 312) use different cues to determine when to ignore informant information (i.e., distrust what an informant tells them by choosing an alternative) in food- and nonfood-specific scenarios. The results of Study 1 indicated that by age 4, children are less trusting of inaccurate sources of information compared with sources that have not demonstrated previous inaccuracy. Study 2 revealed that these results are applicable across the domain of objects. The results of Study 3 indicated that by age 4, children trust benevolent sources more often than malevolent ones. Thus, when reasoning about the evaluative components of food, by age 4, children appraise other people's untrustworthiness by paying attention to their inaccuracy and malevolence. PMID:26704303

Trust and doubt: An examination of children's decision to believe what they are told about food.

PubMed

Nguyen, Simone P; Gordon, Cameron L; Chevalier, Tess; Girgis, Helana

2016-04-01

The domain of food is one that is highly relevant and vital to the everyday lives of children. However, children's reasoning about this domain is poorly understood within the field of developmental psychology. Because children's learning about food, including its evaluative components (e.g., health, taste) is so heavily dependent on information conveyed by other people, a major developmental challenge that children face is determining who to distrust regarding food. In three studies, this investigation examined how 3- and 4-year-olds and adults (N=312) use different cues to determine when to ignore informant information (i.e., distrust what an informant tells them by choosing an alternative) in food- and non-food-specific scenarios. The results of Study 1 indicated that by age 4 years, children are less trusting of inaccurate sources of information compared with sources that have not demonstrated previous inaccuracy. Study 2 revealed that these results are applicable across the domain of objects. The results of Study 3 indicated that by age 4, children trust benevolent sources more often than malevolent ones. Thus, when reasoning about the evaluative components of food, by age 4, children appraise other people's untrustworthiness by paying attention to their inaccuracy and malevolence. Copyright © 2015 Elsevier Inc. All rights reserved.

Knowledge, perceptions and preferences of elderly regarding protein-enriched functional food.

PubMed

van der Zanden, Lotte D T; van Kleef, Ellen; de Wijk, René A; van Trijp, Hans C M

2014-09-01

Promoting protein consumption in the elderly population may contribute to improving the quality of their later years in life. Our study aimed to explore knowledge, perceptions and preferences of elderly consumers regarding protein-enriched food. We conducted three focus groups with independently living (ID) elderly (N = 24, Mage = 67 years) and three with elderly living in a residential home (RH) (N = 18, Mage = 83 years). Both the ID and RH elderly were predominantly sceptical about functional food in general. Confusion, distrust and a perceived lack of personal relevance were main perceived barriers to purchasing and consuming these products, although a majority of the participants did report occasionally consuming at least one type of functional food. For the ID elderly, medical advice was an important facilitator that could overcome barriers to purchasing and consuming protein-enriched food, indicating the importance of personal relevance for this group. For the RH elderly, in contrast, sensory appeal of protein-enriched foods was a facilitator. Carrier preferences were similar for the two groups; the elderly preferred protein-enriched foods based on healthy products that they consumed frequently. Future studies should explore ways to deal with the confusion and distrust regarding functional food within the heterogeneous population of elderly. Copyright © 2014 Elsevier Ltd. All rights reserved.

Why Breast Cancer Risk by the Numbers Is Not Enough: Evaluation of a Decision Aid in Multi-Ethnic, Low-Numerate Women

PubMed Central

Yi, Haeseung; Xiao, Tong; Thomas, Parijatham; Aguirre, Alejandra; Smalletz, Cindy; David, Raven; Crew, Katherine

2015-01-01

Background Breast cancer risk assessment including genetic testing can be used to classify people into different risk groups with screening and preventive interventions tailored to the needs of each group, yet the implementation of risk-stratified breast cancer prevention in primary care settings is complex. Objective To address barriers to breast cancer risk assessment, risk communication, and prevention strategies in primary care settings, we developed a Web-based decision aid, RealRisks, that aims to improve preference-based decision-making for breast cancer prevention, particularly in low-numerate women. Methods RealRisks incorporates experience-based dynamic interfaces to communicate risk aimed at reducing inaccurate risk perceptions, with modules on breast cancer risk, genetic testing, and chemoprevention that are tailored. To begin, participants learn about risk by interacting with two games of experience-based risk interfaces, demonstrating average 5-year and lifetime breast cancer risk. We conducted four focus groups in English-speaking women (age ≥18 years), a questionnaire completed before and after interacting with the decision aid, and a semistructured group discussion. We employed a mixed-methods approach to assess accuracy of perceived breast cancer risk and acceptability of RealRisks. The qualitative analysis of the semistructured discussions assessed understanding of risk, risk models, and risk appropriate prevention strategies. Results Among 34 participants, mean age was 53.4 years, 62% (21/34) were Hispanic, and 41% (14/34) demonstrated low numeracy. According to the Gail breast cancer risk assessment tool (BCRAT), the mean 5-year and lifetime breast cancer risk were 1.11% (SD 0.77) and 7.46% (SD 2.87), respectively. After interacting with RealRisks, the difference in perceived and estimated breast cancer risk according to BCRAT improved for 5-year risk (P=.008). In the qualitative analysis, we identified potential barriers to adopting risk-appropriate breast cancer prevention strategies, including uncertainty about breast cancer risk and risk models, distrust toward the health care system, and perception that risk assessment to pre-screen women for eligibility for genetic testing may be viewed as rationing access to care. Conclusions In a multi-ethnic population, we demonstrated a significant improvement in accuracy of perceived breast cancer risk after exposure to RealRisks. However, we identified potential barriers that suggest that accurate risk perceptions will not suffice as the sole basis to support informed decision making and the acceptance of risk-appropriate prevention strategies. Findings will inform the iterative design of the RealRisks decision aid. PMID:26175193

'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital

PubMed Central

Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han

2015-01-01

Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place. Additionally promoting communication and interaction among health workers can foster team spirit. Also resolving conflicts using the collaborating response may help to create a conducive work environment that will promote healthy work relations, which can facilitate the delivery of quality maternal and neonatal health care. However, such an approach requires that unequal power relations, which is a root cause of the conflicts is addressed. PMID:26285108

Greek health professionals' perceptions of the HPV vaccine, state policy recommendations and their own role with regards to communication of relevant health information.

PubMed

Karamanidou, Christina; Dimopoulos, Kostas

2016-06-03

Every year in Europe 60,000 women develop cervical cancer and 30,000 die from the disease. HPV vaccines are currently believed to constitute an important element of cervical cancer control strategy. Currently in Greece, the HPV vaccine is given on demand after prescription by a healthcare professional. Health care professionals' role is key as they are in a position to discuss HPV vaccination with parents, adolescents and young women. This study is aiming to explore health care professionals' perceptions of the HPV vaccine, state policy recommendations and their own role with regards to communication of relevant health information. This was an in-depth, qualitative study, employing a stratified, purposeful sampling. Fifteen face-to-face, semi-structured interviews were conducted with health care professionals from a variety of disciplines: pediatrics, obstetrics and gynecology, infectious diseases, pharmacy, dermatology, general practice. Thematic qualitative analysis was used to analyze participants' accounts. Five major themes were identified: health care professionals' perceptions towards the HPV vaccine (recognition of importance, concerns about safety, effectiveness and impact of long-term use), animosity between medical specialties (territorial disputes among professional bodies, role advocacy, role limitations), health care professionals' perceptions of the public's attitudes (effects of cultural beliefs, health professionals' attitudes, media and family), the role of the state (health policy issues, lack of guidance, unmet expectations) and their own role (provision of health information, sex education). Health professionals' concerns, lack of role definition and uniform information provision have led to territorial disputes among professional bodies and distrust among different medical specialties. Positive and negative judgements deriving from a multitude of sources have resulted in the confusion of the general public, as manifested by low vaccination rates. Due to the lack of clear regulation of vaccination prescription, administration and mode of delivery, factors such as lack of knowledge, cultural beliefs and personal attitudes have shaped the vaccination landscape. These factors have neither been explored nor addressed prior to the initiation of this public health effort and as such there is an evident less than efficient use of resources.

The Lynchpin Grapples with Frustration and Distrust

DTIC Science & Technology

2012-06-01

contingencies that would trigger the extended nuclear deterrent (END). Obviously, the use of nuclear weapons by the North will trigger END, but so too...2011, notably the Fukushima nuclear accident, affected Japan and its role in the region? What is the situation in the South China Sea? Have the East...threaten to upend relations include: the Korea-US free trade agreement; OPCON transfer; CFC dissolution; the US-ROK 123 nuclear negotiations; US-ROK

Technology Sound not Technology Bound: The Risks of Over-Reliance on Modern Military Capabilities

DTIC Science & Technology

2009-02-19

OF A DIVISIVE AND DISTRUSTFUL ATMOSPHERE People express emotions, beliefs, and mood through body language, intonation , and subtle... perception of the situation provided by command and control PC is a threat to the tactical commander whose immersion in the situation is far more...accurate. That perception can, in many cases, become the catalyst for the abandonment of decentralized control and in turn lead to a tactical defeat

Security Requirements for Post-Transition Cuba

DTIC Science & Technology

2007-08-01

modern circum-Caribbean militaries: control of air- and sea -space against transnational criminals. The military will need a new structure for these...in the yacht , Granma, landing near Playa de Las Colorados in Oriente Province on December 2, 1956. This area of southeastern Cuba had been where...Communist Party of Cuba did 10 not support Fidel until early 1958,14 which irritated him and caused him to distrust the party. By January 1, 1959, the

Opaque Communities: A Framework for Assessing Potential Homeland Security Threats from Voids on the Map

DTIC Science & Technology

2014-09-01

prophecies and statements contained in the King James Version of the Bible were applicable to current events and could be deciphered to predict the...Davidians maintained SDA traditions of being distrustful of both governmental authority and secularism while promoting a Bible -centric lifestyle.66 The group...extent possible. Through their unique religious practices, devotion to Bible study, and special diet, members maintained a regimented lifestyle that

Test and Evaluation of TRUST: Tools for Recognizing Useful Signals of Trustworthiness

DTIC Science & Technology

2016-04-01

guaranteed, social exchange requires trust—the belief that others will follow through on their obligations. The model includes the beliefs that...current reflection could be measured based on properties of the skin, and (2) skin conductance response (SCR), where the fastest could be measured and...SEM prediction (H4d). The results of the LF HRV signals indicate the SEM model predicts distrust base on the experimental SS paradigm and SEM

Patient Race and Outcome Preferences as Predictors of Urologists Treatment Recommendations and Referral Patterns in Early-Stage Prostate Cancer

DTIC Science & Technology

2006-11-01

option for cure [12]. Although African Americans are more likely to fear surgery and distrust physicians than members of other racial/ethnic groups...disadvantaged patients are less appropriate for surgery . Such patients might be more likely to experience postoperative complications and require longer...Center, Denver, Colorado 80262. phone: 303-372-9432; e-mail: tom.denberg@uchsc.edu Key words: surgery ; prostatectomy; surgical volume; postoperative

The New Structure of Brazilian Ministry of Defense: Challenges and Opportunities

DTIC Science & Technology

2011-03-04

collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT...second, to ensure that military power would be under civilian control . The election of the two next presidents, Fernando Henrique Cardoso, of the...but under new leadership. But, what happened concerning civilian control over the military? This has not been easy, particularly because of distrust

An Exploratory Study on University Students' Perceptions of Posthumous Organ Donation Base on the Theory of Reasoned Action.

PubMed

Wong, Shui Hung; Chow, Amy Yin Man

2017-08-01

In view of the general support for organ donation but low registration rate in Hong Kong, the present research attempted to understand the attitude-behavior inconsistency by identifying the underlying beliefs for organ donation through employing the theory of reasoned action. A qualitative approach using semi-structured focus groups was adopted and 19 students from three universities in Hong Kong participated; 10 constructs were identified: attitude, subjective norm, helping, continuation, contribution, body intact, distrust to the medical system, indifference to organ donation, negative affect, and family burden. Findings suggested that their attitudes toward organ donation were of both the cognitive and affective nature; subjective norm of family, friends, and people they respect were identified as influential to students' views on organ donation. The study provided insight in promoting organ donation, that the cognitive concerns about keeping the body intact, and the negative affects introduced should also be addressed.

[Dynamics and interactions between the university community and public health 2.0].

PubMed

Rodríguez-Gómez, Rodolfo

2016-01-01

To explore the experiences of a group of participants in a university community with the web in general and with digital contents on public health, to describe their motivations and to understand how social networks influence their interaction with content on public health. Qualitative research. Deep semi-structured interviews were conducted to understand the phenomenon. Five categories emerged after the study: socialization and internalization of the cyberculture, social marketing linked to the web and public health, culture of fear and distrust, the concept of health, and the health system and public health. Participants have internalized the web and have given it a strong symbolic capital. The challenges of public health 2.0 are not only to achieve interaction with users and to get a place in cyberspace, but also to fight against the stigma of the "public" and to take advantage of the influence of the web on small-world networks to communicate.

Experimental plug and play quantum coin flipping.

PubMed

Pappa, Anna; Jouguet, Paul; Lawson, Thomas; Chailloux, André; Legré, Matthieu; Trinkler, Patrick; Kerenidis, Iordanis; Diamanti, Eleni

2014-04-24

Performing complex cryptographic tasks will be an essential element in future quantum communication networks. These tasks are based on a handful of fundamental primitives, such as coin flipping, where two distrustful parties wish to agree on a randomly generated bit. Although it is known that quantum versions of these primitives can offer information-theoretic security advantages with respect to classical protocols, a demonstration of such an advantage in a practical communication scenario has remained elusive. Here we experimentally implement a quantum coin flipping protocol that performs strictly better than classically possible over a distance suitable for communication over metropolitan area optical networks. The implementation is based on a practical plug and play system, developed by significantly enhancing a commercial quantum key distribution device. Moreover, we provide combined quantum coin flipping protocols that are almost perfectly secure against bounded adversaries. Our results offer a useful toolbox for future secure quantum communications.

Experimental loss-tolerant quantum coin flipping

PubMed Central

Berlín, Guido; Brassard, Gilles; Bussières, Félix; Godbout, Nicolas; Slater, Joshua A.; Tittel, Wolfgang

2011-01-01

Coin flipping is a cryptographic primitive in which two distrustful parties wish to generate a random bit to choose between two alternatives. This task is impossible to realize when it relies solely on the asynchronous exchange of classical bits: one dishonest player has complete control over the final outcome. It is only when coin flipping is supplemented with quantum communication that this problem can be alleviated, although partial bias remains. Unfortunately, practical systems are subject to loss of quantum data, which allows a cheater to force a bias that is complete or arbitrarily close to complete in all previous protocols and implementations. Here we report on the first experimental demonstration of a quantum coin-flipping protocol for which loss cannot be exploited to cheat better. By eliminating the problem of loss, which is unavoidable in any realistic setting, quantum coin flipping takes a significant step towards real-world applications of quantum communication. PMID:22127057

[Users sceptical about generic drugs: an anthropological approach].

PubMed

Sarradon-Eck, A; Blanc, M-A; Faure, M

2007-06-01

Since the enactment of the 2002 legislative measures favoring the prescription of generic drugs, various quantitative studies have shown that approval by prescribers and users has risen in France. Nevertheless, scepticism remains as well as distrust towards these drugs focusing on their effectiveness compared with brand-name drugs, on potential dangers, and on the interruption they cause in prescription and consumption habits. Using a comprehensive approach, this article analyzes the social and cultural logic behind the negative image of generic drugs. The materials issued from an ethnographic study on the prescription of drugs for high blood pressure. Sixty-eight interviews were undertaken between April 2002 and October 2004 with people (39 women and 29 men, between the age of 40 and 95, 52 over the age of 60) treated for over a year for high blood pressure in rural areas in the Southeast of France. Thirteen people provided unsolicited opinions about generic drugs. Analysis of the information collected shows that users have various representations of generic drugs, including the idea of counterfeited and foreign drugs. These representations interfere with the adjustment process and the development of consumer loyalty. They are part of a set of social representations about drugs which form and express the user's reality. In these representations, the drug is an ambivalent object, carrier of both biological effectiveness and toxicity; it is also the metonymical extension of the prescriber, bestowing upon the prescription a symbolic value. By placing the generic drug in its network of symbolic and social meaning, this study highlights the coherence of the scepticism towards generic drugs by consumers (and prescribers) with a system of common opinion in which drugs are everyday things, personalized and compatible with users, symbolic exchange carriers in the physician-patient relationship, and in which confidence in the drug is also that given to the health care system in general.

Why wait? The social determinants underlying tuberculosis diagnostic delay

PubMed Central

Saunders, Matthew James; Zegarra, Roberto; Evans, Carlton; Alegria-Flores, Kei; Guio, Heinner

2017-01-01

Background Early detection and diagnosis of tuberculosis remain major global priorities for tuberculosis control. Few studies have used a qualitative approach to investigate the social determinants contributing to diagnostic delay and none have compared data collected from individual, community, and health-system levels. We aimed to characterize the social determinants that contribute to diagnostic delay among persons diagnosed with tuberculosis living in resource-constrained settings. Methods/Principle findings Data were collected in public health facilities with high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured interviews with persons diagnosed with tuberculosis (n = 105) and their family members (n = 63) explored health-seeking behaviours, community perceptions of tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were conducted with health personnel (n = 35) working in the National Tuberculosis Program. All interview data were transcribed and analysed using a grounded theory approach. The median delay between symptom onset and the public health facility visit that led to the first positive diagnostic sample was 57 days (interquartile range 28–126). The great majority of persons diagnosed with tuberculosis distrusted the public health system and sought care at public health facilities only after exhausting other options. It was universally agreed that persons diagnosed with tuberculosis faced discrimination by public and health personnel. Self-medication with medicines bought at local pharmacies was reported as the most common initial health-seeking behaviour due to the speed and low-cost of treatment in pharmacies. Most persons diagnosed with tuberculosis initially perceived their illness as a simple virus. Conclusions Diagnostic delay was common and prolonged. When individuals reached a threshold of symptom severity, they addressed their health with the least time-consuming, most economically feasible, and well-known healthcare option available to them. In high-burden settings, more human and material resources are required to promote tuberculosis case-finding initiatives, reduce tuberculosis associated stigma and address the social determinants underlying diagnostic delay. PMID:28945782

Why wait? The social determinants underlying tuberculosis diagnostic delay.

PubMed

Bonadonna, Lily Victoria; Saunders, Matthew James; Zegarra, Roberto; Evans, Carlton; Alegria-Flores, Kei; Guio, Heinner

2017-01-01

Early detection and diagnosis of tuberculosis remain major global priorities for tuberculosis control. Few studies have used a qualitative approach to investigate the social determinants contributing to diagnostic delay and none have compared data collected from individual, community, and health-system levels. We aimed to characterize the social determinants that contribute to diagnostic delay among persons diagnosed with tuberculosis living in resource-constrained settings. Data were collected in public health facilities with high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured interviews with persons diagnosed with tuberculosis (n = 105) and their family members (n = 63) explored health-seeking behaviours, community perceptions of tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were conducted with health personnel (n = 35) working in the National Tuberculosis Program. All interview data were transcribed and analysed using a grounded theory approach. The median delay between symptom onset and the public health facility visit that led to the first positive diagnostic sample was 57 days (interquartile range 28-126). The great majority of persons diagnosed with tuberculosis distrusted the public health system and sought care at public health facilities only after exhausting other options. It was universally agreed that persons diagnosed with tuberculosis faced discrimination by public and health personnel. Self-medication with medicines bought at local pharmacies was reported as the most common initial health-seeking behaviour due to the speed and low-cost of treatment in pharmacies. Most persons diagnosed with tuberculosis initially perceived their illness as a simple virus. Diagnostic delay was common and prolonged. When individuals reached a threshold of symptom severity, they addressed their health with the least time-consuming, most economically feasible, and well-known healthcare option available to them. In high-burden settings, more human and material resources are required to promote tuberculosis case-finding initiatives, reduce tuberculosis associated stigma and address the social determinants underlying diagnostic delay.

Selectively willing and conditionally able: HIV vaccine trial participation among women at "high risk" of HIV infection.

PubMed

Voytek, Chelsea D; Jones, Kevin T; Metzger, David S

2011-08-18

Efficacy studies of investigational HIV vaccines require enrollment of individuals at 'high risk' for HIV. This paper examines participation in HIV vaccine trials among women at 'high risk' for HIV acquisition. In-depth interviews were conducted with 17 African-American women who use crack cocaine and/or exchange sex for money/drugs to elicit attitudes toward medical research and motivators and deterrents to HIV vaccine trial participation. Interviews were digitally recorded and transcribed; data were coded and compiled into themes. Most women expressed favorable attitudes toward medical research in general. Motivators for trial participation included compensation; personal benefits including information, social services, and the possibility that the trial vaccine could prevent HIV; and altruism. Deterrents included: dislike of needles; distrust; concern about future consequences of participating. In addition, contingencies, care-giving responsibilities, and convenience issues constituted barriers which could impede participation. Respondents described varied, complex perspectives, and individual cases illustrate how these themes played out as women contemplated trial participation. Understanding factors which influence vaccine research participation among women at 'high risk' can aid sites to tailor recruitment procedures to local contexts. Concerns about future reactions can be addressed through sustained community education. Convenience barriers can be ameliorated by providing rides to study visits when necessary, and/or conducting study visits in accessible neighborhood locations. Women in this sample thought carefully about enrolling in HIV vaccine trials given the structural constraints within which they lived. Further research is needed regarding structural factors which influence personal agency and individuals' thinking about research participation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese.

PubMed

Silva, Fernanda Gonçalves da; Andrade, Renata; Silva, Isabor; Cardoso, Adriana

2016-01-01

The internet has proven to be a valuable resource for self-care, allowing access to information and promoting interaction between professionals, caregivers, users of health care services and people interested in health information. However, recurring searches are often related to excessive health anxiety and a phenomenon known as cyberchondria can have impacts on physical and mental health. Within this background, a Cyberchondria Severity Scale has been developed to differentiate healthy and unhealthy behavior in internet searches for health information, based on the following criteria: compulsion, distress, excesses, and trust and distrust of health professionals. To conduct cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese, because of the lack of an appropriate instrument for Brazil. This study was authorized by the original author of the scale. The process was divided into the following four steps: 1) initial translation, 2) back-translation, 3) development of a synthesized version, and 4) experimental application. Translation into Brazilian Portuguese required some idiomatic expressions to be adapted. In some cases, words were not literally translated from English into Portuguese. Only items 7, 8, 12, 23 and 27 were altered, as a means of both conforming to proper grammar conventions and achieving easy comprehension. The items were rewritten without loss of the original content. This paper presents a translated version of the Cyberchondria Severity Scale that has been semantically adapted for the Brazilian population, providing a basis for future studies in this area, which should in turn contribute to improved understanding of the cyberchondria phenomenon in this population.

ENHANCING STAKEHOLDER ACCEPTANCE OF BIOREMEDIATION TECHNOLOGIES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Focht, Will; Albright, Matt; Anex, Robert P., Jr., ed.

