The Impact of Maternal Deafness on Cradling Laterality with Deaf and Hearing Infants

ERIC Educational Resources Information Center

Sieratzki, Jechil S.; Woll, Bencie

2004-01-01

A recent article in the "Journal of Deaf Studies and Deaf Education" (Leigh, Brice, & Meadow-Orlans, 2004) explored attachment between deaf mothers and their 18-month-old children and reported relationship patterns similar to those for hearing dyads. The study reported here explores a marker of early mother-child relationships: cradling…

Linguistics, Language, and the Professions: Education, Journalism, Law, Medicine, and Technology. Georgetown University Round Table on Languages and Linguistics (Washington, DC, May 4-6, 2000).

ERIC Educational Resources Information Center

Alatis, James E., Ed.; Hamilton, Heidi E., Ed.; Tan, Ai-Hui, Ed.

This volume contains the published version of selected papers from the 2000 Georgetown University Round Table on Languages and Linguistics (GURT). Plenary speeches include the following: "The Talk of Learning Professional Work" (Shirley Brice Heath); "Linguistics, Education, and the Ebonics Firestorm" (John R. Rickford);…

Review of Bruce Horner, Brice Nordquist, and Susan M. Ryan's "Economies of Writing: Revaluations in Rhetoric and Composition"

ERIC Educational Resources Information Center

Johnson, Cynthia

2017-01-01

In 2012, Bruce Horner guest edited a special issue of "JAC" focused on "Economies of Writing" ("JAC" n3-4 p453-778 2012). In his introduction, he explains that the included essays originated from an October 2011 symposium at the University of Louisville, held in preparation for the similarly-themed 2012 Thomas R.…

Mission Command During The Falklands War: Opportunities And Limitations

DTIC Science & Technology

2016-05-26

Monograph by MAJ Brice Roberts United States Army School of Advanced Military Studies United States Army Command and General Staff College Fort...SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) Advanced Military Studies Program CGSC 11. SPONSOR...This study examines the six principles of mission command, as defined by ADP 6-0, as a lens to evaluate operations conducted by the Landing Force

A General Review of Factors Related to the Health Care Delivery Process: A Working Bibliography.

DTIC Science & Technology

1979-08-01

Brice, J. A., & Gonda, H. H. The impact of utilization on long- term patients. Hospital and Community Psychiatry, 1971, 22, 341-344. Galvin, M. E...incongruence: Consequences for health. Journal of Health and Social Behavior, 1975, 16, 198-212. Coburn, D., & Pope, C. R. Socioeconomic status and...American Journal of Public Health, 1977, 67, 946-953. Phillips, L. Socioeconomic factors and mental health. American Journal ot Orthopsychiatry, 1967

Reducing misinformation effects in older adults with cognitive interview mnemonics.

PubMed

Holliday, Robyn E; Humphries, Joyce E; Milne, Rebecca; Memon, Amina; Houlder, Lucy; Lyons, Amy; Bull, Ray

2012-12-01

We examined the effect of a prior Modified Cognitive Interview on young and older adults' recall of a short film of a staged crime and subsequent reporting of misinformation. Participants viewed the film followed the next day by misinformation presented in a postevent summary. They were then interviewed with either a Modified Cognitive Interview or a control interview followed by a recognition memory test. A Modified Cognitive Interview elicited more correct details and improved overall accuracy compared to a control interview in both age groups, although the young adults recollected three times more correct information in a Modified Cognitive Interview than the older adults. In both age groups, correct recollections of person and action details were higher in a Modified Cognitive Interview than a control interview. Importantly, older adults who were interviewed with a Modified Cognitive Interview were not susceptible to misinformation effects. 2013 APA, all rights reserved

Atomistic simulation of trace element incorporation into garnets - comparison with experimental garnet-melt partitioning data

NASA Astrophysics Data System (ADS)

van Westrenen, W.; Allan, N. L.; Blundy, J. D.; Purton, J. A.; Wood, B. J.

2000-05-01

We have studied the energetics of trace element incorporation into pure almandine (Alm), grossular (Gros), pyrope (Py) and spessartine (Spes) garnets (X 3Al 2Si 3O 12, with X = Fe, Ca, Mg, Mn respectively), by means of computer simulations of perfect and defective lattices in the static limit. The simulations use a consistent set of interatomic potentials to describe the non-Coulombic interactions between the ions, and take explicit account of lattice relaxation associated with trace element incorporation. The calculated relaxation (strain) energies Urel are compared to those obtained using the Brice (1975) model of lattice relaxation, and the results compared to experimental garnet-melt trace element partitioning data interpreted using the same model. Simulated Urel associated with a wide range of homovalent (Ni, Mg, Co, Fe, Mn, Ca, Eu, Sr, Ba) and charge-compensated heterovalent (Sc, Lu, Yb, Ho, Gd, Eu, Nd, La, Li, Na, K, Rb) substitutions onto the garnet X-sites show a near-parabolic dependence on trace element radius, in agreement with the Brice model. From application of the Brice model we derived apparent X-site Young's moduli EX(1+, 2+, 3+) and the 'ideal' ionic radii r0(1+, 2+, 3+), corresponding to the minima in plots of Urel vs. radius. For both homovalent and heterovalent substitutions r0 increases in the order Py-Alm-Spes-Gros, consistent with crystallographic data on the size of garnet X-sites and with the results of garnet-melt partitioning studies. Each end-member also shows a marked increase in both the apparent EX and r0 with increasing trace element charge ( Zc). The increase in EX is consistent with values obtained by fitting to the Brice model of experimental garnet-melt partitioning data. However, the increase in r0 with increasing Zc is contrary to experimental observation. To estimate the influence of melt on the energetics of trace element incorporation, solution energies ( Usol) were calculated for appropriate exchange reactions between garnet and melt, using binary and other oxides to simulate cation co-ordination environment in the melt. Usol also shows a parabolic dependence on trace element radius, with inter-garnet trends in EX and r0 similar to those found for relaxation energies. However, r0( i+) obtained from minima in plots of Usol vs. radius are located at markedly different positions, especially for heterovalent substitutions ( i = 1, 3). For each end-member garnet, r0 now decreases with increasing Zc, consistent with experiment. Furthermore, although different assumptions for trace element environment in the melt, e.g., REE 3+ (VI) vs. REE 3+ (VIII), lead to parabolae with differing curvatures and minima, relative differences between end-members are always preserved. We conclude that: 1. The simulated variation in r0 and EX between garnets is largely governed by the solid phase. This stresses the overriding influence of crystal local environment on trace element partitioning. 2. Simulations suggest r0 in garnets varies with trace element charge, as experimentally observed. 3. Absolute values of r0 and EX can be influenced by the presence and structure of a coexisting melt. Thus, quantitative relations between r0, E and crystal chemistry should be derived from well-constrained systematic mineral-melt partitioning studies, and cannot be predicted from crystal-structural data alone.

Abuse potential assessment of propofol by its subjective effects after sedation.

PubMed

Tezcan, Aysu Hayriye; Ornek, Dilsen Hatice; Ozlu, Onur; Baydar, Mustafa; Yavuz, Nurcan; Ozaslan, Nihal Gokbulut; Dilek, Kevser; Keske, Aylin

2014-01-01

In this study, we examined the euphoric effect of propofol and its high satisfaction ratio regarding its liability to be abused, particularly in painless procedures, such as colonoscopy. Fifty subjects aged between 18 and 65 years who fulfilled the criteria for ASA 1-2 and were prepared for colonoscopy were enrolled into this study. For intravenous sedation induction, 2 mg/kg propofol was used, and additional injections were administered according to BIS values. After colonoscopy, the subjects were taken to a recovery room and observed for 30 minutes. Patients were interviewed with the modified Brice questionnare regarding the incidence and the content of dreams. A 5-point Likert scale was used to classify their dreams, and the content of the dreams was also recorded. To assess the subjective effects of propofol, the patients were asked to use the Hall and Van der Castle emotion scale; their biological states were also assessed. The patients' feelings regarding propofol were each rated as absent or present. We used the Morphine-Benzedrine Group scale to measure the euphoric effects of propofol. At the end of the study, subjects scored their satisfaction on a five-point scale. There were no statistically significant differences in sex age, weight, propofol dose, or satisfaction ratio (p>0.05) in the groups, although male patients received a higher dose of propofol and had higher satisfaction ratio. Patients reported no residual after-effects. The incidence of dreaming was 42%. There was no statistically significant difference in dreaming between the sexes, but male patients had a higher dreaming ratio. Dreamers received higher propofol doses and had a higher satisfaction ratio (p>0.05). All dreamers reported happy dreams regarding daily life, and their mean MBG score was 10.5. There was no correlation between MBG scores and propofol doses (r= -0.044, p= 0.761). We conclude that propofol functions as a reward; that patients enjoy its acute effects; and that no residual after-effects should arise. We suggest that propofol may carry potential for abuse, and further abuse liability testing is indicated.

Abuse potential assessment of propofol by its subjective effects after sedation

PubMed Central

Tezcan, Aysu Hayriye; Ornek, Dilsen Hatice; Ozlu, Onur; Baydar, Mustafa; Yavuz, Nurcan; Ozaslan, Nihal Gokbulut; Dilek, Kevser; Keske, Aylin

2014-01-01

Objective: In this study, we examined the euphoric effect of propofol and its high satisfaction ratio regarding its liability to be abused, particularly in painless procedures, such as colonoscopy. Methods: Fifty subjects aged between 18 and 65 years who fulfilled the criteria for ASA 1-2 and were prepared for colonoscopy were enrolled into this study. For intravenous sedation induction, 2 mg/kg propofol was used, and additional injections were administered according to BIS values. After colonoscopy, the subjects were taken to a recovery room and observed for 30 minutes. Patients were interviewed with the modified Brice questionnare regarding the incidence and the content of dreams. A 5-point Likert scale was used to classify their dreams, and the content of the dreams was also recorded. To assess the subjective effects of propofol, the patients were asked to use the Hall and Van der Castle emotion scale; their biological states were also assessed. The patients’ feelings regarding propofol were each rated as absent or present. We used the Morphine-Benzedrine Group scale to measure the euphoric effects of propofol. At the end of the study, subjects scored their satisfaction on a five-point scale. Results: There were no statistically significant differences in sex age, weight, propofol dose, or satisfaction ratio (p>0.05) in the groups, although male patients received a higher dose of propofol and had higher satisfaction ratio. Patients reported no residual after-effects. The incidence of dreaming was 42%. There was no statistically significant difference in dreaming between the sexes, but male patients had a higher dreaming ratio. Dreamers received higher propofol doses and had a higher satisfaction ratio (p>0.05). All dreamers reported happy dreams regarding daily life, and their mean MBG score was 10.5. There was no correlation between MBG scores and propofol doses (r= -0.044, p= 0.761). Conclusions: We conclude that propofol functions as a reward; that patients enjoy its acute effects; and that no residual after-effects should arise. We suggest that propofol may carry potential for abuse, and further abuse liability testing is indicated. PMID:25674117

Population-based Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis Prevalence Using Discarded, Deidentified Urine Specimens Previously Collected for Drug Testing (Open Access Publisher’s Version)

DTIC Science & Technology

2017-10-24

123van Houdt R, et al. Sex Transm Infect 2018;94:117–123. doi:10.1136/sextrans-2017-053133 Epidemiology letter Population-based Neisseria...trichomonas vaginalis testing, Melinda Balansay-ames, chris Myers and gary Brice for Pcr- based sex determination testing, and Kimberly De Vera for...dx. doi. org/ 10. 1136/ sextrans- 2017- 053355) To cite Harbertson J, Jamerson M, graf PcF, et al. Sex Transm Infect 2018;94:123. received 28 July

What's in a name: putting the skills of librarianship back into circulation.

PubMed

Brice, Anne; Grant, Maria J

2014-09-01

Anne Brice, recipient of the 2014 Cyril Barnard Memorial Prize, reflects on the themes of names and skills of the health library and information professions. She questions whether service users share the same concerns of librarians that this nomenclature is too narrow and too closely associated with the buildings that provide its name. She proposes that in mediation between the users and their required knowledge sits a unique opportunity to place the profession in the centre of knowledge translation. © 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal.

The use of the Modified Telephone Interview for Cognitive Status (TICS-M) in the detection of amnestic mild cognitive impairment.

PubMed

Cook, Sarah E; Marsiske, Michael; McCoy, Karin J M

2009-06-01

Many screening tools for detecting cognitive decline require in-person assessment, which is often not cost-effective or feasible for those with physical limitations. The Modified Telephone Interview for Cognitive Status has been used for screening dementia, but little is known about its usefulness in detecting amnestic mild cognitive impairment. Community-dwelling participants (mean age=74.9, mean education = 16.1 years) were administered the Modified Telephone Interview for Cognitive Status during initial screening and subsequently given a multidomain neuropsychological battery. Participants were classified by consensus panel as cognitively normal older adult (noMCI, N=54) or amnestic mild cognitive impairment (N=17) based on neuropsychological performance and Clinical Dementia Rating Scale interview, but independent of Modified Telephone Interview for Cognitive Status score. There was a significant difference between groups in Modified Telephone Interview for Cognitive Status score (t=8.04, P<.01, noMCI range 32-43, mean [SD]=37.4 [2.5], amnestic mild cognitive impairment range 25-37, mean [SD]=31.2 [3.5]). Discriminant function analysis revealed that TICS-M alone correctly classified 85.9% of participants into their respective diagnostic classification (sensitivity=82.4%, specificity=87.0%). Receiver operating characteristics analysis resulted in cutoff score of 34 that optimized sensitivity and specificity of amnestic mild cognitive impairment classification. The Modified Telephone Interview for Cognitive Status is a brief, cost-effective screening measure for identifying those with and without amnestic mild cognitive impairment.

Titan's atomic nitrogen torus - Inferred properties and consequences for the Saturnian aurora

NASA Astrophysics Data System (ADS)

Barbosa, D. D.

1987-10-01

This paper follows up the lead suggested by Barbosa and Eviatar (1986) that Titanogenic nitrogen ions are a key component of the magnetospheric particle populations and can account for the energetics of the Saturnian aurora without undue assumptions. Nitrogen atoms resulting from electron impact dissociations of N2 (Strobel and Shemansky 1982) escape from Titan and form a large doughnut-shaped ring around the satellite's orbit that is cospatial with the McDonough-Brice (1973) hydrogen cloud. Processes attendant to the ionization and pickup of nitrogen ions include the production of a warm kiloelectronvolt electron population and the excitation of the UV aurora by particle precipitation from the outer magnetosphere.

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery.

PubMed

Allen, Megan; Leslie, Kate; Hebbard, Geoffrey; Jones, Ian; Mettho, Tejinder; Maruff, Paul

2015-11-01

This study aimed to determine if the incidence of recall was equivalent between light and deep sedation for colonoscopy. Secondary analysis included complications, patient clinical recovery, and post-procedure cognitive impairment. Two hundred patients undergoing elective outpatient colonoscopy were randomized to light (bispectral index [BIS] 70-80) or deep (BIS < 60) sedation with propofol and fentanyl. Recall was assessed by the modified Brice questionnaire, and cognition at baseline and discharge was assessed using a Cogstate test battery. The median (interquartile range [IQR]) BIS values were different in the two groups (69 [65-74] light sedation vs 53 [46-59] deep sedation; P < 0.0001). The incidence of recall was 12% in the light sedation group and 1% in the deep sedation group. The risk difference for recall was 0.11 (90% confidence interval, 0.05 to 0.17) in the intention-to-treat analysis, thus refuting equivalence in recall between light and deep sedation (0.05 significance level; 10% equivalence margin). Overall sedation-related complications were more frequent with deep sedation than with light sedation (66% vs 47%, respectively; P = 0.008). Recovery was more rapid with light sedation than with deep sedation as determined by the mean (SD) time to reach a score of 5 on the Modified Observer's Assessment of Alertness/Sedation Scale [3 (4) min vs 7 (4) min, respectively; P < 0.001] and by the median [IQR] time to readiness for hospital discharge (65 [57-80] min vs 74 [63-86] min, respectively; P = 0.001). The incidence of post-procedural cognitive impairment was similar in those randomized to light (19%) vs deep (16%) sedation (P = 0.554). Light sedation was not equivalent to deep sedation for procedural recall, the spectrum of complications, or recovery times. This study provides evidence to inform discussions with patients about sedation for colonoscopy. This trial was registered at the Australian and New Zealand Clinical Trials Registry, number 12611000320954.

The time variability of Jupiter's synchrotron radiation

NASA Astrophysics Data System (ADS)

Bolton, Scott Jay

1991-02-01

The time variability of the Jovian synchrotron emission is investigated by analyzing radio observations of Jupiter at decimetric wavelengths. The observations are composed from two distinct sets of measurements addressing both short term (days to weeks) and long term (months to years) variability. The study of long term variations utilizes a set of measurements made several times each month with the NASA Deep Space Network (DNS) antennas operating at 2295 MHz (13.1 cm). The DSN data set, covering 1971 through 1985, is compared with a set of measurements of the solar wind from a number of Earth orbiting spacecraft. The analysis indicates a maximum correlation between the synchrotron emission and the solar wind ram pressure with a two year time lag. Physical mechanisms affecting the synchrotron emission are discussed with an emphasis on radial diffusion. Calculations are performed that suggest the correlation is consistent with inward adiabatic diffusion of solar wind particles driven by Brice's model of ionospheric neutral wind convection (Brice 1972). The implication is that the solar wind could be a source of particles of Jupiter's radiation belts. The investigation of short term variability focuses on a three year Jupiter observing program using the University of California's Hat Creek radio telescope operating at 1400 MHz (21 cm). Measurements are made every two days during the months surrounding opposition. Results from the three year program suggest short term variability near the 10-20 percent level but should be considered inconclusive due to scheduling and observational limitations. A discussion of magneto-spheric processes on short term timescales identifies wave-particle interactions as a candidate source. Further analysis finds that the short term variations could be related to whistler mode wave-particles interactions in the radiation belts associated with atmospheric lightning on Jupiter. However, theoretical calculations on wave particle interactions imply thought if whistler mode waves are to interact with the synchrotron emitting electrons.

[The cultural psychiatry in Latin America].

PubMed

Villaseñor-Bayardo, Sergio J; Rojas-Malpica, Carlos; Aceves-Pulido, Martha P

2014-01-01

This paper presents only some of the most important contributions in the development of cultural psychiatry in Latin America. The continental efforts to understand the role that culture plays in the manifestation and treatment of mental disorders have been fruitful. The authors included are: Fernando Pagés of Argentina; Mario G. Hollweg of Bolivia; Rubim Alvaro de Pinho and Adalberto Barreto of Brazil; Carlos A. Leon and Carlos A. Uribe of Colombia; Antonio José A. Bustamante and Santa Cruz de Cuba, Carlos Leon Andrade of Ecuador, Guatemala Cristina Chavez; Sergio Villasenor J. Bayardo of Mexico; Carlos A. Seguin, Hermilio Valdizán and Javier Mariátegui in Peru; Y. Bespaldi of Consens of Uruguay; Rojas and Carlos Malpica and Jacqueline Briceño Clarac of Venezuela.

Qualitative modification and development of patient- and caregiver-reported outcome measures for iron chelation therapy.

PubMed

Horodniceanu, Erica G; Bal, Vasudha; Dhatt, Harman; Carter, John A; Huang, Vicky; Lasch, Kathryn

2017-06-23

Compliance, palatability, gastrointestinal (GI) symptom, and treatment satisfaction patient- and observer-reported outcome (PRO, ObsRO) measures were developed/modified for patients with transfusion-dependent anemias or myelodysplastic syndrome (MDS) requiring iron chelation therapy (ICT). This qualitative cross-sectional observational study used grounded theory data collection and analysis methods and followed PRO/ObsRO development industry guidance. Patients and caregivers of patients with transfusion-dependent anemias or MDS were individually interviewed face-to-face to cognitively debrief the Compliance, Palatability, GI Symptom Diary, and Modified Satisfaction with Iron Chelation Therapy (SICT) instruments presented electronically. Interviews were conducted in sets. Interviews began open-endedly to spontaneously elicit ICT experiences. Item modifications were debriefed during the later interviews. Interviews were audio recorded, transcribed, and coded. Data was analyzed using ATLAS.ti qualitative research software. Twenty-one interviews were completed (Set 1: 5 patients, 6 caregivers; Set 2: 6 patients, 4 caregivers) in 6 US cities. Mean age was 43 years for patients and 9 years for children of caregivers. Conditions requiring ICT use across groups included transfusion-dependent anemias (85.7%) and MDS (14.3%). Concepts spontaneously reported were consistent with instruments debriefed. Interview analysis resulted in PRO and ObsRO versions of each instrument: Compliance (2 items), Palatability (4 items), GI Symptom Diary (6 items), and Modified SICT (PRO = 13, ObsRO = 17 items). Qualitative research data from cognitive interviews supports the content validity and relevance of the instruments developed/modified. Quantitative validation of these PRO and ObsRO measures is needed testing for validity, reliability, and responsiveness for future research use with new formulations of oral ICT.

Long-term recall accuracy for mobile phone calls in young Japanese people: A follow-up validation study using software-modified phones.

PubMed

Kiyohara, Kosuke; Wake, Kanako; Watanabe, Soichi; Arima, Takuji; Sato, Yasuto; Kojimahara, Noriko; Taki, Masao; Cardis, Elisabeth; Yamaguchi, Naohito

2018-03-01

This study examined changes in recall accuracy for mobile phone calls over a long period. Japanese students' actual call statuses were monitored for 1 month using software-modified phones (SMPs). Three face-to-face interviews were conducted to obtain information regarding self-reported call status during the monitoring period: first interview: immediately after the monitoring period; second interview: after 10-12 months; third interview: after 48-55 months. Using the SMP records as the "gold standard", phone call recall accuracy was assessed for each interview. Data for 94 participants were analyzed. The number of calls made was underestimated considerably and the duration of calls was overestimated slightly in all interviews. Agreement between self-report and SMP records regarding the number of calls, duration of calls and laterality (i.e., use of the dominant ear while making calls) gradually deteriorated with the increase in the interval following the monitoring period (number of calls: first interview: Pearson's r=0.641, third interview: 0.396; duration of calls: first interview: Pearson's r=0.763, third interview: 0.356; laterality: first interview: weighted-κ=0.677, third interview: 0.448). Thus, recall accuracy for mobile phone calls would be consistently imperfect over a long period, and the results of related epidemiological studies should be interpreted carefully.

Evaluation of a modified interview version and of a self-rating version of the Suicide Assessment Scale.

PubMed

Niméus, A; Hjalmarsson Ståhlfors, F; Sunnqvist, C; Stanley, B; Träskman-Bendz, L

2006-10-01

The Suicide Assessment Scale (SUAS) was constructed to be sensitive to change of suicidality. It was recently found to be predictive of suicide in a group of suicide attempters. The aim of the present study was to evaluate the reliability and validity of a modified interview version of SUAS with defined scores and also a new self-rating version (SUAS-S). The subjects consisted of former inpatients, 42 persons who had been admitted because of a suicide attempt about 12 years ago and 22 control patients. The subjects were rated according to the SUAS, the SUAS-S, as well as the Montgomery Asberg Depression Rating Scale (MADRS). The interrater reliability was found to be high. The SUAS correlated significantly with the MADRS, but the concordance was not consistent, which indicates that the SUAS measures something different from depression. The SUAS-S correlated significantly with the interview-rated SUAS, thus exhibiting good concurrent validity. In summary, both the modified interview version of SUAS and the SUAS-S seem to be valid, reliable and easily used suicide assessment instruments.

Making a structured psychiatric diagnostic interview faithful to the nomenclature.

PubMed

Robins, Lee N; Cottler, Linda B

2004-10-15

Psychiatric diagnostic interviews to be used in epidemiologic studies by lay interviewers have, since the 1970s, attempted to operationalize existing psychiatric nomenclatures. How to maximize the chances that they do so successfully has not previously been spelled out. In this article, the authors discuss strategies for each of the seven steps involved in writing, updating, or modifying a diagnostic interview and its supporting materials: 1) writing questions that match the nomenclature's criteria, 2) checking that respondents will be willing and able to answer the questions, 3) choosing a format acceptable to interviewers that maximizes accurate answering and recording of answers, 4) constructing a data entry and cleaning program that highlights errors to be corrected, 5) creating a diagnostic scoring program that matches the nomenclature's algorithms, 6) developing an interviewer training program that maximizes reliability, and 7) computerizing the interview. For each step, the authors discuss how to identify errors, correct them, and validate the revisions. Although operationalization will never be perfect because of ambiguities in the nomenclature, specifying methods for minimizing divergence from the nomenclature is timely as users modify existing interviews and look forward to updating interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, Eleventh Revision.

Research in interactive scene analysis

NASA Technical Reports Server (NTRS)

Tenenbaum, J. M.; Garvey, T. D.; Weyl, S. A.; Wolf, H. C.

1975-01-01

An interactive scene interpretation system (ISIS) was developed as a tool for constructing and experimenting with man-machine and automatic scene analysis methods tailored for particular image domains. A recently developed region analysis subsystem based on the paradigm of Brice and Fennema is described. Using this subsystem a series of experiments was conducted to determine good criteria for initially partitioning a scene into atomic regions and for merging these regions into a final partition of the scene along object boundaries. Semantic (problem-dependent) knowledge is essential for complete, correct partitions of complex real-world scenes. An interactive approach to semantic scene segmentation was developed and demonstrated on both landscape and indoor scenes. This approach provides a reasonable methodology for segmenting scenes that cannot be processed completely automatically, and is a promising basis for a future automatic system. A program is described that can automatically generate strategies for finding specific objects in a scene based on manually designated pictorial examples.

A plasmapause-like density boundary at high latitudes in Saturn's magnetosphere

NASA Astrophysics Data System (ADS)

Gurnett, D. A.; Persoon, A. M.; Kopf, A. J.; Kurth, W. S.; Morooka, M. W.; Wahlund, J.-E.; Khurana, K. K.; Dougherty, M. K.; Mitchell, D. G.; Krimigis, S. M.; Krupp, N.

2010-08-01

Here we report the discovery of a well-defined plasma density boundary at high latitudes in Saturn's magnetosphere. The boundary separates a region of relatively high density at L less than about 8 to 15 from a region with densities nearly three orders of magnitude lower at higher L values. Magnetic field measurements show that strong field-aligned currents, probably associated with the aurora, are located just inside the boundary. Analyses of the anisotropy of energetic electrons show that the magnetic field lines are usually closed inside the boundary and open outside the boundary, although exceptions sometimes occur. The location of the boundary is also modulated at the ˜10.6 to 10.8 hr rotational period of the planet. Many of these characteristics are similar to those predicted by Brice and Ioannidis for the plasmapause at a strongly magnetized, rapidly rotating planet such as Saturn.

Zircon/fluid trace element partition coefficients measured by recrystallization of Mud Tank zircon at 1.5 GPa and 800-1000 °C

NASA Astrophysics Data System (ADS)

Ayers, John C.; Peters, Timothy J.

2018-02-01

Hydrothermal zircon grains have trace element characteristics such as low Th/U, high U, and high rare earth element (REE) concentrations that distinguish them from magmatic, metamorphic, and altered zircon grains, but it is unclear whether these characteristics result from distinctive fluid compositions or zircon/fluid fractionation effects. New experiments aimed at measuring zircon/fluid trace element partition coefficients Dz/f involved recrystallizing natural Mud Tank zircon with low trace element concentrations in the presence of H2O, 1 m NaOH, or 1 m HCl doped with ∼1000 ppm of rare earth elements (REE), Y, U and Th and ∼500 ppm of Li, B, P, Nb, Ba, Hf, and Ta. Experiments were run for 168 h at 1.5 GPa, 800-1000 °C, and fO2 = NNO in a piston cylinder apparatus using the double capsule method. LA-ICP-MS analysis shows that run product zircon crystals have much higher trace element concentrations than in Mud Tank zircon starting material. Dz/f values were estimated from run product zircon analyses and bulk composition using mass balance. Most elements behave incompatibly, with median Dz/f being highest for Hf = 8 and lowest for B = 0.02. Addition of NaOH or HCl had little influence on Dz/f values. Dz/f for LREE are anomalously high, likely due to contamination of run product zircon with quenched solutes enriched in incompatible elements, so DLREE were estimated using lattice strain theory. Brice curves for +3 ions yield zircon/fluid DLu/DLa of ∼800-5000. A Brice curve fit to +4 ions yielded DCe4+ values. Estimated concentrations of Ce3+ and Ce4+ show that the average Ce4+/Ce3+ in zircon of 27 is much higher than in fluid of 0.02. Th and U show little fractionation, with median DTh/DU = 0.7, indicating that the low Th/U in natural hydrothermal zircon is inherited from the fluid. Natural fluid compositions estimated from measured Dz/f and published compositions of hydrothermal zircon grains from aplite and eclogite reflect the mineralogy of the host rock, e.g., fluid in equilibrium with eclogite garnet is depleted in heavy REE relative to middle REE, and has low Th/U.

[Screening for dementia using telephone interviews. An evaluation and reliability study of the Telephone Interview for Cognitive Status (TICS) in its modified German version].

PubMed

Matrisch, M; Trampisch, U; Klaassen-Mielke, R; Pientka, L; Trampisch, H J; Thiem, U

2012-04-01

To assess cognitive impairment or dementia in epidemiologic studies using telephone interviews for data acquisition, valid, reliable and short instruments suitable for telephone administration are required. For the Telephone Interview for Cognitive Status (TICS) in its modified German version, the only instrument used in Germany so far, more data on reliability and practicability are needed. Participants were recruited in the offices of nine primary care physicians. Data from 197 participants (115 females, mean age 78.5±4.1 years) who were tested by telephone and in the office by means of the Mini-Mental State Examination (MMSE) were used for the evaluation. For assessing reliability, a group of 91 participants (55 females, mean age 78.1±4.1 years) was contacted twice during 30 days to be tested during a telephone interview by means of the TICS in its modified German version. The intraclass correlation coefficient (ICC), a measure of reliability, was 0.67 [95% confidence interval (CI): 0.53; 0.77]. The Bland-Altman plot did not reveal any relationship between the variability of the difference between repeated measures and the total amount of the measure. For the overall TICS score, no differences were found between repeated measurements. However, the tasks recall of the word list and counting backwards showed some improvement in the repeated tests. TICS and MMSE showed only moderate correlation, with a correlation coefficient of 0.48 (95% CI: 0.36; 0.58). TICS values were dependent on age and educational level of the person tested. The TICS in its modified German version appears to be of acceptable reliability for the assessment of cognitive impairment during a telephone interview. TICS values depend on age and educational level of the person tested. TICS and MMSE correlate only moderately.

Modified personal interviews: resurrecting reliable personal interviews for admissions?

PubMed

Hanson, Mark D; Kulasegaram, Kulamakan Mahan; Woods, Nicole N; Fechtig, Lindsey; Anderson, Geoff

2012-10-01

Traditional admissions personal interviews provide flexible faculty-student interactions but are plagued by low inter-interview reliability. Axelson and Kreiter (2009) retrospectively showed that multiple independent sampling (MIS) may improve reliability of personal interviews; thus, the authors incorporated MIS into the admissions process for medical students applying to the University of Toronto's Leadership Education and Development Program (LEAD). They examined the reliability and resource demands of this modified personal interview (MPI) format. In 2010-2011, LEAD candidates submitted written applications, which were used to screen for participation in the MPI process. Selected candidates completed four brief (10-12 minutes) independent MPIs each with a different interviewer. The authors blueprinted MPI questions to (i.e., aligned them with) leadership attributes, and interviewers assessed candidates' eligibility on a five-point Likert-type scale. The authors analyzed inter-interview reliability using the generalizability theory. Sixteen candidates submitted applications; 10 proceeded to the MPI stage. Reliability of the written application components was 0.75. The MPI process had overall inter-interview reliability of 0.79. Correlation between the written application and MPI scores was 0.49. A decision study showed acceptable reliability of 0.74 with only three MPIs scored using one global rating. Furthermore, a traditional admissions interview format would take 66% more time than the MPI format. The MPI format, used during the LEAD admissions process, achieved high reliability with minimal faculty resources. The MPI format's reliability and effective resource use were possible through MIS and employment of expert interviewers. MPIs may be useful for other admissions tasks.

Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study.

PubMed

Walker, E M K; Bell, M; Cook, T M; Grocott, M P W; Moonesinghe, S R

2016-06-12

Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement. This cross-sectional observational study in UK National Health Service hospitals, recruited adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period. Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes. 257 hospitals in 171 NHS Trusts participated (97% of eligible organisations). Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires. Anxiety was most frequently cited as the worst aspect of the perioperative experience. Thirty-five per cent of patients reported severe discomfort in at least one domain: thirst (18.5%; 95% CI 17.8-19.1), surgical pain (11.0%; 10.5-11.5) and drowsiness (10.1%; 9.6-10.5) were most common. Despite this, only 5% reported dissatisfaction with any aspect of anaesthesia-related care. Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%) Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Lecturers' and Students' Perceptions of the Use of Modifiers

ERIC Educational Resources Information Center

Lin, Chia-Yen; Lau, Ken; Cousineau, Jacob

2018-01-01

The textual and interpersonal functions of modifiers are extensively discussed in the literature. However, how these linguistic devices can be strategically used to assist lecture comprehension has been under-investigated, particularly in EFL/ESL contexts. Drawing on corpus analyses, interviews, and questionnaires, this study compares Taiwanese…

A consensus-based gold standard for the evaluation of mass casualty triage systems.

PubMed

Lerner, E Brooke; McKee, Courtney H; Cady, Charles E; Cone, David C; Colella, M Riccardo; Cooper, Arthur; Coule, Phillip L; Lairet, Julio R; Liu, J Marc; Pirrallo, Ronald G; Sasser, Scott M; Schwartz, Richard; Shepherd, Greene; Swienton, Raymond E

2015-01-01

Accuracy and effectiveness analyses of mass casualty triage systems are limited because there are no gold standard definitions for each of the triage categories. Until there is agreement on which patients should be identified by each triage category, it will be impossible to calculate sensitivity and specificity or to compare accuracy between triage systems. To develop a consensus-based, functional gold standard definition for each mass casualty triage category. National experts were recruited through the lead investigators' contacts and their suggested contacts. Key informant interviews were conducted to develop a list of potential criteria for defining each triage category. Panelists were interviewed in order of their availability until redundancy of themes was achieved. Panelists were blinded to each other's responses during the interviews. A modified Delphi survey was developed with the potential criteria identified during the interview and delivered to all recruited experts. In the early rounds, panelists could add, remove, or modify criteria. In the final rounds edits were made to the criteria until at least 80% agreement was achieved. Thirteen national and local experts were recruited to participate in the project. Six interviews were conducted. Three rounds of voting were performed, with 12 panelists participating in the first round, 12 in the second round, and 13 in the third round. After the first two rounds, the criteria were modified according to respondent suggestions. In the final round, over 90% agreement was achieved for all but one criterion. A single e-mail vote was conducted on edits to the final criterion and consensus was achieved. A consensus-based, functional gold standard definition for each mass casualty triage category was developed. These gold standard definitions can be used to evaluate the accuracy of mass casualty triage systems after an actual incident, during training, or for research.

Results of the psychiatric, select-out evaluation of US astronaut applications

NASA Technical Reports Server (NTRS)

Faulk, D. M.; Santy, P. A.; Holland, A. W.; Marsh, R.

1992-01-01

The psychiatric exclusion criteria for astronauts are based on NASA Medical Psychiatric Standards for space flight. Until recently, there were no standardized methods to evaluate disqualifying psychopathology in astronaut applicants. Method: One hundred and six astronaut applicants who had passed the intitial screening were evaluated for Axis 1 and Axis 2 DSM-3-R diagnoses using the NASA structured psychiatric interview. The interview consisted of three parts: (1) an unstructured portion for obtaining biographical and historical information, (2) the schedule for effective disorders-lifetime version (SASDL), specially modified to include all disqualifying Axis 1 mental disorders; and, (3) the personality assessment schedule (PAS) also modified to evaluate for Axis 2 disorders. Results: Nine of 106 candidates (8.5 percent) met diagnostic criteria for six Axis 1 disorders (including V code) or Axis 2 disorders. Two of these disorders were disqualifying for the applicants. 'Near' diagnoses (where applicants met at least 50 percent of the listed criteria) were assessed to demonstrate that clinicians using the interview were able to overcome applicants' reluctance to report symptomatomatology. Conclusion: The use of the NASA structured interview was effective in identifying past and present psychopathology in a group of highly motivated astronaut applicants. This was the first time a structured psychiatric interview had been used in such a setting for this purpose.

Role of original and modified Frey's procedures in chronic pancreatitis.

PubMed

Tan, Chun-Lu; Zhang, Hao; Yang, Min; Li, Shao-Jun; Liu, Xu-Bao; Li, Ke-Zhou

2016-12-21

To retrospectively review patients with chronic pancreatitis (CP) treated with Frey's procedures between January 2009 and January 2014. A retrospective review was performed of patients with CP treated with Frey's procedures between January 2009 and January 2014 in the Department of Pancreatic Surgery. A cross-sectional study of postoperative pain relief, quality of life (QoL), and alcohol and nicotine abuse was performed by clinical interview, letters and telephone interview in January 2016. QoL of patients was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) version 3.0. The patients were requested to fill in the questionnaires by themselves via correspondence or clinical interview. A total of 80 patients were enrolled for analysis, including 44 who underwent the original Frey's procedure and 36 who underwent a modified Frey's procedure. The mean age was 46 years in the original group and 48 years in the modified group. Thirty-five male patients (80%) were in the original group and 33 (92%) in the modified group. There were no differences in the operating time, blood loss, and postoperative morbidity and mortality between the two groups. The mean follow-up was 50.3 mo in the original group and 48.7 mo in the modified group. There were no differences in endocrine and exocrine function preservation between the two groups. The original Frey's procedure resulted in significantly better pain relief, as shown by 5-year follow-up ( P = 0.032), better emotional status ( P = 0.047) and fewer fatigue symptoms ( P = 0.028). When stratifying these patients by the M-ANNHEIM severity index, no impact was found on pain relief after the two types of surgery. The original Frey's procedure is as safe as the modified procedure, but the former yields better pain relief. The severity of CP does not affect postoperative pain relief.

Conventional consent with opting in versus simplified consent with opting out: an exploratory trial for studies that do not increase patient risk.

PubMed

Rogers, C G; Tyson, J E; Kennedy, K A; Broyles, R S; Hickman, J F

1998-04-01

The objective of this study was to assess a modified consent procedure allowed under federal regulations and developed for studies, particularly clinical trials, that are judged by the Institutional Review Board to reduce or have no effect on patient risk. This was a randomized trial of a conventional consent procedure that required parental signature to give consent (opting in) after a comprehensive disclosure of the rights of participants in research versus a modified consent procedure that required parental signature to refuse consent (opting out) after specific disclosures appropriate when risk is not increased. Consent was sought for a trial of primary follow-up care for disadvantaged infants at high risk, a trial judged by our Institutional Review Board to increase access to care for both groups. A blinded assessor interviewed mothers within 24 hours of the consent decision. Among the 44 mothers interviewed, the modified consent group scored higher than the conventional consent group in recall and understanding of study purpose and methods (47% vs 30%; p < 0.02). Other comparisons provided no evidence that the modified consent procedure was less desirable. Virtually all mothers reported satisfaction. The modified approach may improve communication and facilitate studies judged by the Institutional Review Board to be risk-neutral or risk-reducing. Further evaluation of a modified consent procedure for such studies is warranted.

Changes in Quality of Life in Visually Impaired Patients after Low-Vision Rehabilitation

ERIC Educational Resources Information Center

Renieri, Giulia; Pitz, Susanne; Pfeiffer, Norbert; Beutel, Manfred E.; Zwerenz, Rudiger

2013-01-01

The objective of the study was to assess the impact of low-vision aids on quality of life. Interviews included a modified version of the National Eye Institute Visual Functioning Questionnaire (Modified German NEI VFQ-25), the Hospital Anxiety and Depression Scale, the Mini-Mental State Examination Blind, and Indicators of the Rehabilitation…

Kalman filter based control for Adaptive Optics

NASA Astrophysics Data System (ADS)

Petit, Cyril; Quiros-Pacheco, Fernando; Conan, Jean-Marc; Kulcsár, Caroline; Raynaud, Henri-François; Fusco, Thierry

2004-12-01

Classical Adaptive Optics suffer from a limitation of the corrected Field Of View. This drawback has lead to the development of MultiConjugated Adaptive Optics. While the first MCAO experimental set-ups are presently under construction, little attention has been paid to the control loop. This is however a key element in the optimization process especially for MCAO systems. Different approaches have been proposed in recent articles for astronomical applications : simple integrator, Optimized Modal Gain Integrator and Kalman filtering. We study here Kalman filtering which seems a very promising solution. Following the work of Brice Leroux, we focus on a frequential characterization of kalman filters, computing a transfer matrix. The result brings much information about their behaviour and allows comparisons with classical controllers. It also appears that straightforward improvements of the system models can lead to static aberrations and vibrations filtering. Simulation results are proposed and analysed thanks to our frequential characterization. Related problems such as model errors, aliasing effect reduction or experimental implementation and testing of Kalman filter control loop on a simplified MCAO experimental set-up could be then discussed.

The use of GIS tools in determining the intensity of meandering of rivers based on the example of Noteć River (Poland)

NASA Astrophysics Data System (ADS)

Szatten, Dawid; Rabant, Hubert; Nadolny, Grzegorz

2017-11-01

The study used the tools of Geographic Information System (GIS) in the analysis of the intensity of meandering of Noteć River, calculated using indicators proposed by Brice [16], Leopold et al. [17], Rust [15] and Rosgen [18]. In this work the emphasis is placed on showing the suitability of using modelling software and spatial data. The study was based on archival cartographic materials and orthophotomap presenting the current course of the river channel. The software of geographic information system used for analysis was ArcMap v.10.0. The rate of meandering of the river in a multiyear period 1876-2013 and four typical scenarios of the development of river channel were determined. Comparing them with the types of human intervention in the fluvial system, the dynamics of transformation channel in the analysed period of time was specified. These types are characteristic for all the meandering rivers. These scenarios can determine the amount of anthropopressure and to evaluate the usefulness of GIS in the analysis of transformations of the fluvial system.

Examination of the Korean Modified Checklist of Autism in Toddlers: Item Response Theory

ERIC Educational Resources Information Center

Seung, HyeKyeung; Ji, Juye; Kim, Soo-Jin; Sung, Inkyung; Youn, Young-Ah; Hong, Gyunghun; Lee, Hyeonjin; Lee, Young Hwan; Lee, Hyunsuk; Youm, Hyun Kyung

2015-01-01

The study examined the clinical utility and psychometric properties of the Korean Modified Checklist of Autism in Toddlers (K-M-CHAT)-2. A sample of 2300 parents of 16- to 36-month-old children was recruited across South Korea. A phone interview was utilized to follow up with participants who initially screened positive for autism spectrum…

Elementary School Students' Interaction with the Planned Curriculum Through Their Valuing, Adapting, and Modifying Subject Matter.

ERIC Educational Resources Information Center

Zuga, Karen F.

Ways in which elementary school students value, adapt, and modify the curriculum are revealed by reporting statements of children in grades 2 through 4 in a midwestern parochial school. Over 250 hours of observation as well as interviews with students, teachers, parents, and the principal formed the basis of research. Data were assembled through…

Mapping the Development of a New MA Programme in Higher Education: Comparing Privately Held Perceptions of a Public Endeavour

ERIC Educational Resources Information Center

Kinchin, Ian; Hosein, Anesa; Medland, Emma; Lygo-Baker, Simon; Warburton, Steven; Gash, Darren; Rees, Roger; Loughlin, Colin; Woods, Rick; Price, Shirley; Usherwood, Simon

2017-01-01

After spending a year working on the development of a new online Master's programme in higher education, members of the development team were interviewed to reveal their thoughts about the nature of the programme. The dialogue of each interview was summarised as a concept map. Analysis of the resulting maps included a modified Bernsteinian…

Improving reliability of a residency interview process.

PubMed

Peeters, Michael J; Serres, Michelle L; Gundrum, Todd E

2013-10-14

To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station-impact of content specificity was greatly reduced with more interview stations. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity.

The Feasibility of Functional Electrical Stimulation to Improve Upper Extremity Function in a Two-year-old Child with Perinatal Stroke: A Case Report.

PubMed

Musselman, Kristin E; Manns, Patricia; Dawe, Jaclyn; Delgado, Rhina; Yang, Jaynie F

2018-02-01

To evaluate the effectiveness and feasibility (i.e. tolerability, adherence) of functional electrical stimulation (FES) for the upper extremity (UE) in a two-year-old child with perinatal stroke. Forty hours of FES over eight weeks was prescribed. FES to the hemiplegic triceps, extensor carpi radialis longus and brevis, extensor carpi ulnaris and extensor digitorum was timed with reaching during play. Assessments were performed before, during, and two months post-intervention. UE function (Melbourne Assessment 2 (MA2), Assisting Hand Assessment (AHA)) and spasticity (Modified Tardieu with electrogoniometry and electromyography) were measured. The mother completed a semi-structured interview post-intervention. Descriptive statistics were used for adherence and UE measures. A repeated-measures ANOVA compared Modified Tardieu parameters (e.g. catch angle) over time. Conventional content analysis was used for the interview data. The child completed 39.2/40 hours. Immediately post-intervention, improvements were observed on MA2's Range of Motion subscale and catch angle (Modified Tardieu, p < 0.001). Two months post-intervention, improvements were observed on MA2's Accuracy and Fluency subscales. No change in AHA score occurred. Three themes emerged from the interview: (1) Ingredients for program success; (2) Information about the FES device; and (3) The child's response. UE FES was feasible in a two-year-old child with hemiplegia.

Content validity of the PedsQL™ 3.2 Diabetes Module in newly diagnosed patients with Type 1 diabetes mellitus ages 8-45.

PubMed

Varni, James W; Curtis, Bradley H; Abetz, Linda N; Lasch, Kathryn E; Piault, Elisabeth C; Zeytoonjian, Andrea A

2013-10-01

The content validity of the 28-item PedsQL™ 3.0 Diabetes Module has not been established in research on pediatric and adult patients with newly diagnosed Type 1 diabetes across a broad age range. This study aimed to document the content validity of three age-specific versions (8-12 years, 13-18 years, and 18-45 years) of the PedsQL™ Diabetes Module in a population of newly diagnosed patients with Type 1 diabetes. The study included in-depth interviews with 31 newly diagnosed patients with Type 1 diabetes between the ages of 8 and 45 years, as well as 14 parents and/or caregivers of child and teenage patients between the ages of 8 and 18 years of age; grounded theory data collection and analysis methods; and review by clinical and measurement experts. Following the initial round of interviews, revisions reflecting patient feedback were made to the Child and Teen versions of the Diabetes Module, and an Adult version of the Diabetes Module was drafted. Cognitive interviews of the modified versions of the Diabetes Module were conducted with an additional sample of 11 patients. The results of these interviews support the content validity of the modified 33-item PedsQL™ 3.2 Diabetes Module for pediatric and adult patients, including interpretability, comprehensiveness, and relevance suitable for all patients with Type 1 Diabetes. Qualitative methods support the content validity of the modified PedsQL™ 3.2 Diabetes Module in pediatric and adult patients. It is recommended that the PedsQL™ 3.2 Diabetes Module replaces version 3.0 and is suitable for measuring patient-reported outcomes in all patients with newly diagnosed, stable, or long-standing diabetes in clinical research and practice.

Screening for Autism in Older and Younger Toddlers with the Modified Checklist for Autism in Toddlers

ERIC Educational Resources Information Center

Pandey, Juhi; Verbalis, Alyssa; Robins, Diana L.; Boorstein, Hilary; Klin, Ami; Babitz, Tammy; Chawarska, Katarzyna; Volkmar, Fred; Green, James; Barton, Marianne; Fein, Deborah

2008-01-01

The Modified Checklist for Autism in Toddlers (M-CHAT) was used to screen younger (16-23 months) versus older (24-30 months) high- and low-risk toddlers. Refusal rates for follow-up interview showed no group differences, but parents of younger/low-risk children were more likely to refuse evaluation than parents of high-risk children. PPP for an…

Examination of the Properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in a Population Sample

ERIC Educational Resources Information Center

Yama, Brie; Freeman, Tom; Graves, Erin; Yuan, Su; Campbell, M. Karen

2012-01-01

This study examines the following properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in an unselected low-risk sample: (a) the maximum age for screen administration; (b) the positive screen rate in the absence of follow-up telephone interviews and; (c) the distributional properties of positive screens. Data came from a…

Modifiable risk factors of ecstasy use: risk perception, current dependence, perceived control, and depression

PubMed Central

Leung, Kit Sang; Ben Abdallah, Arbi; Cottler, Linda B.

2009-01-01

Risk perception, perceived behavioral control of obtaining ecstasy (PBC-obtaining), current ecstasy dependence, and recent depression have been associated with past ecstasy use, however, their utility in predicting ecstasy use has not been demonstrated. This study aimed to determine whether these four modifiable risk factors could predict ecstasy use after controlling for socio-demographic covariates and recent polydrug use. Data from 601 ecstasy users in the National Institute on Drug Abuse funded TriCity Study of Club Drug Use, Abuse and Dependence were analyzed using multivariate logistic regression. Participants were interviewed twice within a 2-week period using standardized instruments. Thirteen percent (n=80) of the participants reported using ecstasy between the two interviews. Low risk perception, high PBC-obtaining (an estimated ecstasy procurement time < 24 hours), and current ecstasy dependence were statistically associated with ecstasy use between the two interviews. Recent depression was not a significant predictor. Despite not being a target predictor, recent polydrug use was also statistically associated with ecstasy use. The present findings may inform the development of interventions targeting ecstasy users. PMID:19880258

Exploring health literacy competencies towards patient education programme for Chinese-speaking healthcare professionals: a Delphi study

PubMed Central

Chang, Li-Chun; Chen, Yu-Chi; Wu, Fei Ling; Liao, Li-Ling

2017-01-01

Objectives To achieve consensus on a set of competencies in health literacy practice based on a literature review and expert consultation. Setting Hospitals and community health centres in Taiwan. Method A 2-stage modified Delphi study involving a literature review was conducted, followed by qualitative interviews and 3 rounds of email-based data collection over a 3-month period in 2011. Participants 15 Chinese healthcare practitioners with more than 6 months’ experience in patient education were interviewed to collect data on health literacy practice. 24 experts (12 academic scholars in health literacy and 12 professionals with training related to health literacy practice) were invited to participate in the Delphi process. Results Qualitative data from the interviews were analysed and summarised to form 99 competency items for health literacy practice, which were categorised into 5 domains of health literacy practice including those pertaining to knowledge and skills. Consensus was reached on 92 of 99 competencies, using a modified Delphi technique. Conclusions The 92 competencies in health literacy practice embraced core components of patient education in the Chinese healthcare profession. PMID:28093428

Improving Reliability of a Residency Interview Process

PubMed Central

Serres, Michelle L.; Gundrum, Todd E.

2013-01-01

Objective. To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. Methods. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. Results. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station—impact of content specificity was greatly reduced with more interview stations. Conclusion. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity. PMID:24159209

Shift in power during an interview situation: methodological reflections inspired by Foucault and Bourdieu.

PubMed

Aléx, Lena; Hammarström, Anne

2008-06-01

This paper presents methodological reflections on power sharing and shifts of power in various interview situations. Narratives are said to be shaped by our attempts to position ourselves within social and cultural circumstances. In an interview situation, power can be seen as something that is created and that shifts between the interviewer and the interviewed. Reflexivity is involved when we as interviewers attempt to look at a situation or a concept from various perspectives. A modified form of discourse analysis inspired by subject positioning was used to reflect on power relations in four different interview situations. The analyses indicate that reflection on the power relations can lead to other forms of understanding of the interviewee. The main conclusion that can be drawn from this study is that power relations are created within an interview situation and therefore it is important to be aware of dominant perspectives. Researchers and nurses face the challenge of constantly raising their level of consciousness about power relationships, and discursive reflexivity is one way of doing this. Thus, reflexivity is an important part of the qualitative research process.

Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnosed with cardiovascular diseases: A systematic review.

PubMed

Lee, Windy W M; Choi, K C; Yum, Royce W Y; Yu, Doris S F; Chair, S Y

2016-01-01

Clinically, there is an increasing trend in using motivational interviewing as a counseling method to help clients with cardiovascular diseases to modify their unhealthy lifestyle in order to decrease the risk of disease occurrence. As motivational interviewing has gained increased attention, research has been conducted to examine its effectiveness. This review attempts to identify the best available evidence related to the effectiveness of motivational interviewing on lifestyle modification, physiological and psychological outcomes for clients at risk of developing or with established cardiovascular diseases. Systematic review of studies incorporating motivational interviewing in modifying lifestyles, improving physiological and psychological outcomes for clients at risk of or diagnosed with cardiovascular diseases. Major English and Chinese electronic databases were searched to identify citations that reported the effectiveness of motivational interviewing. The searched databases included MEDLINE, British Nursing Index, CINAHL Plus, PsycINFO, SCOPUS, CJN, CBM, HyRead, WanFang Data, Digital Dissertation Consortium, and so on. Two reviewers independently assessed the relevance of citations based on the inclusion criteria. Full texts of potential citations were retrieved for more detailed review. Critical appraisal was conducted by using the standardized critical appraisal checklist for randomized and quasi-randomized controlled studies from the Joanna Briggs Institute - Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStaRI). After eligibility screening, 14 articles describing 9 studies satisfied the inclusion criteria and were included in the analysis. Only certain outcomes in certain studies were pooled for meta-analysis because of the large variability of the studies included, other findings were presented in narrative form. For lifestyle modification, the review showed that motivational interviewing could be more effective than usual care on altering smoking habits. For physiological outcomes, the review showed that motivational interviewing positively improved client's systolic and diastolic blood pressures but the result was not significant. For psychological outcomes, the review showed that motivational interviewing might have favorable effect on improving clients' depression. For other outcomes, the review showed that motivational interviewing did not differ from usual care or usual care was even more effective. The review showed that motivational interviewing might have favorable effects on changing clients' smoking habits, depression, and three SF-36 domains. For the other outcomes, most of the results were inconclusive. Further studies should be performed to identify the optimal format and frequency of motivational interviewing. Primary research on the effectiveness of motivational interviewing on increasing clients' motivation and their actual changes in healthy behavior is also recommended. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dyadic Behavior Analysis in Depression Severity Assessment Interviews

PubMed Central

Scherer, Stefan; Hammal, Zakia; Yang, Ying; Morency, Louis-Philippe; Cohn, Jeffrey F.

2016-01-01

Previous literature suggests that depression impacts vocal timing of both participants and clinical interviewers but is mixed with respect to acoustic features. To investigate further, 57 middle-aged adults (men and women) with Major Depression Disorder and their clinical interviewers (all women) were studied. Participants were interviewed for depression severity on up to four occasions over a 21 week period using the Hamilton Rating Scale for Depression (HRSD), which is a criterion measure for depression severity in clinical trials. Acoustic features were extracted for both participants and interviewers using COVAREP Toolbox. Missing data occurred due to missed appointments, technical problems, or insufficient vocal samples. Data from 36 participants and their interviewers met criteria and were included for analysis to compare between high and low depression severity. Acoustic features for participants varied between men and women as expected, and failed to vary with depression severity for participants. For interviewers, acoustic characteristics strongly varied with severity of the interviewee’s depression. Accommodation - the tendency of interactants to adapt their communicative behavior to each other - between interviewers and interviewees was inversely related to depression severity. These findings suggest that interviewers modify their acoustic features in response to depression severity, and depression severity strongly impacts interpersonal accommodation. PMID:28345076

The electron diffusion coefficient in Jupiter's magnetosphere

NASA Technical Reports Server (NTRS)

Birmingham, T.; Northrop, T.; Baxter, R.; Hess, W.; Lojko, M.

1974-01-01

A steady-state model of Jupiter's electron radiation belt is developed. The model includes injection from the solar wind, radial diffusion, energy degradation by synchrotron radiation, and absorption at Jupiter's surface. A diffusion coefficient of the form D sub RR/R sub J squared = k times R to the m-th power is assumed, and then observed data on synchrotron radiation are used to fit the model. The free parameters determined from this fit are m = 1.95 plus or minus 0.5, k = 1.7 plus or minus 0.5 x 10 to the 9th power per sec, and the magnetic moment of injected particles equals 770 plus or minus 300 MeV/G. The value of m shows quite clearly that the diffusion is not caused by magnetic pumping by a variable solar wind or by a fluctuating convection electric field. The process might be field line exchange driven by atmospheric-ionospheric winds; our diffusion coefficient has roughly the same radial dependence but is considerably smaller in magnitude than the upper bound diffusion coefficients recently suggested for this process by Brice and McDonough (1973) and Jacques and Davis (1972).

A qualitative study on feedback provided by students in nurse education.

PubMed

Chan, Zenobia C Y; Stanley, David John; Meadus, Robert J; Chien, Wai Tong

2017-08-01

This study aims to help nurse educators/academics understand the perspectives and expectations of students providing their feedback to educators about teaching performance and subject quality. The aim of this study is to reveal students' voices regarding their feedback in nurse education in order to shed light on how the current student feedback practice may be modified. A qualitative study using focus group inquiry. Convenience sampling was adopted and participants recruited from one school of nursing in Hong Kong. A total of 66 nursing students from two pre-registration programs were recruited for seven focus group interviews: one group of Year 1 students (n=21), two groups of Year 3 students (n=27), and four groups of Final Year students (n=18). The interviews were guided by a semi-structured interview guideline and the interview narratives were processed through content analysis. The trustworthiness of this study was guaranteed through peer checking, research meetings, and an audit trail. The participants' privacy was protected throughout the study. Four core themes were discerned based on the narratives of the focus group interviews: (1) "timing of collecting feedback at more than one time point"; (2) "modify the questions being asked in collecting student feedback"; (3) "are electronic means of collecting feedback good enough?; and (4) "what will be next for student feedback?". This study is significant in the following three domains: 1) it contributed to student feedback because it examined the issue from a student's perspective; 2) it explored the timing and channels for collecting feedback from the students' point of view; and 3) it showed the preferred uses of student feedback. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Owner attitudes and self reported behavior towards modified work after occupational injury absence in small enterprises: a qualitative study.

PubMed

Andersen, Lars Peter; Kines, Pete; Hasle, Peter

2007-03-01

Opportunities for modified work after an occupational injury are thought to be limited in small enterprises. This paper explores owner attitudes and self reported behavior towards modified work after injury-absence in small enterprises. Twenty-two owners of small construction and metal-processing enterprises were interviewed. Opportunities for modified work were possible in spite of some owners' general objections. Owners found their own solutions here-and-now without help from external stakeholders, and had little knowledge of possibilities for financial or practical support for early return-to-work initiatives. Initiatives formalizing modified work must be arranged in a way that supports the close social relations in small enterprises. Information to support the return to work process must be given when it is needed, i.e. at the onset of the prospect of lengthy work absence. The actual form of modified work should mainly be left up to the employer and the injured worker.

Mastering one's destiny: mastery goals promote challenge and success despite social identity threat.

PubMed

Stout, Jane G; Dasgupta, Nilanjana

2013-06-01

We used an achievement goal framework to enhance identity-threatened individuals' motivation and performance by way of an understudied mechanism, namely, challenge appraisals. In three experiments, women were given a mastery goal (focus on building skills) or a performance goal (perform well, avoid errors) before a mock job interview. Women who focused on mastery rather than performance felt more challenged and less threatened when anticipating an identity-threatening interview; goals did not affect appraisals of a nonthreatening interview (Experiment 1). Mastery relative to performance goals enhanced women's intention to be assertive (Experiment 2) and their actual face-to-face performance during the job interview (Experiment 3); challenge appraisals (but not threat appraisals) served as a mediator for these effects. Whereas a great deal of prior work has alleviated identity threat by altering construals of one's identity, the current research uses an alternative strategy--modifying appraisals of the situation, leaving one's self-concept intact.

Exploring health literacy competencies towards patient education programme for Chinese-speaking healthcare professionals: a Delphi study.

PubMed

Chang, Li-Chun; Chen, Yu-Chi; Wu, Fei Ling; Liao, Li-Ling

2017-01-16

To achieve consensus on a set of competencies in health literacy practice based on a literature review and expert consultation. Hospitals and community health centres in Taiwan. A 2-stage modified Delphi study involving a literature review was conducted, followed by qualitative interviews and 3 rounds of email-based data collection over a 3-month period in 2011. 15 Chinese healthcare practitioners with more than 6 months' experience in patient education were interviewed to collect data on health literacy practice. 24 experts (12 academic scholars in health literacy and 12 professionals with training related to health literacy practice) were invited to participate in the Delphi process. Qualitative data from the interviews were analysed and summarised to form 99 competency items for health literacy practice, which were categorised into 5 domains of health literacy practice including those pertaining to knowledge and skills. Consensus was reached on 92 of 99 competencies, using a modified Delphi technique. The 92 competencies in health literacy practice embraced core components of patient education in the Chinese healthcare profession. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A Screening Tool to Identify Spasticity in Need of Treatment

PubMed Central

Zorowitz, Richard D.; Wein, Theodore H.; Dunning, Kari; Deltombe, Thierry; Olver, John H.; Davé, Shashank J.; Dimyan, Michael A.; Kelemen, John; Pagan, Fernando L.; Evans, Christopher J.; Gillard, Patrick J.; Kissela, Brett M.

2017-01-01

Objective To develop a clinically useful patient-reported screening tool for health care providers to identify patients with spasticity in need of treatment regardless of etiology. Design Eleven spasticity experts participated in a modified Delphi panel and reviewed and revised 2 iterations of a screening tool designed to identify spasticity symptoms and impact on daily function and sleep. Spasticity expert panelists evaluated items pooled from existing questionnaires to gain consensus on the screening tool content. The study also included cognitive interviews of 20 patients with varying spasticity etiologies to determine if the draft screening tool was understandable and relevant to patients with spasticity. Results The Delphi panel reached an initial consensus on 21 of 47 items for the screening tool and determined that the tool should have no more than 11 to 15 items and a 1-month recall period for symptom and impact items. After 2 rounds of review, 13 items were selected and modified by the expert panelists. Most patients (n = 16 [80%]) completed the cognitive interview and interpreted the items as intended. Conclusions Through the use of a Delphi panel and patient interviews, a 13-item spasticity screening tool was developed that will be practical and easy to use in routine clinical practice. PMID:27552355

Evaluation, modification and validation of a set of asthma illustrations in children with chronic asthma in the emergency department

PubMed Central

Tulloch, Joanie; Vaillancourt, Régis; Irwin, Danica; Pascuet, Elena

2012-01-01

OBJECTIVES: To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and/or their parents) with chronic asthma who presented to the emergency department at the Children’s Hospital of Eastern Ontario, Ottawa, Ontario. METHODS: Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and/or translucency median score <6, were reviewed by the study team and modified by the study’s graphic designer. Modifications were made based on key concepts identified by study participants. RESULTS: A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. CONCLUSION: The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. PRACTICE IMPLICATIONS: These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care. PMID:22332128

Evaluation, modification and validation of a set of asthma illustrations in children with chronic asthma in the emergency department.

PubMed

Tulloch, Joanie; Irwin, Danica; Pascuet, Elena; Vaillancourt, Régis

2012-01-01

To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and⁄or their parents) with chronic asthma who presented to the emergency department at the Children's Hospital of Eastern Ontario, Ottawa, Ontario. Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and⁄or translucency median score <6, were reviewed by the study team and modified by the study's graphic designer. Modifications were made based on key concepts identified by study participants. A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care.

Dimensions of novelty: a social representation approach to new foods.

PubMed

Bäckström, A; Pirttilä-Backman, A-M; Tuorila, H

2003-06-01

Social representations of new foods were examined with a total of 44 subjects in nine focus groups. Each group was homogenous, defined by age, gender and educational background. Halfway through the interview, commercial packages of functional, genetically modified, organic, nutritionally modified and ethnic foods were presented as visual stimuli for discussion. Thematic and content analyses of the interview data showed that five dichotomies characterized the social representation: trust/distrust, safe/unsafe, natural/artificial, pleasure/necessity, and past/present. Many metaphors were used, with functional products being associated metaphorically with, for example, medicine and genetically modified products being associated with death and terrorism. Chronological references focused on the development of cuisine. The perceived unsafety of new foods was an important argument for women but not for men. The difference between age groups was in relating the discussion to either present time (young subjects) or past time (older subjects). Level of education affected the content of argumentation. In the context of new foods, social representations are formed to cope with the feeling of strangeness evoked by the novelties. They also have a role in cultural acceptance of new products by making them familiar. Overall, the results reflect the development of a new common sense in which popularized scientific notions are anchored in the process of urbanization.

Ego Identity Status: Addressing the Continuum Debate.

ERIC Educational Resources Information Center

Van Wicklin, John F.

From Erikson's (1968) psychosocial criteria of crisis and commitment, Marcia (1964) derived four ego identity statuses, i.e., achievement, moratorium, foreclosure, and diffusion. To explore antecedents of Erikson's ego identity construct, 130 college females completed a modified identity status interview, and questionnaires designed to elicit…

Educational Research in an Introductory Astronomy Course.

ERIC Educational Resources Information Center

Hemenway, Mary Kay; Straits, William J.; Wilke, R. Russell; Hufnagel, Beth

2002-01-01

Used classroom observations, personal interviews, and pre-instruction/post-instruction administration of the Texas Attitude Survey and the Astronomy Diagnostic Test to evaluate hands-on instructional innovations in a college astronomy course. Modified instruction based on student concerns; scores for the second course showed significant…

Modifying autonomy--a concept grounded in nurses' experiences of moral decision-making in psychiatric practice.

PubMed Central

Lützén, K; Nordin, C

1994-01-01

Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making in psychiatric practice. PMID:8083870

Design and methodology of SNAP-1: a Sprint National Anaesthesia Project to measure patient reported outcome after anaesthesia.

PubMed

Moonesinghe, Suneetha Ramani; Walker, Eleanor Mary Kate; Bell, Madeline

2015-01-01

Patient satisfaction is an important metric of health-care quality. Accidental awareness under general anaesthesia (AAGA) is a serious complication of anaesthesia care which may go unrecognised in the immediate perioperative period but leads to long-term psychological harm for affected patients. The SNAP-1 study aimed to measure patient satisfaction with anaesthesia care and the incidence of AAGA, reported on direct questioning within 24 h of surgery, in a large multicentre cohort. A secondary aim of SNAP-1 was to test the effectiveness of a new network of Quality Audit and Research Coordinators in NHS anaesthetic departments, to achieve widespread study participation and high patient recruitment rates. This manuscript describes the study methodology. SNAP-1 was a prospective observational cohort study. The study protocol was approved by the National Research Ethics Service. All UK NHS hospitals with anaesthetic departments were invited to participate. Adult patients undergoing any type of non-obstetric surgery were recruited in participating hospitals on 13th and 14th May 2014. Demographic data were collected by anaesthetists providing perioperative care. Patients were then approached within 24 h of surgery to complete two questionnaires-the Bauer patient satisfaction questionnaire (to measure patient reported outcome) and the modified Brice questionnaire (to detect possible accidental awareness). Completion of postoperative questionnaires was taken as evidence of implied consent. Results were recorded on a standard patient case report form, and local investigators entered anonymised data into an electronic database for later analysis by the core research team. Preliminary analyses indicate that over 15,000 patients were recruited across the UK, making SNAP-1 the largest NIHR portfolio-adopted study in anaesthesia to date. Both descriptive and analytic epidemiological analyses will be used to answer specific questions about the patient perception of anaesthesia care overall and in surgical sub-specialties and to determine the incidence of AAGA. The SNAP-1 study recruited a large number of UK hospitals and thousands of perioperative patients using newly established networks in the UK anaesthetic profession. The results will provide benchmarking information to aid interpretation of patient satisfaction data and also determine the incidence of AAGA reported on a single postoperative visit.

Delving into Teacher Collaboration: Untangling Problems and Solutions for Leadership

ERIC Educational Resources Information Center

Gates, Gordon; Robinson, Sharon

2009-01-01

This article offers description and interpretation for understanding the exercise of leadership in teacher collaboration. Data gathered in two urban high schools through observations and interviews were coded and categorized following Miles and Huberman's modified analytic induction technique. The analysis contributes to emerging theory on…

Design methodology for a community response questionnaire on sonic boom exposure

NASA Technical Reports Server (NTRS)

Farbry, John E., Jr.; Fields, James M.; Molino, John A.; Demiranda, Gwendolyn A.

1991-01-01

A preliminary draft questionnaire concerning community response to sonic booms was developed. Interviews were conducted in two communities that had experienced supersonic overflights of the SR-71 airplane for several years. Even though the overflights had ceased about 6 months prior to the interviews, people clearly remembered hearing sonic booms. A total of 22 people living in central Utah and 23 people living along Idaho/Washington state border took part in these interviews. The draft questionnaire was constantly modified during the study in order to evaluate different versions. Questions were developed which related to annoyance, startle, sleep disturbance, building vibration, and building damage. Based on the data collected, a proposed community response survey response instrument was developed for application in a full-scale sonic boom study.

Design methodology for a community response questionnaire on sonic boom exposure

NASA Astrophysics Data System (ADS)

Farbry, John E., Jr.; Fields, James M.; Molino, John A.; Demiranda, Gwendolyn A.

1991-05-01

A preliminary draft questionnaire concerning community response to sonic booms was developed. Interviews were conducted in two communities that had experienced supersonic overflights of the SR-71 airplane for several years. Even though the overflights had ceased about 6 months prior to the interviews, people clearly remembered hearing sonic booms. A total of 22 people living in central Utah and 23 people living along Idaho/Washington state border took part in these interviews. The draft questionnaire was constantly modified during the study in order to evaluate different versions. Questions were developed which related to annoyance, startle, sleep disturbance, building vibration, and building damage. Based on the data collected, a proposed community response survey response instrument was developed for application in a full-scale sonic boom study.

A Simplified Method of Eliciting Information from Novices.

ERIC Educational Resources Information Center

Brandt, D. Scott; Uden, Lorna

2002-01-01

Discusses the use of applied cognitive task analysis (ACTA) to interview novices and gain insight into their cognitive skills and processes. Focuses particularly on novice Internet searchers at the University of Staffordshire (United Kingdom) and reviews attempts to modify ACTA, which is intended to gather information from experts as part of…

76 FR 13410 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

... and their culture of patient safety. This survey is designed for use in community/retail pharmacies... on Patient Safety Culture Questionnaire; (2) Pretest and modify the questionnaire as necessary; (3... interview guide will be used for each round. (2) Pretest--The draft questionnaire will be pretested with all...

The National Health Educator Job Analysis 2010: Process and Outcomes

ERIC Educational Resources Information Center

Doyle, Eva I.; Caro, Carla M.; Lysoby, Linda; Auld, M. Elaine; Smith, Becky J.; Muenzen, Patricia M.

2012-01-01

The National Health Educator Job Analysis 2010 was conducted to update the competencies model for entry- and advanced-level health educators. Qualitative and quantitative methods were used. Structured interviews, focus groups, and a modified Delphi technique were implemented to engage 59 health educators from diverse work settings and experience…

Undergraduate Female Science-Related Career Choices: A Phenomenological Study

ERIC Educational Resources Information Center

Curry, Kathy S.

2010-01-01

This qualitative phenomenological study used a modified Groenewald's five steps method with semi-structured, recorded, and transcribed interviews to focus on the underrepresentation of females in science-related careers. The study explored the lived experiences of a purposive sample of 25 senior female college students attending a college in…

Group Administration of the Children's Attributional Style Interview

ERIC Educational Resources Information Center

Rueger, Sandra Yu; Malecki, Christine Kerres

2007-01-01

Research testing the reformulated theory of learned helplessness has been limited by the psychometric properties of instruments used to measure children's attributional style. Thus, the goal of this investigation was to modify a relatively new measure of attributional style that has demonstrated strong psychometric properties with young children…

Constructing a Feminist-Inclusive Theory of Leadership.