2009-04-21

This project inquired into the judgments and beliefs of people living near DOE reservations and facilities at Oak Ridge, Tennessee; Hanford, Washington; and Los Alamos, Tennessee about bioremediation of subsurface contamination. The purpose of the investigation was to identify strategies based on these judgments and beliefs for enhancing public support of bioremediation. Several methods were used to collect and analyze data including content analysis of transcripts of face-to-face personal interviews, factor analysis of subjective perspectives using Q methodology, and statistical analysis of results from a large-sample randomized telephone survey. Content analysis of interview transcripts identified themes about public perceptions andmore » constructions of contamination risk, risk management, and risk managers. This analysis revealed that those who have no employment relationship at the sites and are not engaged in technical professions are most concerned about contamination risks. We also found that most interviewees are unfamiliar with subsurface contamination risks and how they can be reduced, believe they have little control over exposure, are frustrated with the lack of progress in remediation, are concerned about a lack of commitment of DOE to full remediation, and distrust site managers to act in the public interest. Concern is also expressed over frequent site management turnover, excessive secrecy, ineffective and biased communication, perceived attempts to talk the public into accepting risk, and apparent lack of concern about community welfare. In the telephone survey, we asked respondents who were aware of site contamination about their perceptions of risk from exposure to subsurface contamination. Response analysis revealed that most people believe that they are at significant risk from subsurface contamination but they acknowledge that more education is needed to calibrate risk perceptions against scientific risk assessments. Most rate their personal control over exposure as low. Slightly more than half believe that risk reduction should be balanced against cost. We also found that distrust of DOE and its contractors exists, primarily due to the perception that site managers do not share public values; hence, the public is generally unwilling to defer to DOE in its decision-making. The concomitant belief of inefficacy confounds distrust by generating frustration that DOE does not care. Moreover, the public is split with respect to trust of each other, primarily because of the belief that citizens lack technical competence. With respect to bioremediation support, we found that more than 40% of the public has no opinion. However, of those who do, 3 of 4 are favorably disposed – particularly among those who believe that risk is lower and who are more trusting of site management. We presented survey respondents with four alternative participation strategies based on the results of the Q analysis and asked their judgments of each. The public prefers strategies that shifts power to them. The least empowered strategy (feedback) was supported by 46%; support grew as public power increased, reaching 66% support for independently facilitated deliberation. More DOE distrust generates more support for high power strategies. We offer the following recommendations to enhance public acceptance. First, and perhaps most importantly, site managers should pursue robust trust-building efforts to gain public confidence in DOE risk management that meets public expectations. Public trust decreases risk perception, which increases public willingness to defer to site managers’ discretion in decision-making, which in turn increases public acceptance of the decisions that result. Second, site managers should address public concerns about bioremediation such as its effectiveness in reducing risk, performance compared to other remediation alternatives, costs compared against benefits, time required to start and complete remediation, level of risk that is currently posed by contamination, and scope of application. Third, more should be done to involve the public in bioremediation decision-making. We recommend a two-stage process: independent facilitated deliberation to build trust and address concerns about the motives and competence of site managers, followed by consultation to maintain that trust. Both stages should be inclusive, transparent, and respectful. Participation objectives and roles of participants should be well specified by the participants. A record of discussion should be published that codifies the concerns raised and how they were addressed, which will facilitate progress by averting the need to reconsider the same issues repeatedly. It is most important that the processes convince the public that its participation influences decision outcomes and that participants genuinely (informed and voluntarily) consent to risk exposure.« less

Armenia, Azerbaijan, and Georgia: Political Developments and Implications for U.S. Interests

DTIC Science & Technology

2011-04-15

of the diplomats] to implement in Azerbaijan the experiments of Arab countries, some of them should be declared persona non grata.” An official of...protections for human rights, including by releasing two Internet bloggers jailed for hooliganism in November 2009 (they were released in November 2010).6...the “frozen Nagorno Karabakh conflict,” in which “heightened rhetoric and distrust on both sides and violent incidents along the Line of Contact

Forest conflict in Thailand: northern minorities in focus.

PubMed

Hares, Minna

2009-03-01

This paper aims at exploring the local background of and solutions to the forest conflict in upland areas inhabited by ethnic minorities, who are called hill tribes, in northern Thailand. A so-called hill tribe problem has been officially identified as a result of the slash-and-burn cultivation and other perceived problems, such as opium poppy cultivation, illegal immigration, and the suspicion of disloyalty to the state. This has created distrust and tension between the groups and authorities. The local conflict has recently been related to the dilemma of conserving the forest from all human interference, while many people live and make their livelihood within and adjacent to the protected areas. Furthermore, as the results imply, strictly protected areas and reforestation have also increased the competition over land and natural resources and, thereby, the likelihood of local conflicts. The scarcity and pollution of water, illegal logging, and poor fire control have contributed to the conflicts between local communities. The conflicts between the local communities and officials have been nourished by political and public discussions. Using definitions and terms with negative connotations and ignoring the heterogeneity between the groups or labeling some groups as malevolent have increased distrust and strengthened existing stereotypical images. Conflict resolution starts with efforts toward better mutual understanding, and changes in structures and attitudes are necessary. Local cooperation, utilization of traditional methods, and local institutions are central to conflict solving.

Distrust of the senses and its association with obsessive-compulsive symptoms.

PubMed

Wong, Shiu F; Williams, Alishia D; Grisham, Jessica R

2017-12-01

Leading cognitive theories of OCD suggests that despite prevalent and persistent doubt, individuals with OCD do not have perceptual deficits. An alternate cognitive theory, the Seeking Proxies for Internal States hypothesis (SPIS), proposes that sensory distrust in OCD stems from actual deficits in accessing internal states. Consistent with the SPIS, previous research has found that high-OC individuals were less accurate than low-OC individuals in producing target levels of muscle tension in a biofeedback task and that OC symptoms were positively associated with reliance on an external proxy. The current study aimed to replicate and extend the SPIS hypothesis in two experiments using a modified version of the biofeedback-aided muscle tensing task using grip strength as the sensory input and a distance perception task. We contrasted the performance of undergraduate students self-reporting high- and low-OC symptoms. Overall, our findings failed to substantially support the SPIS hypothesis such that OC symptoms were not associated with deficient access to internal states of grip strength and distance perception or increased reliance on feedback. As this study was conducted in a non-clinical sample, we were unable to generalise our findings to a clinical population. Findings are commensurate with the wider OCD literature suggesting the absence of cognitive and perceptual deficits in OCD individuals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Forest Conflict in Thailand: Northern Minorities in Focus

NASA Astrophysics Data System (ADS)

Hares, Minna

2009-03-01

This paper aims at exploring the local background of and solutions to the forest conflict in upland areas inhabited by ethnic minorities, who are called hill tribes, in northern Thailand. A so-called hill tribe problem has been officially identified as a result of the slash-and-burn cultivation and other perceived problems, such as opium poppy cultivation, illegal immigration, and the suspicion of disloyalty to the state. This has created distrust and tension between the groups and authorities. The local conflict has recently been related to the dilemma of conserving the forest from all human interference, while many people live and make their livelihood within and adjacent to the protected areas. Furthermore, as the results imply, strictly protected areas and reforestation have also increased the competition over land and natural resources and, thereby, the likelihood of local conflicts. The scarcity and pollution of water, illegal logging, and poor fire control have contributed to the conflicts between local communities. The conflicts between the local communities and officials have been nourished by political and public discussions. Using definitions and terms with negative connotations and ignoring the heterogeneity between the groups or labeling some groups as malevolent have increased distrust and strengthened existing stereotypical images. Conflict resolution starts with efforts toward better mutual understanding, and changes in structures and attitudes are necessary. Local cooperation, utilization of traditional methods, and local institutions are central to conflict solving.

System to Detect Racial-Based Bullying through Gamification.

PubMed

Álvarez-Bermejo, José A; Belmonte-Ureña, Luis J; Martos-Martínez, Africa; Barragán-Martín, Ana B; Del Mar Simón-Marquez, María

2016-01-01

Prevention and detection of bullying due to racial stigma was studied in school contexts using a system designed following "gamification" principles and integrating less usual elements, such as social interaction, augmented reality and cell phones in educational scenarios. "Grounded Theory" and "User Centered Design" were employed to explore coexistence inside and outside the classroom in terms of preferences and distrust in several areas of action and social frameworks of activity, and to direct the development of a cell phone app for early detection of school bullying scenarios. One hundred and fifty-one interviews were given at five schools selected for their high multiracial percentage and conflict. The most outstanding results were structural, that is the distribution of the classroom group by type of activity and subject being dealt with. Furthermore, in groups over 12 years of age, the relational structures in the classroom in the digital settings in which they participated with their cell phones did not reoccur, because face-to-face and virtual interaction between students with the supervision and involvement of the teacher combined to detect bullying caused by racial discrimination.

System to Detect Racial-Based Bullying through Gamification

PubMed Central

Álvarez-Bermejo, José A.; Belmonte-Ureña, Luis J.; Martos-Martínez, Africa; Barragán-Martín, Ana B.; del Mar Simón-Marquez, María

2016-01-01

Prevention and detection of bullying due to racial stigma was studied in school contexts using a system designed following “gamification” principles and integrating less usual elements, such as social interaction, augmented reality and cell phones in educational scenarios. “Grounded Theory” and “User Centered Design” were employed to explore coexistence inside and outside the classroom in terms of preferences and distrust in several areas of action and social frameworks of activity, and to direct the development of a cell phone app for early detection of school bullying scenarios. One hundred and fifty-one interviews were given at five schools selected for their high multiracial percentage and conflict. The most outstanding results were structural, that is the distribution of the classroom group by type of activity and subject being dealt with. Furthermore, in groups over 12 years of age, the relational structures in the classroom in the digital settings in which they participated with their cell phones did not reoccur, because face-to-face and virtual interaction between students with the supervision and involvement of the teacher combined to detect bullying caused by racial discrimination. PMID:27933006

Prediction of adverse drug reactions using decision tree modeling.

PubMed

Hammann, F; Gutmann, H; Vogt, N; Helma, C; Drewe, J

2010-07-01

Drug safety is of great importance to public health. The detrimental effects of drugs not only limit their application but also cause suffering in individual patients and evoke distrust of pharmacotherapy. For the purpose of identifying drugs that could be suspected of causing adverse reactions, we present a structure-activity relationship analysis of adverse drug reactions (ADRs) in the central nervous system (CNS), liver, and kidney, and also of allergic reactions, for a broad variety of drugs (n = 507) from the Swiss drug registry. Using decision tree induction, a machine learning method, we determined the chemical, physical, and structural properties of compounds that predispose them to causing ADRs. The models had high predictive accuracies (78.9-90.2%) for allergic, renal, CNS, and hepatic ADRs. We show the feasibility of predicting complex end-organ effects using simple models that involve no expensive computations and that can be used (i) in the selection of the compound during the drug discovery stage, (ii) to understand how drugs interact with the target organ systems, and (iii) for generating alerts in postmarketing drug surveillance and pharmacovigilance.

When patients take the initiative to audio-record a clinical consultation.

PubMed

van Bruinessen, Inge Renske; Leegwater, Brigit; van Dulmen, Sandra

2017-08-01

to get insight into healthcare professionals' current experience with, and views on consultation audio-recordings made on patients' initiative. 215 Dutch healthcare professionals (123 physicians and 92 nurses) working in oncology care completed a survey inquiring their experiences and views. 71% of the respondents had experience with the consultation audio-recordings. Healthcare professionals who are in favour of the use of audio-recordings seem to embrace the evidence-based benefits for patients of listing back to a consultation again, and mention the positive influence on their patients. Opposing arguments relate to the belief that is confusing for patients or that it increases the chance that information is misinterpreted. Also the lack of control they have over the recording (fear for misuse), uncertainty about the medico-legal status, inhibiting influence on the communication process and feeling of distrust was mentioned. For almost one quarter of respondents these arguments and concerns were reason enough not to cooperate at all (9%), to cooperate only in certain cases (4%) or led to doubts about cooperation (9%). the many concerns that exist among healthcare professionals need to be tackled in order to increase transparency, as audio-recordings are expected to be used increasingly. Copyright © 2017 Elsevier B.V. All rights reserved.

Transforming Scientific Inquiry: Tapping Into Digital Data by Building a Culture of Transparency and Consent

PubMed Central

Smith, Robert J.; Grande, David; Merchant, Raina M.

2015-01-01

With over 1.7 billion individuals engaged in social media, patients and consumers share more about their lives than ever before through wearable devices, smart phone applications, and social media outlets. This cornucopia of data offers significant opportunity for health researchers and clinicians to track and explore how digital presence contributes to patients’ health outcomes and use of health care resources. While patients readily share their information with online communities, it is imperative that they maintain a sense of autonomy over who has access to such data. Recent data breaches of major insurance companies and retailers illustrate the challenges and vulnerabilities related to information safety and privacy. Many Websites and mobile apps require users to agree to data policies, but how those data are mined, protected, utilized, and externally shared is frequently non-transparent, resulting in a climate of fear and distrust around all forums of digital information sharing. While such skepticism is perhaps justified, it should not deter health researchers from attempting to collect and analyze these novel data for the purpose of designing unique health interventions. By clarifying intent around digital data acquisition, simplifying consent procedures, and affirming a commitment to privacy, the authors contend that health researchers can partner with patients to transform the boundaries of scientific inquiry. PMID:26630607

Transforming Scientific Inquiry: Tapping Into Digital Data by Building a Culture of Transparency and Consent.

PubMed

Smith, Robert J; Grande, David; Merchant, Raina M

2016-04-01

With over 1.7 billion individuals engaged in social media, patients and consumers share more about their lives than ever before through wearable devices, smartphone applications, and social media outlets. This cornucopia of data offers significant opportunity for health researchers and clinicians to track and explore how digital presence contributes to patients' health outcomes and use of health care resources. While patients readily share their information with online communities, it is imperative that they maintain a sense of autonomy over who has access to such data. Recent data breaches of major insurance companies and retailers illustrate the challenges and vulnerabilities related to information safety and privacy. Many Web sites and mobile apps require users to agree to data policies, but how those data are mined, protected, used, and externally shared is frequently nontransparent, resulting in a climate of fear and distrust around all forums of digital information sharing. Although such skepticism is perhaps justified, it should not deter health researchers from attempting to collect and analyze these novel data for the purpose of designing unique health interventions. By clarifying intent around digital data acquisition, simplifying consent procedures, and affirming a commitment to privacy, the authors contend that health researchers can partner with patients to transform the boundaries of scientific inquiry.

A Philosophical Case for OPCON Transition on the Korean Peninsula

DTIC Science & Technology

2011-01-01

Korean state was the fault of external meddling and the first step toward civil war. It is a perception that to this day is a source of distrust for...North Korean press statement intoned this message: “It is the unchanging strategic design of the United States to cling more tightly to South Korea...a collapse or jus post bellum situation, the perception that South Korea is in charge will be vital to any reasonable prospect for success

U.S. Navy Capstone Strategies & Concepts (1970-2009) With Context & Insights for the U.S. Navy of 2009 & Beyond

DTIC Science & Technology

2009-02-01

AUTHOR(S) Swartz, Peter, M. 5d. PROJECT NUMBER R0148 5e. TASK NUMBER 4223 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND...government inter-agency partners • US industrial base & shipbuilding • Little on USMC • Just distribution list & USMC CV TACAIR bid 104 Project ...Administration: • USN build -up, including MSC fleet • Distrusted commercial shipbuilding subsidies • Ended construction -differential policy • Allowed

An Unwelcome Future: Updating United States Countering Weapons of Mass Destruction Strategy Regarding Emerging Technology

DTIC Science & Technology

2015-04-23

botany, zoology, microbiology , physiology, biochemistry, and related subjects. This broad term is used throughout the strategy to emphasize the...exports for U.S. based food items, and developing long-term distrust of U.S. products. This is a short list of the likely outcomes of a major biological...successfully deliver a payload directly into the mouse’s stomach wall.21 The micro-motors then dissolved in the acid of the stomach, leaving no trace .22

Shift Focus on the Al Qaeda Network: A More Comprehensive Approach to Defeating Al Qaeda

DTIC Science & Technology

2012-06-15

Declaration of jihad against the United States,” Al-Islah ( Internet ), September 2, 1996. As analyzed in Michael Scheuer, Osama bin Laden (New York...He enhanced his charismatic persona by deliberately modeling his life after that of Mohammed, the Islamic prophet.25 The irony of bin Laden is that...with the sensitive topic of a political ideology linked with a religion whose population is overwhelmingly distrustful of the U.S. Much has been made

Lessons from the 1918 Influenza Pandemic: Using Historical Examples to Inform the Department of Defense’s Response to the Next Pandemic

DTIC Science & Technology

2013-04-01

international containment as near as possible to the origin of an outbreak. Conclusion: The influenza pandemic of 1918 was the most rapidly lethal...fighting strength. Troop ships from the US delivered 1,700 new influenza cases to Brest , France in September 1918.26 These sick soldiers, far from...the population of the US during the pandemic because distrust and terror follow fear. 47 Fear led people to question the origin of the

Iran’s Post-9/11 Grand Bargain: Missed Opportunity for Strategic Rapprochement Between Iran and the United States

DTIC Science & Technology

2013-05-23

relations , since the 1953 CIA orchestrated coup of Mohammad Mossadeq, is one of mutual distrust and policy error. Although successive American presidents...since 1979 have tried to improve relations , each effort failed because both sides refused to adjust the context through which they viewed the other...became less productive in early 2003, Iran proposed a grand bargain to settle differences and resume diplomatic relations . But President Bush chose to end

[The vaccination coverage rate: why is it so low?].

PubMed

Wembonyama, O

1994-01-01

The problems hampering vaccination programs in Zaire include the inaccessibility of vaccination posts, the deplorable condition of vaccines and supplies, transport difficulties, and community disinterest. Most vaccination posts in Zaire are physically inaccessible and poorly stocked. They lack skilled staff and are unable to provide quality care. They do not have the means of providing themselves with vaccine; shortages are so common that vaccination schedules are difficult to follow. Refrigerators are usually not available in vaccination centers and are often diverted to other uses if they are available. The instructions for storing vaccines are often incorrectly followed. Single-use needles and syringes continue to be reused. Vehicles assigned to vaccination programs are often used for the private benefit of program officials or their families. Misuse of vehicles contributes to their short life expectancy. Local communities are disinterested in vaccination programs because they do not contribute to immediate survival. Moreover, the population regularly experiences the death of correctly vaccinated children. Some persons distrust vaccination as a trick to render women sterile or cause fever and convulsions in children. Mass vaccination programs are so poorly organized that their failure is predictable. The officials in charge spend most of their time in their offices rather than getting to know the target populations, and are often more interested in publicity for themselves than in the program. Press coverage is indispensable, but it should be devoted to furthering the program and not the careers of the officials in charge. Training of vaccinators, stocking of vaccination posts, and other essential tasks are often left until the last minute and improvised rather than carefully planned and implemented. The vaccinators are often unemployed persons who have little knowledge of correct techniques. Vaccination coverage could be improved if planners and health officials would acquaint themselves with the target communities, their health problems, and their perceptions of the vaccination program. Vaccination posts, hours of operation, and date of vaccination programs should be carefully planned to ensure that they are accessible to the population. The community should be informed about the program and motivated to participate. The logistics should be carefully worked out, and the vaccinators should be trained well in advance of the campaign.

Consumer satisfaction with primary care provider choice and associated trust

PubMed Central

Chu-Weininger, Ming Ying L; Balkrishnan, Rajesh

2006-01-01

Background Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP), and to analyze the importance of these variables on provider trust. Methods A 1999 randomized national cross-sectional telephone survey conducted of United States residential households, who had a telephone, had seen a medical professional at least twice in the past two years, and aged ≥ 20 years was selected for secondary data analyses. Among 1,117 households interviewed, 564 were selected as the final sample. Subjects responded to a core set of questions related to provider trust, and a subset of questions related to trust in the insurer. A previously developed conceptual framework was adopted. Linear and logistic regressions were performed based on this framework. Results Results affirmed 'satisfaction with amount of PCP choice' was significantly (p < .001) associated with provider trust. 'PCP's care being extremely effective' was strongly associated with 'satisfaction with amount of PCP choice' and 'provider trust'. Having sought a second opinion(s) was associated with lower trust. 'Spoke to the PCP outside the medical office,' 'satisfaction with the insurer' and 'insurer charges less if PCP within network' were all variables associated with 'satisfaction with amount of PCP choice' (all p < .05). Conclusion This study confirmed the association of 'satisfaction with amount of PCP choice' with provider trust. Results affirmed 'enough PCP choice' was a strong predictor of provider trust. 'Second opinion on PCP' may indicate distrust in the provider. Data such as 'trust in providers in general' and 'the role of provider performance information' in choice, though import in PCP choice, were not available for analysis and should be explored in future studies. Results have implications for rethinking the relationships among consumer choice, consumer behaviors in making trade-offs in PCP choice, and the role of healthcare experiences in 'satisfaction with amount of PCP choice' or 'provider trust.' PMID:17059611

Are one-stop shops acceptable? Community perspectives on one-stop shop models of sexual health service provision in the UK.

PubMed

Griffiths, C; Gerressu, M; French, R S

2008-10-01

Traditionally, genitourinary medicine (GUM) and contraceptive services have been provided separately. Providing these services on one site, as a one-stop shop, has been suggested as a way of improving access to care. There is little evidence about the acceptability of such an approach. We aimed to assess acceptability of different one-stop shop models (a young people's, an all ages (mainstream) and a general practice service) of sexual health provision among different community groups. Between April and December 2005, 19 semi-structured interviews and 14 focus groups were conducted with young heterosexual men (n = 48), men who have sex with men (MSM; n = 46) and minority ethnic men and women (n = 28) across England. Knowledge of one-stop shops was limited. The concept was acceptable to participants (except MSM), although there was variation as to the preferred model. Young men and African individuals described distrust of general practice confidentiality, preferring young people's or mainstream models, respectively. South Asians associated stigma with GUM, preferring instead a general practice one-stop shop. Regardless of model, respondents expressed preference for one provider/one session to provide GUM and contraceptive care. In terms of acceptability there can be no blue print one-stop shop model. Local assessments should determine whether a one-stop shop would have public health benefit and if so how best one should be set up to maximise access. To accommodate client preference for one provider/session for their sexual health needs it may be that the development of "integrated training" for providers across clinical specialties is a more realistic way forward.

Emotional responses to unintentional and intentional traumatic injuries among urban black men: A qualitative study.

PubMed

Jiang, Tammy; Webster, Jessica L; Robinson, Andrew; Kassam-Adams, Nancy; Richmond, Therese S

2018-05-01

The burden of injuries is disproportionately concentrated among Black men in the United States. Previous studies suggest that the mental health effects of trauma may vary by the intentionality of the injury (intentional vs. unintentional), yet little is known about this experience among Black men. We explored the emotional responses to traumatic injuries in the context of injury intentionality among Black men in an urban area. We conducted semi-structured, qualitative interviews with 74 Black men who were traumatically injured. The interviews took place three months after discharge from the hospital and they were audiotaped, transcribed, and de-identified. We used systematic thematic analysis to identify themes about post-trauma emotional responses to intentional and unintentional injuries. The narratives of intentionally injured men revealed persistent exposure to neighborhood violence and their distrust of others including the people they knew and to whom they felt close. Survivors of unintentional injuries did not express a similar distrust of others. Our findings suggest that survivors of intentional injuries experience loss of social support following their injuries. Emotional responses can differ by intentionality of traumatic injury among urban Black men. Intentional injuries may be a marker for chronic exposure to violence and limited social support for recovery. Additional resources should be targeted to survivors of intentional injury who return to disadvantaged communities after medical treatment to decrease risk of re-traumatization and adverse emotional responses. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using the multiphase optimization strategy (MOST) to optimize an HIV care continuum intervention for vulnerable populations: a study protocol.