ERIC Educational Resources Information Center

Irby, Beverly J.; Brown, Genevieve

There are some who argue that the existing theoretical paradigm used in leadership training programs should be modified to include the feminist perspective. This paper presents findings of a study that investigated male and female perceptions of effective leadership skills. Indepth interviews were conducted with 120 executives--60 men and 60…

Validation of the modified telephone interview for cognitive status (TICS-m) in Hebrew.

PubMed

Beeri, Michal Schnaider; Werner, Perla; Davidson, Michael; Schmidler, James; Silverman, Jeremy

2003-05-01

The validity of the Hebrew version of the Telephone Interview for Cognitive Status-Modified (TICS-m) for Mild Cognitive Impairment (MCI), for dementia, and for cognitive impairment (either MCI or dementia) was investigated. Of the 10 059 who took part of the Israel Ischemic Heart Disease Cohort, 1902 of the 2901 survivors in 1999 had TICS-m interviews. Those with a score of 27 or below and a random sample with a score of 28 or 29 were invited to have a physician's examination for the diagnosis of dementia. The analysis was performed on the 576 who agreed. Based on physician's diagnosis, 269 were diagnosed as suffering from dementia, 128 as suffering from MCI, and 179 were diagnosed with no cognitive impairment. The TICS-m Hebrew version's internal consistency was very high (Cronbach's alpha = 0.98) and showed a strong convergent validity with the MMSE (r = 0.82; p < 0.0005). The sensitivity was 100% for each of the conditions. Finally, after controlling for age, education and hearing impairment, TICS-m was a strong predictor of dementia, MCI and cognitive impairment. At a cut-off of 27/50 the Hebrew version of the TICS-m is a useful screening instrument to identify subjects suffering from mild cognitive impairment, dementia and cognitive impairment (MCI or dementia). Copyright 2003 John Wiley & Sons, Ltd.

[Sexuality among university women].

PubMed

Fuentes Vasquez, L Y

1989-12-01

Changes in female sexual behavior in Bogota, Colombia are demonstrated, based on a study at Bogota's National University in 1989 analyzing 160 interview of women in such field as Anthropology, Sociology, Psychology, Social Work and Nursing and 21 in-depth interviews. The new changes include acceptance of family planning as compared to the historical subservient roles that women played in Colombia 30 years ago. Some of the conclusions of the study are: 1) 83.7% of those interviewed stated that female sexuality has been facilitated by access to contraception, while 10% disagreed; 2) 75.6% felt that a couple should decide on contraceptive methods used, while 15.6% stated that it should be the woman's decision; 3) 65% of the students stated that they were well- informed about contraceptives as against 35%; 4) 90.0% of the students were using a contraceptive at the time of the interview as against 9% (pills by 14.4%; IUD by 42.2%; condoms by 6.6%; suppositories by 14.4% and the rhythm method by 30%). (Author's modified).

[PedsQL™ 4.0 Generic Core Infant Scales Parents Report for infants (ages 13-24 months). Linguistic validation from original US English version to Italian version].

PubMed

González-Melado, F J; Di Ciommo, V M; Di Pietro, M; Chiarini Testa, M B; Cutrera, R

2013-10-01

The purpose of this research was to show the translation and linguistic validation of the PedsQL™ 4.0 Generic Core Infant Scales Parents Report for Infants (ages 13-24 months) from its original English version to Italian language. The linguistic validation consists in three steps: a) different forward translations from the original US English instrument to Italian; this step includes the drawing of a "reconciliation" version (version 1); b) backward translations from the Italian reconciliation version to US English; c) patient testing: the second version of the questionnaire (obtained after the backward translations) has to be tested on a panel of a minimum of 5 respondents, throughout cognitive interviewing methodology, in order to obtain the final italian version of the PedsQL™ Parents Report for Infants (ages 13-24 months). In this report we summarize the third step of this process. To study the content validity, the applicability and comprehension of our questionnarie translation, we tested it through a qualitative methodology in a sample of parents whose children were hospitalized in Bambino Gesù Children's Hospital with two different kinds of interview: 4 parents responded to the questions posed through a "thinkaloud interview" and 3 parents responded to the questionnaire and to a "respondent debriefing" interview. We modified the main question of each section and also one of the possible answer in order to maintain the Italian translation that appeared in others PedsQL™. We did not modify the questions of each section because respondents expressed that are clearly comprehensible and easy to understand.

Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey.

PubMed

Heuschmann, Peter U; Kircher, Julia; Nowe, Tim; Dittrich, Ralf; Reiner, Zeljko; Cifkova, Renata; Malojcic, Branko; Mayer, Otto; Bruthans, Jan; Wloch-Kopec, Dorota; Prugger, Christof; Heidrich, Jan; Keil, Ulrich

2015-10-01

Previous cross-sectional surveys in different European countries within the EUROASPIRE programme demonstrated a high prevalence of modifiable risk factors, unhealthy lifestyles and inadequate drug treatment in coronary heart disease patients. Comparable data for ischaemic stroke patients is lacking. A stroke-specific study module was added to the EUROASPIRE III core survey. This cross-sectional multicentre survey included consecutive patients with first-ever ischaemic stroke from four European countries. Data were obtained from medical records, patient interviews and patient examinations within 6-36 months after the stroke event. Control of modifiable risk factors after stroke was evaluated against contemporary European guidelines. A total of 881 patients was recruited. Median age was 66 years, 37.5% were female; average time from the stroke event to interview was 550 days. At the time of the interview, 17.6% of stroke patients smoked cigarettes, 35.5% had a body mass index ≥30 kg/m(2), 62.4% showed elevated blood pressure and 75.7% exhibited elevated LDL cholesterol levels. Antiplatelet drugs or oral anticoagulants were used by 87.2%, antihypertensive medication by 84.4% and statins by 56.8% of stroke patients. Among patients using antihypertensive drugs and lipid-lowering medication at the time of the interview, 34.3% and 34.4%, respectively, achieved target blood pressure and total cholesterol values according to current European guidelines. The EUROASPIRE III stroke-specific module shows that secondary prevention and risk factor control in patients after ischaemic stroke need to be improved in four European centres at the time of the study since about half of patients are not achieving risk factor targets defined in European guidelines. © The European Society of Cardiology 2014.

An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF IPQ-R): Unpacking beliefs about treatment control, personal control and symptom triggers.

PubMed

Taylor, Elaina C; O'Neill, Mark; Hughes, Lyndsay D; Moss-Morris, Rona

2018-04-01

This study modified the Revised Illness Perception Questionnaire (IPQ-R) in patients with persistent atrial fibrillation (AF). Qualitative interviews and think-aloud techniques informed modification of the IPQ-R to be specific to AF patients. Confirmatory Factor Analysis (CFA) (n = 198) examined the validity of the modified IPQ-R (AF-IPQ-R). Exploratory factor analysis (EFA) examined the new AF-triggers scale. Construct validity examined associations between the AF-IPQ-R, quality of life (QoL) and beliefs about medicines. Test-retest and internal reliability were examined. Interviews indicated that patients viewed triggers of AF rather than initial causes of illness as more applicable. Patients believed specific behaviours such as rest could control AF. Treatment control beliefs related to pharmacological and procedural treatments. These data were used to modify the IPQ-R subscales and to develop a triggers of AF scale. CFA indicated good model fit. EFA of the triggers scale indicated three factors: emotional; health behaviours; and over-exertion triggers. Expected correlations were found between the AF-IPQ-R, QoL and treatment beliefs, evidencing good construct validity. The AF-IPQ-R showed sound psychometric properties. It provides more detailed specification than the IPQ-R of beliefs that may help to understand poor QoL in AF patients, and guidance for future interventions in this area.

Focus Groups and Exit Interviews Are Components of Chemistry Department Program Assessment

NASA Astrophysics Data System (ADS)

Dreisbach, Joseph H.; Hogan, Thomas P.; Stamford, Anne Marie; Greggo, John W.

1998-10-01

The Chemistry Department, in conjunction with the Assessment and Institutional Research Office (AIRO) and the Department of Counseling and Human Services developed an assessment plan which incorporates use of focus groups and exit interviews. As part of the five-year departmental review, a number of student focus groups were facilitated to evaluate (a) the freshman and sophomore organic chemistry programs which also service other departments and (b) the upper division lecture and laboratory program for majors. Use of direct conversation in program assessment yields less ambiguous results compared with other methods because responses can be clarified with careful follow up questions. Success of this project gave rise to use of annual exit interviews with graduating seniors from the chemistry department. The approach described can easily be modified to meet the needs of any academic setting.

A Study of Instructional Methods Used in Fast-Paced Classes

ERIC Educational Resources Information Center

Lee, Seon-Young; Olszewski-Kubilius, Paula

2006-01-01

This study involved 15 secondary-level teachers who taught fast-paced classes at a university based summer program and similar regularly paced classes in their local schools in order to examine how teachers differentiate or modify instructional methods and content selections for fast-paced classes. Interviews were conducted with the teachers…

Inequality Frames: How Teachers Inhabit Color-Blind Ideology

ERIC Educational Resources Information Center

Cobb, Jessica S.

2017-01-01

This paper examines how public school teachers take up, modify, or resist the dominant ideology of color-blind racism. This examination is based on in-depth interviews with 60 teachers at three segregated schools: one was race/class privileged and two were disadvantaged. Inductive coding revealed that teachers at each school articulated a shared…

Abused Elders: Victims of Villains or of Circumstances?

ERIC Educational Resources Information Center

Sengstock, Mary C.; And Others

Theorists have suggested that domestic abuse may be a result of psychopathology in the abuser or the result of severe stress. To determine whether the families of aged victims exhibit an inordinate number of stressful situations, 20 elderly abuse victims were interviewed about family relationships and problems, and completed a modified version of…

How to Help Parents Pack Better Preschool Sack Lunches: Advice from Parents for Educators

ERIC Educational Resources Information Center

Sweitzer, Sara J.; Briley, Margaret E.; Roberts-Gray, Cindy; Hoelscher, Deanna M.; Staskel, Deanna M.; Almansour, Fawaz D.

2011-01-01

Objectives: This exploratory study obtained parent suggestions about messages and activities to guide parents to pack healthful sack lunches for preschool-aged children. Methods: A facilitator conducted group interviews using a modified nominal group technique with a convenience sample of parents who pack daily lunches for their children.…

Social Indicators of Family Life Satisfaction: A Comparison of Husbands and Wives.

ERIC Educational Resources Information Center

Mancini, Jay A.

Subjective and objective covariates of family life satisfaction among husbands and wives were examined. Interviews were conducted in the Spring of 1976 with 974 married adults selected by means of both probability and modified probability sampling designs. Independent indicators were categorized into three general groups: familial characteristics,…

Understanding Test-Type Assignment: Why Do Special Educators Make Unexpected Test-Type Assignments?

ERIC Educational Resources Information Center

Cho, Hyun-Jeong; Kingston, Neal

2014-01-01

We interviewed special educators (a) whose students with disabilities (SWDs) were proficient on the 2008 general education assessment but were assigned to the 2009 alternate assessment based on modified achievement standards (AA-MAS), and (b) whose students with mild disabilities took the 2008 alternate assessment based on alternate achievement…

The Measurement of Nuclear War Attitudes: Methods and Concerns.

ERIC Educational Resources Information Center

Mayton, Daniel M., II

Measures of adults' attitudes toward nuclear war are briefly discussed, and Mayton's Modified World Affairs Questionnaire (MWAQ) is described. The 23-item MWAQ was developed from Novak and Lerner's World Affairs Questionnaire, a nuclear war attitude measure by Mayton and Delamater, and related interview items by Jeffries. When the MWAQ was…

Experimentally Evoking Nonbelieved Memories for Childhood Events

ERIC Educational Resources Information Center

Otgaar, Henry; Scoboria, Alan; Smeets, Tom

2013-01-01

We report on the 1st experimental elicitation of nonbelieved memories for childhood events in adults (Study 1) and children (Study 2) using a modified false memory implantation paradigm. Participants received true (trip to a theme park) and false (hot air balloon ride) narratives and recalled these events during 2 interviews. After debriefing, 13%…

"What Would Make This a Successful Year for You?" How Students Define Success in College

ERIC Educational Resources Information Center

Jennings, Nancy; Lovett, Suzanne; Cuba, Lee; Swingle, Joe; Lindkvist, Heather

2013-01-01

The New England Consortium on Assessment and Student Learning (NECASL) seeks to understand how students make important decisions during college, assess the extent to which institutional policies and practices foster student learning, and modify those policies and practices accordingly. In this article, the authors analyze interviews with a…

Caring for Students with Type 1 Diabetes: School Nurses' Experiences

ERIC Educational Resources Information Center

Wang, Yueh-Ling; Volker, Deborah L.

2013-01-01

This qualitative study used a Husserlian phenomenological approach to obtain an understanding of the essences of five experienced Taiwanese school nurses' lived experience of caring for students with type 1 diabetes mellitus (T1DM). Audio-recorded, semi-structured, in-depth interviews were conducted. Data analysis entailed a modified method from…

Employer Occupational Needs Assessment, Elko, Nevada, Spring, 1991. Final Report.

ERIC Educational Resources Information Center

Ferry, Cliff

In spring 1991, a survey was conducted by Northern Nevada Community College (NNCC) to determine the vocational education needs of local employers. Ninety-one employers were interviewed at their worksites using a modified open-ended question approach. Survey findings included the following: (1) employers most frequently used newspapers to obtain…

Improving Student Outcomes with mCLASS: Math, a Technology-Enhanced CBM and Diagnostic Interview Assessment

ERIC Educational Resources Information Center

Wang, Ye; Gushta, Matthew

2013-01-01

The No Child Left Behind Act resulted in increased school-level implementation of assessment-based school interventions that aim to improve student performance. Diagnostic assessments are included among these interventions, designed to help teachers use evidence about student performance to modify and differentiate instruction and improve student…

The Ecology of Cooperative Learning in Elementary Physical Education Classes

ERIC Educational Resources Information Center

Dyson, Ben P.; Linehan, Nicole Rhodes; Hastie, Peter A.

2010-01-01

The purpose of this study was to describe and interpret the instructional ecology of Cooperative Learning in elementary physical education classes. Data collection included a modified version of the task structure system (Siedentop, 1994), interviews, field notes, and a teacher's journal. T-tests of the quantitative data revealed that instruction…

Extricating Justification Scheme Theory in Middle School Mathematical Problem Solving

ERIC Educational Resources Information Center

Matteson, Shirley; Capraro, Mary Margaret; Capraro, Robert M.; Lincoln, Yvonna S.

2012-01-01

Twenty middle grades students were interviewed to gain insights into their reasoning about problem-solving strategies using a Problem Solving Justification Scheme as our theoretical lens and the basis for our analysis. The scheme was modified from the work of Harel and Sowder (1998) making it more broadly applicable and accounting for research…

Punjabi Childrearing in Britain: Development of Identity, Religion and Bilingualism.

ERIC Educational Resources Information Center

Dosanjh, J. S.; Ghuman, Paul A. S.

1997-01-01

Interviewed two generations of Punjabi mothers living in Britain. Found that while second-generation Punjabis are changing some traditional mores (equal treatment of boys and girls, modified system of arranged marriage), they are also eager to transmit the core values (religion, mother tongue, familial spirit) of their culture and want their…

Ethnic/Racial Attitudes and Self-Identification of Black Jamaican and White New England Children.

ERIC Educational Resources Information Center

Cramer, Phebe; Anderson, Gail

2003-01-01

Black and white researchers interviewed black Jamaican and white New England elementary students in urban and rural schools regarding skin color, body size preference, and self-identification, using a modified dolls test. Children from all three communities showed white favoritism and average body size favoritism. Within communities, there were…

Performance Assessment and the Components of the Oral Construct across Different Tasks and Rater Groups.

ERIC Educational Resources Information Center

Chalhoub-Deville, Micheline

This study investigated whether different groups of native speakers assess second language learners' language skills differently for three elicitation techniques. Subjects were six learners of college-level Arabic as a second language, tape-recorded performing three tasks: participating in a modified oral proficiency interview, narrating a picture…

The Modified Telephone Interview for Cognitive Status is More Predictive of Memory Abilities Than the Mini-Mental State Examination.

PubMed

Duff, Kevin; Tometich, Danielle; Dennett, Kathryn

2015-09-01

Although not as popular as the Mini-Mental State Examination (MMSE), the modified Telephone Interview for Cognitive Status (mTICS) has some distinct advantages when screening cognitive functioning in older adults. The current study compared these 2 cognitive screening measures in their ability to predict performance on a memory composite (ie, delayed recall of verbal and visual information) in a cohort of 121 community-dwelling older adults, both at baseline and after 1 year. Both the MMSE and the mTICS significantly correlated with the memory composite at baseline (r's of .41 and .62, respectively) and at 1 year (r's of .36 and .50, respectively). At baseline, stepwise linear regression indicated that the mTICS and gender best predicted the memory composite score (R (2) = .45, P < .001), and the MMSE and other demographic variables did not significantly improve the prediction. At 1 year, the results were very similar. Despite its lesser popularity, the mTICS may be a more attractive option when screening for cognitive abilities in this age range. © The Author(s) 2015.

Does the Suicide Assessment Scale predict risk of repetition? A prospective study of suicide attempters at a hospital emergency department.

PubMed

Waern, M; Sjöström, N; Marlow, T; Hetta, J

2010-11-01

To determine whether the modified version of the Suicide Assessment Scale (SUAS) can be utilised to predict risk of repeat suicidal behaviour. Hundred and sixty-five patients aged 18 to 68 years who were admitted to emergency wards after a suicide attempt were interviewed. Follow-up interviews (n=96) were carried out after 2 months. Associations between SUAS scores and repeat attempt (fatal/non-fatal) during the following 3 years were analysed and the instrument's ability to predict repetition was assessed. High SUAS score (>30) was associated with repetition. The ability of the SUAS to correctly predict repeat suicidal behaviour in the entire study group was low (AUC=0.65, 95% CI=0.56-0.74) but better for those (n=42) who reported ongoing psychiatric treatment at follow-up (AUC=0.78, 95% CI 0.63-0.94). Among the latter group, all with baseline SUAS scores >30 made repeats. The modified SUAS performed well as a screening instrument in psychiatric patients. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Using a modified argument-driven inquiry to promote elementary school students' engagement in learning science and argumentation

NASA Astrophysics Data System (ADS)

Chen, Hsiang-Ting; Wang, Hsin-Hui; Lu, Ying-Yan; Lin, Huann-shyang; Hong, Zuway-R.

2016-01-01

This study explored the effects of a modified argument-driven inquiry approach on Grade 4 students' engagement in learning science and argumentation in Taiwan. The students were recruited as an experimental group (EG, n = 36) to join a 12-week study, while another 36 Grade 4 students from the same schools were randomly selected to be the comparison group (CG). All participants completed a questionnaire at the beginning and end of this study. In addition, four target students with the highest and the other four students with the lowest pretest engagement in learning science or argumentation to be observed weekly and interviewed following the posttest. Initial results revealed that the EG students' total engagement in learning science and argumentation and the claim and warrant components were significantly higher than the CG students. In addition, the EG students' anxiety in learning science significantly decreased during the study; and their posttest total engagement in learning science scores were positively associated with their argumentation scores. Interview and observation results were consistent with the quantitative findings. Instructional implications and research recommendations are discussed.

Gender-related stress among Japanese working women.

PubMed

Ogiwara, Chikako; Tsuda, Hitoshi; Akiyama, Tsuyoshi; Sakai, Yoshie

2008-09-01

This article addresses gender-related stresses of working women in Japan. We conducted a study of 399 employees in Japan using the National Institute for Occupational Safety and Health General Job Stress questionnaire. The results suggest that for women the most significant factor related to depression is interpersonal conflict, whereas for men, it is professional matters. In addition, we conducted interviews with Japanese female employees about their occupational stress. Our interviews indicated that for the occupational mental health of working women, the establishment of modified and supportive interpersonal relations within workplace environments may be required because of the gender roles expected of women in a male-dominant socioculture.

Child Abuse in Young, HIV-Positive Women: Linkages to Risk

PubMed Central

Clum, Gretchen A.; Andrinopoulos, Katherine; Muessig, Kathryn; Ellen, Jonathan M.

2010-01-01

In this article we explore the lives of young women living with HIV who experienced physical and/or sexual abuse in childhood. Using a modified version of the Life Story Interview, 40 women recruited from HIV clinics in three different states participated in a qualitative interview. Interviews covered abuse experiences, cognitive and emotional consequences of abuse, coping strategies, and sexual behavior and relationships. Overall, these young women had complex abuse histories, often experiencing more than one type of abuse in the context of other difficult life events. Avoidance and substance use were frequently utilized as coping strategies for abuse-related distress. Young women reported sexual and relationship concerns, including avoidance of sex, sexual dysfunction, sex as a trigger for abuse memories, and difficulty establishing intimacy and trust. Relationships between abuse-related reactions and sexual risk behavior, as well as recommendations for interventions, are discussed. PMID:19949224

A qualitative study assessing patient perspectives in the process of decision-making on disease modifying therapies (DMT's) in multiple sclerosis (MS).

PubMed

Ceuninck van Capelle, Archibald de; Meide, Hanneke van der; Vosman, Frans J H; Visser, Leo H

2017-01-01

Physicians commonly advise patients to begin disease modifying therapies (DMT's) shortly after the establishment of a diagnosis of Multiple Sclerosis (MS) to prevent further relapses and disease progression. However, little is known about the meaning for patients going through the process of the diagnosis of MS and of making decisions on DMT's in early MS. To explore the patient perspective on using DMT's for MS. Methods: Ten participants with a recent (< 2 years) relapsing-remitting MS diagnosis were interviewed. Seven of them were using DMT's at the time of the interview. All interviews were transcribed and analyzed using a hermeneutical-phenomenological approach. The analysis revealed the following themes: (1) Constant confrontation with the disease, (2) Managing inevitable decline, (3) Hope of delaying the progression of the disease, and, (4) The importance of social support. The themes show that patients associate the recommendation to begin DMT's (especially injectable DMT's) with views about their bodies as well as their hopes about the future. Both considering and adhering to treatment are experienced by patients as not only matters of individual and rational deliberation, but also as activities that are lived within a web of relationships with relatives and friends. From the patient perspective, the use of DMT's is not a purely rational and individual experience. More attention to the use of DMT's as relational and lived phenomena will improve the understanding of the process of decision-making for DMT's in MS.

What is the experience of national quality campaigns? Views from the field.

PubMed

Bradley, Elizabeth H; Nembhard, Ingrid M; Yuan, Christina T; Stern, Amy F; Curtis, Jeptha P; Nallamothu, Brahmajee K; Brush, John E; Krumholz, Harlan M

2010-12-01

To identify key characteristics of a national quality campaign that participants viewed as effective, to understand mechanisms by which the campaign influenced hospital practices, and to elucidate contextual factors that modified the perceived influence of the campaign on hospital improvements. In-depth interviews, hospital surveys, and Health Quality Alliance data. We conducted a qualitative study using in-depth interviews with clinical and administrative staff (N = 99) at hospitals reporting strong influence (n = 6) as well as hospitals reporting limited influence (n = 6) of the Door-to-Balloon (D2B) Alliance, a national quality campaign to improve heart attack care. We analyzed these qualitative data as well as changes in hospital use of recommended strategies reported through a hospital survey and changes in treatment times using Health Quality Alliance data. In-depth, open-ended interviews; hospital survey. Key characteristics of the national quality campaign viewed as enhancing its effectiveness were as follows: credibility of the recommendations, perceived simplicity of the recommendations, alignment with hospitals' strategic goals, practical implementation tools, and breadth of the network of peer hospitals in the D2B Alliance. Perceived mechanisms of the campaign's influence included raising awareness and influencing goals, fostering strategy adoption, and influencing aspects of organizational culture. Modifying contextual factors included perceptions about current performance and internal championship for the recommended changes. The impact of national quality campaigns may depend on both campaign design features and on the internal environment of participating hospitals. © Health Research and Educational Trust.

Implementing clinical governance in Isfahan hospitals: Barriers and solutions, 2014.

PubMed

Ferdosi, Masoud; Ziyari, Farhad Bahman; Ollahi, Mehran Nemat; Salmani, Amaneh Rahim; Niknam, Noureddin

2016-01-01

In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance. In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders' opinions. This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi-structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire "validity was confirmed by Cronbach's alpha (0/891)" and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software. According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty-four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors. Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.

Adapting qualitative research strategies to technology savvy adolescents.

PubMed

Mason, Deanna Marie; Ide, Bette

2014-05-01

To adapt research strategies involving adolescents in a grounded theory qualitative research study by conducting email rather than face-to-face interviews. Adolescent culture relies heavily on text-based communication and teens prefer interactions mediated through technology. Traditional qualitative research strategies need to be rethought when working with adolescents. Adapting interviewing strategies to electronic environments is timely and relevant for researching adolescents. Twenty three adolescents (aged 16-21) were interviewed by email. A letter of invitation was distributed. Potential participants emailed the researcher to convey interest in participating. If the inclusion criteria were met, email interviews were initiated. Participants controlled the interviews through their rate of response to interview questions. A grounded theory methodology was employed. Initial contact with participants reiterated confidentiality and the ability to withdraw from the study at any time. Interviews began with the collection of demographic information and a broad opening based on a semi-structured interview guide. All data were permissible, including text, photos, music, videos or outside media, for example YouTube. The participant was allowed to give direction to the interview after initial questions were posed. Email interviews continued until saturation was reached in the data. Participants were enthusiastic about email interviewing. Attrition did not occur. Email interviewing gave participants more control over the research, decreased power differentials between the adolescent and researcher, allowed the study to be adapted to cultural, linguistic and developmental needs, and maintained confidentiality. As participants said that email communication was slow and they preferred instant messaging, replication in faster-paced media is recommended. Repetition in face-to-face settings is warranted to evaluate how technology may have influenced the findings. Implications for practice/research Adolescents' use of the internet and their preference for textbased communication makes a compelling support for modifying traditional face-to-face qualitative investigations to reflect these changing contextual conditions.

Structural State and Elastic Properties of Perovskites in the Earth's Mantle

NASA Astrophysics Data System (ADS)

Ross, N. L.; Angel, R. J.; Zhao, J.

2005-12-01

Recent advances in laboratory-based single-crystal X-ray diffraction techniques for measuring the intensities of diffraction from crystals held in situ at high pressures in the diamond-anvil cell have been used to determine the role of polyhedral compression in the response of 2:4 and 3:3 GdFeO3-type perovskites to high pressure [1]. These new data clearly demonstrate that, contrary to previous belief, the compression of the octahedral sites is significant and that the evolution of the perovskite structure with pressure is controlled by a new principle; that of equipartition of bond-valence strain across the structure [2]. This new paradigm, together with the minimal information available from high- pressure powder diffraction studies, may provide the possibility of predicting the structural state and elastic properties of perovskites of any composition at mantle pressures and temperatures. Cation partioning between silicate perovskites and other phases should then be predictable through the application of a Brice-style model [3]. The geochemical implications of this type of analysis will be presented as well as the possibility for extending these measurements to higher pressures. References [1] e.g. Zhao, Ross & Angel (2004) Phys Chem Miner. 31: 299; Ross, Zhao,. & Angel (2004). J. Solid State Chemistry 177:1276. [2] Zhao, Ross, & Angel (2004). Acta Cryst. B60:263 [3] e.g Walter et al. (2004) Geochim Cosmochim Acta 68:4267; Blundy & Wood (1994) Nature 372:452

Adopting Gayet's Techniques of Totally Laparoscopic Liver Surgery in the United States

PubMed Central

Gumbs, Andrew A.; Gayet, Brice

2013-01-01

Professor Brice Gayet of the Institut Mutualiste Montsouris in Paris, France, has developed totally laparoscopic techniques for all segments of the liver. As a pioneer in the field of minimally invasive hepato-pancreato-biliary surgery, he started a Minimally Invasive Hepato-Pancreato-Biliary Fellowship in 2006. A retrospective review of all hepatic cases performed by a single surgeon since completing this Fellowship was undertaken. From November 2007 to October 2012, a total of 80 liver resections were done, of which 73 were begun with the intention of completing the case laparoscopically. Of these, more than 90% were completed laparoscopically and 88% were for malignant disease. One of the foundations of Professor Gayet's techniques is the low lithotomy or ‘French’ position and the utilization of a small robotically controlled laparoscope holder that is sterilizeable and considerably more economic than complete surgical systems. Prototypes exist of robotically controlled hand-held laparoscopic instruments that, unlike the complete surgical system, enable surgeons to maintain a sense of touch (haptics). Proper training in minimally invasive hepato-pancreato-biliary techniques can be obtained with surgeons able to independently perform laparoscopic major hepatectomies without senior minimally invasive backup. Furthermore, miniature and more affordable robotics may enable more surgeons to enjoy the benefits of minimally invasive surgery while maintaining patient safety and minimizing the rising burden of health-care costs worldwide. PMID:24159591

Transport and acceleration of plasma in the magnetospheres of Earth and Jupiter and expectations for Saturn

NASA Astrophysics Data System (ADS)

Kivelson, M. G.

The first comparative magnetospheres conference was held in Frascati, Italy thirty years ago this summer, less than half a year after the first spacecraft encounter with Jupiter's magnetosphere (Formisano, V. (Ed.), The Magnetospheres of the Earth and Jupiter, Proceedings of the Neil Brice Memorial Symposium held in Frascati, Italy, May 28-June 1, 1974. D. Reidel Publishing Co., Boston, USA, 1975). Disputes highlighted various issues still being investigated, such as how plasma transport at Jupiter deviates from the prototypical form of transport at Earth and the role of substorms in Jupiter's dynamics. Today there is a wealth of data on which to base the analysis, data gathered by seven missions that culminated with Galileo's 8-year orbital tour. We are still debating how magnetic flux is returned to the inner magnetosphere following its outward transport by iogenic plasma. We are still uncertain about the nature of sporadic dynamical disturbances at Jupiter and their relation to terrestrial substorms. At Saturn, the centrifugal stresses are not effective in distorting the magnetic field, so in some ways the magnetosphere appears Earthlike. Yet the presence of plasma sources in the close-in equatorial magnetosphere parallels conditions at Jupiter. This suggests that we need to study both Jupiter and Earth when thinking about what to anticipate from Cassini's exploration of Saturn's magnetosphere. This paper addresses issues relevant to plasma transport and acceleration in all three magnetospheres.

Cognitive Reserve as a Modifier of Clinical Expression in Chronic Traumatic Encephalopathy: A Preliminary Examination.

PubMed

Alosco, Michael L; Mez, Jesse; Kowall, Neil W; Stein, Thor D; Goldstein, Lee E; Cantu, Robert C; Katz, Douglas I; Solomon, Todd M; Kiernan, Patrick T; Murphy, Lauren; Abdolmohammadi, Bobak; Daneshvar, Daniel; Montenigro, Philip H; Nowinski, Christopher J; Stern, Robert A; McKee, Ann C

2017-01-01

This study conducted a preliminary examination on cognitive reserve (CR) as a modifier of symptom expression in subjects with autopsy-confirmed chronic traumatic encephalopathy (CTE). The sample included 25 former professional football players neuropathologically diagnosed with CTE stage III or IV. Next of kin interviews ascertained age at cognitive and behavioral/mood symptom onset and demographic/athletic characteristics. Years of education and occupational attainment defined CR. High occupational achievement predicted later age at cognitive (p=0.02) and behavioral/mood (p=0.02) onset. Education was not an individual predictor. These preliminary findings suggest that CR may forestall the clinical manifestation of CTE.

Ideas of and Attitudes towards Projects and Changing Practices: Voices of Four Teachers

ERIC Educational Resources Information Center

Shome, Saurav; Natarajan, Chitra

2013-01-01

The paper reports a study of the project practices of four Indian middle school teachers, elicited through semi-structured interviews of individual teachers. The teachers also responded to a proposal to modify four aspects of existing project practices, viz. subject integration, assessment, group work, and management of resources. The aspects were…

Service Quality Assessment Scale (SQAS): An Instrument for Evaluating Service Quality of Health-Fitness Clubs

ERIC Educational Resources Information Center

Lam, Eddie T. C.; Zhang, James J.; Jensen, Barbara E.

2005-01-01

This study was designed to develop the Service Quality Assessment Scale to evaluate the service quality of health-fitness clubs. Through a review of literature, field observations, interviews, modified application of the Delphi technique, and a pilot study, a preliminary scale with 46 items was formulated. The preliminary scale was administered to…

Changing the Environment to Improve the Outlook. An Interview with Developmental Psychologist Nathan Fox. Perspectives

ERIC Educational Resources Information Center

National Scientific Council on the Developing Child, 2006

2006-01-01

Research by Nathan Fox and other scientists shows how changes in environmental conditions can help temper the negative effects of a child's predisposition toward fearfulness and anxiety. If certain negative triggers are eliminated or modified, a child's genetic tendency toward inappropriate fearfulness and anxiety may be overcome--or not expressed…

Assessing Medical Students' Self-Regulation as Aptitude in Computer-Based Learning

ERIC Educational Resources Information Center

Song, Hyuksoon S.; Kalet, Adina L.; Plass, Jan L.

2011-01-01

We developed a Self-Regulation Measure for Computer-based learning (SRMC) tailored toward medical students, by modifying Zimmerman's Self-Regulated Learning Interview Schedule (SRLIS) for K-12 learners. The SRMC's reliability and validity were examined in 2 studies. In Study 1, 109 first-year medical students were asked to complete the SRMC.…

Seeking to Improve African American Girls' Attitudes toward Science: A Participatory Action Research Project

ERIC Educational Resources Information Center

Buck, Gayle A.; Cook, Kristin L.; Quigley, Cassie F.; Prince, Pearl; Lucas, Yvonne

2014-01-01

In this participatory action research study, we answered the question, How can we improve attitudes toward science education of the African American girls at an elementary school? Girls in grades 3-6 completed the Modified Attitudes toward Science Inventory. A purposeful sample of 30 girls participated in several focus-group interviews throughout…

The PHQ-9 as a Brief Assessment of Lifetime Major Depression

ERIC Educational Resources Information Center

Cannon, Dale S.; Tiffany, Stephen T.; Coon, Hilary; Scholand, Mary Beth; McMahon, William M.; Leppert, Mark F.

2007-01-01

The Patient Health Questionnaire-9 (PHQ-9; R. L. Spitzer, K. Kroenke, J. B. W. Williams, & The Patient Health Questionnaire Primary Care Study Group, 1999), modified to ask about the worst period of depression lifetime, was validated against lifetime mood disorder diagnoses established by the Structured Clinical Interview for DSM-IV (SCID; M. B.…

Motivation and Career-Development Training Programs: Use of Regulatory Focus to Determine Program Effectiveness

ERIC Educational Resources Information Center

Anthony, Peter J.; Weide, Jeffrey

2015-01-01

The purpose of this study was to focus on the relationship between career-development training programs and the motivation of employees. The study used a qualitative method and a phenomenological design using semistructured interviews conducted with a script of open-ended questions. Two main components of the research design were the modified van…

Application of a Flexible, Clinically Driven Approach for Anger Reduction in the Case of Mr. P

ERIC Educational Resources Information Center

Kassinove, Howard; Tafrate, Raymond Chip

2011-01-01

We treat maladaptive anger in adults with a program based on traditional behavior therapy and cognitive behavior therapy. To these, we add client-centered motivational interviewing techniques. With the goal of modifying maladaptive stimulus-response relationships, our specific aim is to reduce anger reactivity to aversive triggers. Thus, in daily…

Adhesive Sociocultural Adaptation of Korean Immigrants in the U.S.: An Alternative Strategy of Minority Adaptation.