PubMed

Gwadz, Marya Viorst; Collins, Linda M; Cleland, Charles M; Leonard, Noelle R; Wilton, Leo; Gandhi, Monica; Scott Braithwaite, R; Perlman, David C; Kutnick, Alexandra; Ritchie, Amanda S

2017-05-04

More than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employed to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American/Black and Hispanic PLWH not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. A similar set of multi-level factors impede both HIV care and ART initiation for African American/Black and Hispanic PLWH, primary among them individual- (e.g., substance use, distrust, fear), social- (e.g., stigma), and structural-level barriers (e.g., difficulties accessing ancillary services). Guided by a multi-level social cognitive theory, and using the motivational interviewing approach, the study will evaluate five distinct culturally based intervention components (i.e., counseling sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study. Study aims are: 1) using a highly efficient fractional factorial experimental design, identify which of five intervention components contribute meaningfully to improvement in HIV viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of intervention component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American/Black and Hispanic PLWH (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N = 512). This is the first study to apply the MOST framework in the field of HIV prevention and treatment. This innovative study will produce a culturally based HIV care continuum intervention for the nation's most vulnerable PLWH, optimized for cost-effectiveness, and with exceptional levels of efficacy, efficiency, and scalability. ClinicalTrials.gov, NCT02801747 , Registered June 8, 2016.

Administrative gatekeeping - a third way between unrestricted patient advocacy and bedside rationing.

PubMed

Lauridsen, Sigurd

2009-06-01

The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack of political accountability towards citizens. In this paper I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term 'administrative gatekeeping', makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions.

Influences of culture on sexuality.

PubMed

Hogan, R M

1982-09-01

Religion is a cultured phenomenon, a subculture within our larger cultural system. Different religions have different teachings about what constitutes sexual morality, while members within a specific religious denomination may also have different beliefs and practices. Religiosity, or acceptance of the teachings of a particular religion, is more important as a determinant of sexual behavior than a specific religion per se. Orthodox Judaism, traditional Catholicism and traditional Protestantism are alike in their condemnation of masturbation, abortion, homosexuality, and premarital and extramarital coitus. More liberal members of these religions may not tolerate these activities, but may espouse them as necessary means to maintain or attain health. Nurses assess the beliefs that clients hold in regard to sexual morality and also identify if the client is experiencing guilt about past sexual practices. Interventions are planned with the client within the framework of the client's religious and spiritual beliefs and practices. To do otherwise is to invite distrust and distress in the client. Nurses intervene with sensitivity, compassion, and respect for beliefs and values that may be different from their own.

Species identification and quantification in meat and meat products using droplet digital PCR (ddPCR).

PubMed

Floren, C; Wiedemann, I; Brenig, B; Schütz, E; Beck, J

2015-04-15

Species fraud and product mislabelling in processed food, albeit not being a direct health issue, often results in consumer distrust. Therefore methods for quantification of undeclared species are needed. Targeting mitochondrial DNA, e.g. CYTB gene, for species quantification is unsuitable, due to a fivefold inter-tissue variation in mtDNA content per cell resulting in either an under- (-70%) or overestimation (+160%) of species DNA contents. Here, we describe a reliable two-step droplet digital PCR (ddPCR) assay targeting the nuclear F2 gene for precise quantification of cattle, horse, and pig in processed meat products. The ddPCR assay is advantageous over qPCR showing a limit of quantification (LOQ) and detection (LOD) in different meat products of 0.01% and 0.001%, respectively. The specificity was verified in 14 different species. Hence, determining F2 in food by ddPCR can be recommended for quality assurance and control in production systems. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effect of Health Literacy on Research Follow-up

PubMed Central

Leak, Cardella; Goggins, Kathryn; Schildcrout, Jonathan S.; Theobald, Cecelia; Donato, Katharine M.; Bell, Susan P.; Schnelle, John; Kripalani, Sunil

2016-01-01

Previous research has not examined the effect of health literacy on research subjects' completion of scheduled research follow-up. This article evaluates patient factors associated with incomplete research follow-up at three time points after enrollment in a large, hospital-based prospective cohort study. Predictor variables included health literacy, age, race, gender, education, employment status, difficulty paying bills, hospital diagnosis, length of stay, self-reported global health status, depression, perceived health competence, medication adherence and healthcare system distrust. In a sample of 2042 patients, multivariable models demonstrated that lower health literacy and younger age were significantly associated with a lower likelihood of completing research follow-up interviews at 2-3 days, 30 days and 90 days after hospital discharge. Additionally, patients who had less education, were currently employed, and had moderate financial stress were less likely to complete 90-day follow-up. This study is the first to demonstrate that lower health literacy is a significant predictor of incomplete research follow-up. PMID:26513035

Social cohesion: The missing factor required for a successful hand hygiene program.

PubMed

Kwok, Yen Lee Angela; Harris, Peter; McLaws, Mary-Louise

2017-03-01

There are limited explorations into hospital staff reactions to automated hand hygiene surveillance or hand hygiene interventions. An automated surveillance system with daily feedback and a behavioral intervention component was trialed in 2 wards in an Australian tertiary teaching hospital. After 9 months, 12 clinicians from each ward were interviewed prior to the completion of the trial to explore satisfaction with the system and behavioral component of nudging each other with a reminder to comply. Only on completion of the trial were transcripts analyzed for themes. Staff from the ward with improved compliance described a socially cohesive team with a well-liked nurse unit manager who accessed daily compliance rates and worked with staff to set goals. This contrasted with the ward without improvement in compliance, whose staff described their great reluctance and discomfort to nudge each other to comply and distrust of the authenticity of the rates established from the automated system. Interventions for improving compliance are more likely to be successful in a ward with a social cohesive team. Patient safety interventions, in the first instance, may benefit from purposeful selection of wards with cohesive teams and skilled leaders who can transform clinicians into early adopters of the program. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

"On Air": Participation in an Online Radio Show to Foster Speaking Confidence. A Cooperative Learning-Based Strategies Study ("Al aire": participación en un programa de radio en línea para fomentar la confianza al hablar. Un estudio basado en estrategias de aprendizaje cooperativo)

ERIC Educational Resources Information Center

Lemos Tello, Nubia Consuelo

2012-01-01

The daily observation of class sessions has enabled me to recognize that students possess a feeling of self-distrust in oral activities. For this reason, I designed a study carried out with a group of twelve eighth graders. This article illustrates an action research project conducted to enhance students' confidence when speaking on an online…

[Crises of trust].

PubMed

Chen, Thai-Form; Tseng, Hsing-Chau

2006-02-01

Extensive media coverage is warning of a crisis of trust that has emerged as a serious issue in our society. This article explores the meaning of "crisis," concepts of crisis management, mechanisms for building trust, and the underlying significance of trust and distrust. Evidence is adduced to testify to the erosion of trust and factors in our society that reflect the potential for crises of trust. Organizational decision makers, including hospital managers, are urged to identify and reflect upon weaknesses in their organizations in order that remedial action can be taken to preempt such crises.

Private database queries based on counterfactual quantum key distribution

NASA Astrophysics Data System (ADS)

Zhang, Jia-Li; Guo, Fen-Zhuo; Gao, Fei; Liu, Bin; Wen, Qiao-Yan

2013-08-01

Based on the fundamental concept of quantum counterfactuality, we propose a protocol to achieve quantum private database queries, which is a theoretical study of how counterfactuality can be employed beyond counterfactual quantum key distribution (QKD). By adding crucial detecting apparatus to the device of QKD, the privacy of both the distrustful user and the database owner can be guaranteed. Furthermore, the proposed private-database-query protocol makes full use of the low efficiency in the counterfactual QKD, and by adjusting the relevant parameters, the protocol obtains excellent flexibility and extensibility.

Science Under Attack! Public Policy, Science Education and the Emperor's New Clothes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krass, Lawrence

2005-12-05

The popular debate about the teaching of intelligent design in public schools is but one quandary for scientists and policy makers. Given recent developments which have worked to breed a general distrust of science, it is evident that researchers and politicians alike should be wary of using popular opinion as a guide for policy and pedagogy when it comes to science in public education. Dr. Krauss will qualify this complex issue and will address how educators, policy makers and scientists can work effectively to prevent public misconceptions of science.

Science Under Attack! Public Policy, Science Education, and the Emperor's New Clothes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krauss, Lawrence

2005-12-05

The popular debate about the teaching of intelligent design in public schools is but one quandary for scientists and policy makers. Given recent developments which have worked to breed a general distrust of science, it is evident that researchers and politicians alike should be wary of using popular opinion as a guide for policy and pedagogy when it comes to science in public education. Dr. Krauss will qualify this complex issue and will address how educators, policy makers and scientists can work effectively to prevent public misconceptions of science.

Underage abortion and beyond: developments of Spanish law in competent minor's autonomy.

PubMed

Ribot, Jordi

2012-01-01

This paper examines the recent developments in underage abortion and related questions in Spanish law. Despite the prevalence of the language of autonomy, like in Britain, children's interests are not defined in Spain by relying exclusively on the competent child's views. Parental opinion and societal expectations are given due weight, although sometimes only implicitly. Calculated ambiguity in legal practice and in the relevant legal texts provides evidence of the pervasive influence of deeply rooted distrust as against clear-cut rules favouring a young person's autonomy.

A Research Framework for Understanding the Practical Impact of Family Involvement in the Juvenile Justice System: The Juvenile Justice Family Involvement Model.

PubMed

Walker, Sarah Cusworth; Bishop, Asia S; Pullmann, Michael D; Bauer, Grace

2015-12-01

Family involvement is recognized as a critical element of service planning for children's mental health, welfare and education. For the juvenile justice system, however, parents' roles in this system are complex due to youths' legal rights, public safety, a process which can legally position parents as plaintiffs, and a historical legacy of blaming parents for youth indiscretions. Three recent national surveys of juvenile justice-involved parents reveal that the current paradigm elicits feelings of stress, shame and distrust among parents and is likely leading to worse outcomes for youth, families and communities. While research on the impact of family involvement in the justice system is starting to emerge, the field currently has no organizing framework to guide a research agenda, interpret outcomes or translate findings for practitioners. We propose a research framework for family involvement that is informed by a comprehensive review and content analysis of current, published arguments for family involvement in juvenile justice along with a synthesis of family involvement efforts in other child-serving systems. In this model, family involvement is presented as an ascending, ordinal concept beginning with (1) exclusion, and moving toward climates characterized by (2) information-giving, (3) information-eliciting and (4) full, decision-making partnerships. Specific examples of how courts and facilities might align with these levels are described. Further, the model makes predictions for how involvement will impact outcomes at multiple levels with applications for other child-serving systems.

Antenatal Weight Management: Women's Experiences, Behaviours, and Expectations of Weighing in Early Pregnancy.

PubMed

Swift, J A; Pearce, J; Jethwa, P H; Taylor, M A; Avery, A; Ellis, S; Langley-Evans, S C; McMullen, S

2016-01-01

The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative effects associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women's self-reported experiences of usual-care antenatal weight management in early pregnancy and consider these alongside weight monitoring behaviours and future expectations. 193 women (18 yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10-27 weeks, with 41.5% ( n = 80) between 12 and 14 and 43.0% ( n = 83) between 20 and 22 weeks. At recruitment 50.3% of participants ( n = 97) could be classified as overweight or obese. 69.4% of highest weight women (≥30 kg/m 2 ) did not report receiving advice about weight, although they were significantly more likely compared to women with BMI < 30 kg/m 2 . The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue.

Gaining trust as well as respect in communicating to motivated audiences about science topics

PubMed Central

Fiske, Susan T.; Dupree, Cydney

2014-01-01

Expertise is a prerequisite for communicator credibility, entailing the knowledge and ability to be accurate. Trust also is essential to communicator credibility. Audiences view trustworthiness as the motivation to be truthful. Identifying whom to trust follows systematic principles. People decide quickly another’s apparent intent: Who is friend or foe, on their side or not, or a cooperator or competitor. Those seemingly on their side are deemed warm (friendly, trustworthy). People then decide whether the other is competent to enact those intents. Perception of scientists, like other social perceptions, involves inferring both their apparent intent (warmth) and capability (competence). To illustrate, we polled adults online about typical American jobs, rated as American society views them, on warmth and competence dimensions, as well as relevant emotions. Ambivalently perceived high-competence but low-warmth, “envied” professions included lawyers, chief executive officers, engineers, accountants, scientists, and researchers. Being seen as competent but cold might not seem problematic until one recalls that communicator credibility requires not just status and expertise but also trustworthiness (warmth). Other research indicates the risk from being enviable. Turning to a case study of scientific communication, another online sample of adults described public attitudes toward climate scientists specifically. Although distrust is low, the apparent motive to gain research money is distrusted. The literature on climate science communicators agrees that the public trusts impartiality, not persuasive agendas. Overall, communicator credibility needs to address both expertise and trustworthiness. Scientists have earned audiences’ respect, but not necessarily their trust. Discussing, teaching, and sharing information can earn trust to show scientists’ trustworthy intentions. PMID:25225372

Trust in the safety of tourist destinations: hard to gain, easy to lose? New insights on the asymmetry principle.

PubMed

Eitzinger, Claudia; Wiedemann, Peter M

2008-08-01

According to the asymmetry principle of trust, negative events decrease trust to a much higher extent than positive events increase trust. The study at hand intended to verify whether this notion of asymmetry holds true with respect to trust in the safety of tourist destinations. Thus, in contrast to previous research that analyzed trust asymmetry in the context of involuntary technological risks, the present study evaluates the validity of the asymmetry principle of trust in the context of voluntary tourism risks. The hypothesis that negative or risky information on destination safety (absence of proper safety measures and conditions) has a higher impact on distrust than, conversely, positive or nonrisk information on destination safety (provision of proper safety measures and conditions) has on trust was tested in an online survey (N= 640). In contrast to the asymmetry pattern found by Slovic (1993), results of the current work suggest symmetry rather than asymmetry of trust. The presence of proper safety measures and conditions (positive or nonrisk information) was found to have at least the same-and in some cases an even higher-impact on trust than the absence of such measures and conditions (negative or risky information) had on distrust. Findings provide empirical evidence for the thesis that the prevalence of trust asymmetry is dependent on the risk source and demonstrate that trust is symmetric rather than asymmetric in the context of voluntary tourism risks. Furthermore, results imply an influence of positive versus negative expectations as well as of prior trusting relationships on the occurrence of the asymmetry principle.

A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth.

PubMed

Veinot, Tiffany C; Campbell, Terrance R; Kruger, Daniel J; Grodzinski, Alison

2013-01-01

We investigated the user requirements of African-American youth (aged 14-24 years) to inform the design of a culturally appropriate, network-based informatics intervention for the prevention of HIV and other sexually transmitted infections (STI). We conducted 10 focus groups with 75 African-American youth from a city with high HIV/STI prevalence. Data analyses involved coding using qualitative content analysis procedures and memo writing. Unexpectedly, the majority of participants' design recommendations concerned trust. Youth expressed distrust towards people and groups, which was amplified within the context of information technology-mediated interactions about HIV/STI. Participants expressed distrust in the reliability of condoms and the accuracy of HIV tests. They questioned the benevolence of many institutions, and some rejected authoritative HIV/STI information. Therefore, reputational information, including rumor, influenced HIV/STI-related decision making. Participants' design requirements also focused on trust-related concerns. Accordingly, we developed a novel trust-centered design framework to guide intervention design. Current approaches to online trust for health informatics do not consider group-level trusting patterns. Yet, trust was the central intervention-relevant issue among African-American youth, suggesting an important focus for culturally informed design. Our design framework incorporates: intervention objectives (eg, network embeddedness, participation); functional specifications (eg, decision support, collective action, credible question and answer services); and interaction design (eg, member control, offline network linkages, optional anonymity). Trust is a critical focus for HIV/STI informatics interventions for young African Americans. Our design framework offers practical, culturally relevant, and systematic guidance to designers to reach this underserved group better.

How do adolescent girls and boys perceive symptoms suggestive of endometriosis among their peers? Findings from focus group discussions in New York City

PubMed Central

Gupta, Jhumka; Cardoso, Lauren F; Harris, Courtney S; Dance, Arielle D; Seckin, Tamer; Baker, Nina; Ferguson, Yvonne O

2018-01-01

Objective Symptoms of endometriosis, including pelvic pain, back and nerve pain, and gastrointestinal pain, often begin in adolescence. Yet, research on the experience of these debilitating symptoms among young people is scarce. Of particular concern is the influence of adolescent girls’ social context. This study qualitatively examined how, among adolescents, endometriosis and symptoms suggestive of endometriosis is perceived at the family, peer/school and community/society levels. Design Eight focus groups were conducted; vignettes were used to elicit participants’ perceptions of factors that may shape girls’ experiences of endometriosis. Data were analysed using constant comparison analysis. Participants An ethnically diverse sample of girls and boys ages 14–18 (n=54) residing in New York City. Results Fifteen themes emerged and were distilled to eight cross-cutting factors that influence perceptions of endometriosis at different levels of the ecological model: distrust of community healthcare providers, societal stigma of menstruation, peer stigma of endometriosis symptoms, distrust of school healthcare providers, lack of endometriosis knowledge among peers and school personnel, inequitable gender norms, invisibility of symptoms and the stigma of teen sex among parents. Further, these factors may compound symptoms’ impact on individual girl’s social, educational and emotional well-being. Conclusions Findings underscore the importance of understanding the social environment of girls experiencing symptoms suggestive of endometriosis and educating and engaging their peers, family and school personnel to create a supportive, informed social climate. Efforts should specifically include stigma reduction campaigns targeted towards female and male adolescents. PMID:29866728

Conceptions of agency and constraint for HIV-positive patients and healthcare workers to support long-term engagement with antiretroviral therapy care in Khayelitsha, South Africa

PubMed Central

Stern, Erin; Colvin, Christopher; Gxabagxaba, Nobom; Schutz, Charlotte; Burton, Rosie; Meintjes, Graeme

2017-01-01

In the context of the optimism around antiretroviral therapy (ART) as prevention of HIV/AIDS, addressing the barriers to long-term ART adherence is critical. This is particularly important given the tendency to individualise or use a blame discourse when exploring why HIV-infected patients “fail” to adequately adhere to ART, and not sufficiently exploring contextual reasons for poor adherence that may require varying solutions. This study took place at three clinics and one hospital in Khayelitsha, South Africa, to document the contextual factors that challenged ART adherence in this community. Interviews were conducted with 20 HIV-infected patients who had defaulted on their ART and were subsequently admitted to Khayelitsha hospital for clinical complications, and 9 ART service providers including doctors, nurses and HIV counsellors. Interviews assessed the reasons patients defaulted on ART and explored ways this could be prevented. Data from both groups were analysed collectively using thematic analysis. While the interviews revealed a landscape of environmental risks threatening adherence to ART, all patients managed to overcome the identified barriers at some point in their treatment phase, indicating the fluidity of patients’ needs and decision making. Patients reported that distrustful relationships with service providers could inhibit their understanding of ART and/or interrupt their follow-up at clinics. Patients described their rationale and agency underlying non-adherence, such as testing their bodies’ physical limits without ART medication. The study speaks to the need to appreciate contextual social and structural barriers related to ART adherence, and how these are negotiated differently by specific sub-groups, to support an appropriate response. It is imperative to not solely emphasise loss to follow-up but also assess patients’ subjective trajectory of their ART journey, decision making and agency with adhering to ART, their relations with healthcare workers, and how these dynamics are intertwined with broader constraints in health systems. PMID:28367748

Evidence-Based Medicine in Managed Care: A Survey of Current and Emerging Strategies

PubMed Central

Keckley, Paul H

2004-01-01

Background Evidence-based medicine is the “conscientious application of scientific best practice by clinicians in concert with patient understanding and values.”[1] Recent studies by the Institute of Medicine, RAND, and others have called attention to the gap between scientifically supported approaches to care and day-to-day practice by clinicians. Compounding the problem of non-adherence by providers, researchers have observed that patient compliance also falls short. As a result, avoidable costs from inappropriate variability in practice patterns coupled with patient noncompliance are a significant focus of managed care. Managed care plans play a key role in the selection of providers by consumers and in the design of benefits programs by employers. Avoidable costs from misuse, overuse, and under-use of care from clinicians is a strategic focus for health plans. The evidence upon which a plan makes coverage decisions and the incorporation of evidence in programs targeting providers, employers, and consumers was a focus of this study. Methodology A Delphi survey and 2-day interactive sessions with 128 clinical program directors and medical officers from 89 health plans were the primary methods used in this descriptive analysis. To test participant applications of evidence-based medicine in health plan medical management strategy, 3 conditions were used for illustrative purpose: managing rheumatoid arthritis, increasing remission in depression, and reducing heart disease among diabetics. Each provided a unique challenge to plans in terms of condition prevalence, strength of evidence, and cost. Key Findings Health plans incorporate evidence-based medicine in 5 areas overseen by medical management: (1) coverage decisions wherein improvements in pharmaceutical and therapeutic review processes are sought, (2) disease management efforts wherein increased attention to secondary prevention is desirable, (3) provider profiling wherein increased use of adherence measures comparing practices is a focus, (4) pay-for-performance programs linking physician adherence to financial incentives, and (5) consumer-directed care programs wherein patient compliance to evidence-based treatment directives is the focus. Factors that influence a plan's approach to a patient population include prevalence of the condition, the strength of evidence about a particular diagnostic or prognostic strategy, costs associated with the condition, and the influence of employers in coverage decisions. Conclusion Evidence-based medicine is the foundation for significant activity among plans to increase physician and patient adherence. There remain significant challenges in the implementation of evidence-based care management by plans, including the willingness of plans to agree on evidence-based guidelines, the willingness of employers to pay for evidence-based interventions, the balance of short- and long-term benefits for evidence-based interventions where secondary prevention is a consideration, and substantial distrust among providers. PMID:15266281

Initial prejudices create cross-generational intergroup mistrust

PubMed Central

Uhlmann, Eric Luis; Obloj, Tomasz

2018-01-01

The present investigation modeled the emergence and persistence of intergroup bias and discrimination in artificial societies. Initial unfair prejudices held by members of a dominant group elicit confirmatory behavior (diminished cooperation) from members of a subordinate group via a self-fulfilling prophecy. Further, when individual learning is tempered by conformity to peers, inaccurate beliefs about the stigmatized subordinate group persist long-term. Even completely replacing dominant group members with enlightened individuals through generational change is inadequate to break the cycle of intergroup distrust and non-collaboration. The longer the enlightenment of a society is delayed, the more intergroup trust is irretrievably lost. PMID:29694405

The Regulatory Framework for Privacy and Security

NASA Astrophysics Data System (ADS)

Hiller, Janine S.

The internet enables the easy collection of massive amounts of personally identifiable information. Unregulated data collection causes distrust and conflicts with widely accepted principles of privacy. The regulatory framework in the United States for ensuring privacy and security in the online environment consists of federal, state, and self-regulatory elements. New laws have been passed to address technological and internet practices that conflict with privacy protecting policies. The United States and the European Union approaches to privacy differ significantly, and the global internet environment will likely cause regulators to face the challenge of balancing privacy interests with data collection for many years to come.