ERIC Educational Resources Information Center

Hurh, Won Moo; Kim, Kwang Chung

1984-01-01

"Adhesive adaptation" occurs when aspects of a new culture and social relations with members of the host society are added on to immigrants' traditional culture and social networks, without replacing or modifying any significant part of the old. Interviews with 615 Korean immigrants empirically confirmed this adaptation model. (Author/KH)

Exploration of Factors Related to the Development of Science, Technology, Engineering, and Mathematics Graduate Teaching Assistants' Teaching Orientations

ERIC Educational Resources Information Center

Gilmore, Joanna; Maher, Michelle A.; Feldon, David F.; Timmerman, Briana

2014-01-01

Research indicates that modifying teachers' beliefs about learning and teaching (i.e. teaching orientation) may be a prerequisite to changing their teaching practices. This mixed methods study quantitized data from interviews with 65 graduate teaching assistants (GTAs) from science, technology, engineering, and mathematics (STEM) fields to assess…

Using the CanMEDS roles when interviewing for an ophthalmology residency program.

PubMed

Hamel, Patrick; Boisjoly, Hélène; Corriveau, Christine; Fallaha, Nicole; Lahoud, Salim; Luneau, Katie; Olivier, Sébastien; Rouleau, Jacinthe; Toffoli, Daniela

2007-04-01

To improve the admissions process for the Université de Montréal (UdeM) ophthalmology residency program, the interview structure was modified to encompass the seven CanMEDS roles introduced by the Royal College of Physicians and Surgeons of Canada (RCPSC). These roles include an applicant's abilities as a communicator, collaborator, manager, health advocate, professional, scholar, and medical expert. In this retrospective pilot study, the records of all applicants were reviewed by 8 members of the admissions committee, with a high intraclass correlation coefficient of 0.814. Four 2-person interview teams were then formed. The first 3 groups asked the applicants specific questions based on 2-3 of the CanMEDS roles, marking their impressions of each candidate on a visual analogue scale. The last group answered candidates' questions about the program but assigned no mark. The intraclass correlations for the teams were 0.900, 0.739, and 0.585, demonstrating acceptable interrater reliability for 2 of the teams. Pearson correlation coefficients between groups of interviewers were considered adequate at 0.562, 0.432, and 0.417 (p < 0.05). For each interviewer, the Pearson correlation coefficient between record marking and interview scoring was either not statistically significant or very low. By basing the 2006 interview process on the CanMEDS roles defined by the RCPSC, information was obtained about the candidates that could not have been retrieved by a review of the medical students' records alone. Reliability analysis confirmed that this new method of conducting interviews provided sound and reliable judging and rating consistency between all members of the admissions committee.

The Effect of Videotaping Students' Interviews with Patients for Interview Skill Education

PubMed Central

Lee, Woo Sung; Hwang, Ji Young; Lim, Ji Eun; Suh, Sang-Yeon; Park, Ki Heum

2013-01-01

Background The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. Methods This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. Results Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 ± 0.60, after 2.73 ± 0.72), 'timeline' (before 2.82 ± 0.68, after 3.18 ± 0.73), 'positive verbal reinforcement' (before 2.24 ± 0.56, after 2.61 ± 0.90), and the total score (before 21.70 ± 2.62, after 23.39 ± 3.13) (P < 0.05). Conclusion Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores. PMID:23560207

The urology residency matching program in practice.

PubMed

Teichman, J M; Anderson, K D; Dorough, M M; Stein, C R; Optenberg, S A; Thompson, I M

2000-06-01

We evaluate behaviors and attitudes among resident applicants and program directors related to the American Urological Association (AUA) residency matching program and recommend changes to improve the match. Written questionnaires were mailed to 519 resident applicants and 112 program directors after the 1999 American Urological Association match. Subjects were asked about their observations, behaviors and opinions towards the match. Questionnaires were returned by 230 resident applicants and 94 program directors (44% and 83% response rates, respectively.) Of the resident applicants 75% spent $1,001 to $5,000 for interviewing. Of the program directors 47% recalled that applicants asked how programs would rank the applicant and 61% of applicants recalled that program directors asked applicants how they would rank programs. Dishonesty was acknowledged by 31% of program directors and 44% of resident applicants. Of program directors 82% thought applicants "lied", while 67% of applicants thought that programs "lied" (quotations indicate questionnaire language). Participants characterized their own dishonesty as "just playing the game" or they "did not feel badly." Of program directors 81% and of applicants 61% were "skeptical" or "did not believe" when informed they were a "high" or "number 1" selection. Being asked about marital status was recalled by 91% of male and 100% of female (p = 0. 02), if they had children by 53% of male and 67% of female, (p = 0. 03), and intent to have children by 25% of male and 62% of female (p <0.001), applicants, respectively. Free-form comments were written by 132 resident applicants and 28 program directors. The most frequent comments suggested the need to improve ethical behavior, modify the process so applications could be transmitted electronically and modify interviews to reduce applicant financial burden. Nine female applicants commented on their perceptions of sexual discrimination during the interviews. Resident applicants and program directors violate match code rules frequently. Program directors and resident applicants are skeptical of each other. Patterns of faculty behavior differ based on applicant gender. Interviews are costly for applicants. We recommend that 1) programs adopt policies to enhance fairness, 2) applications be filed electronically, 3) programs assist resident applicants with interview accommodation to reduce financial burden and 4) a post-interview code of limited or noncommunication be adopted.

Validation of a structured interview for telephone assessment of the modified Rankin Scale in Brazilian stroke patients.

PubMed

Baggio, Jussara A O; Santos-Pontelli, Taiza E G; Cougo-Pinto, Pedro T; Camilo, Millene; Silva, Nathalia F; Antunes, Paula; Machado, Laura; Leite, João P; Pontes-Neto, Octavio M

2014-01-01

The modified Rankin Scale (mRS) is a commonly used scale to assess the functional outcome after stroke. Several studies on mRS showed good reliability, feasibility, and interrater agreement of this scale using a face-to-face assessment. However, telephone assessment is a more time-efficient way to obtain an mRS grade than a face-to-face interview. The aim of this study was to validate the telephone assessment of mRS among the Portuguese using a structured interview in a sample of Brazilian stroke patients. We evaluated 50 stroke outpatients twice. The first interview was face-to-face and the second was made by telephone and the time between the two assessments ranged between 7 and 14 days. Four certified raters evaluated the patients using a structured interview based on a questionnaire previously published in the literature. Raters were blinded for the Rankin score given by the other rater. For both assessments, the rater could also interview a caregiver if necessary. The patients' mean age was 62.8 ± 14.7, mean number of years of study 5.2 ± 3.4, 52% were males, 55.2% of patients needed a caregiver's help to answer the questions. The majority of caregivers were female (85%), mean age 49.1 ± 15, and mean number of years of study 8.3 ± 3.4. Perfect agreement between the telephone and face-to-face assessments was obtained for 27 (54%) patients, corresponding to an unweighted Kappa of 0.44 (95% CI 0.27-0.61) and a weighted Kappa of 0.89. The median of telephone assessment mRS was 3.5 (interquartile range = 2-4) and of face-to-face assessment was 4 (interquartile range = 2-5). There was no difference between the two assessments (Wilcoxon test, p = 0.35). Despite the low education level of our sample, the telephone assessment of functional impairment of stroke patients using a translated and culturally adapted Brazilian Portuguese version of the mRS showed good validity and reliability. Therefore, the telephone assessment of mRS can be used in clinical practice and scientific studies in Brazil. © 2014 S. Karger AG, Basel.

Linking students and lecturers - a first year student-staff interview project

NASA Astrophysics Data System (ADS)

Hjørnegaard Malm, Rie; Lilleøren, Karianne; Mattias Lundmark, Anders

2017-04-01

With a wish to familiarize our first year geoscience students with their lecturers, we have introduced a staff-student interview project during their first few weeks as students, a project modified from Dwyer (2001). Our main goals with this project are to tighten the (apparent) gap between the faculty members and the students by introducing the students to academia through a personal meeting. The students are grouped and asked to find an interesting staff member to interview, and are instructed to ask for a CV, a list of publications and an example of a scientific paper authored by the interviewee. During the interview the students should find out how this specific academic career was formed, and how the idea for the example paper came up and finally became a published paper. The students then present their interviewee in class. We also asked the students to answer a questionnaire before and after the exercise. After the exercise students reported a better understanding of the nature of the geosciences and a more nuanced view towards research. They express surprise in how accessible the researchers were, and that they feel more at home at the department after the project. These preliminary results are followed up by interviews of the participating students in December and January 2016/17.

How Homeless Sector Workers Deal with the Death of Service Users: A Grounded Theory Study

ERIC Educational Resources Information Center

Lakeman, Richard

2011-01-01

Homeless sector workers often encounter the deaths of service users. A modified grounded theory methodology project was used to explore how workers make sense of, respond to, and cope with sudden death. In-depth interviews were undertaken with 16 paid homeless sector workers who had experienced the death of someone with whom they worked.…

Managing for Motivation: Herzberg's Motivation-Hygiene Theory and Its Application to 4-H Leadership. National Intern Report.

ERIC Educational Resources Information Center

Freeman, Walter J.

A study examined the organizational factors contributing to the motivation of 4-H volunteer leaders. A modified form of Herzberg's Motivation-Hygiene Theory served as the research design of the study. A total of 149 4-H leaders were interviewed regarding thirteen job factors: recognition; personal growth; relationships with other 4-H leaders,…

Extended Kinship in the United States: Competing Models and the Case of La Familia Chicana.

ERIC Educational Resources Information Center

Sena-Rivera, Jaime

1979-01-01

Extended kinship among Chicanos is explored through intensive open-ended interviews with four cases of three generations of Mexican-descent families. "La familia chicana" is posited as a modified extended or kin-integrated family extending over time and space from Mexico at the turn of the century to present day industrial America. (Author)

The Ecology of Collaborative Work. Workscape 21: The Ecology of New Ways of Working.

ERIC Educational Resources Information Center

Becker, Franklin; Quinn, Kristen L.; Tennessen, Carolyn M.

A study examined Chiat/Day inc. Advertising's team-based virtual office in which work could occur at any location inside or outside the office at any time. Three sites used three workplace strategies: full virtual (FV), modified virtual (MV), and conventional (C). Interviews, observations, and archival data were used to assess project teams doing…

A Study of the Utility of Results from the 1992 Trial State Assessment (TSA) in Reading for State-Level Administrators of Assessment.

ERIC Educational Resources Information Center

Bullock, Cheryl Davis; DeStefano, Lizanne

1998-01-01

The usefulness of the 1992 TSA in reading was studied using interviews from 26 state directors of assessment. Perceptions about TSA credibility and orientation of test components and current use of TSA results were examined. The directors suggested involving more teachers in assessment, modifying descriptors, disseminating results quicker, and…

Stressful Life Event Experiences of Homeless Adults: A Comparison of Single Men, Single Women, and Women with Children

ERIC Educational Resources Information Center

Zugazaga, Carole

2004-01-01

This article describes stressful life events experienced by a multi-shelter sample of 162 homeless adults in the Central Florida area. Participants included homeless single men (n = 54), homeless single women (n = 54), and homeless women with children (n = 54). Subjects were interviewed with a modified version of the List of Threatening…

Development of the Learning Health System Researcher Core Competencies.

PubMed

Forrest, Christopher B; Chesley, Francis D; Tregear, Michelle L; Mistry, Kamila B

2017-08-04

To develop core competencies for learning health system (LHS) researchers to guide the development of training programs. Data were obtained from literature review, expert interviews, a modified Delphi process, and consensus development meetings. The competencies were developed from August to December 2016 using qualitative methods. The literature review formed the basis for the initial draft of a competency domain framework. Key informant semi-structured interviews, a modified Delphi survey, and three expert panel (n = 19 members) consensus development meetings produced the final set of competencies. The iterative development process yielded seven competency domains: (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research and implementation in health systems; (6) improvement and implementation science; and (7) engagement, leadership, and research management. A total of 33 core competencies were prioritized across these seven domains. The real-world milieu of LHS research, the embeddedness of the researcher within the health system, and engagement of stakeholders are distinguishing characteristics of this emerging field. The LHS researcher core competencies can be used to guide the development of learning objectives, evaluation methods, and curricula for training programs. © Health Research and Educational Trust.

Quality of life and related factors of nursing home residents in Singapore.

PubMed

Wang, Pei; Yap, Philip; Koh, Gerald; Chong, Jia An; Davies, Lucy Jennifer; Dalakoti, Mayank; Fong, Ngan Phoon; Tiong, Wei Wei; Luo, Nan

2016-07-28

Litter is known about the well-being of nursing home (NH) residents in Singapore. This study aimed to identify predictors of self-reported quality of life (QOL) of NH residents in Singapore. In face-to-face interviews, trained medical students assessed each consenting resident recruited from 6 local NHs using a modified Minnesota QOL questionnaire, and rating scales and questions assessing independence, cognitive function, depression, and communication. Predictors of residents' QOL in five aspects (comfort, dignity, food enjoyment, autonomy, and security) were identified using the censored least absolute deviations (CLAD) models. A total of 375 residents completed the interviews. A higher score on comfort was negatively associated with major depression while a higher score on dignity was positively associated with no difficulty in communication with staff. Higher scores in food enjoyment were negatively associated with major depression and poorer cognitive function. Higher scores in autonomy were negatively associated with major depression, greater dependence, and difficulty in communication with staff. A higher score on security were negatively associated with major depression. It appears that depression and difficulty in communication with staff are the two main modifiable risk factors of poor quality of life of local NH residents.

Customizing Survey Instruments and Data Collection to Reach Hispanic/Latino Adults in Border Communities in Texas

PubMed Central

Pederson, Linda L.; Thorne, Stacy L.; Caraballo, Ralph S.; Evans, Brian; Athey, Leslie; McMichael, Joseph

2010-01-01

Objectives. We sought to modify an instrument and to use it to collect information on smoking knowledge, attitudes, beliefs, and behaviors among Hispanics/Latinos, and to adapt survey methods to obtain high participation levels. Methods. Promotoras (outreach workers) conducted face-to-face interviews with 1485 Hispanic adults (July 2007–April 2008). The project team used GeoFrame field enumeration methods to develop a sampling frame from households in randomly selected colonias (residential areas along the Texas–Mexico border that may lack some basic necessities (e.g. portable water), in El Paso, Texas. Results. The revised questionnaire included 36 unchanged items from the State Adult Tobacco Survey, 7 modified items, and 17 new items focusing on possible culturally specific quitting methods, secondhand smoke issues, and attitudes and knowledge about tobacco use that might be unique for Hispanic/Latino groups. The eligibility rate was 90.2%, and the conservative combined completed screener and interview response rate was 80.0%. Conclusions. Strategic, targeted, carefully designed methods and surveys can achieve high reach and response rates in hard-to-reach populations. Similar procedures could be used to obtain cooperation of groups who may not be accessible with traditional methods. PMID:20147687

Cognitive testing with female nutrition and education assistance program participants informs validity of the Satter eating competence inventory.

PubMed

Krall, Jodi Stotts; Lohse, Barbara

2010-01-01

Examine the validity of a self-report measure of eating competence with low-income women. Twenty-five females (18-49 years old) recruited from low-income venues in Pennsylvania completed cognitive testing through an iterative interview process. Respondents' oral responses were compared to researchers' intended meaning of ecSatter Inventory (ecSI) items; responses were mapped to evaluate the similarity between respondents' internally generated answers and their ecSI choices for survey items; and scored responses were compared among participants. Interview findings provided a rationale for modifying the ecSI prior to use with low-income women. Four items were misinterpreted for various reasons, including problems with clarity and wording. The modified ecSI, termed the ecSatter Inventory for Low-Income (ecSI/LI), was comprehended as intended by researchers. Congruence of cognitive responses and ecS/LI scores further supported the instrument's validity. Cognitive testing resulted in the development of an instrument to measure eating competence in low-income adults. The ecSI/LI requires validation with a large, heterogeneous low-income sample. Copyright 2010 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Relating therapy for people who hear voices: perspectives from clients, family members, referrers and therapists.

PubMed

Hayward, Mark; Fuller, Ella

2010-01-01

Current psychological models of voice hearing emphasise the personal meaning that individuals attribute to the voice hearing experience. Recent developments in theory and research have highlighted the importance of the relationship between the hearer and the voice. This study aims to contribute to this area of research, by exploring the experience and usefulness of a new form of 'Relating Therapy' that aims to modify distressing relationships with voices. Semi-structured interviews were conducted with ten participants and explored the experience and usefulness of a pilot of Relating Therapy: three therapists, three voice hearers, two relatives and two referrers. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis. Three themes that emerged from the analysis are presented for discussion: engaging with the therapeutic model; developing a new relating style; and how change is described and defined by participants. This study is consistent with the growing body of theory and research that highlights the interpersonal nature of the voice hearing experience. It also offers tentative support for a therapeutic framework that aims to modify distressing relationships with voices as a means of bringing about positive change. Clinical implications and areas for future research are outlined.  © 2009 John Wiley & Sons, Ltd.

Adapting a computer-delivered brief alcohol intervention for veterans with Hepatitis C.

PubMed

Cucciare, Michael A; Jamison, Andrea L; Combs, Ann S; Joshi, Gauri; Cheung, Ramsey C; Rongey, Catherine; Huggins, Joe; Humphreys, Keith

2017-12-01

This study adapted an existing computer-delivered brief alcohol intervention (cBAI) for use in Veterans with the hepatitis C virus (HCV) and examined its acceptability and feasibility in this patient population. A four-stage model consisting of initial pilot testing, qualitative interviews with key stakeholders, development of a beta version of the cBAI, and usability testing was used to achieve the study objectives. In-depth interviews gathered feedback for modifying the cBAI, including adding HCV-related content such as the health effects of alcohol on liver functioning, immune system functioning, and management of HCV, a preference for concepts to be displayed through "newer looking" graphics, and limiting the use of text to convey key concepts. Results from usability testing indicated that the modified cBAI was acceptable and feasible for use in this patient population. The development model used in this study is effective for gathering actionable feedback that can inform the development of a cBAI and can result in the development of an acceptable and feasible intervention for use in this population. Findings also have implications for developing computer-delivered interventions targeting behavior change more broadly.

"I didn't have anything to decide, I wanted to help my kids" - An interview-based study of consent procedures for sampling human biological material for genetic research in rural Pakistan.

PubMed

Kongsholm, Nana Cecilie Halmsted; Lassen, Jesper; Sandøe, Peter

2018-05-03

Individual, comprehensive, and written informed consent is broadly considered an ethical obligation in research involving the sampling of human material. In developing countries, however, local conditions, such as widespread illiteracy, low levels of education, and hierarchical social structures complicate compliance with these standards. As a result, researchers may modify the consent process to secure participation. To evaluate the ethical status of such modified consent strategies it is necessary to assess the extent to which local practices accord with the values underlying informed consent. Over a two-week period in April 2014 we conducted semi-structured interviews with researchers from a genetic research institute in rural Pakistan and families who had given blood samples for their research. Interviews with researchers focused on the institute's requirements for consent, and the researchers' strategies for and experiences with obtaining consent in the field. Interviews with donors focused on their motivation for donating samples, their experience of consent and donation, and what factors were central in their decisions to give consent. Researchers often reported modifications to consent procedures suited to the local context, standardly employing oral and elder consent, and tailoring information to the social education level of donor families. Central themes in donors' accounts of their decision to consent were the hope of getting something out of their participation and their remarkably high levels of trust in the researchers. Several donor accounts indicated a degree of confusion about participation and diagnosis, resulting in misconceived expectations of therapeutic benefits. We argue that while building and maintaining trusting relationships in research is important - not least in developing countries - strategies that serve this endeavor should be supplemented with efforts to ensure proper provision and understanding of relevant information, specifically about the nature of research and measures for individual consent and opt-out.

Why patients self-refer to the Emergency Department: A qualitative interview study.

PubMed

Kraaijvanger, Nicole; Rijpsma, Douwe; Willink, Lisa; Lucassen, Peter; van Leeuwen, Henk; Edwards, Michael

2017-06-01

There have been multiple studies investigating reasons for patients to self-refer to the Emergency Department (ED). The majority made use of questionnaires and excluded patients with urgent conditions. The goal of this qualitative study is to explore what motives patients have to self-refer to an ED, also including patients in urgent triage categories. In a large teaching hospital in the Netherlands, a qualitative interview study focusing on reasons for self-referring to the ED was performed. Self-referred patients were included until no new reasons for attending the ED were found. Exclusion criteria were as follows: not mentally able to be interviewed or not speaking Dutch. Patients who were in need of urgent care were treated first, before being asked to participate. Interviews followed a predefined topic guide. Practicing cyclic analysis, the interview topic guide was modified during the inclusion period. Interviews were recorded on an audio recorder, transcribed verbatim, and anonymized. Two investigators independently coded the information and combined the codes into meaningful clusters. Subsequently, these were categorized into themes to build a framework of reasons for self-referral to the ED. Characteristic quotes were used to illustrate the acquired theoretical framework. Thirty self-referred patients were interviewed. Most of the participants were male (63%), with a mean age of 46 years. Two main themes emerged from the interviews that are pertinent to the patients' decisions to attend the ED: (1) health concerns and (2) practical issues. This study found that there are 2 clearly distinctive reasons for self-referral to the ED: health concerns or practical motives. Self-referral because of practical motives is probably most suitable for strategies that aim to reduce inappropriate ED visits. © 2016 John Wiley & Sons, Ltd.

Telephone interview strategy can be used for screening inflammatory back pain in the community.

PubMed

Solmaz, Dilek; Gunduz, Ozgul; Akar, Servet; Can, Gercek; Birlik, Merih; Akkoc, Yesim; Gerdan, Vedat; Onen, Fatos; Akkoc, Nurullah

2017-01-01

Telephone surveys are less expensive and time-consuming for both interviewers and interviewees, with similar or even higher response rates than face-to-face interviews. In rheumatology, telephone technique has been used in a number of epidemiologic studies. In the present study, we conducted a telephone survey for screening inflammatory back pain (IBP) in the community. One hundred and seventy-two patients with axial spondyloarthritis (axSpA) and 25 patients with chronic mechanical back pain were included. A telephone interview and a face-to-face interview was conducted by the same physician using a standardized questionnaire that elicited information on all the components of IBP addressed in the Calin, Berlin and ASAS (the Assessment of SpondyloArthritis International Society) criteria sets. The telephone survey was repeated by another rheumatologist within the same week to assess the inter-rater agreement. Of 172 patients with axSpA, 114 could be classified as ankylosing spondylitis (AS) according to the modified New York criteria (AS group).The remaining 58 patients had active sacroiliitis on magnetic resonance imaging and they constituted the non-radiographic axSpA group (nr-axSpA group). Calin's criteria showed the highest sensitivity but also the lowest specificity with both interview methods. Calin's criteria showed the best agreement between the interview methods (kappa = 0.60). The results of our study indicate that telephone surveys based on Calin's criteria for IBP has a moderate, almost substantial agreement with face-to-face interviews and can be used as an easily applicable, less expensive and time-saving method in screening subjects for IBP. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Feasibility, internal consistency and covariates of TICS-m (telephone interview for cognitive status-modified) in a population-based sample: findings from the KORA-Age study.

PubMed

Lacruz, Me; Emeny, Rt; Bickel, H; Linkohr, B; Ladwig, Kh

2013-09-01

Test the feasibility of the modified telephone interview for cognitive status (TICS-m) as a screening tool to detect cognitive impairment in a population-based sample of older subjects. Data were collected from 3,578 participants, age 65-94 years, of the KORA-Age study. We used analysis of covariance to test for significant sex, age and educational differences in raw TICS-m scores. Internal consistency was analysed by assessing Cronbach's alpha. Correction for education years was undertaken, and participants were divided in three subgroups following validated cut-offs. Finally, a logistic regression was performed to determine the impact of sex on cognition subgroups. Internal consistency of the TICS-m was 0.78. Study participants needed approximately 5.4 min to complete the interview. Lower raw TICS-m scores were associated with male sex, older age and lower education (all p < 0.0001). After correction for education years, 2,851 (79%) had a non-impaired cognitive status (score >31). Male sex was independently associated with having a score equal to or below 27 and 31 (OR = 1.9, 95% CI 1.4-2.5 and OR = 1.5, 95% CI 1.2-1.7, respectively). The TICS-m is a feasible questionnaire for community-dwelling older adults with normal cognitive function or moderate cognitive impairment. Lower cognitive performance was associated with being a man, being older, and having fewer years of formal education. Copyright © 2012 John Wiley & Sons, Ltd.

Suburban Families' Experience With Food Insecurity Screening in Primary Care Practices.

PubMed

Palakshappa, Deepak; Doupnik, Stephanie; Vasan, Aditi; Khan, Saba; Seifu, Leah; Feudtner, Chris; Fiks, Alexander G

2017-07-01

Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices. We conducted 23 semistructured interviews with parents of children <4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved. Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs. Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources. Copyright © 2017 by the American Academy of Pediatrics.

Design and validation of key text messages (Tonsil-Text-To-Me) to improve parent and child perioperative tonsillectomy experience: A modified Delphi study.

PubMed

Song, Jin Soo A; Wozney, Lori; Chorney, Jill; Ishman, Stacey L; Hong, Paul

2017-11-01

Parents can struggle while providing perioperative tonsillectomy care for their children at home. Short message service (SMS) technology is an accessible and direct modality to communicate timely, evidence-based recommendations to parents across the perioperative period. This study focused on validating a SMS protocol, Tonsil-Text-To-Me (TTTM), for parents of children undergoing tonsillectomy. This study used a modified Delphi expert consensus method. Participants were an international sample of 27 clinicians/researchers. Participants rated level of agreement with recommendations across seven perioperative domains, derived systematically from scientific and lay literature. A priori consensus analysis was conducted using threshold criterion. A multidisciplinary team of local clinicians were also individually interviewed to consolidate text messages and implement recurrent suggestions. In the modified Delphi panel, 30 statements reached threshold agreement (>3.0 of 4.0); recommendations surrounding diet (3.87) and hygiene (3.83) had the highest level of consensus, while recommendations regarding activity (3.42) and non-pharmacologic pain management (3.55) had the lowest consensus. The 30 statements reconfigured into 12 concise text messages. After further interviews with local clinicians, 14 final text messages were included in the SMS protocol to be sent two weeks preoperatively to one week postoperatively. This study illustrates the development of TTTM which is designed to deliver key sequential text messages at the optimal time during the perioperative setting to parents caring for their children who are undergoing tonsillectomy. Copyright © 2017 Elsevier B.V. All rights reserved.

Can brief measures effectively screen for pain and somatic malingering? Examination of the Modified Somatic Perception Questionnaire and Pain Disability Index.

PubMed

Crighton, Adam H; Wygant, Dustin B; Applegate, Kathryn C; Umlauf, Robert L; Granacher, Robert P

2014-09-01

Recent rise in fraudulent disability claims in the United States has resulted in psychologists being increasingly called upon to use psychological tests to determine whether disability claims based on psychological or somatic/pain complaints are legitimate. To examine two brief measures, Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI), and their ability to screen for malingering in relation to the Bianchini et al. criteria for malingered pain-related disability published in The Spine Journal (2005). Examined brief self-report measures between litigating and nonlitigating pain samples. We compared 144 disability litigants, predominantly presenting a history of musculoskeletal injuries with psychiatric overlay, with 167 nonlitigating pain patients who were predominantly in treatment for chronic back pain issues and other musculoskeletal conditions. Modified Somatic Perception Questionnaire, Pain Disability Index, Minnesota Multiphasic Personality Inventory-2 Restructured Form, Test of Memory Malingering, Letter Memory Test, Victoria Symptom Validity Test, Structured Interview of Reported Symptoms-second edition, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders somatoform disorders module. We examined a sample of 144 individuals undergoing compensation-seeking evaluations in relation to 167 nonlitigating pain patients. Group differences on both the MSPQ and PDI were calculated, as well as sensitivities, specificities, and positive and negative predictive powers for both measures at selected cutoffs. The results suggest that both the MSPQ and PDI are useful to screen for pain malingering in forensic evaluations, especially the MSPQ, which performed the best in differentiating between the groups. Copyright © 2014 Elsevier Inc. All rights reserved.

Impact of Student vs Faculty Facilitators on Motivational Interviewing Student Outcomes.

PubMed

Widder-Prewett, Rebecca; Draime, Juanita A; Cameron, Ginger; Anderson, Douglas; Pinkerton, Mark; Chen, Aleda M H

2017-08-01

Objective. To determine the impact of student or faculty facilitation on student self-assessed attitudes, confidence, and competence in motivational interviewing (MI) skills; actual competence; and evaluation of facilitator performance. Methods. Second-year pharmacy (P2) students were randomly assigned to a student or faculty facilitator for a four-hour, small-group practice of MI skills. MI skills were assessed in a simulated patient encounter with the mMITI (modified Motivational Interviewing Treatment Integrity) tool. Students completed a pre-post, 6-point, Likert-type assessment addressing the research objectives. Differences were assessed using a Mann-Whitney U test. Results. Student (N=44) post-test attitudes, confidence, perceived or actual competence, and evaluations of facilitator performance were not different for faculty- and student-facilitated groups. Conclusion. Using pharmacy students as small-group facilitators did not affect student performance and were viewed as equally favorable. Using pharmacy students as facilitators can lessen faculty workload and provide an outlet for students to develop communication and facilitation skills that will be needed in future practice.

Modifying attitude and intention toward regular physical activity using protection motivation theory: a randomized controlled trial.

PubMed

Mirkarimi, Kamal; Eri, Maryam; Ghanbari, Mohammad R; Kabir, Mohammad J; Raeisi, Mojtaba; Ozouni-Davaji, Rahman B; Aryaie, Mohammad; Charkazi, Abdurrahman

2017-10-30

We were guided by the Protection Motivation Theory to test the motivational interviewing effects on attitude and intention of obese and overweight women to do regular physical activity. In a randomized controlled trial, we selected using convenience sampling 60 overweight and obese women attending health centres. The women were allocated to 2 groups of 30 receiving a standard weight-control programme or motivational interviewing. All constructs of the theory (perceived susceptibility, severity, self-efficacy and response efficacy) and all anthropometric characteristics (except body mass index) were significantly different between the groups at 3 study times. The strongest predictors of intention to do regular physical exercise were perceived response efficacy and attitude at 2- and 6-months follow-up. We showed that targeting motivational interviewing with an emphasis on Protection Motivation Theory constructs appeared to be beneficial for designing and developing appropriate intervention to improve physical activity status among women with overweight and obesity.

Precedents of perceived social support: personality and early life experiences.

PubMed

Kitamura, T; Kijima, N; Watanabe, K; Takezaki, Y; Tanaka, E

1999-12-01

In order to examine the effects of personality and early life experiences on perceived social support, a total of 97 young Japanese women were investigated. Current interpersonal relationships were measured by an interview modified from Henderson et al.'s Interview Schedule for Social Interaction (ISSI). Personality was measured by Cloninger et al.'s Temperament and Character Inventory. Early life experiences at home and outside of home were also identified in the interview. The number of sources of perceived support was correlated with self-directness, while satisfaction with perceived support was correlated with novelty seeking and with low harm avoidance. No early life experiences--early loss of a parent, perceived parenting, childhood abuse experiences, experiences of being bullied and/or other life events--showed significant correlations with the number or satisfaction of supportive people. The quantity and quality of perception of social support differ in their link to personality, and perceived social support may, to some extent, be explainable in terms of personality.

Understanding Household Behavioral Risk Factors for Diarrheal Disease in Dar es Salaam: A Photovoice Community Assessment

PubMed Central

Badowski, Natalie; Castro, Cynthia M.; Montgomery, Maggie; Pickering, Amy J.; Mamuya, Simon; Davis, Jennifer

2011-01-01

Whereas Tanzania has seen considerable improvements in water and sanitation infrastructure over the past 20 years, the country still faces high rates of childhood morbidity from diarrheal diseases. This study utilized a qualitative, cross-sectional, modified Photovoice method to capture daily activities of Dar es Salaam mothers. A total of 127 photographs from 13 households were examined, and 13 interviews were conducted with household mothers. The photographs and interviews revealed insufficient hand washing procedures, unsafe disposal of wastewater, uncovered household drinking water containers, a lack of water treatment prior to consumption, and inappropriate toilets for use by small children. The interviews revealed that mothers were aware and knowledgeable of the risks of certain household practices and understood safer alternatives, yet were restricted by the perceived impracticality and financial constraints to make changes. The results draw attention to the real economic and behavioral challenges faced in reducing the spread of disease. PMID:21969836

Perceptions and Practices: Biology graduate teaching assistants' framing of a controversial socioscientific issue

NASA Astrophysics Data System (ADS)

Gardner, Grant; Jones, Gail

2011-05-01

Graduate teaching assistants (GTAs) are gaining increasing responsibility for the instruction of undergraduate science students, yet little is known about their beliefs about science pedagogy or subsequent classroom practices. This study looked at six GTAs who were primary instructors in an introductory biology laboratory course. Teaching assistants taught a lesson about the potential social, health, and environmental impacts of genetically modified crops. Through classroom observations and in-depth interviews, the researchers examined how instructors chose to frame their lessons and what GTAs perceived as important for students to know about this particular socioscientific issue (SSI). Results showed a disconnect between the relatively mature conceptualizations of effective SSI instruction that emerged during interviews and classroom practice.

An Investigation of the Fantasy Predisposition and Fantasy Style of Children with Imaginary Companions

ERIC Educational Resources Information Center

Bouldin, Paula

2006-01-01

In this study, the author tested whether children with imaginary companions (ICs) have a different fantasy life than do children without ICs. To measure the fantasy life of the 74 children aged 3.2 to 8.7 years, the author modified the Children's Fantasy Interview (E. Rosenfeld, L. R. Huesmann, L. D. Eron, & J. V. Torney-Purta, 1982) to make…

Psychological Factors in Deliberate Self-Harm as Seen in an Urban African Population in Uganda: A Case-Control Study

ERIC Educational Resources Information Center

Kinyanda, Eugene; Hjelmeland, Heidi; Musisi, Seggane

2005-01-01

Psychological factors associated with deliberate self-harm (DSH) as seen in an African population in Uganda are described. A case-control study design was employed in which a Luganda version (predominant language in the study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect data. The controls were…

Participation in Physical Play and Leisure in Children With Motor Impairments: Mixed-Methods Study to Generate Evidence for Developing an Intervention.

PubMed

Kolehmainen, Niina; Ramsay, Craig; McKee, Lorna; Missiuna, Cheryl; Owen, Christine; Francis, Jill

2015-10-01

Participation in physical play/leisure (PPP) is an important therapy goal of children with motor impairments. Evidence for interventions promoting PPP in these children is scarce. The first step is to identify modifiable, clinically meaningful predictors of PPP for targeting by interventions. The study objective was to identify, in children with motor impairments, body function and structure, activity, environmental, and personal factors related to PPP and modifiable by therapists. This was a mixed-methods, intervention development study. The World Health Organization framework International Classification of Functioning, Disability and Health was used. Participants were children (6-8 years old) with motor impairments, mobilizing independently with or without equipment and seen by physical therapists or occupational therapists in 6 regions in the United Kingdom, and their parents. Self-reported PPP was assessed with the Children's Assessment of Participation and Enjoyment. Modifiable-factor data were collected with therapists' observations, parent questionnaires, and child-friendly interviews. The Children's Assessment of Participation and Enjoyment, therapist, and parent data were analyzed using descriptive statistics and linear regression. Interview data were analyzed for emerging themes. Children's (n=195) PPP (X=18 times per week, interquartile range=11-25) was mainly 'recreational' (eg, pretend play, playing with pets) rather than 'active physical' (eg, riding a bike/scooter). Parents (n=152) reported positive beliefs about children's PPP but various levels of family PPP. Therapists reported 23 unique impairments (eg, muscle tone), 16 activity limitations (eg, walking), and 3 personal factors (eg, child's PPP confidence). Children interviewed (n=17) reported a strong preference for active play but indicated that adults regulated their PPP. Family PPP and impairment in the child's movement-related body structures explained 18% of the variation in PPP. Family PPP explained most of the variation. It is likely that the study had a degree of self-selection bias, and caution must be taken in generalizing the results to children whose parents have less positive views about PPP. The results converge with wider literature about the child's social context as a PPP intervention target. In addition, the results question therapists' observations in explaining PPP. © 2015 American Physical Therapy Association.