Distributed Noise Generation for Density Estimation Based Clustering without Trusted Third Party

NASA Astrophysics Data System (ADS)

Su, Chunhua; Bao, Feng; Zhou, Jianying; Takagi, Tsuyoshi; Sakurai, Kouichi

The rapid growth of the Internet provides people with tremendous opportunities for data collection, knowledge discovery and cooperative computation. However, it also brings the problem of sensitive information leakage. Both individuals and enterprises may suffer from the massive data collection and the information retrieval by distrusted parties. In this paper, we propose a privacy-preserving protocol for the distributed kernel density estimation-based clustering. Our scheme applies random data perturbation (RDP) technique and the verifiable secret sharing to solve the security problem of distributed kernel density estimation in [4] which assumed a mediate party to help in the computation.

Analysis of problems with dry fermentation process for biogas production

NASA Astrophysics Data System (ADS)

Pilát, Peter; Patsch, Marek; Jandačka, Jozef

2012-04-01

The technology of dry anaerobic fermentation is still meeting with some scepticism, and therefore in most biogas plants are used wet fermentation technology. Fermentation process would be not complete without an optimal controlled condition: dry matter content, density, pH, and in particular the reaction temperature. If is distrust of dry fermentation eligible it was on the workplace of the Department of Power Engineering at University of Zilina built an experimental small-scale biogas station that allows analysis of optimal parameters of the dry anaerobic fermentation, in particular, however, affect the reaction temperature on yield and quality of biogas.

Downsizing and reorganization: demands, challenges and ambiguity for registered nurses.

PubMed

Hertting, Anna; Nilsson, Kerstin; Theorell, Töres; Larsson, Ullabeth Sätterlund

2004-01-01

The 1990s were characterized by substantial financial cuts, and related staff redundancies and reorganizations in the Swedish health care sector. A large hospital in Sweden was selected for the study, in which downsizing had occurred between 1995 and 1997. The number of staff in the hospital was reduced by an average of 20%, and 10% were relocated to other departments. The aims of this study were to explore registered nurses' experiences of psychosocial 'stressors' and 'motivators', and how they handled their work situations, following a period of personnel reductions and ongoing reorganization. Interviews were undertaken with 14 nurses working in one Swedish hospital. Nurses were interviewed in 1997 about the recent and last round of redundancies, and were followed up 1 year later in 1998 and again in 2001. Interviews were audiotaped, transcribed and analysed for thematic content. Five themes emerged in relation to nurses' perceived stressors, motivators, and coping options: 'distrust towards the employer', 'concurrent demands and challenges', 'professional ambiguity, 'a wish for collaboration', and 'efforts to gain control'. A common feature was duality and ambiguity in nurses' descriptions of the phenomena studied, meaning that identified themes had underlying sub-themes with both negative and positive dimensions. The concurrence of 'ever-growing job demands' and 'work going unrewarded' contributed to a feeling of being taken advantage of by the employer. The 'waste of human resources' and 'competence drain' that followed redundancies provoked anger. Unfulfilled collaboration with doctors was a major stress producer, which related to both the downsized work organization, and the complex 'deference-dominance' doctor-nurse relationship. The well-being of nurses depends on being an equal/parallel health professional in a comprehensive team that shares knowledge and improves collaborative care of patients. A consciously formulated nursing philosophy emerged as a health-promoting resource. This study demonstrates the importance of analysing feelings relating to professional ambiguity and gaining influence in a gender-related, hierarchical environment, and the need to support professional assertiveness in relation to superiors and doctors. It is also important to stress considerations that relate to differences in the age, care philosophy, and psychosocial health conditions of nurses.

Perceptions of malaria and acceptance of rapid diagnostic tests and related treatment practises among community members and health care providers in Greater Garissa, North Eastern Province, Kenya.

PubMed

Diggle, Emma; Asgary, Ramin; Gore-Langton, Georgia; Nahashon, Erupe; Mungai, James; Harrison, Rebecca; Abagira, Abdullahi; Eves, Katie; Grigoryan, Zoya; Soti, David; Juma, Elizabeth; Allan, Richard

2014-12-17

Conventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears. These methods, if not carried out exactly, easily result in the over- or under-diagnosis of malaria. The reliability and accuracy of malaria RDTs, even in extremely challenging health care settings, have made them a staple in malaria control programmes. Using the setting of a pilot introduction of malaria RDTs in Greater Garissa, North Eastern Province, Kenya, this study aims to identify and understand perceptions regarding malaria diagnosis, with a particular focus on RDTs, and treatment among community members and health care workers (HCWs). The study was conducted in five districts of Garissa County. Focus group discussions (FGD) were performed with community members that were recruited from health facilities (HFs) supported by the MENTOR Initiative. In-depth interviews (IDIs) and FGDs with HCWs were also carried out. Interview transcripts were then coded and analysed for major themes. Two researchers reviewed all codes, first separately and then together, discussed the specific categories, and finally characterized, described, and agreed upon major important themes. Thirty-four FGDs were carried out with a range of two to eight participants (median of four). Of 157 community members, 103 (65.6%) were women. The majority of participants were illiterate and the highest level of education was secondary school. Some 76% of participants were of Somali ethnicity. Whilst community members and HCWs demonstrated knowledge of aspects of malaria transmission, prevention, diagnosis, and treatment, gaps and misconceptions were identified. Poor adherence to negative RDT results, unfamiliarity and distrust of RDTs, and an inconsistent RDT supply were the main challenges to become apparent in FGDs and IDIs. Gaps in knowledge or incorrect beliefs exist in Greater Garissa and have the potential to act as barriers to complete and correct malaria case management. Addressing these knowledge gaps requires comprehensive education campaigns and a reliable and constant RDT supply. The results of this study highlight education and supply chain as key factors to be addressed in order to make large scale roll out of RDTs as successful and effective as possible.

Privacy protection schemes for fingerprint recognition systems

NASA Astrophysics Data System (ADS)

Marasco, Emanuela; Cukic, Bojan

2015-05-01

The deployment of fingerprint recognition systems has always raised concerns related to personal privacy. A fingerprint is permanently associated with an individual and, generally, it cannot be reset if compromised in one application. Given that fingerprints are not a secret, potential misuses besides personal recognition represent privacy threats and may lead to public distrust. Privacy mechanisms control access to personal information and limit the likelihood of intrusions. In this paper, image- and feature-level schemes for privacy protection in fingerprint recognition systems are reviewed. Storing only key features of a biometric signature can reduce the likelihood of biometric data being used for unintended purposes. In biometric cryptosystems and biometric-based key release, the biometric component verifies the identity of the user, while the cryptographic key protects the communication channel. Transformation-based approaches only a transformed version of the original biometric signature is stored. Different applications can use different transforms. Matching is performed in the transformed domain which enable the preservation of low error rates. Since such templates do not reveal information about individuals, they are referred to as cancelable templates. A compromised template can be re-issued using a different transform. At image-level, de-identification schemes can remove identifiers disclosed for objectives unrelated to the original purpose, while permitting other authorized uses of personal information. Fingerprint images can be de-identified by, for example, mixing fingerprints or removing gender signature. In both cases, degradation of matching performance is minimized.

The codex of science: honesty, precision, and truth--and its violations.

PubMed

Lüscher, Thomas F

2013-04-01

Science has made enormous achievements for our understanding of the world and for everyday life: we now know that we live on a spherical planet of the solar system, we understand the origin of the species, we can take a train, survive myocardial infarction, and fly to the moon. This has been made possible thanks to a persistent search for truth by great scientists and the scientific community at large. Our assumptions were often wrong, but the scientific process advanced by a productive interplay of conjectures and refutations. As in any profession, there is misconduct, i.e. sloppiness, plagiarism up to falsification, or even fabrication of data. Although eventually fraudulent science has and will be disproved, it is morally inappropriate, damages the reputation of research and journals in which its products are published, may endanger patients, and misuses grant money of federal and private institutions. Thus, as editors and readers, we should be aware of it based on its typical pattern, but we must avoid an atmosphere of distrust, as trust is the essence of scientific exchange and progress.

Organizational and technological correlates of nurses’ trust in a smart IV pump

PubMed Central

Montague, Enid; Asan, Onur; Chiou, Erin

2013-01-01

The aim of this study was to understand technology and system characteristics that contribute to nurses’ ratings of trust in a smart IV pump. Nurse’s trust in new technologies can influence how technologies are used. Trust in technology is defined as a person’s belief that a technology will not fail them. Potential outcomes of trust in technology are appropriate trust, over trust, distrust, and mistrust. Trust in technology is also related to several use specific outcomes, including appropriate use and inappropriate use such as over reliance, disuse or rejection, or misuse. Understanding trust in relation to outcomes can contribute to designs that facilitate appropriate trust in new technologies. A survey was completed by 391 nurses a year after the implementation of a new smart IV pump. The survey assessed trust in the IV pump and other elements of the sociotechnical system, individual characteristics, technology characteristics and organizational characteristics. Results show perceptions of usefulness, safety, ease of use and usability are related to ratings of trust in smart IV pumps. Other work system factors such as perception of work environment, age, experience, quality of work, and perception of work performance are also related to ratings of trust. Nurses’ trust in smart IV pumps is influenced by both characteristics of the technology and the sociotechnical system. Findings from this research have implications for the design of future smart IV pumps and health systems. Recommendations for appropriately trustworthy smart IV pumps are discussed. Findings also have implications for how trust in health technologies can be measured and conceptualized in complex sociotechnical systems. PMID:23321482

Probiotics, D–Lactic acidosis, oxidative stress and strain specificity

PubMed Central

2017-01-01

ABSTRACT The existence of an implicit living microscopic world, composed primarily of bacteria, has been known for centuries. The exact mechanisms that govern the contribution of bacteria to human health and disease have only recently become the subject of intense research efforts. Within this very evident shift in paradigms, the rational design of probiotic formulations has led to the creation of an industry that seeks to progress the engineering of probiotic bacteria that produce metabolites that may enhance human host health and prevent disease. The promotion of probiotics is often made in the absence of quality scientific and clinically plausible data. The latest incursions into the probiotic market of claims have posited the amelioration of oxidative stress via potent antioxidant attributes or limiting the administration of probiotics to those species that do not produce D-Lactic acid (i.e., claims that D-Lactic acid acidosis is linked to chronic health conditions) or are strain-specific (shaping an industry point of difference) for appraising a therapeutic effect. Evidence-based research should guide clinical practice, as there is no place in science and medicine that supports unsubstantiated claims. Extravagant industry based notions continue to fuel the imprimatur of distrust and skepticism that is leveled by scientists and clinicians at an industry that is already rife with scientific and medical distrust and questionable views on probiotics. Ignoring scientifically discordant data, when sorting through research innovations and false leads relevant to the actions of probiotics, drives researcher discomfit and keeps the bar low, impeding the progress of knowledge. Biologically plausible posits are obligatory in any research effort; companies formulating probiotics often exhibit a lack of analytical understanding that then fuels questionable investigations failing to build on research capacity. PMID:28080206

Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado.

PubMed

Sasson, Comilla; Haukoos, Jason S; Ben-Youssef, Leila; Ramirez, Lorenzo; Bull, Sheana; Eigel, Brian; Magid, David J; Padilla, Ricardo

2015-05-01

Individuals in neighborhoods composed of minority and lower socioeconomic status populations are more likely to have an out-of-hospital cardiac arrest event, less likely to have bystander cardiopulmonary resuscitation (CPR) performed, and less likely to survive. Latino cardiac arrest victims are 30% less likely than whites to have bystander CPR performed. The goal of this study is to identify barriers and facilitators to calling 911, and learning and performing CPR in 5 low-income, Latino neighborhoods in Denver, CO. Six focus groups and 9 key informant interviews were conducted in Denver during the summer of 2012. Purposeful and snowball sampling, conducted by community liaisons, was used to recruit participants. Two reviewers analyzed the data to identify recurrent and unifying themes. A qualitative content analysis was used with a 5-stage iterative process to analyze each transcript. Six key barriers to calling 911 were identified: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. Seven cultural barriers were identified that may preclude performance of bystander CPR: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants suggested that increasing availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR. Distrust of law enforcement, language concerns, lack of recognition of cardiac arrest, and financial issues must be addressed when community-based CPR educational programs for Latinos are implemented. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

How do adolescent girls and boys perceive symptoms suggestive of endometriosis among their peers? Findings from focus group discussions in New York City.

PubMed

Gupta, Jhumka; Cardoso, Lauren F; Harris, Courtney S; Dance, Arielle D; Seckin, Tamer; Baker, Nina; Ferguson, Yvonne O

2018-06-04

Symptoms of endometriosis, including pelvic pain, back and nerve pain, and gastrointestinal pain, often begin in adolescence. Yet, research on the experience of these debilitating symptoms among young people is scarce. Of particular concern is the influence of adolescent girls' social context. This study qualitatively examined how, among adolescents, endometriosis and symptoms suggestive of endometriosis is perceived at the family, peer/school and community/society levels. Eight focus groups were conducted; vignettes were used to elicit participants' perceptions of factors that may shape girls' experiences of endometriosis. Data were analysed using constant comparison analysis. An ethnically diverse sample of girls and boys ages 14-18 (n=54) residing in New York City. Fifteen themes emerged and were distilled to eight cross-cutting factors that influence perceptions of endometriosis at different levels of the ecological model: distrust of community healthcare providers, societal stigma of menstruation, peer stigma of endometriosis symptoms, distrust of school healthcare providers, lack of endometriosis knowledge among peers and school personnel, inequitable gender norms, invisibility of symptoms and the stigma of teen sex among parents. Further, these factors may compound symptoms' impact on individual girl's social, educational and emotional well-being. Findings underscore the importance of understanding the social environment of girls experiencing symptoms suggestive of endometriosis and educating and engaging their peers, family and school personnel to create a supportive, informed social climate. Efforts should specifically include stigma reduction campaigns targeted towards female and male adolescents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth

PubMed Central

Veinot, Tiffany C; Campbell, Terrance R; Kruger, Daniel J; Grodzinski, Alison

2013-01-01

Objective We investigated the user requirements of African-American youth (aged 14–24 years) to inform the design of a culturally appropriate, network-based informatics intervention for the prevention of HIV and other sexually transmitted infections (STI). Materials and Methods We conducted 10 focus groups with 75 African-American youth from a city with high HIV/STI prevalence. Data analyses involved coding using qualitative content analysis procedures and memo writing. Results Unexpectedly, the majority of participants’ design recommendations concerned trust. Youth expressed distrust towards people and groups, which was amplified within the context of information technology-mediated interactions about HIV/STI. Participants expressed distrust in the reliability of condoms and the accuracy of HIV tests. They questioned the benevolence of many institutions, and some rejected authoritative HIV/STI information. Therefore, reputational information, including rumor, influenced HIV/STI-related decision making. Participants’ design requirements also focused on trust-related concerns. Accordingly, we developed a novel trust-centered design framework to guide intervention design. Discussion Current approaches to online trust for health informatics do not consider group-level trusting patterns. Yet, trust was the central intervention-relevant issue among African-American youth, suggesting an important focus for culturally informed design. Our design framework incorporates: intervention objectives (eg, network embeddedness, participation); functional specifications (eg, decision support, collective action, credible question and answer services); and interaction design (eg, member control, offline network linkages, optional anonymity). Conclusions Trust is a critical focus for HIV/STI informatics interventions for young African Americans. Our design framework offers practical, culturally relevant, and systematic guidance to designers to reach this underserved group better. PMID:23512830

Barriers to Calling 911 and Learning and Performing Cardiopulmonary Resuscitation for Residents of Primarily Latino, High-Risk Neighborhoods in Denver, Colorado

PubMed Central

Sasson, Comilla; Haukoos, Jason S.; Ben-Youssef, Leila; Ramirez, Lorenzo; Bull, Sheana; Eigel, Brian; Magid, David J.; Padilla, Ricardo

2016-01-01

Study objective Individuals in neighborhoods composed of minority and lower socioeconomic status populations are more likely to have an out-of-hospital cardiac arrest event, less likely to have bystander cardiopulmonary resuscitation (CPR) performed, and less likely to survive. Latino cardiac arrest victims are 30% less likely than whites to have bystander CPR performed. The goal of this study is to identify barriers and facilitators to calling 911, and learning and performing CPR in 5 low-income, Latino neighborhoods in Denver, CO. Methods Six focus groups and 9 key informant interviews were conducted in Denver during the summer of 2012. Purposeful and snowball sampling, conducted by community liaisons, was used to recruit participants. Two reviewers analyzed the data to identify recurrent and unifying themes. A qualitative content analysis was used with a 5-stage iterative process to analyze each transcript. Results Six key barriers to calling 911 were identified: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. Seven cultural barriers were identified that may preclude performance of bystander CPR: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants suggested that increasing availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR. Conclusion Distrust of law enforcement, language concerns, lack of recognition of cardiac arrest, and financial issues must be addressed when community-based CPR educational programs for Latinos are implemented. PMID:25481112

Social impacts of earthquakes caused by gas extraction in the Province of Groningen, The Netherlands

DOE Office of Scientific and Technical Information (OSTI.GOV)

Voort, Nick van der, E-mail: nickvdvoort@gmail.com; Vanclay, Frank, E-mail: frank.vanclay@rug.nl

Gas extraction from the Groningen gasfield in the northern Netherlands has led to localised earthquakes which are projected to become more severe. The social impacts experienced by local residents include: damage to property; declining house prices; concerns about the chance of dykes breaking; feelings of anxiety and insecurity; health issues; and anger. These social and emotional impacts are exacerbated by the increasing distrust Groningen people have towards the national government and the gas company, NAM, a partnership between Shell and ExxonMobil. The earthquakes have reopened discussions about the distribution of benefits from gas production and the extent to which benefitsmore » are retained locally. Mitigation of the impacts is attempted, but the lack of trust decreases the effectiveness of the mitigation measures. The extent of this experience of previously-unforeseen, unanticipated impacts suggests that a new social and environmental impact assessment needs to be undertaken, and a new Social Impact Management Plan (SIMP) and Impacts and Benefits Agreement (IBA) developed, so that the project can regain its legitimacy and social licence to operate. In addition to conventional gas, this paper has wider relevance for unconventional gas developments, for example shale gas extraction by hydraulic fracturing methods (fracking). - Highlights: • Gas production in Groningen has caused over 1000 earthquakes. • The induced seismicity has caused many social impacts. • Impacts include building damage, reduced house prices, fear and health issues. • Mitigation measures attempted to date are inadequate. • Distrust towards the national government and operator hinders mitigation efforts. • Gas production in Groningen has lost its social licence to operate.« less

The construct of state-level suspicion: a model and research agenda for automated and information technology (IT) contexts.

PubMed

Bobko, Philip; Barelka, Alex J; Hirshfield, Leanne M

2014-05-01

The objective was to review and integrate available research about the construct of state-level suspicion as it appears in social science literatures and apply the resulting findings to information technology (IT) contexts. Although the human factors literature is replete with articles about trust (and distrust) in automation, there is little on the related, but distinct, construct of "suspicion" (in either automated or IT contexts). The construct of suspicion--its precise definition, theoretical correlates, and role in such applications--deserves further study. Literatures that consider suspicion are reviewed and integrated. Literatures include communication, psychology, human factors, management, marketing, information technology, and brain/neurology. We first develop a generic model of state-level suspicion. Research propositions are then derived within IT contexts. Fundamental components of suspicion include (a) uncertainty, (b) increased cognitive processing (e.g., generation of alternative explanations for perceived discrepancies), and (c) perceptions of (mal)intent. State suspicion is defined as the simultaneous occurrence of these three components. Our analysis also suggests that trust inhibits suspicion, whereas distrust can be a catalyst of state-level suspicion. Based on a three-stage model of state-level suspicion, associated research propositions and questions are developed. These propositions and questions are intended to help guide future work on the measurement of suspicion (self-report and neurological), as well as the role of the construct of suspicion in models of decision making and detection of deception. The study of suspicion, including its correlates, antecedents, and consequences, is important. We hope that the social sciences will benefit from our integrated definition and model of state suspicion. The research propositions regarding suspicion in IT contexts should motivate substantial research in human factors and related fields.

Association of stress and delinquency in children and adolescents.

PubMed

Stasević, Ina; Ropac, Darko; Lucev, Oskar

2005-06-01

The aim of investigation was to assess the impact of subjective stress exposure on delinquent behaviour in children and adolescents. The study included 174 young male delinquents, selected by the method of stratified systematic (random) sample and divided into three age groups of <14, 14-17, and 18-21 years. General data, data on the type of criminal offence, and data on the type of deviant behaviour were collected. A standardised scale of subjective stress was used to allow for comparison of the results obtained in the study with those reported elsewhere. Analysis of variance, chi2-test and factor analysis were used on data processing. A majority of study subjects (55.2%) committed one criminal offence. The criminal offence structure was predominated by proprietary violation (66.7%). Common forms of deviant behaviour included shirking school duties (55.2%), and aggressive behaviour at school (31.0%), in public (29.5%) and in the family (23.6). Parental distrust and punishment (abuse) of the child were identified as the major sources of subjective stress. Youngest subjects significantly differed from other age groups according to their experience of subjective stress described as punishment (abuse) (F = 22.1389, p < 0.001). They were considerably more vulnerable to this type of stress than older age groups. These sources of stress were found to positively correlate with the number of criminal offences committed. Among the sources of stress, parents' distrust of the child significantly correlated with commitment of one criminal offence (F = 2.8618, p < 0.05), and child's punishment (abuse) with a higher number of criminal offences (F = 3.1539, p < 0.05). Criminal activity of children and adolescents is significantly associated with their history of stress exposure over the last two years of life. The higher the stress severity, the greater the rate of delinquency.

Probiotics, D-Lactic acidosis, oxidative stress and strain specificity.

PubMed

Vitetta, Luis; Coulson, Samantha; Thomsen, Michael; Nguyen, Tony; Hall, Sean

2017-07-04

The existence of an implicit living microscopic world, composed primarily of bacteria, has been known for centuries. The exact mechanisms that govern the contribution of bacteria to human health and disease have only recently become the subject of intense research efforts. Within this very evident shift in paradigms, the rational design of probiotic formulations has led to the creation of an industry that seeks to progress the engineering of probiotic bacteria that produce metabolites that may enhance human host health and prevent disease. The promotion of probiotics is often made in the absence of quality scientific and clinically plausible data. The latest incursions into the probiotic market of claims have posited the amelioration of oxidative stress via potent antioxidant attributes or limiting the administration of probiotics to those species that do not produce D-Lactic acid (i.e., claims that D-Lactic acid acidosis is linked to chronic health conditions) or are strain-specific (shaping an industry point of difference) for appraising a therapeutic effect. Evidence-based research should guide clinical practice, as there is no place in science and medicine that supports unsubstantiated claims. Extravagant industry based notions continue to fuel the imprimatur of distrust and skepticism that is leveled by scientists and clinicians at an industry that is already rife with scientific and medical distrust and questionable views on probiotics. Ignoring scientifically discordant data, when sorting through research innovations and false leads relevant to the actions of probiotics, drives researcher discomfit and keeps the bar low, impeding the progress of knowledge. Biologically plausible posits are obligatory in any research effort; companies formulating probiotics often exhibit a lack of analytical understanding that then fuels questionable investigations failing to build on research capacity.