Nitrate in drinking water and bladder cancer risk in Spain.

PubMed

Espejo-Herrera, Nadia; Cantor, Kenneth P; Malats, Nuria; Silverman, Debra T; Tardón, Adonina; García-Closas, Reina; Serra, Consol; Kogevinas, Manolis; Villanueva, Cristina M

2015-02-01

Nitrate is a widespread contaminant in drinking water and ingested nitrate under conditions resulting in endogenous nitrosation is suspected to be carcinogenic. However, the suggested association between nitrate in drinking water and bladder cancer remains inconsistent. We evaluated the long-term exposure to drinking water nitrate as a risk factor for bladder cancer, considering endogenous nitrosation modifiers and other covariables. We conducted a hospital-based case-control study of bladder cancer in Spain (1998-2001). Residential histories and water consumption information were ascertained through personal interviews. Historical nitrate levels (1940-2000) were estimated in study municipalities based on monitoring records and water source. Residential histories of study subjects were linked with nitrate estimates by year and municipality to calculate individual exposure from age 18 to recruitment. We calculated odds ratios (OR) and 95% confidence intervals (CI) for bladder cancer among 531 cases and 556 controls with reliable interviews and nitrate exposure information covering at least 70% of years from age 18 to interview. Average residential levels ranged from 2.1mg/L to 12.0mg/L among regions. Adjusted OR (95%CI) for average residential levels relative to ≤ 5 mg/L were 1.2 (0.7-2.0) for >5-10mg/L and 1.1 (0.6-1.9) for >10mg/L. The OR for subjects with longest exposure duration (>20 years) to highest levels (>9.5mg/L) was 1.4 (0.9-2.3). Stratification by intake of vitamin C, vitamin E, meat, and gastric ulcer diagnosis did not modify these results. A non-significant negative association was found with waterborne ingested nitrate with an OR of 0.7 (0.4-1.0) for >8 vs. ≤ 4 mg/day. Adjustment for several covariables showed similar results to crude analyses. Bladder cancer risk was inconsistently associated with chronic exposure to drinking water nitrate at levels below the current regulatory limit. Elevated risk is suggested only among subjects with longest exposure duration to the highest levels. No evidence of interaction with endogenous nitrosation modifiers was observed. Copyright © 2014 Elsevier Inc. All rights reserved.

Improving the readability and processability of a pediatric informed consent document: effects on parents' understanding.

PubMed

Tait, Alan R; Voepel-Lewis, Terri; Malviya, Shobha; Philipson, Sandra J

2005-04-01

To examine whether a consent document modified to conform with the federal guidelines for readability and processability would result in greater parental understanding compared with a standard form. Randomized clinical study. The preoperative waiting area of a larger tertiary care children's hospital. A total of 305 parents of children scheduled for minor elective surgical procedures. Parents were randomized to receive information about a clinical study in 1 of 4 ways: (1) standard consent form alone, (2) standard consent form with verbal disclosure, (3) modified form alone (standard form modified to meet the federal guidelines for readability and processability), and (4) modified form with verbal disclosure. Parents were interviewed to determine their understanding of 11 elements of consent, including study purpose, protocol, risks, benefits to child (direct), benefit to others (indirect), freedom to withdraw, alternatives, duration of study, voluntariness, confidentiality, and whom to contact. Their responses were scored by 2 independent assessors. Understanding of the protocol, study duration, risks, and direct benefits, together with overall understanding, was greater among parents who received the modified form (P<.001). Additionally, parents reported that the modified form had greater clarity (P = .009) and improved layout compared with the standard form (P<.001). When parents were shown both forms, 81.2% preferred the modified version. Results suggest that a consent form written according to federal guidelines for readability and processability can improve parent understanding and thus will be important in enhancing the informed consent process.

In Situ Boundary Layer Coral Metabolism in the Atlantic Ocean Acidification Test Bed

NASA Astrophysics Data System (ADS)

McGillis, Wade

2013-04-01

and Chris Langdon, Brice Loose, Dwight Gledhill, Diana Hsueh, Derek Manzello, Ian Enochs, Ryan Moyer We present net ecosystem productivity (nep) and net ecosystem calcification (nec) in coral and seagrass ecosystems using the boundary layer gradient flux technique (CROSS). Coastal anthropogenic inputs and changes in global ocean chemistry in response to rising levels of atmospheric carbon dioxide has emerged in recent years as a topic of considerable concern. Coral reefs are particularly vulnerable from eroded environmental conditions including ocean acidification and water pollution. The Atlantic Ocean Acidification Testbed (AOAT) project monitors metabolism to ascertain the continuing health of coral reef ecosystems. The CROSS boundary layer nep/nec approach is one component of this diagnostic program. Certification of CROSS as an operational monitoring tool is underway in the AOAT. CROSS inspects a benthic community and measures productivity/respiration and calcification/dissolution over an area of 10 square meters. Being a boundary layer tool, advection and complex mesoscale flows are not a factor or concern and CROSS is autonomous and can be used at deep benthic sites. The interrogation area is not enclosed therefore exposed to ambient light, flow, and nutrient levels. CROSS is easy to deploy, unambiguous, and affordable. Repeated measurements have been made from 2011-2012 in reefal systems in La Parguera Puerto Rico and the Florida Keys, USA. Diurnal, seasonal and regional metabolism will be compared and discussed. The ability to accurately probe benthic ecosystems provides a powerful management and research tool to policy makers and researchers.

A Model for Plasma Transport in a Corotation-Dominated Magnetosphere.

NASA Astrophysics Data System (ADS)

Pontius, Duane Henry, Jr.

1988-06-01

The gross structures of the magnetospheres of the outer planets are decided by processes quite different from those predominant in that of the earth. The terrestrial plasmapause, the boundary beyond which plasma motion is principally determined by magnetospheric interaction with the solar wind, is typically inside geosynchronous orbit. Within the plasmasphere, rotational effects are present, but gravity exceeds the centrifugal force of corotation. In contrast, the Jovian plasmasphere extends to a distance at least twenty times farther than synchronous orbit, affording a large region where rotational effects are expected to he clearly manifest (Brice and Ioannidis, 1970). The goal of this thesis is to develop an appropriate theoretical model for treating the problem of plasma transport in a corotation dominated plasmasphere. The model presented here is intended to describe the radial transport of relatively cold plasma having an azimuthally uniform distribution in a dipolar magnetic field. The approach is conceptually similar to that of the radial diffusion model in that small scale motions are examined to infer global consequences, but the physical understanding of those small scale motions is quite different. In particular, discrete flux tubes of small cross section are assumed to move over distances large compared to their widths. The present model also differs from the corotating convection model by introducing a mechanism whereby the conservation of flux tube content along flowlines is violated. However, it is quite possible that a global convection pattern co -exists with the motions described here, leading to longitudinal asymmetries in the plasma distribution.

Restoring Bladder Function by Spinal Cord Neuromodulation in SCI

DTIC Science & Technology

2016-10-01

conduct interviews/ surveys , recruit participants, obtain consent, review records, etc. View For existing protocols: Item 2.0 has been modified and...apply: A mechanism such as Survey Monkey, Zoomerang, or an e-mail anonymizing service will be used to strip off the IP addresses for data submitted via...attach the following: Protocol, Dissertation Proposal or Study Plan Preliminary Data Surveys , Questionnaires or other instruments to be used with

Creating a Culturally Appropriate Web-Based Behavioral Intervention for American Indian/Alaska Native Women in Southern California: The Healthy Women Healthy Native Nation Study

ERIC Educational Resources Information Center

Gorman, Jessica R.; Clapp, John D.; Calac, Daniel; Kolander, Chelsea; Nyquist, Corinna; Chambers, Christina D.

2013-01-01

Health disparities in fetal alcohol spectrum disorders (FASD) are of high importance to American Indian/Alaska Native (AI/AN) communities. We conducted focus groups and interviews with 21 AI/AN women and key informants in Southern California to modify a brief, Web-based program for screening and prevention of prenatal alcohol use. This process…

Consumers' Preferences for Electronic Nicotine Delivery System Product Features: A Structured Content Analysis.

PubMed

Kistler, Christine E; Crutchfield, Trisha M; Sutfin, Erin L; Ranney, Leah M; Berman, Micah L; Zarkin, Gary A; Goldstein, Adam O

2017-06-07

To inform potential governmental regulations, we aimed to develop a list of electronic nicotine delivery system (ENDS) product features important to U.S. consumers by age and gender. We employed qualitative data methods. Participants were eligible if they had used an ENDS at least once. Groups were selected by age and gender (young adult group aged 18-25, n = 11; middle-age group aged 26-64, n = 9; and women's group aged 26-64, n = 9). We conducted five individual older adult interviews (aged 68-80). Participants discussed important ENDS features. We conducted a structured content analysis of the group and interview responses. Of 34 participants, 68% were white and 56% were female. Participants mentioned 12 important ENDS features, including: (1) user experience; (2) social acceptability; (3) cost; (4) health risks/benefits; (5) ease of use; (6) flavors; (7) smoking cessation aid; (8) nicotine content; (9) modifiability; (10) ENDS regulation; (11) bridge between tobacco cigarettes; (12) collectability. The most frequently mentioned ENDS feature was modifiability for young adults, user experience for middle-age and older adults, and flavor for the women's group. This study identified multiple features important to ENDS consumers. Groups differed in how they viewed various features by age and gender. These results can inform ongoing regulatory efforts.

Consumers’ Preferences for Electronic Nicotine Delivery System Product Features: A Structured Content Analysis

PubMed Central

Kistler, Christine E.; Crutchfield, Trisha M.; Sutfin, Erin L.; Ranney, Leah M.; Berman, Micah L.; Zarkin, Gary A.; Goldstein, Adam O.

2017-01-01

To inform potential governmental regulations, we aimed to develop a list of electronic nicotine delivery system (ENDS) product features important to U.S. consumers by age and gender. We employed qualitative data methods. Participants were eligible if they had used an ENDS at least once. Groups were selected by age and gender (young adult group aged 18–25, n = 11; middle-age group aged 26–64, n = 9; and women’s group aged 26–64, n = 9). We conducted five individual older adult interviews (aged 68–80). Participants discussed important ENDS features. We conducted a structured content analysis of the group and interview responses. Of 34 participants, 68% were white and 56% were female. Participants mentioned 12 important ENDS features, including: (1) user experience; (2) social acceptability; (3) cost; (4) health risks/benefits; (5) ease of use; (6) flavors; (7) smoking cessation aid; (8) nicotine content; (9) modifiability; (10) ENDS regulation; (11) bridge between tobacco cigarettes; (12) collectability. The most frequently mentioned ENDS feature was modifiability for young adults, user experience for middle-age and older adults, and flavor for the women’s group. This study identified multiple features important to ENDS consumers. Groups differed in how they viewed various features by age and gender. These results can inform ongoing regulatory efforts. PMID:28590444

Patterns and predictors of ADHD persistence into adulthood: Results from the National Comorbidity Survey Replication

PubMed Central

Kessler, Ronald C.; Adler, Lenard A.; Barkley, Russell; Biederman, Joseph; Conners, C. Keith; Faraone, Stephen V.; Greenhill, Laurence L.; Jaeger, Savina; Secnik, Kristina; Spencer, Thomas; Üstün, T. Bedirhan; Zaslavsky, Alan M.

2010-01-01

BACKGROUND Despite growing interest in adult ADHD, little is known about predictors of persistence of childhood cases into adulthood. METHODS A retrospective assessment of childhood ADHD, childhood risk factors, and a screen for adult ADHD were included in a sample of 3197 18–44 year old respondents in the National Comorbidity Survey Replication (NCS-R). Blinded adult ADHD clinical reappraisal interviews were administered to a sub-sample of respondents. Multiple imputation (MI) was used to estimate adult persistence of childhood ADHD. Logistic regression was used to study retrospectively reported childhood predictors of persistence. Potential predictors included socio-demographics, childhood ADHD severity, childhood adversity, traumatic life experiences, and comorbid DSM-IV child-adolescent disorders (anxiety, mood, impulse-control, and substance disorders). RESULTS 36.3% of respondents with retrospectively assessed childhood ADHD were classified by blinded clinical interviews as meeting DSM-IV criteria for current ADHD. Childhood ADHD severity and childhood treatment significantly predicted persistence. Controlling for severity and excluding treatment, none of the other variables significantly predicted persistence even though they were significantly associated with childhood ADHD. CONCLUSIONS No modifiable risk factors were found for adult persistence of ADHD. Further research, ideally based on prospective general population samples, is needed to search for modifiable determinants of adult persistence of ADHD. PMID:15950019

PCI Choice: Cardiovascular clinicians' perceptions of shared decision making in stable coronary artery disease.

PubMed

Coylewright, Megan; O'Neill, Elizabeth S; Dick, Sara; Grande, Stuart W

2017-06-01

Describe cardiovascular clinicians' perceptions of Shared Decision Making following use of a decision aid (DA) for stable coronary artery disease (CAD) "PCI Choice", in a randomized controlled trial. We conducted a semi-structured qualitative interview study with cardiologists and physician extenders (n=13) after using PCI Choice in practice. Interviews were transcribed then coded. Codes were organized into salient themes. Final themes were determined by consensus with all authors. Most clinicians (70%) had no prior knowledge of SDM or DAs. Mixed views about the role of the DA in the visit were related to misconceptions of how patient education differed from SDM. Qualitative assessment of clinician perceptions generated three themes: 1) Gaps exist in clinician knowledge around SDM; 2) Clinicians are often uncomfortable with modifying baseline practice; and 3) Clinicians express interest in using DAs after initial exposure within a research setting. Use of DAs by clinicians during clinic visits may improve understanding of SDM. Initial use is marked by a reluctance to modify established practice patterns. As clinicians explore new approaches to benefit their patients, there is an opportunity for DAs that provide clinician instruction on core elements of SDM to lead to enhanced SDM in clinical practice. Copyright © 2017 Elsevier B.V. All rights reserved.

Estimates of complications of medical care in the adult US population.

PubMed

Villanueva, E V; Anderson, J N

2001-01-01

Total US population estimates of complications of medical care have relied on extrapolations of state-specific estimates. Generalizability is suspect because findings are limited by geographical location or time. We describe the relationship between the annual prevalence of complications of medical care (CM) and socio-demographic characteristics in the adult US population. We used data from the National Health Interview Surveys, annual nationwide surveys of the resident, civilian, noninstitutionalized population of the United States. The main outcome of interest was self-reported conditions from CMs (ICD-9 996-999) and activity limitations that arise from such events. Univariate estimates and multivariably adjusted models accounting for selected socio-demographic characteristics and health status were derived. A total of 618,167 reports of conditions from 313,438 subjects 18 years and older from 1987 to 1994 were examined. In 1987, 830,386 adults reported complications of medical care, increasing by about 40% to 1,174,089 adults in 1994. Based on an extrapolation to the US adult population, rates increased by 25% from 558 to 678 per 100,000 during the same period. One-third reported onset a year prior to the interview; two-thirds visited a doctor six months prior; half experienced limitation in major activities; a quarter reported limitation in personal care activities. In the two weeks preceding the interview, complications of medical care caused an average of 1.72 days of restricted activity, 0.79 days spent in bed, and 0.58 days of work lost. Race modified the age-specific risk of these complications. Complications of medical care impose heavier morbidity than previously considered with some indication that socio-demographic variables modify the risk for injuries.

Saving lives, maintaining safety, and science-based policy: qualitative interview findings from the Blood Donation Rules Opinion Study (Blood DROPS).

PubMed

Hughes, Shana; Sheon, Nicolas; Siedle-Khan, Bob; Custer, Brian

2015-12-01

Indefinite deferral from donation for any man who discloses having had sex with another man even once since 1977 (MSM77) is the US FDA's standing policy. This qualitative component of the Blood Donation Rules and Opinion Study was designed to provide insight into the perceptions and practices of current or previous donors with MSM history. Forty human immunodeficiency virus (HIV)-negative MSM completed an online survey, indicating that they had donated blood and were willing to be interviewed. Semistructured, individual interviews with these key informants covered donation experience and motivations, perceptions of MSM77, policy change preferences, and possible impact of a change to a time-limited deferral. Transcripts were coded deductively and inductively, following a modified Grounded Theory approach. Analysis identified recurrent and divergent themes. Ninety-five percent of participants endorsed modifying MSM77. Preferred deferral length ranged from none to 5 years; a common opinion was that a science-based deferral period would be less than 1 year. Other policy change recommendations included incorporating questions about specific HIV risk behaviors to the donor questionnaire for all potential donors. Interviewees recognized HIV infection rates are higher in MSM than the general US population, but participants considered themselves low-risk for HIV, donated blood "to save lives," and justified their recommendations as being more effective ways to identify donors at risk for HIV. Results suggest that MSM donors are concerned with blood safety; they can be appealed to as such. Communications about a new deferral policy should include scientific explanations and acknowledge altruistic motivations of potential donors. © 2015 AABB.

English children as personality theorists: accounts of the modifiability, development, and origin of traits.

PubMed

Yuill, N

1997-02-01

Forty-eight children, 4, 6, 7, and 10 years old, were interviewed to assess their accounts of the modifiability, development, and origin of four character traits (grumpy, shy, mean, fussy) and two physical traits (fat, thin). The youngest children described traits as moderately controllable and usually stable, whereas for the 2 middle groups, physiological traits in particular were highly modifiable and less stable. Six-year-olds frequently cited preferences as sources of individual differences, possibly as a precursor to a fuller understanding of traits as internal, partly uncontrollable, and idiosyncratic attributes. Seven-year-olds were more likely to mention cognitively mediated accounts of personality change, as were 10-year-olds, who were also more aware of the interactive and variable nature of influences on personality. All age groups showed coherent patterns of trait explanation and used different models of explanation for different traits. The results suggest that a monolithic model of trait understanding is misleading, because the children used a variety of different models of development.

How concept images affect students' interpretations of Newton's method

NASA Astrophysics Data System (ADS)

Engelke Infante, Nicole; Murphy, Kristen; Glenn, Celeste; Sealey, Vicki

2018-07-01

Knowing when students have the prerequisite knowledge to be able to read and understand a mathematical text is a perennial concern for instructors. Using text describing Newton's method and Vinner's notion of concept image, we exemplify how prerequisite knowledge influences understanding. Through clinical interviews with first-semester calculus students, we determined how evoked concept images of tangent lines and roots contributed to students' interpretation and application of Newton's method. Results show that some students' concept images of root and tangent line developed throughout the interview process, and most students were able to adequately interpret the text on Newton's method. However, students with insufficient concept images of tangent line and students who were unwilling or unable to modify their concept images of tangent line after reading the text were not successful in interpreting Newton's method.

Ability to Resist Temptations of Technology Use: A Qualitative Analysis of Children's Views on Factors Associated with Delay of Gratification.

PubMed

Ang, Chin-Siang; Lee, Kam-Fong

2017-01-01

Excessive technology use among young children remains a public health concern with diverse serious consequences. It is important to find out how children resist the temptation to use technology. Using focus group interviews, the authors explored what factors influence children's ability to delay gratification in using technology. Four specific themes emerged from the interview data: they found (a) fear of punishment, (b) self-directed speech, (c) reinforcement, and (d) parental modeling are effective measures to train children to forgo immediate pleasures of using technology. These findings provided some support for the hypothesis that children's self-control of technology use can be modified and improved. This study suggests methods to leverage and strengthen existing initiatives to promote self-control of technology use for children.

A Tool for Tracking and Assessing Chronic Illness Care in Prison (ACIC-P)

PubMed Central

Wang, Emily A.; Aminawung, Jenerius A.; Ferguson, Warren; Trestman, Robert; Wagner, Edward H.; Bova, Carol

2014-01-01

Chronic disease care is being transformed in correctional settings, given an aging inmate population, ongoing quality improvement efforts, litigation, and rising costs. The Chronic Care Model, established for chronic disease care in the community, might be a suitable framework to transform chronic disease care in prison, but it has not been systematically adapted for the correctional health care setting. We employed cognitive interviewing to adapt an extant survey used to measure the delivery of chronic illness care in the community, Assessment of Chronic Illness Care, for a prison setting. Results from the cognitive interviews and the modified Assessment of Chronic Illness Care–Prison (ACIC-P) instrument are presented in this article. Future studies will need to test the reliability and psychometric properties of the adapted ACIC-P. PMID:25117427

Recognition of irrationality of fear and the diagnosis of social anxiety disorder and specific phobia in adults: implications for criteria revision in DSM-5.

PubMed

Zimmerman, Mark; Dalrymple, Kristy; Chelminski, Iwona; Young, Diane; Galione, Janine N

2010-11-01

In DSM-IV, the diagnosis of social anxiety disorder (SAD) and specific phobia in adults requires that the person recognize that his or her fear of the phobic situation is excessive or unreasonable (criterion C). The DSM-5 Anxiety Disorders Work Group has proposed replacing this criterion because some patients with clinically significant phobic fears do not recognize the irrationality of their fears. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project we determined the number of individuals who were not diagnosed with SAD and specific phobia because they did not recognize the excessiveness or irrationality of their fear. We interviewed 3,000 psychiatric outpatients and 1,800 candidates for bariatric surgery with a modified version of the Structured Clinical Interview for DSM-IV. In the SAD and specific phobia modules we suspended the skip-out that curtails the modules if criterion C is not met. Patients who met all DSM-IV criteria for SAD or specific phobia except criterion C were considered to have "modified" SAD or specific phobia. The lifetime rates of DSM-IV SAD and specific phobia were 30.5 and 11.8% in psychiatric patients and 11.7 and 10.2% in bariatric surgery candidates, respectively. Less than 1% of the patients in both samples were diagnosed with modified SAD or specific phobia. Few patients were excluded from a phobia diagnosis because of criterion C. We suggest that in DSM-5 this criterion be eliminated from the SAD and specific phobia criteria sets. © 2010 Wiley-Liss, Inc.

The modifying role of caregiver burden on predictors of quality of life of caregivers of hospitalized chronic stroke patients.

PubMed

Jeong, Yeon-Gyu; Myong, Jun-Pyo; Koo, Jung-Wan

2015-10-01

Caregiver burden is an important predictor of quality of life (QoL) among caregivers of stroke patients. While caregiver burden and QoL might be closely related, caregiver burden seems also to be a potential modifier of the associations between patients' and caregivers' characteristics and caregivers' QoL. The purpose of this study was to investigate the effect of caregiver burden in caregivers of hospitalized chronic stroke patients and the predictors of caregivers' QoL by level of caregiver burden. A total of 238 patients and their caregivers were interviewed using questionnaires consisting of the Zarit Burden Interview and the Korean-version of the World Health Organization Quality of Life-BREF. Multiple hierarchical regression analyses were performed to determine the predictors of caregivers' QoL among caregivers stratified by median caregiver burden score (high/low). Caregiver burden had a modifying effect on caregivers' QoL. In caregivers with high burden, the patient characteristics of being unemployed and the caregiver characteristics of poor health status, lower income, and being a spouse were negative predictors of caregivers' QoL. In caregivers with low burden, the patient characteristics of being hospitalized for a longer duration and the caregiver characteristics of poor health status were negative predictors of caregivers' QoL (all ps < 0.05). This study found that in South Korea, more attention should be paid to spouses who are caring for hospitalized chronic stroke patients, particularly with regard to their health status and financial problems. Further studies are needed to examine the impact of factors not examined in the Korean cultural context. Copyright © 2015 Elsevier Inc. All rights reserved.

Preliminary assessment of framework conditions for release of genetically modified mosquitoes in Burkina Faso.

PubMed

De Freece, Chenoa; Paré Toé, Léa; Esposito, Fulvio; Diabaté, Abdoulaye; Favia, Guido

2014-09-01

Genetically modified mosquitoes (GMMs) are emerging as a measure to control mosquito-borne diseases, but before any genetically modified organisms (GMOs) are released into the environment, it is imperative to establish regulatory standards incorporating public engagement. A previous project in Burkina Faso introduced a type of genetically modified cotton [Bacillus thuringiensis (Bt)] cotton) that produces insecticide, and incorporated policies on public engagement. We explored the perspectives of Burkinabè (citizens of Burkina Faso) on bio-agricultural exposure to GMOs and their receptiveness to the use of GMOs. Interviews were conducted in a village (Bondoukuy) and with representatives from stakeholder organizations. The population may be very receptive to the use of GMMs against malaria, but may voice unfounded concerns that GMMs can transmit other diseases. It is important to constantly supply the population with correct and factual information. Investigating the application of Burkina Faso's biotechnology policies with regard to Bt cotton has shown that it may be conceivable in the future to have open discussions about the merits of GMM release. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Predictors of Depressive Symptoms Among Israeli Jews and Arabs During the Al Aqsa Intifada: A Population-Based Cohort Study

PubMed Central

Tracy, Melissa; Hobfoll, Stevan E.; Canetti–Nisim, Daphna; Galea, Sandro

2009-01-01

PURPOSE We sought to assess the predictors of depressive symptoms in a population–based cohort exposed to ongoing and widespread terrorism. METHODS Interviews of a representative sample of adults living in Israel, including both Jews and Arabs, were conducted between August and September 2004, with follow-up interviews taking place between February and April 2005. Censoring weights were estimated to account for differential loss to follow-up. Zero-inflated negative binomial models with bootstrapped confidence intervals were fit to assess predictors of severity of depressive symptoms, assessed using items from the Patient Health Questionnaire. RESULTS A total of 1613 Israeli residents participated in the baseline interview (80.8% Jewish, 49.4% male, mean age 43 years); 840 residents also participated in the follow-up interview. In multivariable models, Israeli Arab ethnicity, lower household income, lower social support, experiencing economic loss from terrorism, experiencing higher levels of psychosocial resource loss, and meeting criteria for post-traumatic stress disorder were significantly associated with increased severity of depressive symptoms. CONCLUSIONS Material deprivation is the primary modifiable risk factor for depressive symptoms in the context of ongoing terrorism. Efforts to minimize ongoing material and economic stressors may mitigate the mental health consequences of ongoing terrorism. PMID:18261923

Abuse of power in relationships and sexual health.

PubMed

Gesink, Dionne; Whiskeyjack, Lana; Suntjens, Terri; Mihic, Alanna; McGilvery, Priscilla

2016-08-01

STI rates are high for First Nations in Canada and the United States. Our objective was to understand the context, issues, and beliefs around high STI rates from a nêhiyaw (Cree) perspective. Twenty-two in-depth interviews were conducted with 25 community participants between March 1, 2011 and May 15, 2011. Interviews were conducted by community researchers and grounded in the Cree values of relationship, sharing, personal agency and relational accountability. A diverse purposive snowball sample of community members were asked why they thought STI rates were high for the community. The remainder of the interview was unstructured, and supported by the interviewer through probes and sharing in a conversational style. Modified grounded theory was used to analyze the narratives and develop a theory. The main finding from the interviews was that abuse of power in relationships causes physical, mental, emotional and spiritual wounds that disrupt the medicine wheel. Wounded individuals seek medicine to stop suffering and find healing. Many numb suffering by accessing temporary medicines (sex, drugs and alcohol) or permanent medicines (suicide). These medicines increase the risk of STIs. Some seek healing by participating in ceremony and restoring relationships with self, others, Spirit/religion, traditional knowledge and traditional teachings. These medicines decrease the risk of STIs. Younger female participants explained how casual relationships are safer than committed monogamous relationships. Resolving abuse of power in relationships should lead to improvements in STI rates and sexual health. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Translating and culturally adapting the shortened version of the Hospital Ethical Climate Survey (HECS-S) - retaining or modifying validated instruments.

PubMed

Pergert, Pernilla; Bartholdson, Cecilia; Wenemark, Marika; Lützén, Kim; Af Sandeberg, Margareta

2018-05-10

The Hospital Ethical Climate Survey (HECS) was developed in the USA and later shortened (HECS-S). HECS has previously been translated into Swedish and the aim of this study was to describe a process of translating and culturally adapting HECS-S and to develop a Swedish multi-professional version, relevant for paediatrics. Another aim was to describe decisions about retaining versus modifying the questionnaire in order to keep the Swedish version as close as possible to the original while achieving a good functional level and trustworthiness. In HECS-S, the respondents are asked to indicate the veracity of statements. In HECS and HECS-S the labels of the scale range from 'almost never true' to 'almost always true'; while the Swedish HECS labels range from 'never' to 'always'. The procedure of translating and culturally adapting the Swedish version followed the scientific structure of guidelines. Three focus group interviews and three cognitive interviews were conducted with healthcare professionals. Furthermore, descriptive data were used from a previous study with healthcare professionals (n = 89), employing a modified Swedish HECS. Decisions on retaining or modifying items were made in a review group. The Swedish HECS-S consists of 21 items including all 14 items from HECS-S and items added to develop a multi-professional version, relevant for paediatrics. The descriptive data showed that few respondents selected 'never' and 'always'. To obtain a more even distribution of responses and keep Swedish HECS-S close to HECS-S, the original labels were retained. Linguistic adjustments were made to retain the intended meaning of the original items. The word 'respect' was used in HECS-S with two different meanings and was replaced in one of these because participants were concerned that respecting patients' wishes implied always complying with them. The process of developing a Swedish HECS-S included decisions on whether to retain or modify. Only minor adjustments were needed to achieve a good functional level and trustworthiness although some items needed to be added. Adjustments made could be used to also improve the English HECS-S. The results shed further light on the need to continuously evaluate even validated instruments and adapt them before use.

Impact of Student vs Faculty Facilitators on Motivational Interviewing Student Outcomes

PubMed Central

Widder-Prewett, Rebecca; Cameron, Ginger; Anderson, Douglas; Pinkerton, Mark; Chen, Aleda M. H.

2017-01-01

Objective. To determine the impact of student or faculty facilitation on student self-assessed attitudes, confidence, and competence in motivational interviewing (MI) skills; actual competence; and evaluation of facilitator performance. Methods. Second-year pharmacy (P2) students were randomly assigned to a student or faculty facilitator for a four-hour, small-group practice of MI skills. MI skills were assessed in a simulated patient encounter with the mMITI (modified Motivational Interviewing Treatment Integrity) tool. Students completed a pre-post, 6-point, Likert-type assessment addressing the research objectives. Differences were assessed using a Mann-Whitney U test. Results. Student (N=44) post-test attitudes, confidence, perceived or actual competence, and evaluations of facilitator performance were not different for faculty- and student-facilitated groups. Conclusion. Using pharmacy students as small-group facilitators did not affect student performance and were viewed as equally favorable. Using pharmacy students as facilitators can lessen faculty workload and provide an outlet for students to develop communication and facilitation skills that will be needed in future practice. PMID:28970608

Healthy or Unhealthy Lifestyle: A Thematic Analysis of Iranian Male Adolescents' Perspectives.

PubMed

Zareiyan, Armin

2017-01-01

Identifying what adolescents perceive as their lifestyle and exploring the factors persuading their decisions to engage in or avoid healthy or unhealthy lifestyle behaviors could improve the ability of healthcare professionals to develop innovative preventive strategies and modify negative health behaviors in adolescents. Hence, the literature on adolescent health-related issues reported by adults showed a rarity of information from adolescents themselves. A qualitative study using the thematic analysis approach was conducted. Data were collected by semi-structured, digitally recorded interviews from 32 male adolescents. Interviews were transcribed verbatim, and after collecting the data, the thematic analysis process was started and conducted in six phases. After data collection, the interview texts were transcribed, and approximately 800 initial codes were extracted. The initial codes were reevaluated to yield 48 main themes. Hence, the final thematic map was created as having 5 overarching themes and 12 subthemes, showing that interviewees emphasized unhealthy lifestyle. The components of unhealthy lifestyle seem important to them because they consider that they could lead a healthy lifestyle through elimination of negative behaviors.

Modifying a Social Problem-Solving Program With the Input of Individuals With Intellectual Disabilities and Their Staff

PubMed Central

Ailey, Sarah H.; Friese, Tanya R.; Nezu, Arthur M.

2016-01-01

Social problem-solving programs have shown success in reducing aggressive/challenging behaviors among individuals with intellectual disabilities in clinical settings, but have not been adapted for health promotion in community settings. We modified a social problem-solving program for the community setting of the group home. Multiple sequential methods were used to seek advice from community members on making materials understandable and on intervention delivery. A committee of group home supervisory staff gave advice on content and delivery. Cognitive interviews with individuals with intellectual disabilities and residential staff provided input on content wording and examples. Piloting the program provided experience with content and delivery. The process provides lessons on partnering with vulnerable populations and community stakeholders to develop health programs. PMID:22753149

Modifiable risk factors of hypertension: A hospital-based case-control study from Kerala, India.

PubMed

Pilakkadavath, Zarin; Shaffi, Muhammed

2016-01-01

Hypertension is a major cause of cardiovascular morbidity and mortality in Kerala. Excess dietary salt, low dietary potassium, overweight and obesity, physical inactivity, excess alcohol, smoking, socioeconomic status, psychosocial stressors, and diabetes are considered as modifiable risk factors for hypertension. To estimate and compare the distribution of modifiable risk factors among hypertensive (cases) and nonhypertensive (controls) patients and to estimate the effect relationship of risk factors. Age- and sex-matched case-control study was conducted in a tertiary care hospital in Kerala using a pretested interviewer-administered structured questionnaire based on the WHO STEPS instrument for chronic disease risk factor surveillance. Bivariate and multiple logistic regression analyses were done. A total of 296 subjects were included in the study. The mean age of study sample was 50.13 years. All modifiable risk factors studied vis-ΰ-vis obesity, lack of physical activity, inadequate fruits and vegetable intake, diabetes, smoking, and alcohol use were significantly different in proportion among cases and controls. Obesity, lack of physical activity, smoking, and diabetes were found to be significant risk factors for hypertension after adjusting for other risk factors. Hypertension is strongly driven by a set of modifiable risk factors. Massive public awareness campaign targeting risk factors is essential in controlling hypertension in Kerala, especially focusing on physical exercise and control of diabetes, obesity, and on quitting smoking.

Participation in Physical Play and Leisure in Children With Motor Impairments: Mixed-Methods Study to Generate Evidence for Developing an Intervention

PubMed Central

Ramsay, Craig; McKee, Lorna; Missiuna, Cheryl; Owen, Christine; Francis, Jill

2015-01-01

Background Participation in physical play/leisure (PPP) is an important therapy goal of children with motor impairments. Evidence for interventions promoting PPP in these children is scarce. The first step is to identify modifiable, clinically meaningful predictors of PPP for targeting by interventions. Objective The study objective was to identify, in children with motor impairments, body function and structure, activity, environmental, and personal factors related to PPP and modifiable by therapists. Design This was a mixed-methods, intervention development study. The World Health Organization framework International Classification of Functioning, Disability and Health was used. Methods Participants were children (6–8 years old) with motor impairments, mobilizing independently with or without equipment and seen by physical therapists or occupational therapists in 6 regions in the United Kingdom, and their parents. Self-reported PPP was assessed with the Children's Assessment of Participation and Enjoyment. Modifiable-factor data were collected with therapists' observations, parent questionnaires, and child-friendly interviews. The Children's Assessment of Participation and Enjoyment, therapist, and parent data were analyzed using descriptive statistics and linear regression. Interview data were analyzed for emerging themes. Results Children's (n=195) PPP (X=18 times per week, interquartile range=11–25) was mainly ‘recreational’ (eg, pretend play, playing with pets) rather than ‘active physical’ (eg, riding a bike/scooter). Parents (n=152) reported positive beliefs about children's PPP but various levels of family PPP. Therapists reported 23 unique impairments (eg, muscle tone), 16 activity limitations (eg, walking), and 3 personal factors (eg, child's PPP confidence). Children interviewed (n=17) reported a strong preference for active play but indicated that adults regulated their PPP. Family PPP and impairment in the child's movement-related body structures explained 18% of the variation in PPP. Family PPP explained most of the variation. Limitations It is likely that the study had a degree of self-selection bias, and caution must be taken in generalizing the results to children whose parents have less positive views about PPP. Conclusions The results converge with wider literature about the child's social context as a PPP intervention target. In addition, the results question therapists' observations in explaining PPP. PMID:25997950

The process of whistleblowing in a Japanese psychiatric hospital.