Partition and poliomyelitis: an investigation of the polio disparity affecting Muslims during India's eradication program.

PubMed

Hussain, Rashid S; McGarvey, Stephen T; Fruzzetti, Lina M

2015-01-01

Significant disparities in the incidence of polio existed during its eradication campaign in India. In 2006, Muslims, who comprise 16% of the population in affected states, comprised 70% of paralytic polio cases. This disparity was initially blamed on the Muslims and a rumor that the vaccination program was a plot to sterilize their children. Using the framework of structural violence, this paper describes how the socio-political and historical context of Muslim populations in India shaped the polio disparity. A qualitative study utilizing methods of rapid ethnography was conducted from May-August 2009 in Aligarh, Uttar Pradesh, India. Field methods included participant observation of vaccination teams, historical document research, and 107 interviews with both Global Polio Eradication Initiative (GPEI) stakeholders and families with vaccine-eligible children. Almost all respondents agreed that Aligarh was a highly segregated city, mostly due to riots after Partition and during the 1990s. Since the formation of segregated neighborhoods, most respondents described that "Muslim areas" had been underdeveloped compared to "Hindu areas," facilitating the physical transmission of poliovirus. Distrust of the government and resistance to vaccination were linked to this disparate development and fears of sterilization influenced by the "Family Planning Program" from 1976-1977. Ethnic violence and social marginalization since the Partition and during the rise of Hindu nationalism led to distrust of the government, the formation of segregated slums, and has made Muslims victims of structural violence. This led to the creation of disease-spreading physical environments, lowered vaccine efficacy, and disproportionately higher levels of resistance to vaccination. The causes of the polio disparity found in this study elucidate the nature of possible other health disparities affecting minorities in India. This study is limited by the manual coding of the transcribed data, size, and some dialectal difficulties in translation.

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia.

PubMed

Ward, Paul R; Attwell, Katie; Meyer, Samantha B; Rokkas, Philippa; Leask, Julie

2017-01-01

In terms of public health, childhood vaccination programs have benefits that far outweigh risks. However, some parents decide not to vaccinate their children. This paper explores the ways in which such parents talked about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013-2016 we undertook 29 in-depth interviews with non-vaccinating and/or 'vaccine hesitant' parents in Australia. Interviews were conducted in an open and non-judgmental manner, akin to empathic neutrality. Interviews focused on parents talking about the factors that shaped their decisions not to (or partially) vaccinate their children. All interviews were transcribed and analysed using both inductive and deductive processes. The main themes focus on parental perceptions of: 1. their capacity to reason; 2. their rejection of Western medical epistemology; and 3. their participation in labour intensive parenting practices (which we term salutogenic parenting). Parents engaged in an ongoing search for information about how best to parent their children (capacity to reason), which for many led to questioning/distrust of traditional scientific knowledge (rejection of Western medical epistemology). Salutogenic parenting spontaneously arose in interviews, whereby parents practised health promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations). Salutogenic parenting practices included breastfeeding, eating organic and/or home-grown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. We interpret our data as a 'logic of care', which is seen by parents as internally consistent, logically inter-related and inter-dependent. Whilst not necessarily sharing the parents' reasoning, we argue that an understanding of their attitudes towards health and well-being is imperative for any efforts to engage with their vaccine refusal at a policy level.

Female commercial sex worker perspective on susceptibility of HIV-AIDS in Yogyakarta

NASA Astrophysics Data System (ADS)

Mahmudah, Nurul; Dasuki, Djaswadi; Kurniawati, Herlin Fitriani

2017-08-01

Commercial sex worker is one of the groups with the highest level of susceptibility against HIV infection. They are 13,5 fold more prone to a living with HIV infection than the female of non commercial sex workers. Moreover, these commercial sex workers are also stigmatized with social sanction and discrimination against people with HIV-AIDS. The society mostly avoid them, deject them, isolate them, insult them, despise them, distrust them, and even go against the existence of those suffering from or infected by HIV-AIDS. Thus, stigmatizing and discrimination are basicly highly prohibited since they can incur higher social problems. It is also vital to handle the spread of HIV-AIDS in the society as soon as possible in the attempt of fighting against the spread of the disease. Hence, being broad minded, tolerant, and caring towards them as well as working hand in hand with the community are expected to diminish, minimize, and even eradicate the outbreak of HIV-AIDS. Caring towards those suffering from the infection without stigmatizing them and discriminating them will be one of the first measurements to take to improve what is needed to prevent the prevalence and spread of the disease. Thus, the primary objective of this research is to know the perception of female commercial sex workers on the susceptibility of HIV-AIDS in Yogyakarta. The research participants were selected from three localizations in Yogyakarta namely Pasar Kembang, Bongsuwung, and Giwangan. It is revealed that the participants had a good perception on the susceptibility of AIDS infection as seen from the fact there are free avalaible condoms for them to use everytime they have a sexual intercourse with the clients. All participants were aware of their high susceptibility against the infection of STIs/HIV/AIDS and thus they want to save their skin from those diseases. Also they had a good knowledge that having an intercourse without condom may get them infected.

Patient-family EoL communication and its predictors: Reports from caregivers of Latino patients in the rural U.S.-Mexico border region.

PubMed

Ko, Eunjeong; Lee, Jaehoon; Ramirez, Carlos; Lopez, Denicka; Martinez, Stephanie

2017-10-26

Family caregivers play an important role in end-of-life (EoL) decision making when the patient is unable to make his/her own decisions. While communication about EoL care between patients and family is perhaps a first step toward advance care planning (ACP)/EoL decisions, not every culture puts great value on open communication about this topic. The aims of the present study were to explore EoL communication and the aspects of communication among caregivers of Latino patients in the rural United States (U.S.)-Mexico border region. This study analyzed data from a hospice needs assessment collected from 189 family caregivers of Latino patients at a home health agency in a rural U.S.-Mexico border region. Bivariate tests and logistic regression were used to address our aims. About half of the family caregivers (n = 96, 50.8%) reported to have ever engaged in EoL discussion with patients. Significant predictors of EoL discussion included life-sustaining treatment preference (odds ratio [OR] = 0.44, p < 0.05); knowledge of an advance directive (AD) (OR = 5.50, p < 0.01); and distrust of physicians (OR = 0.29, p < 0.01). Caregivers who preferred extending the life of their loved one even if he/she had to rely on life supports were less likely to engage in EoL communication. Also, caregivers who worried that physicians might want to stop treatments (i.e., "pull the plug") too soon were less likely to do so. Conversely, caregivers who had knowledge about ADs were more likely to engage in EoL communication. EoL communication is a complex process influenced by individual, social, and cultural values and the beliefs of both the patient and his/her family. Inclusion of family caregivers in the ACP process and facilitating culturally tailored EoL communication between patients and family caregivers is important.

Reporting dream experience: Why (not) to be skeptical about dream reports

PubMed Central

Windt, Jennifer M.

2013-01-01

Are dreams subjective experiences during sleep? Is it like something to dream, or is it only like something to remember dreams after awakening? Specifically, can dream reports be trusted to reveal what it is like to dream, and should they count as evidence for saying that dreams are conscious experiences at all? The goal of this article is to investigate the relationship between dreaming, dream reporting and subjective experience during sleep. I discuss different variants of philosophical skepticism about dream reporting and argue that they all fail. Consequently, skeptical doubts about the trustworthiness of dream reports are misguided, and for systematic reasons. I suggest an alternative, anti-skeptical account of the trustworthiness of dream reports. On this view, dream reports, when gathered under ideal reporting conditions and according to the principle of temporal proximity, are trustworthy (or transparent) with respect to conscious experience during sleep. The transparency assumption has the status of a methodologically necessary default assumption and is theoretically justified because it provides the best explanation of dream reporting. At the same time, it inherits important insights from the discussed variants of skepticism about dream reporting, suggesting that the careful consideration of these skeptical arguments ultimately leads to a positive account of why and under which conditions dream reports can and should be trusted. In this way, moderate distrust can be fruitfully combined with anti-skepticism about dream reporting. Several perspectives for future dream research and for the comparative study of dreaming and waking experience are suggested. PMID:24223542

Cesarean Birth Regret and Dissatisfaction: A Qualitative Approach.

PubMed

Burcher, Paul; Cheyney, Melissa J; Li, Kalie N; Hushmendy, Shazeen; Kiley, Kevin C

2016-12-01

The most consistently noted difference between unplanned cesarean and vaginal births is patient dissatisfaction or regret. This has been explored in multiple quantitative studies. However, the causes of this dissatisfaction remain elusive as a result of the limitations of survey instruments that restrict possible choices. Using open-ended, semi-structured interviews (n = 14), the purpose of this study was to identify potentially alterable factors that contribute to cesarean section regret when the surgery is performed during labor. In interviews that took place between 2 and 6 weeks postpartum, patients who had undergone an unscheduled cesarean birth during labor and had volunteered for the study were asked to share the story of their birth. Each participant was prompted to describe her understanding of the indication for her cesarean, and reflect on what felt positive and negative about her experience. Using consensus coding, three investigators independently evaluated the transcribed interviews, identifying recurring themes that were then discussed until consensus on the major themes was achieved. Four key themes emerged from patients' unplanned cesarean narratives: poor communication, fear of the operating room, distrust of the medical team, and loss of control. Lack of or incomplete trust in care providers was a new factor not previously recognized as a cause of distress or dissatisfaction in the literature to date. The four factors identified in this study are all potentially ameliorable, suggesting that changes in physician behavior may reduce patient dissatisfaction with unplanned cesarean birth. © 2016 Wiley Periodicals, Inc.

Utilization of alternative medical services by people of a north central city of Nigeria.

PubMed

Abodunrin, O L; Omojasola, T; Rojugbokan, O O

2011-06-01

The use of alternative therapies is becoming more popular in the recent times especially due to the increasing cost, distrust and limitations of modern western medical care. There is a universal trend toward naturalness and herbal medicine is now being modernized and being accepted by people who would not have used them. This community based study seeks to assess the prevalence, pattern, behaviour and determinants of AT use. It was a cross-sectional descriptive survey among adults in the Ilorin city of Nigeria. Participants were selected by multistage sampling and information obtained by the use of semi-structured questionnaire. Total prevalence AT use was 67.7% while total prevalence of indigenous and foreign AT use was 44.8 and 30.4% respectively. Among indigenous AT users, 87.5% will use both conventional and modernized type while 12.5% will use only the modernized type. More than 10% were new users of AT. Respondents use AT for promotive, preventive and curative purposes. Only 3.5% were considered as safe users according to 9-point items. The male respondents and the never married ones practice a safer use of alternative therapy (p<0.05). Similarly, the respondents with higher educational status also have a safer practice of AT use (p<0.05). There is high prevalence but unsafe AT use in Ilorin. There should be intensification of regulation of advertisement and sales of unwholesome herbal medicines. Further research to integrate the practice into modern healthcare is recommended.

Moving Beyond the Debate Over Restricting Sugary Drinks in the Supplemental Nutrition Assistance Program.

PubMed

Schwartz, Marlene B

2017-02-01

To address the dual problem of food insecurity and poor nutrition, the U.S. Department of Agriculture has recently revised the nutrition standards for nearly all of its federal food programs to align with the Dietary Guidelines for Americans. One notable exception is the Supplemental Nutrition Assistance Program (SNAP). Policy proposals to restrict SNAP benefits based on nutrition quality (e.g., excluding sugary drinks) have generated controversy and have polarized previous research and advocacy allies. This essay presents many of the issues that have emerged, which include challenges about the feasibility, justification, and effectiveness of restricting benefits; the risk of a slippery slope; concerns about participant dignity; and finally, distrust about the motives behind promoting and opposing a policy change. The purpose of this review is to increase mutual understanding and respect of different perspectives. The conclusion is that the rationales behind both support and opposition to updating the policies regulating SNAP benefits based on nutrition are fundamentally the same-the belief that a fair and just society cares for and protects vulnerable citizens, which in this case are low-income Americans who need assistance affording healthy food. Recommendations include activities to restore trust between the public health and anti-hunger communities, authentic engagement of SNAP participants in the conversation, and an optional SNAP program that includes both incentives and restrictions. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Healthcare avoidance: a critical review.

PubMed

Byrne, Sharon K

2008-01-01

The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

Norwegian nursing and medical students’ perception of interprofessional teamwork: a qualitative study

PubMed Central

2014-01-01

Background Little is known about the ways in which nursing and medical students perceive and understand their roles in interprofessional teamwork. A 2010 report by the World Health Organization highlights the importance of students’ understanding of teamwork in healthcare, and their ability to be effective team players. This study aims at describing nursing and medical students’ perceptions of interprofessional teamwork, focusing on experiences and recommendations that can be used to guide future educational efforts. Methods The study uses a qualitative research design. Data were collected from four focus group interviews: two homogenous groups (one with medical students, one with nursing students) and two mixed groups (medical and nursing students). Results The results show that traditional patterns of professional role perception still prevail and strongly influence students’ professional attitudes about taking responsibility and sharing responsibility across disciplinary and professional boundaries. It was found that many students had experienced group cultures detrimental to team work. Focusing on clinical training, the study found a substantial variation in perception with regard to the different arenas for interprofessional teamwork, ranging from arenas with collaborative learning to arenas characterized by distrust, confrontation, disrespect and hierarchical structure. Conclusions This study underlines the importance of a stronger focus on interprofessional teamwork in health care education, particularly in clinical training. The study results suggest that the daily rounds and pre-visit “huddles,” or alternatively psychiatric wards, offer arenas suitable for interprofessional training, in keeping with the students’ assessments and criteria proposed in previous studies. PMID:25124090

Norwegian nursing and medical students' perception of interprofessional teamwork: a qualitative study.

PubMed

Aase, Ingunn; Hansen, Britt Sæthre; Aase, Karina

2014-08-14

Little is known about the ways in which nursing and medical students perceive and understand their roles in interprofessional teamwork. A 2010 report by the World Health Organization highlights the importance of students' understanding of teamwork in healthcare, and their ability to be effective team players. This study aims at describing nursing and medical students' perceptions of interprofessional teamwork, focusing on experiences and recommendations that can be used to guide future educational efforts. The study uses a qualitative research design. Data were collected from four focus group interviews: two homogenous groups (one with medical students, one with nursing students) and two mixed groups (medical and nursing students). The results show that traditional patterns of professional role perception still prevail and strongly influence students' professional attitudes about taking responsibility and sharing responsibility across disciplinary and professional boundaries. It was found that many students had experienced group cultures detrimental to team work. Focusing on clinical training, the study found a substantial variation in perception with regard to the different arenas for interprofessional teamwork, ranging from arenas with collaborative learning to arenas characterized by distrust, confrontation, disrespect and hierarchical structure. This study underlines the importance of a stronger focus on interprofessional teamwork in health care education, particularly in clinical training. The study results suggest that the daily rounds and pre-visit "huddles," or alternatively psychiatric wards, offer arenas suitable for interprofessional training, in keeping with the students' assessments and criteria proposed in previous studies.

Reporting dream experience: Why (not) to be skeptical about dream reports.

PubMed

Windt, Jennifer M

2013-01-01

Are dreams subjective experiences during sleep? Is it like something to dream, or is it only like something to remember dreams after awakening? Specifically, can dream reports be trusted to reveal what it is like to dream, and should they count as evidence for saying that dreams are conscious experiences at all? The goal of this article is to investigate the relationship between dreaming, dream reporting and subjective experience during sleep. I discuss different variants of philosophical skepticism about dream reporting and argue that they all fail. Consequently, skeptical doubts about the trustworthiness of dream reports are misguided, and for systematic reasons. I suggest an alternative, anti-skeptical account of the trustworthiness of dream reports. On this view, dream reports, when gathered under ideal reporting conditions and according to the principle of temporal proximity, are trustworthy (or transparent) with respect to conscious experience during sleep. The transparency assumption has the status of a methodologically necessary default assumption and is theoretically justified because it provides the best explanation of dream reporting. At the same time, it inherits important insights from the discussed variants of skepticism about dream reporting, suggesting that the careful consideration of these skeptical arguments ultimately leads to a positive account of why and under which conditions dream reports can and should be trusted. In this way, moderate distrust can be fruitfully combined with anti-skepticism about dream reporting. Several perspectives for future dream research and for the comparative study of dreaming and waking experience are suggested.

Effect of subcutaneous Enoxaparin injection duration on bruising size in acute coronary syndrome patients.

PubMed

Dehghani, Khadije; Najari, Zahra; Dehghani, Hamideh

2014-11-01

Bruising is an unpleasant result of subcutaneous injection of Enoxaparin, which causes physical discomfort, limitation of injection site, patient's refusal of treatment, and distrust in nurses' ability. The application of techniques which reduce patients' fear, anxiety, and physical damage is one of the tasks of nurses. This clinical trial investigated the effect of duration of subcutaneous Enoxaparin injection on the bruising size in acute coronary syndrome patients. Seventy 35-75-year-old acute coronary syndrome patients hospitalized in Coronary Care Units were selected randomly. Each subject received 10- and 30-sec duration of injections by a single researcher on both sides of the abdomen in 12-h intervals. The bruising size was measured using a transparent millimeter measuring paper, 24 and 48 h after each injection. Data were gathered by a data recording form (demographic and measurements data) and analyzed by descriptive statistics and non-parametric tests through SPSS. Results showed that the mean bruising sizes at 24 h after 10- and 30-sec injection were 33.26 mm(2) (72.77) and 48.96 mm(2) (99.91), respectively, and at 48 h were 15.61 mm(2) (142.02) and 52.48 mm(2) (143), respectively. There was no significant relationship between the two techniques (P > 0.05), although the effect of age on bruising size was significant (P = 0.01). According to the findings of the present study, length of Enoxaparin subcutaneous injection has no effect on the bruising size.

Organizational and technological correlates of nurses' trust in a smart intravenous pump.

PubMed

Montague, Enid; Asan, Onur; Chiou, Erin

2013-03-01

The aim of this study was to understand technology and system characteristics that contribute to nurses' ratings of trust in a smart intravenous pump. Nurses' trust in new technologies can influence how technologies are used. Trust in technology is defined as a person's belief that a technology will not fail them. Potential outcomes of trust in technology are appropriate trust, overtrust, distrust, and mistrust. Trust in technology is also related to several use-specific outcomes, including appropriate use and inappropriate use such as overreliance, disuse or rejection, or misuse. Understanding trust in relation to outcomes can contribute to designs that facilitate appropriate trust in new technologies. A survey was completed by 391 nurses a year after the implementation of a new smart intravenous pump. The survey assessed trust in the intravenous pump and other elements of the sociotechnical system, individual characteristics, technology characteristics, and organizational characteristics. Results show that perceptions of usefulness, safety, ease of use, and usability are related to ratings of trust in smart intravenous pumps. Other work systemfactors such as perception of work environment, age, experience, quality of work, and perception of work performance are also related to ratings of trust. Nurses' trust in smart intravenous pumps is influenced by both characteristics of the technology and the sociotechnical system. Findings from this research have implications for the design of future smart intravenous pumps and health systems. Recommendations for appropriately trustworthy smart intravenous pumps are discussed. Findings also have implications for how trust in health technologies can be measured and conceptualized in complex sociotechnical systems.

Experimental Quantum Coin Tossing

NASA Astrophysics Data System (ADS)

Molina-Terriza, G.; Vaziri, A.; Ursin, R.; Zeilinger, A.

2005-01-01

In this Letter we present the first implementation of a quantum coin-tossing protocol. This protocol belongs to a class of “two-party” cryptographic problems, where the communication partners distrust each other. As with a number of such two-party protocols, the best implementation of the quantum coin tossing requires qutrits, resulting in a higher security than using qubits. In this way, we have also performed the first complete quantum communication protocol with qutrits. In our experiment the two partners succeeded to remotely toss a row of coins using photons entangled in the orbital angular momentum. We also show the experimental bounds of a possible cheater and the ways of detecting him.

A Privacy-Preserving Platform for User-Centric Quantitative Benchmarking

NASA Astrophysics Data System (ADS)

Herrmann, Dominik; Scheuer, Florian; Feustel, Philipp; Nowey, Thomas; Federrath, Hannes

We propose a centralised platform for quantitative benchmarking of key performance indicators (KPI) among mutually distrustful organisations. Our platform offers users the opportunity to request an ad-hoc benchmarking for a specific KPI within a peer group of their choice. Architecture and protocol are designed to provide anonymity to its users and to hide the sensitive KPI values from other clients and the central server. To this end, we integrate user-centric peer group formation, exchangeable secure multi-party computation protocols, short-lived ephemeral key pairs as pseudonyms, and attribute certificates. We show by empirical evaluation of a prototype that the performance is acceptable for reasonably sized peer groups.

[Influenza A from the rational choice theory: proposals for decision making in prevention policies].

PubMed

Peña, Francisco Garrido; Fernández, Luís Andrés López; García, Eugenia Gil

2009-01-01

This article is a reflection on the social uncertainty caused by Influenza A and on the consequences that it can have on decision making in health promotion policies. We use concepts and metaphors of the Rational Choice Theory, among them, the "in gratitude effect" or the "distrust effect", as we analyse how these can become obstacles for the efficiency of prevention policies. Then, we focus on the information asymmetry of the principal-agent relationship, and we propose measures to diminish the "moral risk" that they cause. We finish by advancing some proposals for designing lines and strategies of action in health promotion policies.

Enhancing interpretability of automatically extracted machine learning features: application to a RBM-Random Forest system on brain lesion segmentation.

PubMed

Pereira, Sérgio; Meier, Raphael; McKinley, Richard; Wiest, Roland; Alves, Victor; Silva, Carlos A; Reyes, Mauricio

2018-02-01

Machine learning systems are achieving better performances at the cost of becoming increasingly complex. However, because of that, they become less interpretable, which may cause some distrust by the end-user of the system. This is especially important as these systems are pervasively being introduced to critical domains, such as the medical field. Representation Learning techniques are general methods for automatic feature computation. Nevertheless, these techniques are regarded as uninterpretable "black boxes". In this paper, we propose a methodology to enhance the interpretability of automatically extracted machine learning features. The proposed system is composed of a Restricted Boltzmann Machine for unsupervised feature learning, and a Random Forest classifier, which are combined to jointly consider existing correlations between imaging data, features, and target variables. We define two levels of interpretation: global and local. The former is devoted to understanding if the system learned the relevant relations in the data correctly, while the later is focused on predictions performed on a voxel- and patient-level. In addition, we propose a novel feature importance strategy that considers both imaging data and target variables, and we demonstrate the ability of the approach to leverage the interpretability of the obtained representation for the task at hand. We evaluated the proposed methodology in brain tumor segmentation and penumbra estimation in ischemic stroke lesions. We show the ability of the proposed methodology to unveil information regarding relationships between imaging modalities and extracted features and their usefulness for the task at hand. In both clinical scenarios, we demonstrate that the proposed methodology enhances the interpretability of automatically learned features, highlighting specific learning patterns that resemble how an expert extracts relevant data from medical images. Copyright © 2017 Elsevier B.V. All rights reserved.

Analysis of trust in autonomy for convoy operations

NASA Astrophysics Data System (ADS)

Gremillion, Gregory M.; Metcalfe, Jason S.; Marathe, Amar R.; Paul, Victor J.; Christensen, James; Drnec, Kim; Haynes, Benjamin; Atwater, Corey

2016-05-01

With growing use of automation in civilian and military contexts that engage cooperatively with humans, the operator's level of trust in the automated system is a major factor in determining the efficacy of the human-autonomy teams. Suboptimal levels of human trust in autonomy (TiA) can be detrimental to joint team performance. This mis-calibrated trust can manifest in several ways, such as distrust and complete disuse of the autonomy or complacency, which results in an unsupervised autonomous system. This work investigates human behaviors that may reflect TiA in the context of an automated driving task, with the goal of improving team performance. Subjects performed a simulated leaderfollower driving task with an automated driving assistant. The subjects had could choose to engage an automated lane keeping and active cruise control system of varying performance levels. Analysis of the experimental data was performed to identify contextual features of the simulation environment that correlated to instances of automation engagement and disengagement. Furthermore, behaviors that potentially indicate inappropriate TiA levels were identified in the subject trials using estimates of momentary risk and agent performance, as functions of these contextual features. Inter-subject and intra-subject trends in automation usage and performance were also identified. This analysis indicated that for poorer performing automation, TiA decreases with time, while higher performing automation induces less drift toward diminishing usage, and in some cases increases in TiA. Subject use of automation was also found to be largely influenced by course features.

[Medical systems which coexist in the Novena region of Chile: a general description].

PubMed

Oyarce, A M

1988-09-01

3 distinct systems of ideas about health and illness, types of persons dedicated to curing, and treatments and remedies are recognized to coexist in Chile. In the 9th region, the Mapuche traditional indigenous system operates alongside the traditional popular system which resulted from the blending of prehispanic and medieval European medical beliefs and practices and the western, official, scientific medical system. Relations between the western and the 2 traditional systems have been characterized by distrust, lack of esteem, and rejection, both because the western system belongs to the dominant social sectors and because it lacks a frame of reference for understanding medical practices different from its own. The Mapuche medical system is one of the aspects of Mapuche culture that has best withstood cultural change, perhaps because its magicoreligious basis expresses the central core of Mapuche culture. It is transmitted by oral tradition and formal teaching to young Mapuche who receive signs of their vocation. The Mapuche medical system is practiced predominantly in the 9th health region. It is a personalistic system, in which recognized causes of illness are generally attributed to 3rd parties. Illnesses are produced by 3 types of agents including malicious spirits or forces which assume different human, animal, or natural forms and persons with evil powers or those contracting with them. Illnesses may also result from the failure to satisfy a norm, duty, or divine calling. Even in cases in which a disease or injury is recognized to be due to natural causes, a magicoreligious type of cause is believed to originate the condition. A field study conducted in 1987 in a Mapuche community produced evidence within the community of 2 women working in the traditional Mapuche system and 3 in the traditional popular system. Members of the community also consulted at least 6 traditional Mapuche and 5 traditional popular medical specialists in nearby communities, as well as 2 western health centers located 10 and 27 km away.

Bird flu, influenza and 1918: the case for mutant Avian tuberculosis.

PubMed

Broxmeyer, Lawrence

2006-01-01

Influenza is Italian for "influence", Latin: influentia. It used to be thought that the disease was caused by a bad influence from the heavens. Influenza was called a virus long, long before it was proven to be one. In 2005, an article in the New England Journal of Medicine estimated that a recurrence of the 1918 influenza epidemic could kill between 180 million and 360 million people worldwide. A large part of the current bird-flu hysteria is fostered by a distrust among the lay and scientific community regarding the actual state of our knowledge regarding the bird flu or H5N1 and the killer "Influenza" Pandemic of 1918 that it is compared to. And this distrust is not completely unfounded. Traditionally, "flu" does not kill. Experts, including Peter Palese of the Mount School of Medicine in Manhattan, remind us that even in 1992, millions in China already had antibodies to H5N1, meaning that they had contracted it and that their immune system had little trouble fending it off. Dr. Andrew Noymer and Michel Garenne, UC Berkely demographers, reported in 2000 convincing statistics showing that undetected tuberculosis may have been the real killer in the 1918 flu epidemic. Aware of recent attempts to isolate the "Influenza virus" on human cadavers and their specimens, Noymer and Garenne summed that: "Frustratingly, these findings have not answered the question why the 1918 virus was so virulent, nor do they offer an explanation for the unusual age profile of deaths". Bird flu would certainly be diagnosed in the hospital today as Acute Respiratory Distress Syndrome (ARDS). Roger and others favor suspecting tuberculosis in all cases of acute respiratory failure of unknown origin. By 1918, it could be said, in so far as tuberculosis was concerned, that the world was a supersaturated sponge ready to ignite and that among its most vulnerable parts was the very Midwest where the 1918 unknown pandemic began. It is theorized that the lethal pig epidemic that began in Kansas just prior to the first human outbreaks was a disease of avian and human tuberculosis genetically combined through mycobacteriophage interchange, with the pig, susceptible to both, as its involuntary living culture medium. What are the implications of mistaking a virus such as Influenza A for what mycobacterial disease is actually causing? They would be disastrous, with useless treatment and preventative stockpiles. The obvious need for further investigation is presently imminent and pressing.

Public Health and Social Desirability in Kazakhstan: Methodological Considerations

PubMed Central

Craig, Brett J.; Engstrom, Martha C.

2015-01-01

Background: As the Republic of Kazakhstan undertakes new public health efforts to promote healthy lifestyles among its citizens, the local perceptions of health and health behaviors need to be examined and understood from the sociocultural and historical perspectives. The primary aim of this study is to examine the association between perception of control on one’s health and engagement in good and bad health behaviors. Methods: Students enrolled in a health communication course surveyed 310 citizens of Kazakhstan on their perceptions of control over their own health and multiple health behaviors (i.e. smoking status, physical activity, etc.). Twenty-seven students were divided into groups and approached every third passerby as a potential participant during common shopping hours in nine popular marketplaces in Astana, Kazakhstan. Perception of control on one’s health was measured using a validated measure of health control: the multidimensional health locus of control scale (MHLC), developed by Wallston and colleagues. The MHLC measures three separate loci of control: internal, chance, and powerful others. Results: Participants perceived themselves as having highest control over their health (MHLC subscale internal: 29.70±0.64), powerful others had second highest control (MHLC subscale power others: 23.72±0.77), and chance had the lowest but still some control on their health (MHLC subscale chance: 20.82±0.85). Most participants rated their current health as very good (18.1%), good (45.0%), or moderate (32.3%). Approximately 23.4% of participants were smokers, and 22.2% consumed alcohol. Physical activity averaged 3.63 days in the past week, and fruit and vegetable consumption averaged 2 servings of each per day. Tobacco and the powerful others subscale were significantly negatively correlated (r=−0.17, p<0.05). Conclusions: Participant reports regarding personal health behaviors and lifestyle did not reflect the national reports regarding lifestyle behaviors. The relationship between powerful others subscale and tobacco smoking indicate that using healthcare providers may open up avenues to lowering tobacco use through patient education; however, social desirability is a notable concern for public health interventions. More importantly, the surveys uncovered future questions for conducting public health research with the general public, including issues of trust in the healthcare system and social desirability bias. Additional factors such as distrust in healthcare and government also may play a role in the public’s participation in social scientific research. The students who conducted the surveys reported a general skepticism from the public ranging from unfamiliarity with survey research to explicit distrust in the intentions and purpose of the research itself. PMID:29138719

Peace and Human Rights Education in the Middle East: Comparing Jewish and Palestinian Experiences

NASA Astrophysics Data System (ADS)

Velloso, Agustín

1998-07-01

The Washington agreement of 1993 gave a new impetus to attempts by Palestinian and Israeli leaders to find a peaceful solution to their differences. The author asks to what extent this process has been accompanied by peace/human rights education programmes for Israeli and Palestinian children. While such programmes exist, they are very limited and have so far made little impact in reversing the long educational legacy of mutual distrust and hostility, which the article examines in detail. Furthermore, the continuing conflicts between the two communities make peace/human rights education difficult. However, despite the enormous obstacles, the author concludes that the efforts of peace/human rights educators are not wasted.

Paranoid personality disorder and the schizophrenia spectrum-Where to draw the line?

PubMed

Birkeland, Søren Fryd

2013-08-01

By means of a case vignette, this study explores the clinical intersection between paranoid personality disorder and other schizophrenia-spectrum illness. Even though the patient described had paramount signs of a paranoid personality disorder and was diagnosed as such, psychopathological symptoms extended considerably beyond the common concept and diagnostic criteria of the disorder. Management strategies included psychopharmacological and non-pharmacological interventions, yet psychosocial functioning permanently appeared defective. While there is a persistent need for an opportunity to distinguish the characteristic syndromal pattern of paranoid personality attributes, the case exemplifies the challenges associated with classifying some largely suspicious and distrustful eccentrics within the schizophrenia spectrum. Copyright © 2013 John Wiley & Sons, Ltd.

The challenge of recruiting people with schizophrenia to a health promotion trial

PubMed Central

Abbott, Margaret; Arthur, Antony; Walker, Liz; Doody, Gillian

2005-01-01

People with schizophrenia have an increased risk of coronary heart disease. This pilot study tested the feasibility of carrying out a randomised controlled trial to compare coronary heart disease prevention for this population through an enhanced occupational therapy support intervention versus a practice-based intervention. Difficulty in deciding whether to take part meant that 123 visits were made to 25 people with 12 ultimately providing informed consent. Participants' discussion at a subsequent focus group (n = 3) suggested a poor understanding of the study process. Distrust of randomisation suggests that randomised controlled trials may not be the best way to evaluate community-based interventions for people with schizophrenia. PMID:16105374

A Non-reductionist Approach to Trust

NASA Astrophysics Data System (ADS)

Castelfranchi, Cristiano; Falcone, Rino; Lorini, Emiliano

We develop in this chapter a conceptual and logical model of social trust. We first present a modal logic of mental attitudes and action in which the concepts of plausible belief, certain belief, and a possibility order over formulas can be characterized. Then, we apply the logic to the formalization of the truster's expectation about some fundamental properties of the trustee (trustee's opportunity to accomplish a given task, his skills, abilities, and willingness to perform a given action for the accomplishment of the task). A, part of this chapter is devoted to discuss and formalize some concepts related to trust such as distrust, mistrust, lack of trust, and delegation. Finally, a concept of comparative trust is presented.

Challenging Assumptions About Minority Participation in US Clinical Research

PubMed Central

Kalbaugh, Corey A.

2011-01-01

Although extensive research addresses minorities’ low participation in clinical research, most focuses almost exclusively on therapeutic trials. The existing literature might mask important issues concerning minorities’ participation in clinical trials, and minorities might actually be overrepresented in phase I safety studies that require the participation of healthy volunteers. It is critical to consider the entire spectrum of clinical research when discussing the participation of disenfranchised groups; the literature on minorities’ distrust, poor access, and other barriers to trial participation needs reexamination. Minority participation in clinical trials is an important topic in public health discussions because this representation touches on issues of equality and the elimination of disparities, which are core values of the field. PMID:22021285

Understanding and Reconciling Differences in Surface and Satellite-Based Lower Troposphere Temperatures

NASA Astrophysics Data System (ADS)

Hausfather, Z.; Thorne, P.; Mears, C. A.

2017-12-01

One of the main remaining uncertainties in global temperatures over the past few decades is the disagreement between surface and microwave sounding unit (MSU) satellite-based observations of the lower troposphere. Reconciling these will prove an important step in improving our understanding of modern climate change, and help resolve an issue that has been frequently brought to the attention of policymakers and highlighted as a reason to distrust climate observations. To assess differences between surface and satellite records, we examine data from radiosondes, from atmospheric reanalysis, from numerous different satellites, from surface observations over the land and ocean, and from global climate models. Controlling for spatial coverage, we determine where these datasets agree and disagree, isolate the differences, and identify for common factors to explain the divergences. We find large systemic differences between surface and lower troposphere warming in MSU/AMSU records compared to radiosondes, reanalysis products, and climate models that suggest possible residual inhomogeneities in satellite records. We further show that no reasonable subset of surface temperature records exhibits as little warming over the last two decades as satellite observations, suggesting that inhomogeneities in the surface record are very likely not responsible for the divergence.

The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community.

PubMed

Thomas, S B; Quinn, S C

1991-11-01

The Tuskegee study of untreated syphilis in the Negro male is the longest nontherapeutic experiment on human beings in medical history. The strategies used to recruit and retain participants were quite similar to those being advocated for HIV/AIDS prevention programs today. Almost 60 years after the study began, there remains a trail of distrust and suspicion that hampers HIV education efforts in Black communities. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The belief that AIDS is a form of genocide is rooted in a social context in which Black Americans, faced with persistent inequality, believe in conspiracy theories about Whites against Blacks. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. An open and honest discussion of the Tuskegee Syphilis Study can facilitate the process of rebuilding trust between the Black community and public health authorities. This dialogue can contribute to the development of HIV education programs that are scientifically sound, culturally sensitive, and ethnically acceptable.

Implementing Indigenous community control in health care: lessons from Canada.

PubMed

Lavoie, Josée G; Dwyer, Judith

2016-09-01

Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions. What does this paper add? The Canadian experience indicates that transferring PHC from government to community ownership requires sustained commitment, adequate resourcing of the change process and the development of a meaningful accountability framework tailored to the sector. What are the implications for practitioners? Policy makers in Australia will need to attend to reform in contractual arrangements (towards pooled or bundled funding), adopt a long-term vision for transfer and find ways to harmonise the roles of federal and state governments. The arrangements achieved in some communities in the Australian Coordinated Care Trials (and still in place) provide a model.

Patient Education in Inflammatory Bowel Disease: A Patient-Centred, Mixed Methodology Study.

PubMed

McDermott, Edel; Healy, Gerard; Mullen, Georgina; Keegan, Denise; Byrne, Kathryn; Guerandel, Allys; Forry, Mary; Moloney, Jenny; Doherty, Glen; Cullen, Gareth; Malone, Kevin; Mulcahy, Hugh

2018-03-28

Consensus guidelines from the European Crohns and Colitis Organisation conclude that optimizing quality of care in inflammatory bowel disease [IBD] involves information and education. However, there is no standardized patient education programme in IBD and education varies from centre to centre. To assess patients' education needs in IBD to facilitate design of a patient education programme. We created focus groups of 12 patients with IBD and used qualitative analysis to generate hypotheses. We then developed a quantitative questionnaire which was disseminated to 327 IBD patients attending three different centres. Five patients declined to participate and thus 322 patients (159 [49%] male, 180 [58%] Crohn's disease, median age 38 years and disease duration 7 years) were included. Patients were most keen to receive education on medications, 'what to expect in future', living with IBD and diet. They wanted to receive this information from specialist doctors or nurses and believed it could improve their quality of life. Though the internet was the preferred source of general information [i.e. planning holidays], it was the least preferred source of IBD education. While there was a trend for females to prefer peer education, family history of IBD was the only statistically significant factor associated with information preferences. This is a patient-centred, mixed methodology study on patient education in IBD. Patients' preferences for education include components such as what to expect and diet and patients seem to distrust the internet as an IBD information source. International validation would be valuable to create a consensus education programme.

Trust in telemedicine portals for rehabilitation care: an exploratory focus group study with patients and healthcare professionals.

PubMed

Van Velsen, Lex; Wildevuur, Sabine; Flierman, Ina; Van Schooten, Boris; Tabak, Monique; Hermens, Hermie

2016-01-27

For many eServices, end-user trust is a crucial prerequisite for use. Within the context of Telemedicine, the role of trust has hardly ever been studied. In this study, we explored what determines trust in portals that facilitate rehabilitation therapy, both from the perspective of the patient and the healthcare professional. We held two focus groups with patients (total n = 15) and two with healthcare professionals (total n = 13) in which we discussed when trust matters, what makes up trust in a rehabilitation portal, what effect specific design cues have, and how much the participants trust the use of activity sensor data for informing treatment. Trust in a rehabilitation portal is the sum of trust in different factors. These factors and what makes up these factors differ for patients and healthcare professionals. For example, trust in technology is made up, for patients, mostly by a perceived level of control and privacy, while for healthcare professionals, a larger and different set of issues play a role, including technical reliability and a transparent data storage policy. Healthcare professionals distrust activity sensor data for informing patient treatment, as they think that sensors are unable to record the whole range of movements that patients make (e.g., walking and ironing clothes). The set of factors that affect trust in a rehabilitation portal are different from the sets that have been found for other contexts, like eCommerce. Trust in telemedicine technology should be studied as a separate subject to inform the design of reliable interventions.

Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study

PubMed Central

Canvin, Krysia; Jones, Chris; Marttila, Anneli; Burström, Bo; Whitehead, Margaret

2007-01-01

Objectives To improve understanding of how families living in adverse conditions perceive their encounters with public services and how past experiences influence current and future attempts to seek help. Design Qualitative interviews with adult members of households living in poverty in deprived areas, plus observations conducted in the surrounding neighbourhoods and service settings. Participants Purposive sample of 25 adults living in a deprived area, on welfare benefits. Setting Eight sites in disadvantaged areas in Merseyside, North Wales, London and Greater Manchester in 2004/05. Results Participants generally perceived public services as a source of distrust and a potential risk to well‐being. Encounters with a range of services were perceived as risky in terms of losing resources, being misunderstood or harshly judged, and carrying the ultimate threat of losing custody of their children. Participants perceived that they were subjected to increasing levels of surveillance, with fear of “being told on” by neighbours, in addition to service providers, adding to anxiety. Adverse consequences included avoiding child health and social services, anxiety and self‐imposed isolation. Conclusions Approaching services was perceived as akin to taking a gamble that might or might not result in their needs being met. Faced with this “choice”, participants employed strategies to minimise the risks that on the surface may appear risky to health. If public services are to succeed in providing support to disadvantaged families, greater efforts are needed to build trust and demonstrate understanding for the strategies these families use to maintain their well‐being against formidable odds. PMID:17933957

Community-Based Participatory Research Integrates Behavioral and Biological Research to Achieve Health Equity for Native Hawaiians.

PubMed

Townsend, Claire K M; Dillard, Adrienne; Hosoda, Kelsea K; Maskarinec, Gregory G; Maunakea, Alika K; Yoshimura, Sheryl R; Hughes, Claire; Palakiko, Donna-Marie; Kehauoha, Bridget Puni; Kaholokula, Joseph Keawe'aimoku

2015-12-22

Native Hawaiians bear a disproportionate burden of type-2 diabetes and related complications compared to all other groups in Hawai'i (e.g., Whites, Japanese, Korean). Distrust in these communities is a significant barrier to participation in epigenetic research studies seeking to better understand disease processes. The purpose of this paper is to describe the community-based participatory research (CBPR) approach and research process we employed to integrate behavior and biological sciences with community health priorities. A CBPR approach was used to test a 3-month evidence-based, diabetes self-management intervention (N = 65). To investigate the molecular mechanisms linking inflammation with glucose homeostasis, a subset of participants (n = 16) provided peripheral blood mononuclear cells. Community and academic researchers collaborated on research design, assessment protocols, and participant recruitment, prioritizing participants' convenience and education and strictly limiting the use of the data collected. Preliminary results indicate significant changes in DNA methylation at gene regions associated with inflammation and diabetes signaling pathways and significant improvements in hemoglobin A1c, self-care activities, and diabetes distress and understanding. This study integrates community, behavioral, and epigenomic expertise to better understand the outcomes of a diabetes self-management intervention. Key lessons learned suggest the studies requiring biospecimen collection in indigenous populations require community trust of the researchers, mutual benefits for the community and researchers, and for the researchers to prioritize the community's needs. CBPR may be an important tool in providing communities the voice and protections to participate in studies requiring biospecimens.

Employment participation and work experience of male cancer survivors: a NOCWO study.

PubMed

Gunnarsdottir, Holmfridur K; Vidarsdottir, Halldora; Rafnsdottir, Gudbjorg Linda; Tryggvadottir, Laufey; Olafsdottir, Elinborg J; Lindbohm, Marja-Liisa

2013-01-01

To investigate whether employment status and work experiences, assessed in terms of job resources (organizational culture and superiors' and co-workers' support), commitment to organization, work motives, and experiences of discrimination, differ between survivors of prostate or testicular cancer or lymphoma and cancer-free reference subjects. Questionnaires were sent to 1349 male cancer survivors and 2666 referents in Denmark, Finland, Iceland, and Norway. Valid responses were 59% and 45%, respectively. Odds ratios (OR) and 95% confidence intervals (CI) were estimated with logistic regression models. Compared to the referents, survivors of lymphoma and prostate cancer were less likely to be employed (OR=0.53; CI: 0.30-0.95 and OR=0.50; CI: 0.35-0.73, respectively), but decreased employment was not evident among testicular cancer survivors. Testicular cancer survivors experienced less discrimination at work than did the referents, for example, testicular cancer survivors were less likely to report that their colleagues doubted their ability to carry out their work tasks (OR=0.38; CI: 0.17-0.83). Lymphoma survivors were less likely than the referents to praise their workplace as an enjoyable place to work (OR=0.48; CI: 0.26-0.88). The prostate cancer survivors were more likely than the referents to find the organizational climate competitive, distrustful, and suspicious. Employment participation and work experiences of male cancer survivors varied substantially according to type of cancer. Occupational therapists and other health care personnel should keep this in mind when assisting cancer survivors in identifying their strengths and limitations at work.

Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study.

PubMed

Canvin, Krysia; Jones, Chris; Marttila, Anneli; Burström, Bo; Whitehead, Margaret

2007-11-01

To improve understanding of how families living in adverse conditions perceive their encounters with public services and how past experiences influence current and future attempts to seek help. Qualitative interviews with adult members of households living in poverty in deprived areas, plus observations conducted in the surrounding neighbourhoods and service settings. Purposive sample of 25 adults living in a deprived area, on welfare benefits. Eight sites in disadvantaged areas in Merseyside, North Wales, London and Greater Manchester in 2004/05. Participants generally perceived public services as a source of distrust and a potential risk to well-being. Encounters with a range of services were perceived as risky in terms of losing resources, being misunderstood or harshly judged, and carrying the ultimate threat of losing custody of their children. Participants perceived that they were subjected to increasing levels of surveillance, with fear of "being told on" by neighbours, in addition to service providers, adding to anxiety. Adverse consequences included avoiding child health and social services, anxiety and self-imposed isolation. Approaching services was perceived as akin to taking a gamble that might or might not result in their needs being met. Faced with this "choice", participants employed strategies to minimise the risks that on the surface may appear risky to health. If public services are to succeed in providing support to disadvantaged families, greater efforts are needed to build trust and demonstrate understanding for the strategies these families use to maintain their well-being against formidable odds.

Barred from better medicine? Reexamining regulatory barriers to the inclusion of prisoners in research.