PubMed

Ohnishi, Kayoko; Hayama, Yumiko; Asai, Atsushi; Kosugi, Shinji

2008-09-01

This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions.

A tool for tracking and assessing chronic illness care in prison (ACIC-P).

PubMed

Wang, Emily A; Aminawung, Jenerius A; Ferguson, Warren; Trestman, Robert; Wagner, Edward H; Bova, Carol

2014-10-01

Chronic disease care is being transformed in correctional settings, given an aging inmate population, ongoing quality improvement efforts, litigation, and rising costs. The Chronic Care Model, established for chronic disease care in the community, might be a suitable framework to transform chronic disease care in prison, but it has not been systematically adapted for the correctional health care setting. We employed cognitive interviewing to adapt an extant survey used to measure the delivery of chronic illness care in the community, Assessment of Chronic Illness Care, for a prison setting. Results from the cognitive interviews and the modified Assessment of Chronic Illness Care-Prison (ACIC-P) instrument are presented in this article. Future studies will need to test the reliability and psychometric properties of the adapted ACIC-P. © The Author(s) 2014.

Factors Considered by Elementary Teachers When Developing and Modifying Mathematical Tasks to Support Children's Mathematical Thinking

NASA Astrophysics Data System (ADS)

Fredenberg, Michael Duane

The idea that problems and tasks play a pivotal role in a mathematics lesson has a long standing in mathematics education research. Recent calls for teaching reform appeal for training teachers to better understand how students learn mathematics and to employ students' mathematical thinking as the basis for pedagogy (CCSSM, 2010; NCTM, 2000; NRC 1999). The teaching practices of (a) developing a task for a mathematics lesson and, (b) modifying the task for students while enacting the lesson fit within the scope of supporting students' mathematical thinking. Surprisingly, an extensive search of the literature did not yield any research aimed to identify and refine the constituent parts of the aforementioned teaching practices in the manner called for by Grossman and xiii colleagues (2009). Consequently, my research addresses the two questions: (a) what factors do exemplary elementary teachers consider when developing a task for a mathematics lesson? (b) what factors do they consider when they modify a task for a student when enacting a lesson? I conducted a multiple case study involving three elementary teachers, each with extensive training in the area of Cognitively Guided Instruction (CGI), as well as several years experience teaching mathematics following the principles of CGI (Carpenter et al., 1999). I recorded video of three mathematics lessons with each participant and after each lesson I conducted a semi-structured stimulated recall interview. A subsequent follow-up clinical interview was conducted soon thereafter to further explore the teacher's thoughts (Ginsberg, 1997). In addition, my methodology included interjecting myself at select times during a lesson to ask the teacher to explain her reasoning. Qualitative analysis led to a framework that identified four categories of influencing factors and seven categories of supporting objectives for the development of a task. Subsets of these factors and objectives emerged as particularly relevant when the teachers decided to modify a task. Moreover, relationships between and among the various factors were identified. The emergent framework from this study offers insight into decompositions of the two teaching practices of interest, and, in particular, the utility of the number choices made by the teachers.

Interprofessional Health Team Communication About Hospital Discharge: An Implementation Science Evaluation Study.

PubMed

Bahr, Sarah J; Siclovan, Danielle M; Opper, Kristi; Beiler, Joseph; Bobay, Kathleen L; Weiss, Marianne E

The Consolidated Framework for Implementation Research guided formative evaluation of the implementation of a redesigned interprofessional team rounding process. The purpose of the redesigned process was to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process.

Coping strategies used by poorly adherent patients for self-managing bipolar disorder.

PubMed

Blixen, Carol; Levin, Jennifer B; Cassidy, Kristin A; Perzynski, Adam T; Sajatovic, Martha

2016-01-01

Bipolar disorder (BD) is a chronic mental illness associated with reduced quality of life, high rates of suicide, and high financial costs. Evidence indicates that psychosocial stress might play an important role in the onset and course of BD. The objective of this study was to address the gap between coping theory and the clinical use of coping strategies used to self-manage BD. In-depth interviews were conducted with a sample of 21 poorly adherent patients with BD. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. Transcript-based analysis generated two major domains of coping strategies used to self-manage BD: 1) problem focused (altering eating habits, managing mood-stabilizing medications, keeping psychiatric appointments, seeking knowledge, self-monitoring, and socializing) and 2) emotion focused (distracting activities, denial, isolation, modifying/avoiding, helping others, and seeking social support). Participants used both types of coping strategies to deal with stressful situations brought about by the internal and external demands associated with self-management of BD. This qualitative study provided a first step in evaluating coping strategies as a possible mediator in the self-management of BD and has implications for health care providers. Being able to characterize an individual's coping behaviors can help patients modify or replace more maladaptive coping with better coping strategies in the self-management of this chronic mental illness.

Identifying determinants of medication adherence following myocardial infarction using the Theoretical Domains Framework and the Health Action Process Approach.

PubMed

Presseau, Justin; Schwalm, J D; Grimshaw, Jeremy M; Witteman, Holly O; Natarajan, Madhu K; Linklater, Stefanie; Sullivan, Katrina; Ivers, Noah M

2017-10-01

Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine adherence could help to develop novel adherence interventions. Compare the utility of different behaviour theory-based approaches for identifying modifiable determinants of medication adherence post-MI that could be targeted by interventions. Two studies were conducted with patients 0-2, 3-12, 13-24 or 25-36 weeks post-MI. Study 1: 24 patients were interviewed about barriers and facilitators to medication adherence. Interviews were conducted and coded using the Theoretical Domains Framework. Study 2: 201 patients answered a telephone questionnaire assessing Health Action Process Approach constructs to predict intention and medication adherence (MMAS-8). Study 1: domains identified: Beliefs about Consequences, Memory/Attention/Decision Processes, Behavioural Regulation, Social Influences and Social Identity. Study 2: 64, 59, 42 and 58% reported high adherence at 0-2, 3-12, 13-24 and 25-36 weeks. Social Support and Action Planning predicted adherence at all time points, though the relationship between Action Planning and adherence decreased over time. Using two behaviour theory-based approaches provided complimentary findings and identified modifiable factors that could be targeted to help translate Intention into action to improve medication adherence post-MI.

Factors associated to adherence to different treatment schemes with meglumine antimoniate in a clinical trial for cutaneous leishmaniasis.

PubMed

Ribeiro, Madelon Novato; Pimentel, Maria Inês Fernandes; Schubach, Armando de Oliveira; Oliveira, Raquel de Vasconcellos Carvalhães de; Teixeira, José Liporage; Leite, Madson Pedro da Silva; Fonseca, Monique; Santos, Ginelza Peres Lima dos; Salgueiro, Mariza Matos; Ferreira e Vasconcellos, Erica de Camargo; Lyra, Marcelo Rosandiski; Saheki, Mauricio Naoto; Valete-Rosalino, Claudia Maria

2014-01-01

The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL), in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule); we observed 82.1% (vial return), 86.0% (monitoring card), 66.7% (Morisky test) and 86.0% (modified Morisky test) adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods.

Modifying the food supply at a community swimming pool: a case study.

PubMed

Lloyd, Beverley; Dumbrell, Susan

2011-04-01

We report on a process evaluation of a project that aimed to replace energy-dense, nutrient-poor (EDNP) items at a community swimming pool kiosk. The analytic framework was the Analysis Grid for Environments Linked to Obesity (ANGELO). To contribute to health promotion practice in recreational settings, the process evaluation sought to determine the extent to which project'controversies' modified project objectives and strategies. The case study method captured the project narrative. The primary data were interviews with key project participants, supplemented with project records and media articles.These were analysed thematically. The socio-cultural and political environments, particularly the capacity to exercise choice in relation to ENDP products, had considerable influence on the project. In the face of two controversies -"I thought everyone was signed up to it"and "We can't deny the kiddies their ice-cream" it was necessary for the project partners to modify the objectives and strategies and substantially change the target. The setting is highly responsive to both the micro and macro socio-cultural and political aspects of the environment.

“What's the right thing to do?” Correctional healthcare providers' knowledge, attitudes and experiences caring for transgender inmates

PubMed Central

Clark, Kirsty A.; White Hughto, Jaclyn M.; Pachankis, John E.

2017-01-01

Rational Incarcerated transgender individuals may need to access physical and mental health services to meet their general and gender-affirming (e.g., hormones, surgery) medical needs while incarcerated. Objective This study sought to examine correctional healthcare providers’ knowledge of, attitudes toward, and experiences providing care to transgender inmates. Method In 2016, 20 correctional healthcare providers (e.g., physicians, social workers, psychologists, mental health counselors) from New England participated in in-depth, semi-structured interviews examining their experiences caring for transgender inmates. The interview guide drew on healthcare-related interviews with recently incarcerated transgender women and key informant interviews with correctional healthcare providers and administrators. Data were analyzed using a modified grounded theory framework and thematic analysis. Results Findings revealed that transgender inmates do not consistently receive adequate or gender-affirming care while incarcerated. Factors at the structural level (i.e., lack of training, restrictive healthcare policies, limited budget, and an unsupportive prison culture); interpersonal level (i.e., custody staff bias); and individual level (i.e., lack of transgender cultural and clinical competence) impede correctional healthcare providers’ ability to provide gender-affirming care to transgender patients. These factors result in negative health consequences for incarcerated transgender patients. Conclusions Results call for transgender-specific healthcare policy changes and the implementation of transgender competency trainings for both correctional healthcare providers and custody staff (e.g., officers, lieutenants, wardens). PMID:29028559

Use of the Computer for Research on Instruction and Student Understanding in Physics.

NASA Astrophysics Data System (ADS)

Grayson, Diane Jeanette

This dissertation describes an investigation of how the computer may be utilized to perform research on instruction and on student understanding in physics. The research was conducted within three content areas: kinematics, waves and dynamics. The main focus of the research on instruction was the determination of factors needed for a computer program to be instructionally effective. The emphasis in the research on student understanding was the identification of specific conceptual and reasoning difficulties students encounter with the subject matter. Most of the research was conducted using the computer -based interview, a technique developed during the early part of the work, conducted within the domain of kinematics. In a computer-based interview, a student makes a prediction about how a particular system will behave under given circumstances, observes a simulation of the event on a computer screen, and then is asked by an interviewer to explain any discrepancy between prediction and observation. In the course of the research, a model was developed for producing educational software. The model has three important components: (i) research on student difficulties in the content area to be addressed, (ii) observations of students using the computer program, and (iii) consequent program modification. This model was used to guide the development of an instructional computer program dealing with graphical representations of transverse pulses. Another facet of the research involved the design of a computer program explicitly for the purposes of research. A computer program was written that simulates a modified Atwood's machine. The program was than used in computer -based interviews and proved to be an effective means of probing student understanding of dynamics concepts. In order to ascertain whether or not the student difficulties identified were peculiar to the computer, laboratory-based interviews with real equipment were also conducted. The laboratory-based interviews were designed to parallel the computer-based interviews as closely as possible. The results of both types of interviews are discussed in detail. The dissertation concludes with a discussion of some of the benefits of using the computer in physics instruction and physics education research. Attention is also drawn to some of the limitations of the computer as a research instrument or instructional device.

Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US.

PubMed

Patel, Mihir; Phillips-Caesar, Erica; Boutin-Foster, Carla

2014-10-01

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance.

Preachers who are not believers.

PubMed

Dennett, Daniel C; Lascola, Linda

2010-03-27

There are systemic features of contemporary Christianity that create an almost invisible class of non-believing clergy, ensnared in their ministries by a web of obligations, constraints, comforts, and community. Exemplars from five Protestant denominations, Southern Baptist, United Church of Christ, Presbyterian, Methodist and Church of Christ, were found and confidentially interviewed at length about their lives, religious education and indoctrination, aspirations, problems and ways of coping. The in-depth, qualitative interviews formed the basis for profiles of all five, together with general observations about their predicaments and how they got into them. The authors anticipate that the discussion generated on the Web (at On Faith, the Newsweek/Washington Post website on religion, http://newsweek.washingtonpost.com/onfaith//2010/03/disbelief_in_the_pulpit/all.html) and on other websites will facilitate a larger study that will enable the insights of this pilot study to be clarified, modified, and expanded.

Mixing medication into foodstuffs: identifying the issues for paediatric nurses.

PubMed

Akram, Gazala; Mullen, Alex B

2015-04-01

Medication is often mixed into soft foods to aid swallowing in children. However, this can alter the physical/chemical properties of the active drug. This study reports on the prevalence of the modification procedure, the nature of foodstuffs routinely used and factors which influence how the procedure is performed by nurses working in the National Health Service in Scotland. Mixed methods were employed encompassing an online self-administered questionnaire and semi-structured interviews. One hundred and eleven nurses participated, of whom 87% had modified medication prior to administration. Fruit juice (diluted and concentrated) and yoghurts were most commonly used. The interviews (i) identified the limitations of the procedure; (ii) explored the decision-making process; and (iii) confirmed the procedure was a last resort. This study intends to address some of the uncertainty surrounding the medicine modification procedure within the paediatric population. © 2013 Wiley Publishing Asia Pty Ltd.

Is the metaphor of 'barriers to change' useful in understanding implementation? Evidence from general medical practice.

PubMed

Checkland, Kath; Harrison, Stephen; Marshall, Martin

2007-04-01

To investigate how general medical practices in the UK react to bureaucratic initiatives, such as National Health Service (NHS) National Service Frameworks (NSFs), and to explore the value of the metaphor of 'barriers to change' for understanding this. Interviews, non-participant observation and documentary analysis within case studies of four practices in northern England. The practices had not actively implemented NSFs. At interview, various 'barriers' that had prevented implementation were listed, including the complexity of the documents and lack of time. Observation suggested that these barriers were constructions used by the participants to make sense of the situation in which they found themselves. The metaphor of 'removing barriers to change' was of limited use in a context where non-implementation of policy was an emergent property of underlying organizational realities, likely to be modifiable only if these realities were addressed.

Attitudes and Beliefs Regarding Cardiovascular Risk Factors Among Bangladeshi Immigrants in the US

PubMed Central

Phillips-Caesar, Erica; Boutin-Foster, Carla

2015-01-01

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance. PMID:23861069

[Life lessons of eight families donating organs of deceased family members].

PubMed

Avilés R, Lissette; Rivera M, M Soledad; Catoni S, María Isabel

2014-06-01

Most organ donors are already death. Therefore family members become an essential link in the final decision for organ donation. To get acquainted about the life lessons of people who accepted donating an organ of a deceased family member. Qualitative research, in depth interviews to eight families that accepted donating an organ of a deceased family member. The interviews were analyzed using the method proposed by Streubert et al and modified by Rivera. The life lessons are described in six comprehensive categories. The painful experience changed towards the feeling that the loved one remains alive. This sensation generated a sense of pride in family members and sensitized them towards the painful experience of other people. Therefore, a desire to help and improve as humans beings was awakened. A compassionate approach towards families donating organs with improve organ donation and humanize the process.

The Environmental Production of Disability for Seniors with Age-Related Vision Loss.

PubMed

McGrath, Colleen; Laliberte Rudman, Debbie; Spafford, Marlee; Trentham, Barry; Polgar, Jan

2017-03-01

To date, attention to the environmental production of disability among older adults with age-related vision loss (ARVL) has been limited. This critical ethnographic study aimed to reveal the ways in which environmental barriers produced and perpetuated disability for 10 older adults with ARVL. A modified version of Carspecken's five-stage approach for critical ethnography was adopted with three methods of data collection used, including a narrative interview, a participant observation session, and a semi-structured, in-depth interview. Findings revealed how disability is shaped for older adults with ARVL when they encounter environmental features that are embedded within an ageist and disablist society. These findings are illustrated via presenting analysis of three commonly discussed activities: shopping, eating, and community mobility. Our discussion suggests that addressing the environmental production of disability requires inclusive social policy, advocacy, and a focus on education in order to develop and sustain age and low-vision-friendly environments.

Self-perception of when old age begins for Cambodian elders living in the United States.

PubMed

Dubus, Nicole M

2014-06-01

To deepen the understanding of the life course of refugees this study explores the question: when do Cambodian elders perceive the beginning of old age? In-depth interviews were conducted with 32 Cambodians, age range 53-82, who attended an elder day center in an urban setting in Massachusetts. Interviews were transcribed and analyzed using the modified grounded theory approach. The analysis revealed that the participants primarily reported two determinants to defining when old age begins: 1) the body "has too many illnesses" due to harsh working conditions; and 2) social role transition into grandparent. This study extends research on cultural differences in aging, specifically identifying the cultural difference in the definition of when "old age" begins. Age is culturally derived and creates expectations for social roles, health, self-identity, and behavior. Understanding how refugees experience the cultural discrepancies in their expectations of aging can inform providers who serve this population.

Substance use disorders in a sample of Canadian patients with chronic mental illness.

PubMed

Toner, B B; Gillies, L A; Prendergast, P; Cote, F H; Browne, C

1992-03-01

In a study designed to investigate the pattern of substance use disorders among a group of chronic mentally ill patients in Toronto, 102 patients completed the Structured Clinical Interview for DSM-III-R and a modified substance-use-disorder module of the Diagnostic Interview Schedule. Forty percent of the sample met criteria for substance use disorders, and 49 percent for personality disorder. Among patients with personality disorder, all those with a personality disorder in cluster B (that is, with antisocial, borderline, histrionic, or narcissistic personality disorder) had a substance use disorder, while the majority of patients in cluster A and cluster C were not substance abusers. In the overall sample, the group with substance use disorders was significantly younger than the group without. In contrast to findings of previous studies, women met criteria for substance use disorders as often as men did.

An international measure of awareness and beliefs about cancer: development and testing of the ABC

PubMed Central

Simon, Alice E; Forbes, Lindsay J L; Boniface, David; Warburton, Fiona; Brain, Kate E; Dessaix, Anita; Donnelly, Michael; Haynes, Kerry; Hvidberg, Line; Lagerlund, Magdalena; Petermann, Lisa; Tishelman, Carol; Vedsted, Peter; Vigmostad, Maria Nyre; Wardle, Jane; Ramirez, Amanda J

2012-01-01

Objectives To develop an internationally validated measure of cancer awareness and beliefs; the awareness and beliefs about cancer (ABC) measure. Design and setting Items modified from existing measures were assessed by a working group in six countries (Australia, Canada, Denmark, Norway, Sweden and the UK). Validation studies were completed in the UK, and cross-sectional surveys of the general population were carried out in the six participating countries. Participants Testing in UK English included cognitive interviewing for face validity (N=10), calculation of content validity indexes (six assessors), and assessment of test–retest reliability (N=97). Conceptual and cultural equivalence of modified (Canadian and Australian) and translated (Danish, Norwegian, Swedish and Canadian French) ABC versions were tested quantitatively for equivalence of meaning (≥4 assessors per country) and in bilingual cognitive interviews (three interviews per translation). Response patterns were assessed in surveys of adults aged 50+ years (N≥2000) in each country. Main outcomes Psychometric properties were evaluated through tests of validity and reliability, conceptual and cultural equivalence and systematic item analysis. Test–retest reliability used weighted-κ and intraclass correlations. Construction and validation of aggregate scores was by factor analysis for (1) beliefs about cancer outcomes, (2) beliefs about barriers to symptomatic presentation, and item summation for (3) awareness of cancer symptoms and (4) awareness of cancer risk factors. Results The English ABC had acceptable test–retest reliability and content validity. International assessments of equivalence identified a small number of items where wording needed adjustment. Survey response patterns showed that items performed well in terms of difficulty and discrimination across countries except for awareness of cancer outcomes in Australia. Aggregate scores had consistent factor structures across countries. Conclusions The ABC is a reliable and valid international measure of cancer awareness and beliefs. The methods used to validate and harmonise the ABC may serve as a methodological guide in international survey research. PMID:23253874

Patient Perspectives on Accessing Acute Illness Care

PubMed Central

Finta, Mary K.; Borkenhagen, Amy; Werner, Nicole E.; Duckles, Joyce; Sellers, Craig R.; Seshadri, Sandhya; Lampo, Denise; Shah, Manish N.

2017-01-01

Introduction Older adults use the emergency department (ED) at high rates, including for illnesses that could be managed by their primary care providers (PCP). Policymakers have implemented barriers and incentives, often financial, to try to modify use patterns but with limited success. This study aims to understand the factors that influence older adults’ decision to obtain acute illness care from the ED rather than from their PCPs. Methods We performed a qualitative study using a directed content analysis approach from February to October 2013. Fifteen community-dwelling older adults age≥65 years who presented to the ED of an academic medical center hospital for care and who were discharged home were enrolled. Semi-structured interviews were conducted initially in the ED and subsequently in patients’ homes over the following six weeks. All interviews were audio-recorded, transcribed, verified, and coded. The study team jointly analyzed the data and identified themes that emerged from the interviews. Results The average age of study participants was 74 years (standard deviation ±7.2 years); 53% were female; 80% were white. We found five themes that influenced participants’ decisions to obtain acute illness care from the ED: limited availability of PCP-based care, variable interactions with healthcare providers and systems, limited availability of transportation for illness care, desire to avoid burdening friends and family, and previous experiences with illnesses. Conclusion Community-dwelling older adults integrate multiple factors when deciding to obtain care from an ED rather than their PCPs. These factors relate to personal and social considerations, practical issues, and individual perceptions based on previous experiences. If these findings are validated in confirmatory studies, policymakers wishing to modify where older adults receive care should consider person-centered interventions at the system and individual level, such as decision support, telemedicine, improved transport services, enhancing PCPs’ capabilities, and enhancing EDs’ resources to care for older patients. PMID:28611875

Effect of a Motivational Interviewing-Based Health Coaching on Quality of Life in Subjects With COPD.

PubMed

Rehman, Hamid; Karpman, Craig; Vickers Douglas, Kristin; Benzo, Roberto P

2017-08-01

Improving quality of life (QOL) is a key goal in the care of patients with COPD. Pulmonary rehabilitation (PR) has clearly been shown to improve QOL, but is not accessible to many eligible patients. There is a need for alternative programs designed to improve patient well-being that are accessible to all patients with COPD. Our goal was to pilot test a simple, telephone-based health-coaching intervention that was recently shown to decrease readmission among hospitalized COPD patients and stable COPD patients eligible for PR. Subjects received a 3-month intervention consisting of 10 health-coaching telephone calls based on motivational interviewing principles. Outcome measures included dyspnea level, measured by the modified Medical Research Council scale, and QOL, measured by the Chronic Respiratory Questionnaire and a single-item general self-rated health status. Fifty subjects with moderate to severe COPD were enrolled in the study. Forty-four subjects (86%) completed the study intervention. Dyspnea measured by the modified Medical Research Council score improved significantly after the intervention ( P = .002). The domains of fatigue, emotional function, and mastery on the Chronic Respiratory Disease Questionnaire and the single-item QOL question also improved significantly after the 3 months of health coaching ( P = .001, P = .001, P = .007, and P = .03, respectively). Thirty-six (71%) subjects had a clinically meaningful improvement in at least 1 study end point (either in the severity of dyspnea or a domain of QOL). Thirty subjects (58%) had an improvement of ≥0.5 points, the minimum clinically important difference in at least 1 component of the Chronic Respiratory Disease Questionnaire. A telephone-delivered motivational interviewing-based coaching program for COPD patients is a feasible, well-accepted (by both participants and providers), simple, and novel intervention to improve the well-being of patients with COPD. This pilot study provides insight into a possible alternative to a conventional PR program for patients with limited access to that program. Copyright © 2017 by Daedalus Enterprises.

Counselling parents on young children's healthy diet: A modified scoping review.

PubMed

Holmberg Fagerlund, Bettina; Helseth, Sølvi; Owe, Jenny; Glavin, Kari

2017-12-01

To map and describe key information in existing research about counselling of parents of children aged 0-2 years on the child's healthy diet in preventive healthcare settings, particularly in public health nursing. Many parents are likely to be concerned with their infant's food-related happiness "here and now," disregarding the child's long-term health and development related to feeding practices. Hence, a focus on counselling parents in considering young children's healthy diet is important. A modified scoping review with an inductive qualitative content analysis of selected empirical studies. Systematic searches in EMBASE (1996-2015 Week 46), Ovid Nursing Database (1946-2015 November Week 1), Ovid MEDLINE and Ovid OLDMEDLINE (2000-18 November 2015) and CINAHL (2000-22 December 2015), using search terms based on aims. Eight included studies, with participants per sample ranging from 19->500. Research designs were focus group discussions and/or interview study (n = 2), cluster-randomised trials (n = 2), randomised controlled trials (n = 2), a follow-up interview study (n = 1) to a previous randomised controlled trial and a cross-sectional electronic questionnaire study (n = 1). The studies included a total sample of 2,025 participants, 42 of them in interview studies. Findings indicate parents' perceptions of inconsistency, misconceptions and uncertainty related to the recommendations on child feeding from the authorities. Thus, adapted advice could impact healthier child diet. Maternal knowledge on child feeding and reduced use of food as a reward are mediators for improved diet quality in children. Counselling on young children's healthy diet should be anticipatory, consistent and adapted to the family. Due to inconsistent recommendations and omitted focus on anticipatory counselling on child feeding, parents might perceive pressure and uncertainty related to the child's diet. © 2017 John Wiley & Sons Ltd.

Medical students' agenda-setting abilities during medical interviews.

PubMed

Roh, HyeRin; Park, Kyung Hye; Jeon, Young-Jee; Park, Seung Guk; Lee, Jungsun

2015-06-01

Identifying patients' agendas is important; however, the extent of Korean medical students' agenda-setting abilities is unknown. The study aim was to investigate the patterns of Korean medical students' agenda solicitation. A total of 94 third-year medical students participated. One scenario involving a female patient with abdominal pain was created. Students were video-recorded as they interviewed the patient. To analyze whether students identify patients' reasons for visiting, a checklist was developed based on a modified version of the Calgary-Cambridge Guide to the Medical Interview: Communication Process checklist. The duration of the patient's initial statement of concerns was measured in seconds. The total number of patient concerns expressed before interruption and the types of interruption effected by the medical students were determined. The medical students did not explore the patients' concerns and did not negotiate an agenda. Interruption of the patient's opening statement occurred in 4.62±2.20 seconds. The most common type of initial interruption was a recompleter (79.8%). Closed-ended questions were the most common question type in the second and third interruptions. Agenda setting should be emphasized in the communication skills curriculum of medical students. The Korean Clinical Skills Exam must assess medical students' ability to set an agenda.

Expert Knowledge Influences Decision-Making for Couples Receiving Positive Prenatal Chromosomal Microarray Testing Results.

PubMed

Rubel, M A; Werner-Lin, A; Barg, F K; Bernhardt, B A

2017-09-01

To assess how participants receiving abnormal prenatal genetic testing results seek information and understand the implications of results, 27 US female patients and 12 of their male partners receiving positive prenatal microarray testing results completed semi-structured phone interviews. These interviews documented participant experiences with chromosomal microarray testing, understanding of and emotional response to receiving results, factors affecting decision-making about testing and pregnancy termination, and psychosocial needs throughout the testing process. Interview data were analyzed using a modified grounded theory approach. In the absence of certainty about the implications of results, understanding of results is shaped by biomedical expert knowledge (BEK) and cultural expert knowledge (CEK). When there is a dearth of BEK, as in the case of receiving results of uncertain significance, participants rely on CEK, including religious/spiritual beliefs, "gut instinct," embodied knowledge, and social network informants. CEK is a powerful platform to guide understanding of prenatal genetic testing results. The utility of culturally situated expert knowledge during testing uncertainty emphasizes that decision-making occurs within discourses beyond the biomedical domain. These forms of "knowing" may be integrated into clinical consideration of efficacious patient assessment and counseling.

Empirical testing of criteria for dissociative schizophrenia.

PubMed

Laferrière-Simard, Marie-Christine; Lecomte, Tania; Ahoundova, Lola

2014-01-01

This study examined the validity of dissociative schizophrenia diagnostic criteria. In the first phase, 50 participants with a psychotic disorder were administered the Dissociative Experiences Scale and the Childhood Trauma Questionnaire to identify those with dissociative characteristics. In the second phase, we selected those who had a score of 15 or above on the Dissociative Experiences Scale. Fifteen of these participants were evaluated thoroughly with the Structured Clinical Interview for DSM-IV Axis I, Structured Clinical Interview for DSM-IV Axis II, and Structured Clinical Interview for DSM-IV Dissociative Disorders to determine whether they met the criteria for dissociative schizophrenia and to generate a clinical description. Our results indicated that 24% of the individuals we tested met these criteria. We propose making mandatory 1 of the 3 dissociative symptoms of the criteria to eliminate people with only nonspecific symptoms (e.g., extensive comorbidity). According to this modified criterion, 14% of our sample would receive a diagnosis of dissociative schizophrenia. However, a more comprehensive look at the clinical picture begs the question of whether dissociative schizophrenia is truly present in every person meeting the criteria. We discuss the relevance of creating a new schizophrenia subtype and offer recommendations for clinicians.

3-D bone models to improve treatment initiation among patients with osteoporosis: A randomised controlled pilot trial.

PubMed

Stephens, Melika H; Grey, Andrew; Fernandez, Justin; Kalluru, Ramanamma; Faasse, Kate; Horne, Anne; Petrie, Keith J

2016-01-01

To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis. Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models. Participants' beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data. Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%, p = .19). The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment.

Prevalence of the metabolic syndrome in Pudong New Area of Shanghai using three proposed definitions among Chinese adults.

PubMed

Xu, Wang-hong; Ruan, Xiao-nan; Fu, Xiao-jin; Zhu, Qiu-li; Zhang, Hong; Bai, Yun; Wu, Hong-yan; Zhou, Yi; Qiu, Hua; Sun, Qiao; Jiang, Qing-wu; Yang, Li-ming; Gu, Jian-jun; Zhao, Gen-ming

2010-05-12

The prevalence of metabolic syndrome (MS) has been increasing in China in recent years. The aim of this study is to estimate and compare the prevalence of MS among Chinese adults in Shanghai, one of the most economic developed areas in China, using definitions proposed by World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (modified ATP III) and International Diabetes Federation (IDF). This cross-sectional study included 5,584 adults at age 20-79 randomly selected from Pudong New Area of Shanghai, China, through a three-stage sampling. All participants were interviewed in-person between April and July of 2008 to collect information on demographic and lifestyle characteristics. At the interview, anthropometry and blood pressure were measured and bio-specimens were collected. The prevalence estimates for the MS increased with age for each definition in men and women, but the estimates varied greatly between the definitions and by sex. The prevalence of the MS was higher in men (20.2%) than in women (18.7%) using WHO definition but this sex difference was reversed when using the modified ATP III (28.4% for men vs. 35.1% for women) and the IDF (15.9% for men vs. 26.7% for women) criteria. The most common metabolic disorder in this population was dyslipidaemia, regardless of the definition used. Substantial agreement, estimated using the kappa statistic, was found between the modified ATP III and IDF definition, whereas the lowest agreement was observed between the WHO and ATP III criteria. The MS is highly prevalent among Chinese adults in Pudong New Area of Shanghai and the most prevalent component was dyslipidemia. These findings underscore the importance of prevention and control efforts for the MS in this area and the need for a unified predictive definition for the syndrome for use by clinical practitioners and public health agencies.

Soccer-based promotion of voluntary medical male circumcision: A mixed-methods feasibility study with secondary students in Uganda.

PubMed

Miiro, George; DeCelles, Jeff; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Muzira, Philip; Ssembajjwe, Wilber; Musoke, Saidat; Gibson, Lorna J; Hershow, Rebecca B; Francis, Suzanna; Torondel, Belen; Ross, David A; Weiss, Helen A

2017-01-01

The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention ("Make The Cut") among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised "coaches" who facilitated a 60-minute session delivered in schools, including an interactive penalty shoot-out game using metaphors for HIV prevention, sharing of the coaches' circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale.

Modification of Peyton's four-step approach for small group teaching - a descriptive study.

PubMed

Nikendei, Christoph; Huber, Julia; Stiepak, Jan; Huhn, Daniel; Lauter, Jan; Herzog, Wolfgang; Jünger, Jana; Krautter, Markus

2014-04-02

Skills-lab training as a methodological teaching approach is nowadays part of the training programs of almost all medical faculties. Specific ingredients have been shown to contribute to a successful learning experience in skills-labs. Although it is undoubted that the instructional approach used to introduce novel clinical technical skills to learners has a decisive impact on subsequent skills performance, as yet, little is known about differential effects of varying instructional methods. An instructional approach that is becoming increasingly prevalent in medical education is "Peyton's Four-Step Approach". As Peyton's Four Step Approach was designed for a 1:1 teacher : student ratio, the aim of the present study was to develop and evaluate a modified Peyton's Approach for small group teaching. The modified Peyton's Approach was applied in three skills-lab training sessions on IV catheter insertion, each with three first- or second year medical students (n = 9), delivered by three different skills-lab teachers. The presented descriptive study investigated the practicability and subjective impressions of skills-lab trainees and tutors. Skills-lab sessions were evaluated by trainees' self-assessment, expert ratings, and qualitative analysis of semi-standardized interviews conducted with trainees and tutors. The model was well accepted by trainees, and was rated as easy to realize, resulting in a good flow of teaching and success in attracting trainee's attention when observed by expert raters. Qualitative semi-standardized interviews performed with all of the trainees and tutors revealed that trainees valued repeated observation, instruction of trainees and the opportunity for independent performance, while tutors stressed that trainees were highly concentrated throughout the training and that they perceived repeated observation to be a valuable preparation for their own performance. The modified Peyton's Approach to instruct small groups of students in skills-lab training sessions has revealed to be practicable, well accepted by trainees, and easy for tutors to realize. Further research should address the realization of the model in larger skills-lab training groups.

Application of best practice guidelines for OSCEs-An Australian evaluation of their feasibility and value.

PubMed

Mitchell, Marion L; Henderson, Amanda; Jeffrey, Carol; Nulty, Duncan; Groves, Michele; Kelly, Michelle; Knight, Sabina; Glover, Pauline

2015-05-01

Objective Structured Clinical Examinations (OSCEs) are widely used in health professional education and should be based on sound pedagogical foundations. The aim of this study is to evaluate the feasibility and utility of using Best Practice Guidelines (BPGs) within an OSCE format in a broad range of tertiary education settings with under-graduate and post-graduate nursing and midwifery students. We evaluated how feasible it was to apply the BPGs to modify OSCEs in a course; students' perspective of the OSCE; and finally, if the BPG-revised OSCEs better prepared students for clinical practice when compared with the original OSCEs. A mixed method with surveys, focus groups and semi-structured interviews evaluated the BPGs within an OSCE. Four maximally different contexts across four sites in Australia were used. Participants included lecturers and undergraduate nursing students in high and low fidelity simulation settings; under-graduate midwifery students; and post-graduate rural and remote area nursing students. 691 students participated in revised OSCEs. Surveys were completed by 557 students; 91 students gave further feedback through focus groups and 14 lecturers participated in interviews. At all sites the BPGs were successfully used to modify and implement OSCEs. Students valued the realistic nature of the modified OSCEs which contributed to students' confidence and preparation for clinical practice. The lecturers considered the revised OSCEs enhanced student preparedness for their clinical placements. The BPGs have a broad applicability to OSCEs in a wide range of educational contexts with improved student outcomes. Students and lecturers identified the revised OSCEs enhanced student preparation for clinical practice. Subsequent examination of the BPGs saw further refinement to a set of eight BPGs that provide a sequential guide to their application in a way that is consistent with best practice curriculum design principles. Copyright © 2015 Elsevier Ltd. All rights reserved.

Soccer-based promotion of voluntary medical male circumcision: A mixed-methods feasibility study with secondary students in Uganda

PubMed Central

DeCelles, Jeff; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Muzira, Philip; Ssembajjwe, Wilber; Musoke, Saidat; Gibson, Lorna J.; Hershow, Rebecca B.; Francis, Suzanna; Torondel, Belen; Ross, David A.

2017-01-01

The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention (“Make The Cut”) among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised “coaches” who facilitated a 60-minute session delivered in schools, including an interactive penalty shoot-out game using metaphors for HIV prevention, sharing of the coaches’ circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale. PMID:29016651

Referring Physicians' Tendency to Collaborate With Radiologists in Managing Contrast Media-Related Risk Factors.

PubMed

İmamoğlu, Hakan; Doğan, Serap; Erdoğan, Nuri

2018-02-01

The aim of this study was to investigate the tendency of referring physicians to collaborate with radiologists in managing contrast media (CM)-related risk factors. The study was conducted at a single academic hospital. Among 150 referring physicians from various specialties, 51 referring physicians (34%) responded to the invitation letter asking for an interview with a radiologist. During the interview, a modified form of the Control Preferences Scale was administered, in which there were five preferences (each displayed on a separate card) that ranged from the fully active to fully passive involvement of referring physicians in managing CM-related risk factors. A descriptive analysis was performed through categorization of the results depending on the respondents' two most preferred roles. Thirty-six referring physicians (70.5%) preferred a collaborative role, and 15 (29.4%) preferred a noncollaborative role (i.e., remained on either the fully active or fully passive side). Among the referring physicians who preferred a collaborative role, the most common response (n = 15 [29.4%]) was collaborative-active. Referring physicians at the authors' institution have basic cognitive and motivational-affective tone toward collaboration in future teamwork aimed at the management of CM-related risk factors. A modified form of the Control Preferences Scale, as in this study, can be used to investigate the tendency of referring physicians to collaborate with radiologists. The results are discussed from ethical and legal perspectives. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Exploring nursing expertise in residential care for older people: a mixed method study.

PubMed

Phelan, Amanda; McCormack, Brendan

2016-10-01

To explore the expertise of Registered Nurses in residential care for older people. As older people in residential care have many complex dependencies, nursing expertise is an essential component of care excellence. However, the work of these nurses can be invisible and, therefore, unrecognized. Thus, additional attention is required to illuminate such nursing expertise. A mixed method design was used in this study. The research took place in 2012 in the Republic of Ireland. Twenty-three case study nurses were recruited from nursing homes. Each case study nurse involved five data collection methods: shadowing, interview with a colleague, interview with a resident, a demographic profile and a director of nursing survey. The study was also informed by a modified focus group. Qualitative data were analysed using directed content analysis using a conceptual framework generated from the literature on nursing expertise. Quantitative data were analysed using SPSS and presented in descriptive statistics. The findings from the case studies and the modified focus group are presented in seven themes, which represent nursing expertise in residential care of older people: transitions, context of the nursing home, saliency, holistic practice knowledge, knowing the resident, moral agency and skilled know how. Nursing expertise in residential care of older people is a complex phenomenon which encompasses many aspects of care delivery in a person-centred framework. By rendering this expertise visible, the need for appropriate and adequate skill mix for a growing residential care population is presented. © 2016 John Wiley & Sons Ltd.

Idaho rural family physician workforce study: the Community Apgar Questionnaire.

PubMed

Schmitz, D F; Baker, E; Nukui, A; Epperly, T

2011-01-01

Community factors of varied importance help determine the success of achieving and maintaining a physician workforce. The purpose of this study was to develop an evaluation instrument (Community Apgar Questioinnaire) useful to rural Idaho communities' in their assessment of the assets and capabilities related to physician recruitment and retention. A quantitative scoring interview instrument was developed based on a literature review, site visits and discussions with rural physicians and hospital administrators. A total of 11 rural Idaho communities differing in geography and other known variables were selected, some identified historically to have more success in recruitment and retention (α communities) and some historically noted to have more challenges (β comunities). In each community, the administrator of the hospital and the physician with recruiting responsibilities participated individually in a structured interview. A total of 11 physicians and 11 CEOs participated in the study. Differences were found across and within classes of factors associated with success in physician recruitment and retention where alpha communities scored higher on Community Apgar Questionnaire metrics. Some differences were noted by respondent class. Cumulative mean Community Apgar scores are higher in communities that have historically better track records in recruitment and retention. The Community Apgar Questionnaire seems to discriminate between communities with differing assets and capabilities, based on historical community-specific workforce trends. This assessment may allow for identification of both modifiable and non-modifiable factors and also may suggest which factors are most important for a community with limited available resources to address.

Coping strategies used by poorly adherent patients for self-managing bipolar disorder

PubMed Central

Blixen, Carol; Levin, Jennifer B; Cassidy, Kristin A; Perzynski, Adam T; Sajatovic, Martha

2016-01-01

Background Bipolar disorder (BD) is a chronic mental illness associated with reduced quality of life, high rates of suicide, and high financial costs. Evidence indicates that psychosocial stress might play an important role in the onset and course of BD. Objective The objective of this study was to address the gap between coping theory and the clinical use of coping strategies used to self-manage BD. Methods In-depth interviews were conducted with a sample of 21 poorly adherent patients with BD. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. Results Transcript-based analysis generated two major domains of coping strategies used to self-manage BD: 1) problem focused (altering eating habits, managing mood-stabilizing medications, keeping psychiatric appointments, seeking knowledge, self-monitoring, and socializing) and 2) emotion focused (distracting activities, denial, isolation, modifying/avoiding, helping others, and seeking social support). Participants used both types of coping strategies to deal with stressful situations brought about by the internal and external demands associated with self-management of BD. Conclusion This qualitative study provided a first step in evaluating coping strategies as a possible mediator in the self-management of BD and has implications for health care providers. Being able to characterize an individual’s coping behaviors can help patients modify or replace more maladaptive coping with better coping strategies in the self-management of this chronic mental illness. PMID:27524888

Emotional Numbness Modifies the Effect of End-of-Life Discussions on End-of-Life Care

PubMed Central

Maciejewski, Paul K.; Prigerson, Holly G.

2012-01-01

Context Overall, end-of-life (EOL) discussions are unrelated to psychological distress and associated with lower rates of aggressive care near death. Nevertheless, patients who report they feel emotionally numb about their illness might encounter difficulties cognitively processing an EOL discussion. Objectives We hypothesized that emotional numbness would modify the influence of EOL discussions on the receipt of less aggressive EOL care. Methods Data were derived from structured interviews with 290 participants in the federally-funded Coping with Cancer Study, a multisite, prospective cohort study of advanced cancer patients followed through their death. Patients’ reports of EOL discussions with their physician and emotional numbness were assessed a median of 4.6 months before death. Information about aggressive EOL care (i.e., ventilation, resuscitation in the last week of life, death in the Intensive Care Unit) was obtained from postmortem caregiver interviews and medical charts. Main and interactive effects of EOL discussions and emotional numbness on aggressive EOL care, adjusting for potential confounds, were evaluated using multiple logistic regression. Results The likelihood of aggressive EOL care associated with having EOL discussions increased by a factor of nine (adjusted odds ratio=9.02, 95% confidence interval 1.37, 59.6, P=0.022) for every unit increase in a patient’s emotional numbness score. Conclusion Emotional numbness diminishes a patient’s capacity to benefit from EOL discussions. EOL decision making may be more effective if clinical communications with emotionally numb patients are avoided. PMID:22926093

Evaluation of a social support measure that may indicate risk of depression during pregnancy.

PubMed

Spoozak, Lori; Gotman, Nathan; Smith, Megan V; Belanger, Kathleen; Yonkers, Kimberly A

2009-04-01

Strong social support has been linked with positive mental health and better birth outcomes for pregnant women. Our aim was to replicate the psychometric properties of the Kendler Social Support Interview modified for use in pregnant women and to establish the inventory's relationship to depression in pregnancy. The modified Kendler Social Support Interview (MKSSI) was evaluated using principal components analysis. The association with depression was used as an indicator of external validity and was assessed by logistic regression. Data from 783 subjects were analyzed. One large principal component, termed "global support," (eigenvalue=6.086) represented 22.5% of the total variance. However, 6 of the 27 items (frequency of contact with spouse, siblings, other relatives, and friends, and attendance at church and clubs) had low levels of association (<0.4) and thus were excluded from suggested items for a total score. Varimax rotation of the remaining 21 items resulted in subscales that fell into expected groupings: mother, father, siblings, friends, etc. One unit and two unit increases in the global support score were associated with 58.3% (OR=0.417, 95% CI=0.284-0.612) and 82.6% (OR=0.174, 95% CI=0.081-0.374) reductions in odds for depression, respectively. The ability of this social support scale to predict future depression in pregnancy has not yet been established due to cross-sectional design. The MKSSI is reliable and valid for use in evaluating social support and its relationship to depression in pregnant women.

Mastectomy, body deconstruction, and impact on identity: a qualitative study.

PubMed

Piot-Ziegler, C; Sassi, M-L; Raffoul, W; Delaloye, J-F

2010-09-01

This qualitative study aims at understanding the consequences of body deconstruction through mastectomy on corporality and identity in women with breast cancer. Nineteen women were contacted through the hospital. All had to undergo mastectomy. Some were offered immediate breast reconstruction, others, because of cancer treatments, had no planned reconstruction. A qualitative reflexive methodological background was chosen. Women were invited to participate in three semi-structured interviews, one shortly before or after mastectomy, and the other interviews later in their illness courses, after surgery. All interviews were transcribed verbatim. Thematic analysis was performed. The analysis of the first interview of each woman is presented in this article. Mastectomy provokes a painful experience of body deconstruction. Even when immediate reconstruction is proposed, contrasted feelings and dissonance are expressed when comparing the former healthy body to the present challenged body entity. Body transformations are accompanied with experiences of mutilation, strangeness, and modify the physical, emotional social, symbolic and relational dimensions of the woman's gendered identity. Although the opportunity of breast reconstruction is seen as a possible recovery of a lost physical symmetry and body integrity, grieving the past body and integrating a new corporality leads to a painful identity crisis. With mastectomy, the roots of the woman's identity are challenged, leading to a re-evaluation of her existential values. The consequences of mastectomy transform the woman's corporality and embodiment, and question her identity. Psychological support is discussed in the perspective of our results.

Occupational therapy in Australian acute hospitals: A modified practice.

PubMed

Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley

2016-08-01

Ongoing changes to health-care funding Australia wide continue to influence how occupational therapists practise in acute hospitals. This study describes the practice challenges experienced by Western Australian acute care occupational therapists. Then, it explores if and how acute care occupational therapists are modifying their practice in response to these practice changes. This study used a qualitative grounded theory approach. Semi-structured interviews were completed with 13 purposively selected acute care occupational therapists from four Western Australian metropolitan hospitals. Data were analysed using a constant comparative method to provide detailed descriptions of acute care occupational therapy practice and to generate theory. Five conceptual categories were developed. The first two addressed practice challenges: pragmatic organisational influences on client care and establishing a professional identity within the multidisciplinary team. Three categories related to therapist responses are as follows: becoming the client advocate, being the facilitator and applying clinical reasoning. Finally, modified practice was identified as the core category which explains the process whereby acute care occupational therapists are ensuring they remain relevant and authentic in the acute care context. Western Australian acute care occupational therapists are practising in a highly complex health context that presents many challenges. They are responding by using a modified form of practice that ensures occupational therapy skills remain relevant within the narrow confines of this health setting. © 2016 Occupational Therapy Australia.

Partners in adversity. V: Support, personality and coping behaviour at the time of crisis.

PubMed

Miller, P M; Surtees, P G

1995-01-01

This paper presents further results from a study of married women in Edinburgh who had just suffered an adverse experience: either their husband's non-fatal myocardial infarction, their husband's death or their own arrival in a Women's Aid refuge for battered women. Interviews were carried out 4-6 weeks following the adverse experience and, where possible, again approximately 3 months later. Symptoms were assessed using the 30-item General Health Questionnaire and criterion-based measures of depression and anxiety derived from it. The extent and nature of crisis support from household members and from groups of people outside the household, and also of failures in expected support, was measured at first interview. A modified version of Tyrer and Alexander's (1979) personality schedule was administered at the follow-up interview, and the resulting personality data were then reduced to six factors using principal components analysis. An interviewer assessment of how well the subject was coping was made at both interviews. The vast majority of the sample received extensive practical and emotional support from family and friends, and perhaps because such positive support was so prevalent, variations in it seemed to have little effect on symptoms. However, subjects who were unexpectedly 'let down' or criticised by friends or family tended to show higher symptom levels, although, surprisingly, this was less true for the bereaved wives than for the others. The six personality factors that emerged were labelled nervousness (similar to neuroticism) impulsivity, social withdrawal, helplessness, inferiority and aggressiveness. There was evidence that subjects high on nervousness remained symptomatic longer following the adverse experience. The aggressiveness factor showed a curvilinear trend with high and low aggressives showing higher symptom levels than middle aggressives. However, for the coronary wives the trend was linear with low aggressives having high symptoms. Subjects low on impulsivity were more affected by being 'let down' by friends and family. The interviewer-assessed coping measure was linearly related to nervousness and showed a curvilinear relationship with aggressiveness.

How well will you FIT? Use of a modified MMI to assess applicants' compatibility with an emergency medicine residency program.

PubMed

Min, Alice A; Leetch, Aaron; Nuño, Tomas; Fiorello, Albert B

2016-01-01

Emergency medicine residency programs have evaluated the use of Multiple Mini Interviews (MMIs) for applicants. The authors developed an MMI-style method called the Fast Interview Track (FIT) to predict an applicant's 'fit' within an individual residency program. Applicants meet with up to five residents and are asked one question by each. Residents score the applicant using a Likert scale from 1 to 5 on two questions: 'How well does the applicant think on his/her feet?' and 'How well do you think the applicant will fit in here?'. To assess how well these questions predicted a resident's 'fit', current residents scored fellow residents on these same questions. These scores were compared with the residents' interview FIT scores. A postmatch survey of applicants who did not match at this program solicited applicants' attitudes toward the FIT sessions. Among the junior class, the correlation between interview and current scores was significant for question 1 (rho=0.5192 [p=0.03]) and question 2 (rho=0.5753 [p=0.01]). Among seniors, Spearman's rho was statistically significant for question 2, though not statistically significant for question 1. The chi-square measure of high scores (4-5) versus low scores (1-3) found a statistically significant association between interview and current scores for interns and juniors. Of the 29 responses to the postmatch survey, 16 (55%) felt FIT sessions provided a good sense of the program's personality and only 6 (21%) disagreed. Nine (31%) felt FIT sessions positively impacted our program's ranking and 11 (38%) were 'Neutral'. Only two (7%) reported that FIT sessions negatively impacted their ranking of our program. FIT provided program leadership with a sense of an applicant's 'fit' within this program. Interview day scores correlated with scores received during residency. Most applicants report a positive experience with FIT sessions. FIT provides a useful tool to recruit applicants who fit with the residency program.

Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs leadership, policymaker, research and stakeholder partnership.

PubMed

Elwy, A Rani; Bokhour, Barbara G; Maguire, Elizabeth M; Wagner, Todd H; Asch, Steven M; Gifford, Allen L; Gallagher, Thomas H; Durfee, Janet M; Martinello, Richard A; Schiffner, Susan; Jesse, Robert L

2014-12-01

The Department of Veterans Affairs (VA) mandates disclosure of large-scale adverse events to patients, even if risk of harm is not clearly present. Concerns about past disclosures warranted further examination of the impact of this policy. Through a collaborative partnership between VA leaders, policymakers, researchers and stakeholders, the objective was to empirically identify critical aspects of disclosure processes as a first step towards improving future disclosures. Semi-structured interviews were conducted with participants at nine VA facilities where recent disclosures took place. Ninety-seven stakeholders participated in the interviews: 38 employees, 28 leaders (from facilities, regions and national offices), 27 Veteran patients and family members, and four congressional staff members. Facility and regional leaders were interviewed by telephone, followed by a two-day site visit where employees, patients and family members were interviewed face-to-face. National leaders and congressional staff also completed telephone interviews. Interviews were analyzed using rapid qualitative assessment processes. Themes were mapped to the stages of the Crisis and Emergency Risk Communication model: pre-crisis, initial event, maintenance, resolution and evaluation. Many areas for improvement during disclosure were identified, such as preparing facilities better (pre-crisis), creating rapid communications, modifying disclosure language, addressing perceptions of harm, reducing complexity, and seeking assistance from others (initial event), managing communication with other stakeholders (maintenance), minimizing effects on staff and improving trust (resolution), and addressing facilities' needs (evaluation). Through the partnership, five recommendations to improve disclosures during each stage of communication have been widely disseminated throughout the VA using non-academic strategies. Some improvements have been made; other recommendations will be addressed through implementation of a large-scale adverse event disclosure toolkit. These toolkit strategies will enable leaders to provide timely and transparent information to patients and families, while reducing the burden on employees and the healthcare system during these events.

How well will you FIT? Use of a modified MMI to assess applicants' compatibility with an emergency medicine residency program.

PubMed

Min, Alice A; Leetch, Aaron; Nuño, Tomas; Fiorello, Albert B

2016-01-01

Purpose Emergency medicine residency programs have evaluated the use of Multiple Mini Interviews (MMIs) for applicants. The authors developed an MMI-style method called the Fast Interview Track (FIT) to predict an applicant's 'fit' within an individual residency program. Methods Applicants meet with up to five residents and are asked one question by each. Residents score the applicant using a Likert scale from 1 to 5 on two questions: 'How well does the applicant think on his/her feet?' and 'How well do you think the applicant will fit in here?'. To assess how well these questions predicted a resident's 'fit', current residents scored fellow residents on these same questions. These scores were compared with the residents' interview FIT scores. A postmatch survey of applicants who did not match at this program solicited applicants' attitudes toward the FIT sessions. Results Among the junior class, the correlation between interview and current scores was significant for question 1 (rho=0.5192 [p=0.03]) and question 2 (rho=0.5753 [p=0.01]). Among seniors, Spearman's rho was statistically significant for question 2, though not statistically significant for question 1. The chi-square measure of high scores (4-5) versus low scores (1-3) found a statistically significant association between interview and current scores for interns and juniors. Of the 29 responses to the postmatch survey, 16 (55%) felt FIT sessions provided a good sense of the program's personality and only 6 (21%) disagreed. Nine (31%) felt FIT sessions positively impacted our program's ranking and 11 (38%) were 'Neutral'. Only two (7%) reported that FIT sessions negatively impacted their ranking of our program. Conclusions FIT provided program leadership with a sense of an applicant's 'fit' within this program. Interview day scores correlated with scores received during residency. Most applicants report a positive experience with FIT sessions. FIT provides a useful tool to recruit applicants who fit with the residency program.

Significant and safe reduction of propofol sedation dose for geriatric population undergoing pacemaker implantation: randomized clinical trial.

PubMed

Hernandez-Perez, Ana Luisa; Gallardo-Hernandez, Ana Gabriela; Ordoñez-Espinosa, German; Martinez-Carrillo, Beatriz; Bermudez-Ochoa, Manuel Gerardo; Revilla-Monsalve, Cristina; Sanchez-Lopez, Jose Antonio; Saturno-Chiu, Guillemo; Leder, Ronald

2018-02-21

A previous multidisciplinary pilot study based on computer simulations for the geriatric population showed that a dose of 0.5 mg/kg/h of propofol could sedate patients older than 65 for pacemaker implantation. The present study validates that the pacemaker implantation can be done in the elderly using 0.5-1 mg/kg/h of propofol with hemodynamic stability. 66 patients from 65 to 88 years old scheduled for pacemaker implantation were randomly assigned one of three doses of propofol. The first group received 2 mg/kg/h of propofol (P2) that is within normal range of the sedation dose. The second group received 1 mg/kg/h (P1) dose and the third group received the dose of 0.5 mg/kg/h (P0.5) according to the simulation-predicted dose for geriatric populations. All patients kept MAP between 76 and 85 mmHg, with no hypotension episodes in any of the groups; therefore, they were all hemodynamically stable during the procedure. BIS was between 80 and 65 during the pacemaker implantation for the three groups, BIS of group P2 was significantly lower than the other groups. BIS in groups P1 and P0.5 was within the appropriated range for moderate sedation. Brice was positive for auditory recalls only when there was arousing noise in the operating room. Moderate sedation, adequate for pacemaker implantation, can be achieved infusing 0.5-1 mg/kg/h of propofol in elderly patients when the patient has proper analgesia management at the device implantation site. The second important condition is to avoid unnecessary and alerting auditory and mechanical stimuli in the operating room, so that the patient will remain calm.

Psychological violence experienced by men who have sex with men in Puducherry, India: a qualitative study.

PubMed

Elouard, Yajna; Essén, Birgitta

2013-01-01

Men who have sex with men are a hidden population in India. This study explores the psychological violence such men are exposed to in Puducherry, India. Eleven in-depth interviews probe experiences of blackmail, discrimination, and rejection. Some informants modified their behaviors or appearances to avoid harassment and safeguard their families' reputations. Others told how Indian men accepted their behaviors, but rejected their identities. Social pressure to marry was also a recurring theme. Understanding the factors behind these violent experiences may facilitate their amelioration.

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India.

PubMed

Devpura, Bhanu; Bhadesia, Pranav; Nimbalkar, Somashekhar; Desai, Sandeep; Phatak, Ajay

2016-01-01

Objective . We explored reasons for discharged against medical advice (DAMA) of neonates from a neonatal intensive care unit (NICU) through in-depth interviews of the parents/guardians. Methods . Of 456 babies admitted to NICU during April 2014 to March 2015, 116 babies were DAMA. Parents of randomly selected 50 babies of these 116, residing within 50 kilometers, were approached for in-depth interviews at their homes. Audio recordings were done and manually transcribed, analyzed in detail to explore common threads leading to DAMA. Basic demographic information of the newborns was retrieved from hospital records. Results . The prevalence of DAMA was 25.4%. Of 50 parents approached, 41 in-depth interviews were completed. Nonaffordability (38.6%), no improvement (14.6%), poor prognosis (12%), and inappropriate behavior of the patient relation office personnel (10.6%) were major factors contributing to DAMA. Parents of 6.6% neonates wanted guarantee of survival and 5.3% parents reported poor behavior of nurses. No gender bias was observed related to DAMA. One-third of neonates (34.1%) were DAMA on first day of admission. Conclusions . The issue of DAMA needs attention. Besides nonaffordability and clinical characteristics of the baby, communication (breaking bad news, counseling, etc.) and lack of adequate infrastructure for relatives emerged as modifiable factors leading to DAMA.

Developing biology teachers' pedagogical content knowledge through learning study: the case of teaching human evolution

NASA Astrophysics Data System (ADS)

Bravo, Paulina; Cofré, Hernán

2016-11-01

This work explores how pedagogical content knowledge (PCK) on evolution was modified by two biology teachers who participated in a professional development programme (PDP) that included a subsequent follow-up in the classroom. The PDP spanned a semester and included activities such as content updates, collaborative lesson planning, and the presentation of planned lessons. In the follow-up part, the lessons were videotaped and analysed, identifying strategies, activities, and conditions based on student learning about the theory of evolution. Data were collected in the first round with an interview before the training process, identifying these teachers' initial content representation (CoRe) for evolution. Then, a group interview was conducted after the lessons, and, finally, an interview of stimulated recall with each teacher was conducted regarding the subject taught to allow teachers to reflect on their practice (final CoRe). This information was analysed by the teachers and the researchers, reflecting on the components of the PCK, possible changes, and the rationale behind their actions. The results show that teachers changed their beliefs and knowledge about the best methods and strategies to teach evolution, and about students' learning obstacles and misconceptions on evolution. They realised how a review of their own practices promotes this transformation.

Brazilian version of the body dysmorphic disorder examination.

PubMed

Jorge, Renata Trajano Borges; Sabino Neto, Miguel; Natour, Jamil; Veiga, Daniela Francescato; Jones, Anamaria; Ferreira, Lydia Masako

2008-03-06

Body image improvement is considered to be the main reason for undergoing plastic surgery. The objective was to translate the Body Dysmorphic Disorder Examination (BDDE) into Brazilian Portuguese and to adapt and validate this questionnaire for use in Brazil. Cross-sectional survey, at the Department of Plastic Surgery of Universidade Federal de São Paulo. The BDDE was first translated into Portuguese and then back-translated into English. These translations were then discussed by healthcare professionals in order to establish the final Brazilian version. In a second stage, the validity and reliability of the BDDE were assessed. For this, patients were initially interviewed by two interviewers and subsequently, by only one of these interviewers. On the first occasion, in addition to the BDDE, the body shape questionnaire (BSQ) and the Rosenberg self-esteem scale were also applied. These questionnaires were applied to 90 patients. Six questions were modified during the assessment of cultural equivalence. Cronbach's alpha was 0.89 and the intraclass correlation coefficients for interobserver and test-retest reliability were 0.91 and 0.87, respectively. Pearson's coefficient showed no correlation between the BDDE and the Rosenberg self-esteem scale (0.22), whereas there was a moderate correlation between the BDDE and the BSQ (0.64). The BDDE was successfully translated and adapted, with good internal consistency, reliability and construct validity.

The Role of Family in a Dietary Risk Reduction Intervention for Cardiovascular Disease.

PubMed

Schumacher, Tracy L; Burrows, Tracy L; Thompson, Deborah I; Callister, Robin; Spratt, Neil J; Collins, Clare E

2016-09-30

Diet is an essential strategy for the prevention of primary and secondary cardiovascular disease (CVD) events. The objectives were to examine: how families at increased risk of CVD perceived personal risk, their motivations to make dietary changes, their understanding of diet, and the influence of other family members. Individuals (>18 years) who completed an Australian family-based CVD risk reduction program were invited to a semi-structured telephone interview. Responses were recorded, transcribed verbatim and analysed using a systematic deductive approach with coding derived from key concepts developed as part of the interview structure. Seventeen participants from eight families were interviewed (aged 18-70 years, 47% male, five with CVD diagnosis). Key themes indicated both intrinsic and extrinsic motivations to improve heart health, variations in risk perception, recognition of the role diet plays in heart health, and the extent of family influences on eating patterns. Discrepancies between perceived and actual CVD risk perception impacted on perceived "need" to modify current dietary patterns towards heart health recommendations. Therefore, strategies not reliant on risk perception are needed to engage those with low risk perception. This could involve identifying and accessing the family "ringleader" to influence involvement and capitalising on personal accountability to other family members.

Pancreatitis Quality of Life Instrument: Development of a new instrument

PubMed Central

Bova, Carol; Barton, Bruce; Hartigan, Celia

2014-01-01

Objectives: The goal of this project was to develop the first disease-specific instrument for the evaluation of quality of life in chronic pancreatitis. Methods: Focus groups and interview sessions were conducted, with chronic pancreatitis patients, to identify items felt to impact quality of life which were subsequently formatted into a paper-and-pencil instrument. This instrument was used to conduct an online survey by an expert panel of pancreatologists to evaluate its content validity. Finally, the modified instrument was presented to patients during precognitive testing interviews to evaluate its clarity and appropriateness. Results: In total, 10 patients were enrolled in the focus groups and interview sessions where they identified 50 items. Once redundant items were removed, the 40 remaining items were made into a paper-and-pencil instrument referred to as the Pancreatitis Quality of Life Instrument. Through the processes of content validation and precognitive testing, the number of items in the instrument was reduced to 24. Conclusions: This marks the development of the first disease-specific instrument to evaluate quality of life in chronic pancreatitis. It includes unique features not found in generic instruments (economic factors, stigma, and spiritual factors). Although this marks a giant step forward, psychometric evaluation is still needed prior to its clinical use. PMID:26770703

Changing stress while stressing change: the role of interprofessional education in mediating stress in the introduction of a transformative technology.

PubMed

Gillan, Caitlin; Wiljer, David; Harnett, Nicole; Briggs, Kaleigh; Catton, Pamela

2010-11-01

The introduction of a transformative technology into practice settings can affect the functioning of interprofessional teams, placing stress on interprofessional relationships, thus slowing adoption and change. This study explored the potential of an interprofessional education (IPE) approach to mediate this stress and facilitate the adoption of a transformative technology- Image Guided Radiation Therapy (IGRT). Oncologists, physicists, and therapists in radiation medicine who attended an interprofessional IGRT Education Course were interviewed about perceived benefits and stressors to IPE and to interprofessional practice (IPP) in the IGRT context. A modified grounded theory approach was used to conduct 14 interviews, with 200 minutes of interview time recorded. In introducing IGRT, participants noted interprofessional stress in understanding and adopting new technology. IPE offered common terminology, appreciation for others' knowledge, and a holistic framework for practice. Outcomes were thought to foster collaboration, efficiency, and improved professional role definition. Time constraints and power relations were noted to be residual stressors exacerbated by IPE, but were thought to be transient. IPE can thus be of benefit in the implementation of transformative technologies such as IGRT, through mediation of interprofessional stress inherent in change. Interprofessional knowledge, collaboration, and efficiency in practice facilitate the development and adoption of a new practice model.

Negative Symptoms and Avoidance of Social Interaction: A Study of Non-Verbal Behaviour.

PubMed

Worswick, Elizabeth; Dimic, Sara; Wildgrube, Christiane; Priebe, Stefan

2018-01-01

Non-verbal behaviour is fundamental to social interaction. Patients with schizophrenia display an expressivity deficit of non-verbal behaviour, exhibiting behaviour that differs from both healthy subjects and patients with different psychiatric diagnoses. The present study aimed to explore the association between non-verbal behaviour and symptom domains, overcoming methodological shortcomings of previous studies. Standardised interviews with 63 outpatients diagnosed with schizophrenia were videotaped. Symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS), the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale. Independent raters later analysed the videos for non-verbal behaviour, using a modified version of the Ethological Coding System for Interviews (ECSI). Patients with a higher level of negative symptoms displayed significantly fewer prosocial (e.g., nodding and smiling), gesture, and displacement behaviours (e.g., fumbling), but significantly more flight behaviours (e.g., looking away, freezing). No gender differences were found, and these associations held true when adjusted for antipsychotic medication dosage. Negative symptoms are associated with both a lower level of actively engaging non-verbal behaviour and an increased active avoidance of social contact. Future research should aim to identify the mechanisms behind flight behaviour, with implications for the development of treatments to improve social functioning. © 2017 S. Karger AG, Basel.

Multi-level assessment protocol (MAP) for adoption in multi-site clinical trials

PubMed Central

Guydish, J.; Manser, S.T.; Jessup, M.; Tajima, B.; Sears, C.; Montini, T.

2010-01-01

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is intended to test promising drug abuse treatment models in multi-site clinical trials, and to support adoption of new interventions into clinical practice. Using qualitative research methods we asked: How might the technology of multi-site clinical trials be modified to better support adoption of tested interventions? A total of 42 participants, representing 8 organizational levels ranging from clinic staff to clinical trial leaders, were interviewed about their role in the clinical trial, its interactions with clinics, and intervention adoption. Among eight clinics participating in the clinical trial, we found adoption of the tested intervention in one clinic only. In analysis of interview data we identified four conceptual themes which are likely to affect adoption and may be informative in future multi-site clinical trials. We offer the conclusion that planning for adoption in the early stages of protocol development will better serve the aim of integrating new interventions into practice. PMID:20890376

The Unanticipated Benefits of Behavioral Assessments and Interviews on Anxiety, Self-Esteem and Depression Among Women Engaging in Transactional Sex.

PubMed

Gunn, Jayleen K L; Roth, Alexis M; Center, Katherine E; Wiehe, Sarah E

2016-11-01

Women engaging in transactional sex have disproportional mental health co-morbidity and face substantial barriers to accessing social services. We hypothesized that participation in a longitudinal research study, with no overt intervention, would lead to short-term mental health improvements. For 4-weeks, 24 women disclosed information about their lives via twice daily cell-phone diaries and weekly interviews. We used t tests to compare self-esteem, anxiety, and depression at baseline and exit. Tests were repeated for hypothesized effect modifiers (e.g., substance abuse severity; age of sex work debut). For particularly vulnerable women (e.g., less educated, histories of abuse, younger initiation of sex work) participation in research conferred unanticipated mental health benefits. Positive interactions with researchers, as well as discussing lived experiences, may explain these effects. Additional studies are needed to confirm findings and identify mechanisms of change. This work contributes to the growing body of literature documenting that study participation improves mental health.

A qualitative study exploring women's journeys to becoming smokers in the social context of urban India.

PubMed

Salvi, Devashri; Nagarkar, Aarti

2018-04-01

In India, the prevalence of smoking among women is increasing, and the reasons behind this are unclear. We aimed to study the factors leading to initiation and maintenance of the smoking habit in women in Pune, India. Twenty-seven urban women smokers, ranging from 21 to 60 years of age (31.96 ± 10.70 years), were interviewed between September 2015 and February 2016. The in-depth interviews consisted of questions on pre-decided categories, including initiation, motivation to continue smoking, and risk perception. Thematic analysis revealed that peer pressure, curiosity, fascination, experimentation, and belonging to a group were factors that led to initiation, while lack of alternatives for stress relief, work environments, and lack of leisure time activities provided circumstances to continue smoking. Participants recognized a sense of liberation and independence from smoking cigarettes and perceived health risks as minor and distant. These findings can be used to develop or modify interventions to prevent and control smoking among urban Indian women.

Outbreak of Salmonella enterica serotype I 4,5,12:i:- infections: the challenges of hypothesis generation and microwave cooking.

PubMed

Mody, R K; Meyer, S; Trees, E; White, P L; Nguyen, T; Sowadsky, R; Henao, O L; Lafon, P C; Austin, J; Azzam, I; Griffin, P M; Tauxe, R V; Smith, K; Williams, I T

2014-05-01

We investigated an outbreak of 396 Salmonella enterica serotype I 4,5,12:i:- infections to determine the source. After 7 weeks of extensive hypothesis-generation interviews, no refined hypothesis was formed. Nevertheless, a case-control study was initiated. Subsequently, an iterative hypothesis-generation approach used by a single interviewing team identified brand A not-ready-to-eat frozen pot pies as a likely vehicle. The case-control study, modified to assess this new hypothesis, along with product testing indicated that the turkey variety of pot pies was responsible. Review of product labels identified inconsistent language regarding preparation, and the cooking instructions included undefined microwave wattage categories. Surveys found that most patients did not follow the product's cooking instructions and did not know their oven's wattage. The manufacturer voluntarily recalled pot pies and improved the product's cooking instructions. This investigation highlights the value of careful hypothesis-generation and the risks posed by frozen not-ready-to-eat microwavable foods.

A caring partnership: expectations of ageing persons with disabilities for their primary care doctors.

PubMed

Shapiro, Johanna; Mosqueda, Laura; Botros, Danny

2003-12-01

The population of individuals who are ageing with a disability is growing rapidly, yet we know little about their views of their primary care and family physicians. In this qualitative study using a modified form of life history interviewing, 30 older respondents with a variety of disabilities discussed their past and current relationships with physicians. Data analysis identified as the primary theme of these interviews the importance of establishing a caring partnership between patient and physician. Important subthemes included physician avoidance of assumptions and stereotypes about persons with disabilities, physician commitment to patient well-being balanced by a capacity for keeping the disability in perspective, and the relationship between the need for physician specialized knowledge and the necessity of acknowledging patient expertise. Certain patient characteristics such as self-reliance and assertiveness also emerged as significant influences. A partnership with primary care/family physicians that communicates concern while avoiding stereotyping and recognizing patient expertise is important for many patients ageing with a disability.

Health seeking behavior of the mothers for the special care new-born unit discharged children: a comparative study.

PubMed

Jeet, Gursimer; Sharma, Atul; Mohanta, Tulika Goswami; Trakroo, Ajay

2013-01-01

Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mothers who had normal uneventful institutional deliveries. Mothers of 29 SCNU discharged, 34 institutions delivered and 26 home delivered children were interviewed using a semi-structured interview schedule and a knowledge, attitude and practice (KAP) survey tool. Mothers of children admitted to SCNU scored better in questions related to vaccination, contraception, protection of child from infections and cold and perceptions about traditional healers, but overall KAP scores in the three groups were not found significantly different.

Rural Latinos' mental wellbeing: a mixed-methods pilot study of family, environment and social isolation factors.