PubMed

Huang, Elaine; Cauley, Jacqueline; Wagner, Jennifer K

2017-04-01

In 2015, President Obama announced plans for the Precision Medicine Initiative ® (PMI), an ambitious longitudinal project aimed at revolutionizing medicine. Integral to this Initiative is the recruitment of over one million Americans into a volunteer research cohort, the All of Us SM Research Program. The announcement has generated much excitement but absent is a discussion of how the All of Us Research Program-to be implemented within the context of social realities of mass incarcerations and racial disparities in criminal justice and healthcare-might excaberate health disparities. We examine how attainment of Initiative's stated goals of reflecting the diversity of the American population and including all who are interested in participating might be impeded by regulatory and administrative barriers to the involvement of participants who become incarcerated during longitudinal studies. Changes have been proposed to the federal policy for human subjects research protections, but current regulations and administrative policies-developed under a protectionist paradigm in response to scandalous research practices with confined populations-dramatically limit research involving prisoners. Our review provides rationale for the development of Initiative policies that anticipate recruitment and retention obstacles that might frustrate inclusivity and exacerbate health disparities. Furthermore, we question the effective ban on biomedical and behavioral research involving prisoners and advocate for regulatory reforms that restore participatory research rights of prisoners. Disparities in health and justice are intertwined, and without regulatory reforms to facilitate participatory research rights of prisoners and careful planning of viable and responsible recruitment, engagement, and retention strategies, Initiative could miss discovery opportunities, exacerbate health disparities, and increase levels of distrust in science.

"Caught with a body" yet protected by law? Calling 911 for opioid overdose in the context of the Good Samaritan Law.

PubMed

Latimore, Amanda D; Bergstein, Rachel S

2017-12-01

To address soaring opioid overdose fatality rates, 41U.S. states have passed Good Samaritan Laws (GSLs) extending legal immunity to overdose bystanders who call for emergency assistance. This study, conducted during the period that followed implementation of a GSL, aimed to characterize current factors determining the decision to call for emergency medical help (911) at the scene of an overdose with specific attention to exploring the role of the GSL as one such factor in decision-making. We conducted 22 in-depth interviews with needle exchange program clients in Baltimore, MD. Most participants reported calling 911 or witnessing a 911 call after drug overdose, but widely remained fearful of arrest for drug or paraphernalia possession, homicide, outstanding warrants, and/or trespassing. These concerns were underpinned by a history of police maltreatment and threat, and strong distrust of police; concerns which were specifically related to perceptions of police conduct at the scene of an overdose as well as perceptions of police conduct in general. Additional considerations included: fear of losing housing, informal shelter or custody of children; encountering social stigma; and facing violent and fatal repercussions at the hands of local drug dealers. Additionally, some participants did not perceive a significant enough medical risk to call 911. Two thirds of participants were unaware of the GSL. Some believed a GSL would positively impact law enforcement behaviour and increase the likelihood of a bystander call; but due to distrust of police, others believed the GSL would have little influence on bystander decisions. Insights from overdose bystanders during the post-implementation period of a Good Samaritan Law demonstrate persistent deterrents to bystanders calling 911 after overdose. Additional measures are needed to align policy aims with lived experiences of overdose bystanders, and to achieve overdose prevention aims. Copyright © 2017 Elsevier B.V. All rights reserved.

General practitioners using complementary and alternative medicine differ from general practitioners using conventional medicine in their view of the risks of electromagnetic fields: a postal survey from Germany.

PubMed

Kowall, Bernd; Breckenkamp, Jürgen; Berg-Beckhoff, Gabriele

2015-01-01

General practitioners (GPs) play a key role in consulting patients worried about health effects of electromagnetic fields (EMF). We compared GPs using conventional medicine (COM) with GPs using complementary and alternative medicine (CAM) concerning their perception of EMF risks. Moreover, we assessed whether the kind of alternative medicine has an influence on the results. A total of 2795 GPs drawn randomly from lists of German GPs were sent an either long or short self-administered postal questionnaire on EMF-related topics. Adjusted logistic regression models were fitted to assess the association of an education in alternative medicine with various aspects of perceiving EMF risks. Concern about EMF, misconceptions about EMF, and distrust toward scientific organizations are more prevalent in CAM-GPs. CAM-GPs more often falsely believed that mobile phone use can lead to head warming of more than 1°C (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.5-3.3), more often distrusted the Federal Office for Radiation Protection (OR = 2.2, 95% CI = 1.4-3.6), were more often concerned about mobile phone base stations (OR = 2.4, 95% CI = 1.6-3.6), more often attributed own health complaints to EMF (OR = 3.2, 95% CI = 1.8-5.6), and more often reported at least 1 EMF consultation (OR = 2.5, 95% CI = 1.6-3.9). GPs using homeopathy perceived EMF as more risky than GPs using acupuncture or naturopathic treatment. Concern about common EMF sources is highly prevalent among German GPs. CAM-GPs perceive stronger associations between EMF and health problems than COM-GPs. There is a need for evidence-based information about EMF risks for GPs and particularly for CAM-GPs. This is the precondition that GPs can inform patients about EMF and health in line with current scientific knowledge. © The Author(s) 2014.

Should I trust you? Learning and memory of social interactions in dementia.

PubMed

Wong, Stephanie; Irish, Muireann; O'Callaghan, Claire; Kumfor, Fiona; Savage, Greg; Hodges, John R; Piguet, Olivier; Hornberger, Michael

2017-09-01

Social relevance has an enhancing effect on learning and subsequent memory retrieval. The ability to learn from and remember social interactions may impact on susceptibility to financial exploitation, which is elevated in individuals with dementia. The current study aimed to investigate learning and memory of social interactions, the relationship between performance and financial vulnerability and the neural substrates underpinning performance in 14 Alzheimer's disease (AD) and 20 behavioural-variant frontotemporal dementia (bvFTD) patients and 20 age-matched healthy controls. On a "trust game" task, participants invested virtual money with counterparts who acted either in a trustworthy or untrustworthy manner over repeated interactions. A non-social "lottery" condition was also included. Participants' learning of trust/distrust responses and subsequent memory for the counterparts and nature of the interactions was assessed. Carer-rated profiles of financial vulnerability were also collected. Relative to controls, both patient groups showed attenuated learning of trust/distrust responses, and lower overall memory for social interactions. Despite poor learning performance, both AD and bvFTD patients showed better memory of social compared to non-social interactions. Importantly, better memory for social interactions was associated with lower financial vulnerability in AD, but not bvFTD. Learning and memory of social interactions was associated with medial temporal and temporoparietal atrophy in AD, whereas a wider network of frontostriatal, insular, fusiform and medial temporal regions was implicated in bvFTD. Our findings suggest that although social relevance influences memory to an extent in both AD and bvFTD, this is associated with vulnerability to financial exploitation in AD only, and is underpinned by changes to different neural substrates. Theoretically, these findings provide novel insights into potential mechanisms that give rise to vulnerability in people with dementia, and open avenues for possible interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

A comparison of language use in pro- and anti-vaccination comments in response to a high profile Facebook post.

PubMed

Faasse, Kate; Chatman, Casey J; Martin, Leslie R

2016-11-11

Vaccinations are important for controlling the spread of disease, yet an increasing number of people are distrustful of vaccines, and choose not to (fully) vaccinate themselves and their children. One proposed contributor to this distrust is anti-vaccination misinformation available on the internet, where people search for and discuss health information. The language people use in these discussions can provide insights into views about vaccination. Following a prominent Facebook post about childhood vaccination, language used by participants in a comment thread was analysed using LIWC (Linguistic Inquiry and Word Count). Percentage of words used across a number of categories was compared between pro-vaccination, anti-vaccination, and unrelated (control) comments. Both pro- and anti-vaccination comments used more risk-related and causation words, as well as fewer positive emotion words compared to control comments. Anti-vaccine comments were typified by greater analytical thinking, lower authenticity, more body and health references, and a higher percentage of work-related word use in comparison to pro-vaccine comments, plus more money references than control comments. In contrast, pro-vaccination comments were more authentic, somewhat more tentative, and evidenced higher anxiety words, as well as more references to family and social processes when compared to anti-vaccination comments. Although the anti-vaccination stance is not scientifically-based, comments showed evidence of greater analytical thinking, and more references to health and the body. In contrast, pro-vaccination comments demonstrated greater comparative anxiety, with a particular focus on family and social processes. These results may be indicative of the relative salience of these issues and emotions in differing understandings of the benefits and risks of vaccination. Text-based analysis is a potentially useful and ecologically valid tool for assessing perceptions of health issues, and may provide unique information about particular concerns or arguments expressed on social media that could inform future interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Partition and Poliomyelitis: An Investigation of the Polio Disparity Affecting Muslims during India's Eradication Program

PubMed Central

Hussain, Rashid S.; McGarvey, Stephen T.; Fruzzetti, Lina M.

2015-01-01

Background Significant disparities in the incidence of polio existed during its eradication campaign in India. In 2006, Muslims, who comprise 16% of the population in affected states, comprised 70% of paralytic polio cases. This disparity was initially blamed on the Muslims and a rumor that the vaccination program was a plot to sterilize their children. Using the framework of structural violence, this paper describes how the socio-political and historical context of Muslim populations in India shaped the polio disparity. Methods and Findings A qualitative study utilizing methods of rapid ethnography was conducted from May-August 2009 in Aligarh, Uttar Pradesh, India. Field methods included participant observation of vaccination teams, historical document research, and 107 interviews with both Global Polio Eradication Initiative (GPEI) stakeholders and families with vaccine-eligible children. Almost all respondents agreed that Aligarh was a highly segregated city, mostly due to riots after Partition and during the 1990s. Since the formation of segregated neighborhoods, most respondents described that "Muslim areas" had been underdeveloped compared to "Hindu areas," facilitating the physical transmission of poliovirus. Distrust of the government and resistance to vaccination were linked to this disparate development and fears of sterilization influenced by the "Family Planning Program" from 1976-1977. Conclusions Ethnic violence and social marginalization since the Partition and during the rise of Hindu nationalism led to distrust of the government, the formation of segregated slums, and has made Muslims victims of structural violence. This led to the creation of disease-spreading physical environments, lowered vaccine efficacy, and disproportionately higher levels of resistance to vaccination. The causes of the polio disparity found in this study elucidate the nature of possible other health disparities affecting minorities in India. Limitations This study is limited by the manual coding of the transcribed data, size, and some dialectal difficulties in translation. PMID:25742622

Financial stress, attitudes toward money, and scores on a Dream Inventory.

PubMed

Kroth, Jerry; Mann, Sonia; Cervantes, Carolina; Jaffe, Matthew; Ristic, Vera

2010-08-01

During stock market losses in 2009 and high unemployment, ratings on the KJP Dream Inventory were correlated with factors of the Money Attitude Scale and items on the Contemporary Financial Stress Inventory for 71 graduate students in Counseling Psychology and Education. Correlations were significant for Retention on the Money Attitude Scale with Dissociative Avoidance (-.31), Dreams of falling (.26), Risk-taking in dreams (.24), and Dreaming of being chased (.28). Also, ratings for the Money Attitude Scale of Distrust correlated with Discontentedness in dreams (.33) and Dreams of being chased (.26), Repetitive trauma (.33), Nightmares (.30), and Recurring nightmares (.35). Concern about retention in graduate school due to finances correlated with recalled frequencies of nightmares (.27) and dreams of flying (.25).

Science as religion: when science becomes (too) irrational.

PubMed

Muzur, Amir; Rinčić, Iva

2017-04-01

Science is expected to be objective: however, since practiced and produced by humans, it has to reflect human flows - prejudices, stubbornness, malice, and the tendency to be misused. No wonder an excellent scientist like John Eccles proclaimed science to be among the most personal activities he had known. By analysing a few examples from the history of science (in particular the intellectual development of Van Rensselaer Potter, the American onco-biochemist and bioethics pioneer), as well as the current trend of the evidence-based approach, the present paper will try to demonstrate that denying, distrusting, and opposing science for the sake of religion, as seen so many times in human history, has significant similarities to the overestimation of science we more often encounter in our times.

A social exchange-based model of the antecedents of workplace exclusion.

PubMed

Scott, Kristin L; Restubog, Simon Lloyd D; Zagenczyk, Thomas J

2013-01-01

We conducted 2 studies of coworker dyads to test a theoretical model exploring why and under what circumstances employees are the targets of workplace exclusion. Adopting a victim precipitation perspective, we integrate belongingness and social exchange theories to propose that employees who display workplace incivility are distrusted and therefore are targets of workplace exclusion. Highlighting the importance of the context of the perpetrator-target relationship, we also find support for the postulation that this mediated relationship is strengthened when the target employee is perceived to be a weak exchange partner and is attenuated when he or she is viewed as a valuable exchange partner. Theoretical and practical implications are discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

RELATIONAL SCHEMAS, HOSTILE ROMANTIC RELATIONSHIPS, AND BELIEFS ABOUT MARRIAGE AMONG YOUNG AFRICAN AMERICAN ADULTS

PubMed Central

Simons, Ronald L.; Simons, Leslie Gordon; Lei, Man Kit; Landor, Antoinette

2011-01-01

The present study tests a developmental model designed to explain the romantic relationship difficulties and reluctance to marry often reported for African Americans. Using longitudinal data from a sample of approximately 400 African American young adults, we examine the manner in which race-related adverse experiences during late childhood and early adolescence give rise to the cynical view of romantic partners and marriage held by many young African Americans. Our results indicate that adverse circumstances disproportionately suffered by African American youth (viz., harsh parenting, family instability, discrimination, criminal victimization, and financial hardship) promote distrustful relational schemas that lead to troubled dating relationships, and that these negative relationship experiences, in turn, encourage a less positive view of marriage. PMID:22328799

Public health, science, and policy debate: being right is not enough.

PubMed

Camargo, Kenneth; Grant, Roy

2015-02-01

Public health is usually enacted through public policies, necessitating that the public engage in debates that, ideally, are grounded in solid scientific findings. Mistrust in science, however, has compromised the possibility of deriving sound policy from such debates, partially owing to justified concerns regarding undue interference and even outright manipulation by commercial interests. This situation has generated problematic impasses, one of which is the emergence of an anti-vaccination movement that is already affecting public health, with a resurgence in the United States of preventable diseases thought to have been eradicated. Drawing on British sociologist Harry Collins' work on expertise, we propose a theoretical framework in which the paralyzing, undue public distrust of science can be analyzed and, it is hoped, overcome.

Rumors and Realities: Making Sense of HIV/AIDS Conspiracy Narratives and Contemporary Legends

PubMed Central

2015-01-01

The social context of the early HIV/AIDS epidemic in the United States provided fertile ground for rumors about transmission. Today, however, rumors about HIV/AIDS persist only within the African American public. Focus group and public discourse data reveal the content and distribution of HIV/AIDS origin and conspiracy rumors. Rumor and contemporary legend theory allows reinterpretation of rumors as a measure of trust between the African American public and health professionals, not as evidence of ignorance or of historical racial oppression. To improve public health results in the African American community, HIV/AIDS efforts must acknowledge the sources and meanings of rumors, include rumors as a measure of trust, and address the underlying distrust that the rumors signify. PMID:25393166

Military confidence building on the Korean Peninsula: possible first steps toward cooperation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vannoni, M.

The Korean Peninsula is one of the world`s most tense military confrontational sites. Nearly 2 million North Korean, South Korean, and U.S. troops face each other along the 255-km long military demarcation line. Confidence building measures (CBMs), particularly military ones, that address the security needs of both countries could decrease the danger of conflict and help create an environment where a peace regime might be negotiated. In spite of the present high level of mutual distrust, steps can still be taken to prepare for future development and implementation of CBMs. This paper defines some simple and specific first steps towardmore » CBMs that might be useful on the Korean Peninsula.« less

Seeking asylum-trauma, mental health, and human rights: an Australian perspective.

PubMed

Newman, Louise

2013-01-01

Asylum seekers represent a highly traumatized group with experiences of systematic oppression, loss, displacement, and exposure to violence. Around the world many are viewed with distrust and anxiety. The Australian response to asylum seekers is one that has used prolonged detention with significant negative impact on mental health. This has prompted much social debate and the involvement of clinicians and researchers in advocating for the human rights of asylum seekers. This article reviews the impact of mandatory prolonged detention on the mental health of asylum seekers and the significance of this for recovery and adaption. It concludes that the mandatory detention of high-risk and oppressed groups compounds trauma, with a potential long-term negative impact on mental health.

Marriageable Women: A Focus on Participants in a Community Healthy Marriage Program

PubMed Central

Manning, Wendy D.; Trella, Deanna; Lyons, Heidi; Toit, Nola Cora Du

2012-01-01

Although disadvantaged women are the targets of marriage programs, little attention has been paid to women's marriage constraints and their views of marriage. Drawing on an exchange framework and using qualitative data collected from single women participating in a marriage initiative, we introduce the concept of marriageable women—the notion that certain limitations may make women poor marriage partners. Like their male counterparts, we find women also possess qualities that are not considered assets in the marriage market, such as economic constraints, mental and physical health issues, substance use, multiple partner fertility, and gender distrust. We also consider how women participating in a marriage program frame their marriage options, whereas a few opt out of the marriage market altogether. PMID:23258947

Cultural sensitivity and health promotion: assessing breast cancer education pamphlets designed for African American women.

PubMed

Kline, Kimberly N

2007-01-01

This study discusses the implications for cultural sensitivity of the rhetorical choices in breast cancer education materials developed specifically for African American audiences by national organizations. Using the PEN-3 model of cultural sensitivity as an analytic framework for a generative rhetorical criticism, this study revealed that adaptations have been made in some pamphlets to acknowledge African American cultural values related to community, self-reliance, spirituality, and distrust of the Western medical establishment, but many messages could be revised to achieve a more comprehensive, balanced, accurate, and audience-specific discussion of the breast cancer issue. Achieving cultural sensitivity in health promotion materials necessitates attention to nuanced meanings in messages, revision of questionable arguments and evidence, and avoidance of ambiguity.

A systematic review of the limitations and approaches to improve detection and management of peripheral arterial disease in Hispanics.

PubMed

Rosero, Eric B; Kane, Katherine; Clagett, G Patrick; Timaran, Carlos H

2010-04-01

Peripheral arterial disease (PAD) is a highly prevalent public health problem associated with major detrimental effects on quality of life and functional status, and it is also the main cause of limb amputation. More importantly, PAD has been classified as a coronary artery disease equivalent, meaning that patients with a diagnosis of PAD carry a risk for major coronary events equal to that of established coronary artery disease. PAD is also a potent predictor of stroke and death. Despite its frequent occurrence (8 to 10 million Americans are affected), little is known about the natural history of PAD in racial/ethnic minorities, particularly in Hispanics, who represent 12.5% of the United States population. Furthermore, the disease is commonly underdiagnosed and undertreated in this minority group, and outcomes are poorer in Hispanics as compared with whites. Limited access to health care, difficulties for recruitment in population-based studies, and limitations of the noninvasive screening tests are well-established barriers to determine the prevalence and natural history of PAD in Hispanics. Although the most widely used test for assessment of patients at risk for PAD is the ankle-brachial index (ABI), the test has substantial limitations in individuals with diabetes and arterial calcification, which are highly prevalent in Hispanics. The ABI should, therefore, be supplemented by the use of other noninvasive tests, such as the pulse volume recordings (PVR) and toe-brachial index. Besides the use of a combination of diagnostic techniques, the implementation of a research methodology that improves recruitment of Hispanics in population-based studies is necessary to obtain better knowledge of the epidemiology of the disease in this group. Community-based participatory research may be the most appropriate approach to study this ethnic minority because it overcomes barriers for limited access to health care and increases the possibility of overcoming distrust of research on the part of communities. Understanding the epidemiology of PAD to improve its detection and treatment among Hispanics is relevant to reduce disparities in the health status of this group, the most rapidly growing ethnic minority in the United States. Published by Mosby, Inc.

The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community.

PubMed Central

Thomas, S B; Quinn, S C

1991-01-01

The Tuskegee study of untreated syphilis in the Negro male is the longest nontherapeutic experiment on human beings in medical history. The strategies used to recruit and retain participants were quite similar to those being advocated for HIV/AIDS prevention programs today. Almost 60 years after the study began, there remains a trail of distrust and suspicion that hampers HIV education efforts in Black communities. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The belief that AIDS is a form of genocide is rooted in a social context in which Black Americans, faced with persistent inequality, believe in conspiracy theories about Whites against Blacks. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. An open and honest discussion of the Tuskegee Syphilis Study can facilitate the process of rebuilding trust between the Black community and public health authorities. This dialogue can contribute to the development of HIV education programs that are scientifically sound, culturally sensitive, and ethnically acceptable. Images p1500-a p1502-a p1503-a PMID:1951814

Integrated water resources management and water users' associations in the arid region of northwest China: a case study of farmers' perceptions.

PubMed

Hu, Xiao-Jun; Xiong, You-Cai; Li, Yong-Jin; Wang, Jian-Xin; Li, Feng-Min; Wang, Hai-Yang; Li, Lan-Lan

2014-12-01

Water scarcity is a critical policy issue in the arid regions of northwest China. The local government has widely adopted integrated water resources management (IWRM), but lacks support from farmers and farm communities. We undertook a case study in the Minqin oasis of northwest China to examine farmers' responses to IWRM and understand why farmer water users' associations (WUAs) are not functioning effectively at the community level. Results of quantitative and qualitative surveys of 392 farmers in 27 administrative villages showed that over 70% of farmers disapprove of the IWRM market-based reforms. In particular, the failure of farmer WUAs can be attributed to overlapping organizational structures between the WUAs and the villagers' committees; mismatches between the organizational scale of the WUAs and practical irrigation management by the farmers themselves; marginalization of rural women in water decision-making processes; and the inflexibility of IWRM implementation. An important policy implication from this study is that rebuilding farmer WUAs is key to overcoming the difficulties of IWRM. The current water governance structure, which is dominated by administrative systems, must be thoroughly reviewed to break the vicious cycle of tension and distrust between farmers and the government. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clarifying anti-reflexivity: conservative opposition to impact science and scientific evidence

NASA Astrophysics Data System (ADS)

Dunlap, Riley E.

2014-01-01

The recent study reported by McCright et al (2013 Environ. Res. Lett. 8 044029) extends current research on conservatives’ distrust of science by distinguishing between public trust in production versus impact scientists (i.e. those whose work yields new technologies and marketable products versus those assessing the health and environmental impacts of such technologies and products). As expected, they find that conservatives are significantly less trustful of impact scientists but somewhat more trustful of production scientists. In the process they provide support for the Anti-Reflexivity Thesis, a perspective that attributes conservatives’ (and Republicans’) denial of anthropogenic climate change (ACC) and other environmental problems and attacks on climate/environmental science to their staunch commitment to protecting the current system of economic production. McCright et al’s innovative study deserves replication, and their approach should prove useful in accounting for divergent views of ACC. It is also important to keep in mind that anti-reflexivity is an institutional and structural issue, becoming more consequential when it is employed by political elites such as the George W Bush Administration in the US. Institutional anti-reflexivity is further illustrated by the widespread denial of ACC and a range of other problems among current Republican members of the US Congress.

The aftermath of the Fukushima nuclear accident: Measures to contain groundwater contamination.

PubMed

Gallardo, Adrian H; Marui, Atsunao

2016-03-15

Several measures are being implemented to control groundwater contamination at the Fukushima Daiichi Nuclear Plant. This paper presents an overview of work undertaken to contain the spread of radionuclides, and to mitigate releases to the ocean via hydrological pathways. As a first response, contaminated water is being held in tanks while awaiting treatment. Limited storage capacity and the risk of leakage make the measure unsustainable in the long term. Thus, an impervious barrier has been combined with a drain system to minimize the discharge of groundwater offshore. Caesium in seawater at the plant port has largely dropped, although some elevated concentrations are occasionally recorded. Moreover, a dissimilar decline of the radioactivity in fish could indicate additional sources of radionuclides intake. An underground frozen shield is also being constructed around the reactors. This structure would reduce inflows to the reactors and limit the interaction between fresh and contaminated waters. Additional strategies include groundwater abstraction and paving of surfaces to lower water levels and further restrict the mobilisation of radionuclides. Technical difficulties and public distrust pose an unprecedented challenge to the site remediation. Nevertheless, the knowledge acquired during the initial work offers opportunities for better planning and more rigorous decisions in the future. Copyright © 2016 Elsevier B.V. All rights reserved.

[Milk and food security].

PubMed

Díaz Yubero, Miguel Ángel

2015-04-07

In the history of food security in the EU there is a before and after the White Paper published in January 2000; since then we are witnessing radical new approaches in the Commission strategy to ensure the highest standards of food safety for EU citizens, based on a more coordinated and integrated organization. The basic principle was to extend the application of control measures at all stages of the production chain, which was summarized in the slogan which has since been repeated regularly: 'From Farm to Consumer'. The new guidelines for action were the answer to a series of food crises (dioxin, hormones, BSE...) that called into question the European agri-food system and, what was even more severe, produced a deep distrust of consumers by health risks attached to feeding. Beef and cow's milk, two basic components of the European diet, were the products most affected by the aforementioned crisis, which showed that in those years very few companies paid attention to the quality from the source. In this paper a review of the issues presented at the time, the measures implemented by the White Paper and the path travelled is done, while it raised the need to use safe and quality raw materials, so that consumers have absolute confidence in their food. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Community Perceptions of Biobanking Participation: A Qualitative Study among Mexican-Americans in Three Texas Cities.

PubMed

Heredia, Natalia I; Krasny, Sarah; Strong, Larkin L; Von Hatten, Laura; Nguyen, Lynne; Reininger, Belinda M; McNeill, Lorna H; Fernández, María E

2017-01-01

Most biospecimens in the US are collected from non-Hispanic Whites, limiting the generalizability of findings. There is a need to increase participation in biobanking among ethnic and racial minorities. The purpose of this study was to use qualitative methods to identify factors that may influence Mexican-American individuals' willingness to participate in biobanking. We conducted 15 focus groups in three Texas cities with Mexican-American individuals, in both Spanish and English. Lack of knowledge about medical research and biobanks, lack of information about the specifics of biobanking participation, lack of communication of the results, fear of pain or harm, and distrust of the healthcare system or health research were identified as barriers to biobanking participation. Facilitators to participation were altruism, safety, understanding biobanking procedures and purposes, perceived benefits to participation, and culturally appropriate recruitment strategies. Although Mexican-Americans living in Texas are willing to donate biospecimens for altruistic reasons, such as helping society or advancing science, they want more information about what biobanking entails. They want to be assured that participation will not cause them harm and that the research is conducted with good intentions. Results from this study can inform educational materials or interventions to increase Hispanic participation in biobanking. © 2016 S. Karger AG, Basel.

Community perceptions of biobanking participation: A qualitative study among Mexican-Americans in three Texas cities

PubMed Central

Heredia, Natalia I.; Krasny, Sarah; Strong, Larkin L.; Von Hatten, Laura; Nguyen, Lynne; Reininger, Belinda M.; McNeill, Lorna H.; Fernández, María E.

2016-01-01

Background Most biospecimens in the U.S. are collected from Non-Hispanic Whites, limiting the generalizability of findings. There is a need to increase participation in biobanking among ethnic and racial minorities. The purpose of this study was to use qualitative methods to identify factors that may influence Mexican-American individuals’ willingness to participate in biobanking. Methods We conducted 15 focus groups in three Texas cities with Mexican-American individuals, in both Spanish and English. Results Lack of knowledge about medical research and biobanks, lack of information about the specifics of biobanking participation, lack of communication of the results, fear of pain or harm, and distrust of the healthcare system or health research were identified as barriers to biobanking participation. Facilitators to participation were altruism, safety, understanding biobanking procedures and purposes, perceived benefits to participation, and culturally-appropriate recruitment strategies. Although Mexican-Americans living in Texas are willing to donate biospecimens for altruistic reasons, such as helping society or advancing science, they want more information about what biobanking entails. They want to be assured that participation will not cause them harm, and that the research is conducted with good intentions. Conclusion Results from this study can inform educational materials or interventions to increase Hispanic participation in biobanking. PMID:27926908

WE-G-BRA-03: Developing a Culture of Patient Safety Utilizing the National Radiation Oncology Incident Learning System (ROILS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hasson, B; Workie, D; Geraghty, C

Purpose: To transition from an in-house incident reporting system to a ROILS standards system with the intent to develop a safety focused culture in the Department and enroll in ROILS. Methods: Since the AAPM Safety Summit (2010) several safety and reporting systems have been implemented within the Department. Specific checklists and SBAR reporting systems were introduced. However, the active learning component was lost due to reporting being viewed with distrust and possible retribution.To Facilitate introducing ROILS each leader in the Department received a copy of the ROILS participation guide. Four specific tasks were assigned to each leader: develop a reportingmore » tree, begin the ROILS based system, facilitate adopting ROILS Terminology, and educate the staff on expectations of safety culture. Next, the ROILS questions were broken down into area specific questions (10–15) per departmental area. Excel spreadsheets were developed for each area and setup for error reporting entries. The Role of the Process Improvement Committee (PI) has been modified to review and make recommendations based on the ROILS entries. Results: The ROILS based Reporting has been in place for 4 months. To date 64 reports have been entered. Since the adoption of ROILS the reporting of incidents has increased from 2/month to 18/month on average. Three reports had a dosimetric effect on the patient (<5%) dose variance. The large majority of entries have been Characterized as Processes not followed or not sure how to Characterize, and Human Behavior. Conclusion: The majority of errors are typo’s that create confusion. The introduction of the ROILS standards has provided a platform for making changes to policies that increase patient safety. The goal is to develop a culture that sees reporting at a national level as a safe and effective way to improve our safety, and to dynamically learn from other institutions reporting.« less

Introducing malaria rapid diagnostic tests at registered drug shops in Uganda: limitations of diagnostic testing in the reality of diagnosis.

PubMed

Chandler, Clare I R; Hall-Clifford, Rachel; Asaph, Turinde; Pascal, Magnussen; Clarke, Siân; Mbonye, Anthony K

2011-03-01

In Uganda, around two thirds of medicines are procured from the private sector, mostly from drug shops. The introduction of malaria rapid diagnostic tests (RDTs) at drug shops therefore has the potential to make a significant contribution to targeting antimalarial drugs to those with malaria parasites. We undertook formative research in a district in Uganda in preparation for a randomised trial of RDTs in drug shops. In May to July 2009, we interviewed 9 drug shop workers, 5 health workers and 4 district health officials and carried out 10 focus group discussions with a total of 75 community members to investigate the role of drug shops and the potential for implementation of RDTs at these health care outlets. Drug shops were seen to provide an important service to community members, the nature of which is determined by responsiveness to client demands. However, drug shops hold a liminal status: in the eyes of different actors, these outlets are at once a shop and clinic; legitimate and illegitimate; and trusted and distrusted. Malaria treatment was found to be synonymous with diagnosis. Diagnostic testing was deemed useful in theory, and community members were curious about the results, with the expectation that a test would decrease uncertainty and help secure an end to illness. However, whether testing would be sought as a routine step in treatment decisions in practice is uncertain, since the appeal of the tests waned in light of their costs and potential for results to conflict with presumed diagnosis. Interventions that increase awareness of multiple causes and management of malaria-like illness will be needed to support the new rationalisation for malaria treatment represented by parasitological diagnosis. Copyright © 2011 Elsevier Ltd. All rights reserved.

Introducing malaria rapid diagnostic tests at registered drug shops in Uganda: Limitations of diagnostic testing in the reality of diagnosis.

PubMed Central

Hall-Clifford, Rachel; Asaph, Turinde; Magnussen, Pascal; Clarke, Siân; Mbonye, Anthony K

2014-01-01

In Uganda, around two thirds of medicines are procured from the private sector, mostly from drug shops. The introduction of malaria rapid diagnostic tests (RDTs) at drug shops therefore has the potential to make a significant contribution to targeting antimalarial drugs to those with malaria parasites. We undertook formative research in a district in Uganda in preparation for a randomised trial of RDTs in drug shops. In May to July 2009, we interviewed 9 drug shop workers, 5 health workers and 4 district health officials and carried out 10 focus group discussions with a total of 75 community members to investigate the role of drug shops and the potential for implementation of RDTs at these health care outlets. Drug shops were seen to provide an important service to community members, the nature of which is determined by responsiveness to client demands. However, drug shops hold a liminal status: in the eyes of different actors, these outlets are at once a shop and clinic; legitimate and illegitimate; and trusted and distrusted. Malaria treatment was found to be synonymous with diagnosis. Diagnostic testing was deemed useful in theory, and community members were curious about the results, with the expectation that a test would decrease uncertainty and help secure an end to illness. However, whether testing would be sought as a routine step in treatment decisions in practice is uncertain, since the appeal of the tests waned in light of their costs and potential for results to conflict with presumed diagnosis. Interventions that increase awareness of multiple causes and management of malaria-like illness will be needed to support the new rationalisation for malaria treatment represented by parasitological diagnosis. PMID:21349623

Trust During the Early Stages of the 2009 H1N1 Pandemic

PubMed Central

FREIMUTH, VICKI S.; MUSA, DON; HILYARD, KAREN; QUINN, SANDRA CROUSE; KIM, KEVIN

2013-01-01

Distrust of the government often stands in the way of cooperation with public health recommendations in a crisis. The purpose of this paper is to describe the public’s trust in government recommendations during the early stages of the H1N1 pandemic and identify factors that might account for these trust levels. We surveyed 1543 respondents about their experiences and attitudes related to H1N1 influenza between June 3, 2009 and July 6, 2009, during the first wave of the pandemic using the Knowledge Networks (KN) online panel. This panel is representative of the US population, and uses a combination of random-digit dial and address-based probability sampling frames covering 99% of the US household population to recruit participants. To ensure participation of low-income individuals and those without Internet access, KN provides hardware and access to the Internet if needed. Measures included standard demographics, a trust scale, trust ratings for individual spokespersons, involvement with H1N1, experience with H1N1, and past discrimination in health care. We found that trust of government was low (2.3 out of 4) and varied across demographic groups. Blacks and Hispanics reported higher trust in government than did Whites. Of the spokespersons included, personal health professionals received the highest trust ratings and religious leaders the lowest. Attitudinal and experience variables predicted trust better than demographic characteristics. Closely following the news about the flu virus, having some self-reported knowledge about H1N1, self-reporting of local cases and previously experiencing discrimination were the significant attitudinal and experience predictors of trust. Using a second longitudinal survey, trust in the early stages of the pandemic did predict vaccine acceptance later but only for white, non-Hispanic individuals. PMID:24117390

Perceptions of Workplace Bullying Among Athletic Trainers in the Collegiate Setting

PubMed Central

Weuve, Celest; Pitney, William A.; Martin, Malissa; Mazerolle, Stephanie M.

2014-01-01

Context: Bullying has received a vast amount of attention in the recent past. One form of bullying, workplace bullying (WPB), has been a substantial concern explored in many health professions that can negatively influence a health care provider's role in an organization. To date, however, WPB has not been investigated in athletic training contexts. Objective: To examine the perceptions of certified athletic trainers who experienced or witnessed WPB during employment in the collegiate setting. Design: Qualitative study. Setting: College or university. Patients or Other Participants: Fifteen athletic trainers (7 women, 8 men) with an average age of 42 ± 12 years. Data Collection and Analysis: Data were collected via semistructured, in-depth phone interviews or asynchronous online interviews. Data were analyzed using an inductive content analysis. Trustworthiness was established with member checks and peer debriefing. Results: Four themes emerged from the analysis: (1) antecedents of WPB, (2) consequences of WPB, (3) coping with WPB, and (4) lack of workplace environment training. The antecedents of WPB involved the bully's personality and perceptions of the athletic training profession as well as environmental factors including the pressure to win and a lack of administrative support. The consequences of WPB included increased stress, feelings of inadequacy, and increased distrust. Individuals coped with WPB by relying on emotional resilience and avoidance. A final theme, lack of workplace environment training, revealed that little attention was given to interpersonal issues and WPB in the workplace. Conclusions: Workplace bullying incidents occur when administrators tolerate bullying behaviors from controlling and manipulative individuals who lack respect for the athletic training professional. Several negative outcomes result from bullying interactions, including stress and anxiety; WPB is dealt with by learning to be more emotionally resilient and avoiding confrontations. Workplace training is needed to prepare athletic trainers for such negative experiences. PMID:25098658

"Grin(d) and bear it": narratives from Sami women with and without temporomandibular disorders. A qualitative study.

PubMed

Mienna, Christina Storm; Johansson, Eva E; Wänman, Anders

2014-01-01

To explore thoughts, experiences, and beliefs regarding temporomandibular disorders (TMD) among Sami women with and without TMD in order to gain insights into their health care experiences and to generate a hypothesis regarding factors associated with long-standing TMD. Qualitative thematic interviews were conducted with a strategic sample of 17 Sami women, of whom 10 had a TMD diagnosis according to the Research Diagnostic Criteria for TMD and 7 age-matched women who had no signs or symptoms of TMD. Their ages were between 23 and 58 years. The thematic interviews were audiotaped, transcribed verbatim, and analyzed based on Grounded Theory, a qualitative methodology aiming to generate hypotheses grounded in the gathered data. The core category that evolved was "Grin(d) and bear it," which summarizes the Sami participants' various ways and stages of processing and handling the interacting categories (triggers, strains, distrust, and reconciliation with pain and/or difficulties in life). They described divergent as well as similar understandings of triggering factors. Maintaining factors were described as mental-physical strain and stress, and also a jaw-clenching behavior. Women without TMD contributed with factors that helped them to handle strains, reconcile, and stay healthy. They relied on strong social support. Based on the analysis, the following hypothesis was generated: Women with TMD, associated headaches, and neck-shoulder pain may benefit from efforts aimed at empowering them to use their own abilities to reduce stress behavior, strain, and disuse of the jaw. Rehabilitation strategies in groups might increase their sense of coherence and increase social support, which seems to be more limited than in women with no symptoms of TMD.

Fathers' encounter of support from paediatric diabetes teams; the tension between general recommendations and personal experience.

PubMed

Boman, Ase; Povlsen, Lene; Dahlborg-Lyckhage, Elisabeth; Hanas, Ragnar; Borup, Ina

2013-05-01

The purpose of this grounded theory study was to explore and discuss how fathers involved in caring for a child with type 1 diabetes experienced support from Swedish paediatric diabetes teams (PDTs) in everyday life with their child. Eleven fathers of children with type 1 diabetes, living in Sweden and scoring high on involvement on the Parental Responsibility Questionnaire, participated. Data were collected from January 2011 to August 2011, initially through online focus group discussions in which 6 of 19 invited fathers participated. Due to high attrition, the data collection continued in eight individual interviews. A semi-structured interview guide was used, and the fathers were asked to share experiences of their PDT's support in everyday life with their child. A simultaneous and constant comparison approach to data collection and analysis allowed the core category to emerge: the tension between general recommendations and personal experience. This core category illuminates how the fathers experienced tension between managing their unique everyday life with their child and balancing this to meet their PDT's expectations with regard to blood glucose levels. The core category was supported by two categories: the tension between the fathers'and their PDT's knowledge, whereby fathers reported discrepancies between their PDT's medical knowledge and their own unique knowledge of their child; and the tension between the fathers'and their PDT's goals, whereby the fathers identified differences between the family's and their PDT's goals. As a dimension of the core category, fathers felt trust or distrust in their PDT. We conclude that to achieve high-quality support for children with diabetes and to enhance their health and well-being, involved fathers' knowledge of their unique family situation needs to be integrated into the diabetes treatment. © 2012 Blackwell Publishing Ltd.

Perceptions of workplace bullying among athletic trainers in the collegiate setting.

PubMed

Weuve, Celest; Pitney, William A; Martin, Malissa; Mazerolle, Stephanie M

2014-01-01

Bullying has received a vast amount of attention in the recent past. One form of bullying, workplace bullying (WPB), has been a substantial concern explored in many health professions that can negatively influence a health care provider's role in an organization. To date, however, WPB has not been investigated in athletic training contexts. To examine the perceptions of certified athletic trainers who experienced or witnessed WPB during employment in the collegiate setting. Qualitative study. College or university. Fifteen athletic trainers (7 women, 8 men) with an average age of 42 ± 12 years. Data were collected via semistructured, in-depth phone interviews or asynchronous online interviews. Data were analyzed using an inductive content analysis. Trustworthiness was established with member checks and peer debriefing. Four themes emerged from the analysis: (1) antecedents of WPB, (2) consequences of WPB, (3) coping with WPB, and (4) lack of workplace environment training. The antecedents of WPB involved the bully's personality and perceptions of the athletic training profession as well as environmental factors including the pressure to win and a lack of administrative support. The consequences of WPB included increased stress, feelings of inadequacy, and increased distrust. Individuals coped with WPB by relying on emotional resilience and avoidance. A final theme, lack of workplace environment training, revealed that little attention was given to interpersonal issues and WPB in the workplace. Workplace bullying incidents occur when administrators tolerate bullying behaviors from controlling and manipulative individuals who lack respect for the athletic training professional. Several negative outcomes result from bullying interactions, including stress and anxiety; WPB is dealt with by learning to be more emotionally resilient and avoiding confrontations. Workplace training is needed to prepare athletic trainers for such negative experiences.

The issue of trust and its influence on risk communication during a volcanic crisis

NASA Astrophysics Data System (ADS)

Haynes, Katharine; Barclay, Jenni; Pidgeon, Nick

2008-03-01

This paper investigates trust in the scientists, government authorities and wider risk management team during the ongoing volcanic crisis in Montserrat, WI. Identifying the most trusted communicator and how trust in information can be enhanced are considered important for improving the efficacy of volcanic risk communication. Qualitative interviews, participant observations and a quantitative survey were utilised to investigate the views and attitudes of the public, authorities and scientists. Trust was found to be dynamic, influenced by political factors made more complex by the colonial nature of Montserrat’s governance and the changing level of volcanic activity. The scientists were viewed by the authorities as a highly trusted expert source of volcanic information. Mistrust among some of the local authorities towards the scientists and British Governor was founded in the uncertainty of the volcanic situation and influenced by differences in levels of acceptable risk and suspicions about integrity (e.g. as a consequence of employment by the British Government). The public viewed friends and relatives as the most trusted source for volcanic information. High trust in this source allowed competing messages to reinforce beliefs of lower risk than were officially being described. The scientists were the second most trusted group by the public and considered significantly more competent, reliable, caring, fair and open than the authorities. The world press was the least trusted, preceded closely by the British Governor’s Office and Montserratian Government officials. These results tally well with other empirical findings suggesting that government ministers and departments are typically distrusted as sources of risk-related information. These findings have implications for risk communication on Montserrat and other volcanic crises. The importance and potential effectiveness of scientists as communicators, because of, and despite, the existence of political, cultural and institutional barriers, is exemplified by this study.

Attention-Deficit/Hyperactivity Disorder-Related Impulsivity and Cyberbullying in Social Media.

PubMed

Reilly, Marie; Fogler, Jason; Selkie, Ellen; Augustyn, Marilyn

2016-01-01

Sarah is a 13-year-old eighth grader who was recently diagnosed for the first time with attention-deficit/hyperactivity disorder (ADHD)-inattentive type, and the family elected to treat her with behavioral interventions to help her organization and attention. She had struggled with distractibility and disorganization since the fourth grade. At home, Sarah's mother described her as "spacey" and unable to complete the morning routine without constant supervision. Over time, her mother observed that it seemed as if Sarah had given up on school.As Sarah became an adolescent, her self-esteem suffered because of her academic struggles, and she placed increasing emphasis on her appearance, including focus on remaining thin and refusing to leave the house without makeup. It was in this context that Sarah recently posted photographs of herself in various stages of undress and/or drinking alcohol on Snapchat, a photograph-sharing application in which users can send "snaps"-photographs that disappear soon after opening. However, snap recipients can take a screenshot or photograph of the snap, thereby saving the image. For unknown reasons, Sarah's close female friend took screenshots of these provocative photographs and sent them to their classmates and Sarah's older brother.Sarah's family contacted the police and has been working with her school to address this incident. This experience resulted in significant family stress and distrust of Sarah. For example, her mother took away her cell phone and laptop and has "grounded her" for a month from all out of school activities.Sarah's family seeks guidance regarding teaching Sarah about using social media responsibly and preventing this from happening again. Sarah's mom comes to your urgent care session asking for help because she does not feel that Sarah has "learned her lesson." What would you do next?

Barred from better medicine? Reexamining regulatory barriers to the inclusion of prisoners in research

PubMed Central

Huang, Elaine; Cauley, Jacqueline

2017-01-01

Abstract In 2015, President Obama announced plans for the Precision Medicine Initiative® (PMI), an ambitious longitudinal project aimed at revolutionizing medicine. Integral to this Initiative is the recruitment of over one million Americans into a volunteer research cohort, the All of UsSM Research Program. The announcement has generated much excitement but absent is a discussion of how the All of Us Research Program—to be implemented within the context of social realities of mass incarcerations and racial disparities in criminal justice and healthcare—might excaberate health disparities. We examine how attainment of Initiative's stated goals of reflecting the diversity of the American population and including all who are interested in participating might be impeded by regulatory and administrative barriers to the involvement of participants who become incarcerated during longitudinal studies. Changes have been proposed to the federal policy for human subjects research protections, but current regulations and administrative policies—developed under a protectionist paradigm in response to scandalous research practices with confined populations—dramatically limit research involving prisoners. Our review provides rationale for the development of Initiative policies that anticipate recruitment and retention obstacles that might frustrate inclusivity and exacerbate health disparities. Furthermore, we question the effective ban on biomedical and behavioral research involving prisoners and advocate for regulatory reforms that restore participatory research rights of prisoners. Disparities in health and justice are intertwined, and without regulatory reforms to facilitate participatory research rights of prisoners and careful planning of viable and responsible recruitment, engagement, and retention strategies, Initiative could miss discovery opportunities, exacerbate health disparities, and increase levels of distrust in science. PMID:28852561

Expanding Ethics Review Processes to Include Community-Level Protections: A Case Study from Flint, Michigan.

PubMed

Key, Kent D

2017-10-01

As the Flint community endeavors to recover and move forward in the aftermath of the Flint water crisis, distrust of scientific and governmental authorities must be overcome. Future community engagement in research will require community-level protections ensuring that no further harm is done to the community. A community ethics review explores risks and benefits and complements institutional review board (IRB) review. Using the case of Flint, I describe how community-level ethical protections can reestablish a community's trust. All IRBs reviewing protocols that include risk to communities and not merely individual participants should consider how community members are engaged in the proposed research and identify and respond to questions and domains of concern from community members. © 2017 American Medical Association. All Rights Reserved.