PubMed

Stacciarini, Jeanne-Marie R; Smith, Rebekah; Garvan, Cynthia Wilson; Wiens, Brenda; Cottler, Linda B

2015-05-01

Upon immigration to the rural areas in the US, Latino families may experience cultural, geographic, linguistic and social isolation, which can detrimentally affect their wellbeing by acting as chronic stressors. Using a community engagement approach, this is a pilot mixed-method study with an embedded design using concurrent qualitative and quantitative data. The purpose of this study is to evaluate family and social environments in terms of protective factors and modifiable risks associated with mental well-being in Latino immigrants living in rural areas of Florida. Latino immigrant mother and adolescent dyads were interviewed by using in-depth ethnographic semistructured interviews and subsequent quantitative assessments, including a demographic questionnaire and three structured instruments: the Family Environment Scale Real Form, the SF-12v2™ Health Survey and the short version (eight items) of PROMIS Health Organization Social Isolation. This mixed-method pilot study highlighted how family, rural, and social environments can protect or impair wellbeing in rural Latino immigrant mother and adolescent dyads.

Symptoms associated with the DSM IV diagnosis of depression in pregnancy and post partum.

PubMed

Kammerer, Martin; Marks, Maureen N; Pinard, Claudia; Taylor, Alyx; von Castelberg, Brida; Künzli, Hansjörg; Glover, Vivette

2009-06-01

Pregnancy and the postpartum may affect symptoms of depression. However it has not yet been tested how the symptoms used for the DSM IV diagnosis of depression discriminate depressed from non depressed women perinatally. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all associated DSM IV symptoms of depression with depressed and non depressed women in pregnancy and the postpartum period. Loss of appetite was not associated with depression either ante or postnatally. The antenatal symptom pattern was different from the postnatal. The sensitivity of the symptoms ranged from 0.7% to 51.6%, and specificity from 61.3% to 99.1%. The best discriminating symptoms were motor retardation/agitation and concentration antenatally, and motor retardation/agitation, concentration and fatigue postnatally. Depression in pregnancy and postpartum depression show significantly different symptom profiles. Appetite is not suitable for the diagnosis of depression in the perinatal period.

Racial/Ethnic Differences in the Association between Arrest and Unprotected Anal Sex among Young Men Who Have Sex with Men: The P18 Cohort Study.

PubMed

Ompad, Danielle C; Kapadia, Farzana; Bates, Francesca C; Blachman-Forshay, Jaclyn; Halkitis, Perry N

2015-08-01

This analysis aimed to determine whether the relationship between a history of arrest and unprotected anal sex (UAS) is the same for Black/Latino gay, bisexual, and other young men who have sex with men (YMSM) as compared to White/Asian/Pacific Islander (API) YMSM in New York City (NYC). Baseline audio-computer-assisted self-interview (ACASI) and interviewer-administered survey data from a sample of 576 YMSM aged 18-19 years old who self-reported being HIV-negative were analyzed. Data included history of arrest and incarceration as well as UAS in the past 30 days. Race/ethnicity was an effect modifier of the association between arrest and UAS among YMSM: White/API YMSM with a lifetime arrest history were more than three times as likely to report UAS, and Black/Latino YMSM with a lifetime history of arrest were approximately 70 % less likely to report UAS as compared with White/API YMSM with no reported arrest history. Race/ethnicity may modify the relationship between arrest and sexual risk behavior because the etiology of arrest differs by race, as partially evidenced by racial/ethnic disparities in police stop, arrest, and incarceration rates in NYC. Arrest could not only be an indicator of risky behavior for White/API YMSM but also an indicator of discrimination for Black/Latino YMSM. Further research is needed to assess whether the differential associations observed here vis-à-vis race/ethnicity are robust across different populations and different health outcomes.

Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens.

PubMed

Shaw, Yomei; Metes, Ilinca D; Michaud, Kaleb; Donohue, Julie M; Roberts, Mark S; Levesque, Marc C; Chang, Judy C

2018-04-01

Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients' feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. In addition to feelings about the necessity and dangers of medications, patients' feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients' motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients' feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients' feelings throughout the treatment decision-making process. © 2017, American College of Rheumatology.

The PHQ-PD as a Screening Tool for Panic Disorder in the Primary Care Setting in Spain

PubMed Central

Wood, Cristina Mae; Ruíz-Rodríguez, Paloma; Tomás-Tomás, Patricia; Gracia-Gracia, Irene; Dongil-Collado, Esperanza; Iruarrizaga, M. Iciar

2016-01-01

Introduction Panic disorder is a common anxiety disorder and is highly prevalent in Spanish primary care centres. The use of validated tools can improve the detection of panic disorder in primary care populations, thus enabling referral for specialized treatment. The aim of this study is to determine the accuracy of the Patient Health Questionnaire-Panic Disorder (PHQ-PD) as a screening and diagnostic tool for panic disorder in Spanish primary care centres. Method We compared the psychometric properties of the PHQ-PD to the reference standard, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview. General practitioners referred 178 patients who completed the entire PHQ test, including the PHQ-PD, to undergo the SCID-I. The sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of the PHQ-PD were assessed. Results The operating characteristics of the PHQ-PD are moderate. The best cut-off score was 5 (sensitivity .77, specificity .72). Modifications to the questionnaire's algorithms improved test characteristics (sensitivity .77, specificity .72) compared to the original algorithm. The screening question alone yielded the highest sensitivity score (.83). Conclusion Although the modified algorithm of the PHQ-PD only yielded moderate results as a diagnostic test for panic disorder, it was better than the original. Using only the first question of the PHQ-PD showed the best psychometric properties (sensitivity). Based on these findings, we suggest the use of the screening questions for screening purposes and the modified algorithm for diagnostic purposes. PMID:27525977

Women's experiences of hormonal therapy for breast cancer: exploring influences on medication-taking behaviour.

PubMed

Cahir, Caitriona; Dombrowski, Stephan U; Kelly, Catherine M; Kennedy, M John; Bennett, Kathleen; Sharp, Linda

2015-11-01

Five to 10 years of adjuvant hormonal therapy is recommended to prevent breast cancer recurrence. This study investigated modifiable influences on adjuvant hormonal therapy medication-taking behaviour (MTB) in women with stage I-III breast cancer. Semi-structured face-to-face interviews among women with stage I-III breast cancer prescribed adjuvant hormonal therapy purposively sampled by their MTB at two cancer centres. Thematic analysis was conducted based on the Framework approach, with the Theoretical Domains Framework (TDF) informing the analysis framework; the TDF is an integrative framework consisting of 14 domains of behavioural change to inform intervention design. Thirty-one women participated in interviews (14 adherent/persistent; 7 non-adherent/persistent; 10 non-persistent). Three domains identified both barriers and enablers to hormonal therapy MTB across the three MTB strata: beliefs about consequences, intentions and goals and behaviour regulation, but their influence was different across the strata. Other domains influenced individual MTB strata. Key enablers for adherent/persistent women were identified within the domain beliefs about consequences (breast cancer recurrence), intentions and goals (high-priority), beliefs about capabilities (side effects) and behaviour regulation (managing medication). Barriers were identified within the domain behaviour regulation (no routine), memory, attention and decision processes (forgetting) and environmental context and resources (stressors) for non-adherent/persistent women and intentions and goals (quality of life), behaviour regulation (temporal self-regulation), reinforcement, beliefs about consequences (non-necessity) and social influences (clinical support) for non-persistent women. This study identified modifiable influences on hormonal therapy MTB. Targeting these influences in clinical practice may improve MTB and hence survival in this population.

How faculty learn about and implement research-based instructional strategies: The case of Peer Instruction

NASA Astrophysics Data System (ADS)

Dancy, Melissa; Henderson, Charles; Turpen, Chandra

2016-06-01

[This paper is part of the Focused Collection on Preparing and Supporting University Physics Educators.] The lack of knowledge about how to effectively spread and sustain the use of research-based instructional strategies is currently a significant barrier to the improvement of undergraduate physics education. In this paper we address this lack of knowledge by reporting on an interview study of 35 physics faculty, of varying institution types, who were self-reported users of, former users of, or knowledgeable nonusers of the research-based instructional strategy Peer Instruction. Interview questions included in this analysis focused on the faculty's experiences, knowledge, and use of Peer Instruction, along with general questions about current and past teaching methods used by the interviewee. The primary findings include the following: (i) Faculty self-reported user status is an unreliable measure of their actual practice. (ii) Faculty generally modify specific instructional strategies and may modify out essential components. (iii) Faculty are often unaware of the essential features of an instructional strategy they claim to know about or use. (iv) Informal social interactions provide a significant communication channel in the dissemination process, in contrast to the formal avenues of workshops, papers, websites, etc., often promoted by change agents, and (v) experience with research-based strategies as a graduate student or through curriculum development work may be highly impactful. These findings indicate that educational transformation can be better facilitated by improving communication with faculty, supporting effective modification by faculty during implementation, and acknowledging and understanding the large impact of informal social interactions as a mode of dissemination.

Assessing for domestic violence in sexual health environments: a qualitative study.

PubMed

Horwood, Jeremy; Morden, Andrew; Bailey, Jayne E; Pathak, Neha; Feder, Gene

2018-03-01

Domestic violence and abuse (DVA) is a major clinical challenge and public health issue. Sexual health services are an important potential site of DVA intervention. The Assessing for Domestic Violence in Sexual Health Environments (ADViSE) intervention aimed to improve identification and management of DVA in sexual healthcare settings and is a modified version of the Identification and Referral to Improve Safety (IRIS) general practice programme. Our qualitative evaluation aimed to explore the experiences of staff participating in an IRIS ADViSE pilot. Interviews were conducted with 17 sexual health clinic staff and DVA advocate workers. Interviews were audio recorded, transcribed, anonymised and analysed thematically. Staff prioritised enquiring about DVA and tailored their style of enquiry to the perceived characteristics of patients, current workload and individual clinical judgements. Responding to disclosures of abuse was divided between perceived low-risk cases (with quick onwards referral) and high-risk cases (requiring deployment of institution safeguarding procedures), which were viewed as time consuming and could create tensions with patients. Ongoing training and feedback, commissioner recognition, adequate service-level agreements and reimbursements are required to ensure sustainability and wider implementation of IRIS ADViSE. Challenges of delivering and sustaining IRIS ADViSE included the varied styles of enquiry, as well as tensions and additional time pressure arising from disclosure of abuse. These can be overcome by modifying initial training, providing regular updates and stronger recognition (and resources) at policy and commissioning levels. © 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 digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters.

PubMed

Grande, Stuart W; Castaldo, Mary Ganger; Carpenter-Song, Elizabeth; Griesemer, Ida; Elwyn, Glyn

2017-08-01

Are the benefits of recording clinical encounters shared across different groups, or do they vary based on social position? Studies show that educated patients record their clinical visits to enhance their experience, but very little is known about recording benefits among "hard-to-reach" populations. To examine the reactions of homeless people to the idea of using a smartphone to record their own clinical encounter, either covertly or with permission from their physician. We conducted semi-structured interviews with individuals at a temporary housing shelter in Northern New England. A thematic analysis identified themes that were iteratively refined into representative groups. Eighteen (18) interviews were conducted, 12 with women and six with men. Initial reactions to clinical recordings were positive (11 of 18). A majority (17 of 18) were willing to use recordings in future visits. A thematic analysis characterized data in two ways: (i) by providing reliable evidence for review, they functioned as an advocacy measure for patients; (ii) by promoting transparency and levelling social distance, this technology modified clinical relationships. Recordings permitted the sharing of data with others, providing tangible proof of behaviour and refuting misconceptions. Asking permission to record appeared to modify relationships and level perceived social distance with clinicians. We found that while many rural, disadvantaged individuals felt marginalized by the wide social distance between themselves and their clinicians, recording technology may serve as an advocate by holding both patients and doctors accountable and by permitting the burden of clinical proof to be shared. © 2016 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Child food insecurity increases risks posed by household food insecurity to young children's health.

PubMed

Cook, John T; Frank, Deborah A; Levenson, Suzette M; Neault, Nicole B; Heeren, Tim C; Black, Maurine M; Berkowitz, Carol; Casey, Patrick H; Meyers, Alan F; Cutts, Diana B; Chilton, Mariana

2006-04-01

The US Food Security Scale (USFSS) measures household and child food insecurity (CFI) separately. Our goal was to determine whether CFI increases risks posed by household food insecurity (HFI) to child health and whether the Food Stamp Program (FSP) modifies these effects. From 1998 to 2004, 17,158 caregivers of children ages 36 mo were interviewed in six urban medical centers. Interviews included demographics, the USFSS, child health status, and hospitalization history. Ten percent reported HFI, 12% HFI and CFI (H&CFI). Compared with food-secure children, those with HFI had significantly greater adjusted odds of fair/poor health and being hospitalized since birth, and those with H&CFI had even greater adverse effects. Participation in the FSP modified the effects of FI on child health status and hospitalizations, reducing, but not eliminating, them. Children in FSP-participating households that were HFI had lower adjusted odds of fair/poor health [1.37 (95% CI, 1.06-1.77)] than children in similar non-FSP households [1.61 (95% CI, 1.31-1.98)]. Children in FSP-participating households that were H&CFI also had lower adjusted odds of fair/poor health [1.72 (95% CI, 1.34-2.21)] than in similar non-FSP households [2.14 (95% CI, 1.81-2.54)]. HFI is positively associated with fair/poor health and hospitalizations in young children. With H&CFI, odds of fair/poor health and hospitalizations are even greater. Participation in FSP reduces, but does not eliminate, effects of FI on fair/poor health.

Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health

PubMed Central

2012-01-01

Purpose Aims of this study were to identify aspects of functioning and health relevant to patients with vertigo expressed by ICF categories and to explore the potential of the ICF to describe the patient perspective in vertigo. Methods We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF). Results From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect “dizziness” most participants reported problems within “Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported “Immediate family (e310)” as a relevant modifying environmental factor. Conclusions From the patients’ perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals’ daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo. PMID:22738067

Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease.

PubMed

Campbell, David J T; Manns, Braden J; Leblanc, Pamela; Hemmelgarn, Brenda R; Sanmartin, Claudia; King-Shier, Kathryn

2016-12-01

Patients with chronic diseases often face financial barriers to optimize their health. These financial barriers may be related to direct healthcare costs such as medications or self-monitoring supplies, or indirect costs such as transportation to medical appointments. No known framework exists to understand how financial barriers impact patients' lives or their health outcomes.We undertook a grounded theory study to develop such a framework. We used semistructured interviews with a purposive sample of participants with cardiovascular-related chronic disease (hypertension, diabetes, heart disease, or stroke) from Alberta, Canada. Interview transcripts were analyzed in triplicate, and interviews continued until saturation was reached.We interviewed 34 participants. We found that the confluence of 2 events contributed to the perception of having a financial barrier-onset of chronic disease and lack of income or health benefits. The impact of having a perceived financial barrier varied considerably. Protective, predisposing, or modifying of factors determined how impactful a financial barrier would be. An individual's particular set of factors is then shaped by their worldview. This combination of factors and lens determines one's degree of resiliency, which ultimately impacts how well they cope with their disease.The role of financial barriers is complex. How well an individual copes with their financial barriers is intimately tied to resiliency, which is related to the composite of a personal circumstances and their worldview. Our framework for understanding the experience of financial barriers can be used by both researchers and clinicians to better understand patient behavior.

Clinical decision making in the recognition of dying: a qualitative interview study.

PubMed

Taylor, Paul; Dowding, Dawn; Johnson, Miriam

2017-01-25

Recognising dying is an essential clinical skill for general and palliative care professionals alike. Despite the high importance, both identification and good clinical care of the dying patient remains extremely difficult and often controversial in clinical practice. This study aimed to answer the question: "What factors influence medical and nursing staff when recognising dying in end-stage cancer and heart failure patients?" This study used a descriptive approach to decision-making theory. Participants were purposively sampled for profession (doctor or nurse), specialty (cardiology or oncology) and grade (senior vs junior). Recruitment continued until data saturation was reached. Semi-structured interviews were conducted with NHS medical and nursing staff in an NHS Trust which contained cancer and cardiology tertiary referral centres. An interview schedule was designed, based on decision-making literature. Interviews were audio-recorded and transcribed and analysed using thematic framework. Data were managed with Atlas.ti. Saturation was achieved with 19 participants (7 seniors; 8 intermediate level staff; 4 juniors). There were 11 oncologists (6 doctors, 5 nurses) and 8 cardiologists (3 doctors, 5 nurses). Six themes were generated: information used; decision processes; modifying factors; implementation; reflecting on decisions and related decisions. The decision process described was time-dependent, ongoing and iterative, and relies heavily on intuition. This study supports the need to recognise the strengths and weaknesses of expertise and intuition as part of the decision process, and of placing the recognition of dying in a time-dependent context. Clinicians should also be prepared to accept and convey the uncertainty surrounding these decisions, both in practice and in communication with patients and carers.

Rasch validation of the PHQ-9 in people with visual impairment in South India.

PubMed

Gothwal, Vijaya K; Bagga, Deepak K; Sumalini, Rebecca

2014-01-01

The Patient-Health Questionnaire (PHQ-9) is a widely used screening instrument for depression. Recently, its properties as a measure were investigated using Rasch analysis in an Australian population with visual impairment (VI) and it was demonstrated to possess excellent measurement properties, but the response scale required shortening (modified PHQ-9). However, further validation was recommended to substantiate its use with the growing population of VI. Therefore, we aimed to use Rasch analysis to evaluate the measurement properties of the modified PHQ-9 in an Indian population with VI. 303 patients with VI (mean age 40.2 years; 71% male) referred to Vision Rehabilitation Centres were administered the PHQ-9 by trained interviewer. Rasch analysis was used to investigate the psychometric properties of the modified PHQ-9. Rasch analysis showed good fit to the model, no misfitting items and an acceptable person separation reliability (0.82). Dimensionality testing supported combining 9 items to create a total score. Targeting was sub-optimal (-1.30 logits); more difficult items are needed. One item ('trouble falling asleep') showed notable differential item functioning, DIF (1.18 logits) by duration of VI. The generalisability of these results might be restricted to patients with VI presenting to a tertiary eye care centre. Except for DIF, the performance of the modified PHQ-9 is consistent with that of the original, albeit in a different cultural context (Indian population with VI). Clinicians/researchers can readily use the modified PHQ-9 without formal training in Rasch procedures given the provision of ready-to-use spreadsheets that convert raw to Rasch-scaled scores. However the conversions will apply only if the sample being tested is similar to that of the present study. Copyright © 2014 Elsevier B.V. All rights reserved.

Intentionality in Healing--The Voices of Men in Nursing: A Grounded Theory Investigation.

PubMed

Zahourek, Rothlyn P

2015-12-01

The purpose of this study was to evaluate and potentially modify or expand a previously developed theory: Intentionality: The Matrix of Healing (IMH) using a sample of men in nursing. A modified grounded theory approach described by Chen and Boore (2009) and by Amsteus (2014). Twelve men in nursing were recruited. Each was interviewed at least once and their feedback solicited to determine accuracy of interpretation. Results were compared and contrasted to those obtained from the earlier research with six female nurses and their patients. Both groups viewed intentionality as different from, and greater than, intention. Intentionality reflects the whole person's values, goals, and experiences. The men emphasized the importance of reflective spiritual practices, developing self-awareness, being aware of the stress experienced by males in a female profession, and the role of action in manifesting intentionality in healing. The theory is substantiated with minor changes in emphases. Further study is warranted to expand the understanding of this basic concept in nursing and healing. © The Author(s) 2015.

"Like Holding an Umbrella Before It Rains": Acceptability of Future Rectal Microbicides Among Men Who Have Sex With Men in India-A Modified Technology Acceptance Model.

PubMed

Chakrapani, Venkatesan; Newman, Peter A; Shunmugam, Murali; Mengle, Shruta; Nelson, Ruban; Rubincam, Clara; Kumar, Pushpesh

2017-07-01

Topical rectal microbicides (RMs) are a new prevention technology in development that aims to reduce the risk of HIV acquisition from anal sex. We examined RM acceptability among men who have sex with men (MSM) in India. We conducted a qualitative exploratory study guided by a modified Technology Acceptance Model, with 10 focus groups ( n = 61) of MSM and 10 key informant interviews. Data were explored using framework analysis. RM acceptability was influenced by technological contexts: perceived usefulness of RMs, perceived ease of use of RM and applicator, and habits around condom and lubricant use; individual and interpersonal contexts: perceived relevance and preferences for product formulation and dosing frequency; and MSM community/social contexts: perceived social approval, RM-related stigma, social support. Implementation of RMs for MSM in India may be supported by multi-level interventions that engage community-based organizations in destigmatizing and distributing RMs, ideally gel-based products that enable on-demand use before sex.

Modifying Photovoice for community-based participatory Indigenous research.

PubMed

Castleden, Heather; Garvin, Theresa

2008-03-01

Scientific research occurs within a set of socio-political conditions, and in Canada research involving Indigenous communities has a historical association with colonialism. Consequently, Indigenous peoples have been justifiably sceptical and reluctant to become the subjects of academic research. Community-Based Participatory Research (CBPR) is an attempt to develop culturally relevant research models that address issues of injustice, inequality, and exploitation. The work reported here evaluates the use of Photovoice, a CBPR method that uses participant-employed photography and dialogue to create social change, which was employed in a research partnership with a First Nation in Western Canada. Content analysis of semi-structured interviews (n=45) evaluated participants' perspectives of the Photovoice process as part of a larger study on health and environment issues. The analysis revealed that Photovoice effectively balanced power, created a sense of ownership, fostered trust, built capacity, and responded to cultural preferences. The authors discuss the necessity of modifying Photovoice, by building in an iterative process, as being key to the methodological success of the project.

Modifiable Risk Factors for West Nile Virus Infection during an Outbreak—Arizona, 2010

PubMed Central

Gibney, Katherine B.; Colborn, James; Baty, Steven; Bunko Patterson, Andrean M.; Sylvester, Tammy; Briggs, Graham; Stewart, Tasha; Levy, Craig; Komatsu, Ken; MacMillan, Katherine; Delorey, Mark J.; Mutebi, John-Paul; Fischer, Marc; Staples, J. Erin

2012-01-01

West Nile virus (WNV) is the leading cause of mosquito-borne disease in the United States; however, risk factors for infection are poorly defined. We performed a case-control study to identify modifiable risk factors for WNV infection. Case-patients (N = 49) had laboratory evidence of recent WNV infection, whereas control-subjects (N = 74) had negative WNV serology. We interviewed participants, surveyed households, and assessed environmental data. WNV infection was associated with living in or near Water District X within Gilbert Township (adjusted odds ratio [aOR] 5.2; 95% confidence interval [95% CI] = 1.5–18.1), having water-holding containers in their yard (aOR 5.0; 95% CI = 1.5–17.3), and not working or attending school outside the home (aOR 2.4; 95% CI = 1.1–5.5). During this outbreak, WNV infection was likely primarily acquired peri-domestically with increased risk associated with potential mosquito larval habitats around the home and neighborhood. PMID:22556093

The effect of changes to question order on the prevalence of 'sufficient' physical activity in an Australian population survey.

PubMed

Hanley, Christine; Duncan, Mitch J; Mummery, W Kerry

2013-03-01

Population surveys are frequently used to assess prevalence, correlates and health benefits of physical activity. However, nonsampling errors, such as question order effects, in surveys may lead to imprecision in self reported physical activity. This study examined the impact of modified question order in a commonly used physical activity questionnaire on the prevalence of sufficient physical activity. Data were obtained from a telephone survey of adults living in Queensland, Australia. A total of 1243 adults participated in the computer-assisted telephone interview (CATI) survey conducted in July 2008 which included the Active Australia Questionnaire (AAQ) presented in traditional or modified order. Binary logistic regression analyses was used to examine relationships between question order and physical activity outcomes. Significant relationships were found between question order and sufficient activity, recreational walking, moderate activity, vigorous activity, and total activity. Respondents who received the AAQ in modified order were more likely to be categorized as sufficiently active (OR = 1.28, 95% CI 1.01-1.60). This study highlights the importance of question order on estimates of self reported physical activity. This study has shown that changes in question order can lead to an increase in the proportion of participants classified as sufficiently active.

Economic analysis of opportunities to accelerate Alzheimer’s disease research and development

PubMed Central

Scott, Troy J; O'Connor, Alan C; Link, Albert N; Beaulieu, Travis J

2014-01-01

The development of disease-modifying treatments for Alzheimer's disease (AD) faces a number of barriers. Among these are the lack of surrogate biomarkers, the exceptional size and duration of clinical trials, difficulties in identifying appropriate populations for clinical trials, and the limitations of monotherapies in addressing such a complex multifactorial disease. This study sets out to first estimate the consequent impact on the expected cost of developing disease-modifying treatments for AD and then to estimate the potential benefits of bringing together industry, academic, and government stakeholders to co-invest in, for example, developing better biomarkers and cognitive assessment tools, building out advanced registries and clinical trial-readiness cohorts, and establishing clinical trial platforms to investigate combinations of candidate drugs and biomarkers from the portfolios of multiple companies. Estimates based on interviews with experts on AD research and development suggest that the cost of one new drug is now $5.7 billion (95% confidence interval (CI) $3.7–9.5 billion) and could be reduced to $2.0 billion (95% CI $1.5–2.9 billion). The associated acceleration in the arrival of disease-modifying treatments could reduce the number of case years of dementia by 7.0 million (95% CI 4.4–9.4 million) in the United States from 2025 through 2040. PMID:24673372

Neighborhood noise pollution as a determinant of displaced aggression: a pilot study.

PubMed

Dzhambov, Angel; Dimitrova, Donka

2014-01-01

Noise pollution is still a growing public health problem with a significant impact on psychological health and well-being. The aim of this study was to investigate the impact of noise on displaced aggression (DA) in different subgroups of residents in one of the neighborhoods of Plovdiv city. A cross-sectional semi-structured interview survey was conducted using specially designed data registration forms and 33 close-ended and open-ended questions, divided into two major panels - one original and a modified version of the Displaced Aggression Questionnaire (DAQ). The mean score for DA was 61.12 (±19.97). Hearing noises above the perceived normal threshold, higher noise sensitivity and continuous noises were associated with higher levels of DA. Low frequency and high intensity noises were also associated with higher DA scores. Multiple regression model supported these findings. Contradictory to previous research age was positively correlated with noise sensitivity and aggression. We speculated that this might be due to the relatively lower socio-economic standard and quality of life in Bulgaria. Therefore, social climate might be modifying the way people perceive and react to environmental noise. Finally, the DAQ proved to be a viable measurement tool of these associations and might be further implemented and modified to suit the purposes of psychoacoustic assessment.

Validation of the custo screen pediatric blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Beime, Beate; Deutsch, Cornelia; Krüger, Ralf; Wolf, Andreas; Müller, Peter; Hammel, Gertrud; Bramlage, Peter

2017-05-01

The purpose of the study was to validate the ambulatory blood pressure monitoring (ABPM) device custo screen pediatric in children aged 3 to 12 years according to the International Protocol of the European Society of Hypertension (ESH-IP revision 2010). Thirty-three children were included and systolic and diastolic blood pressure measurements were performed according to the ESH-IP. The protocol was modified for children considering data from the German Health Interview and Examination Survey for Children and Adolescents (KIGGS). The custo screen pediatric met all the requirements of the ESH-IP. The mean difference between the test device and the reference was -1.4 ± 3.0 mmHg for systolic blood pressure (SBP) and -0.7 ± 3.2 mmHg for diastolic blood pressure (DBP). For SBP and DBP, all 99 measurements were within the absolute difference of 10 mmHg between the test device and the reference. As to part 2 of the protocol, for DBP in all subjects, two out of three measurements were within 5 mmHg between the device and the standard, whereas for SBP in 32 of 33 subjects, two out of three measurements were within this range. The custo screen pediatric met all criteria of the ESH-IP review 2010, modified for children from 3 to about 12 years, and can be recommended for ABPM in children. What is Known: • Validation of blood pressure measuring devices is essential to provide patients with an accurate blood pressure measuring device. • The majority of devices has not been validated in children. What is New: • Prior to the present validation, study protocol adjustments of ESH-IP review 2010 for children were defined according to German Health Interview and Examination Survey for Children and Adolescents 2013 (KIGGS). • The custo screen pediatric test device met all criteria of ESH-IP revision 2010, modified for children, and can be recommended for ABPM in children aged 3 to about 12 years.

Conceptual model for dietary behaviour change at household level: a 'best-fit' qualitative study using primary data.

PubMed

Daivadanam, Meena; Wahlström, Rolf; Ravindran, T K Sundari; Thankappan, K R; Ramanathan, Mala

2014-06-09

Interventions having a strong theoretical basis are more efficacious, providing a strong argument for incorporating theory into intervention planning. The objective of this study was to develop a conceptual model to facilitate the planning of dietary intervention strategies at the household level in rural Kerala. Three focus group discussions and 17 individual interviews were conducted among men and women, aged between 23 and 75 years. An interview guide facilitated the process to understand: 1) feasibility and acceptability of a proposed dietary behaviour change intervention; 2) beliefs about foods, particularly fruits and vegetables; 3) decision-making in households with reference to food choices and access; and 4) to gain insights into the kind of intervention strategies that may be practical at community and household level. The data were analysed using a modified form of qualitative framework analysis, which combined both deductive and inductive reasoning. A priori themes were identified from relevant behaviour change theories using construct definitions, and used to index the meaning units identified from the primary qualitative data. In addition, new themes emerging from the data were included. The associations between the themes were mapped into four main factors and its components, which contributed to construction of the conceptual model. Thirteen of the a priori themes from three behaviour change theories (Trans-theoretical model, Health Belief model and Theory of Planned Behaviour) were confirmed or slightly modified, while four new themes emerged from the data. The conceptual model had four main factors and its components: impact factors (decisional balance, risk perception, attitude); change processes (action-oriented, cognitive); background factors (personal modifiers, societal norms); and overarching factors (accessibility, perceived needs and preferences), built around a three-stage change spiral (pre-contemplation, intention, action). Decisional balance was the strongest in terms of impacting the process of behaviour change, while household efficacy and perceived household cooperation were identified as 'markers' for stages-of-change at the household level. This type of framework analysis made it possible to develop a conceptual model that could facilitate the design of intervention strategies to aid a household-level dietary behaviour change process.

Conceptual model for dietary behaviour change at household level: a ‘best-fit’ qualitative study using primary data

PubMed Central

2014-01-01

Background Interventions having a strong theoretical basis are more efficacious, providing a strong argument for incorporating theory into intervention planning. The objective of this study was to develop a conceptual model to facilitate the planning of dietary intervention strategies at the household level in rural Kerala. Methods Three focus group discussions and 17 individual interviews were conducted among men and women, aged between 23 and 75 years. An interview guide facilitated the process to understand: 1) feasibility and acceptability of a proposed dietary behaviour change intervention; 2) beliefs about foods, particularly fruits and vegetables; 3) decision-making in households with reference to food choices and access; and 4) to gain insights into the kind of intervention strategies that may be practical at community and household level. The data were analysed using a modified form of qualitative framework analysis, which combined both deductive and inductive reasoning. A priori themes were identified from relevant behaviour change theories using construct definitions, and used to index the meaning units identified from the primary qualitative data. In addition, new themes emerging from the data were included. The associations between the themes were mapped into four main factors and its components, which contributed to construction of the conceptual model. Results Thirteen of the a priori themes from three behaviour change theories (Trans-theoretical model, Health Belief model and Theory of Planned Behaviour) were confirmed or slightly modified, while four new themes emerged from the data. The conceptual model had four main factors and its components: impact factors (decisional balance, risk perception, attitude); change processes (action-oriented, cognitive); background factors (personal modifiers, societal norms); and overarching factors (accessibility, perceived needs and preferences), built around a three-stage change spiral (pre-contemplation, intention, action). Decisional balance was the strongest in terms of impacting the process of behaviour change, while household efficacy and perceived household cooperation were identified as ‘markers’ for stages-of-change at the household level. Conclusions This type of framework analysis made it possible to develop a conceptual model that could facilitate the design of intervention strategies to aid a household-level dietary behaviour change process. PMID:24912496

Using Cognitive Interviewing to Better Assess Young Adult E-cigarette Use.

PubMed

Hinds, Josephine T; Loukas, Alexandra; Chow, Sherman; Pasch, Keryn E; Harrell, Melissa B; Perry, Cheryl L; Delnevo, Cristine; Wackowski, Olivia A

2016-10-01

Characteristics of electronic nicotine delivery systems (ENDS) make assessment of their use a challenge for researchers. Cognitive interviews are a way of gaining insight into participants' interpretations of survey questions and the methods they use in answering them, to improve survey tools. We used cognitive interviews to modify a young adult survey and improve assessment of quantity and frequency of ENDS use, as well as reasons for initiation and use of ENDS products. Twenty-five college students between the ages of 18 and 32 participated in individual cognitive interviews, which assessed question comprehension, answer estimation, retrieval processes, and answer response processes. Comprehension issues arose discerning between ENDS device types (eg, cigalikes vs. vape pens), and answer estimation issues arose regarding ENDS use as drug delivery systems. These issues appeared to improve when pictures were added specifying the device in question, as well as when specific language naming nicotine as the ENDS product content was added to survey questions. Regarding answer retrieval, this sample of users had problems reporting their frequency of ENDS use, as well as quantifying the amount of ENDS products consumed (eg, volume of e-juice, number of cartridges, nicotine concentration). Accurate assessment of ENDS products proved challenging, but cognitive interviews provided valuable insight into survey interpretation that was otherwise inaccessible to researchers. Future research that explores how to assess the wide array of ENDS devices, as well as possible population differences among specific device-type users would be valuable to public health researchers and professionals. This study extends the current literature by using cognitive interviews to test ENDS assessment questions in a sample of young adults, a population at elevated risk for ENDS use. Problems encountered when answering ENDS use questions underscore the need to develop easily understood ENDS questions that allow for quantification of ENDS use. Future research examining the nature of ENDS product types and different levels of user experience will yield valuable assessment tools for researchers and tobacco control professionals. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Using Cognitive Interviewing to Better Assess Young Adult E-cigarette Use

PubMed Central

Hinds, Josephine T; Chow, Sherman; Pasch, Keryn E; Harrell, Melissa B; Perry, Cheryl L; Delnevo, Cristine; Wackowski, Olivia A

2016-01-01

Abstract Introduction Characteristics of electronic nicotine delivery systems (ENDS) make assessment of their use a challenge for researchers. Cognitive interviews are a way of gaining insight into participants’ interpretations of survey questions and the methods they use in answering them, to improve survey tools. Methods We used cognitive interviews to modify a young adult survey and improve assessment of quantity and frequency of ENDS use, as well as reasons for initiation and use of ENDS products. Twenty-five college students between the ages of 18 and 32 participated in individual cognitive interviews, which assessed question comprehension, answer estimation, retrieval processes, and answer response processes. Results Comprehension issues arose discerning between ENDS device types (eg, cigalikes vs. vape pens), and answer estimation issues arose regarding ENDS use as drug delivery systems. These issues appeared to improve when pictures were added specifying the device in question, as well as when specific language naming nicotine as the ENDS product content was added to survey questions. Regarding answer retrieval, this sample of users had problems reporting their frequency of ENDS use, as well as quantifying the amount of ENDS products consumed (eg, volume of e-juice, number of cartridges, nicotine concentration). Conclusions Accurate assessment of ENDS products proved challenging, but cognitive interviews provided valuable insight into survey interpretation that was otherwise inaccessible to researchers. Future research that explores how to assess the wide array of ENDS devices, as well as possible population differences among specific device-type users would be valuable to public health researchers and professionals. Implications This study extends the current literature by using cognitive interviews to test ENDS assessment questions in a sample of young adults, a population at elevated risk for ENDS use. Problems encountered when answering ENDS use questions underscore the need to develop easily understood ENDS questions that allow for quantification of ENDS use. Future research examining the nature of ENDS product types and different levels of user experience will yield valuable assessment tools for researchers and tobacco control professionals. PMID:27029822

How well will you FIT? Use of a modified MMI to assess applicants’ compatibility with an emergency medicine residency program

PubMed Central

Min, Alice A.; Leetch, Aaron; Nuño, Tomas; Fiorello, Albert B.

2016-01-01

Purpose Emergency medicine residency programs have evaluated the use of Multiple Mini Interviews (MMIs) for applicants. The authors developed an MMI-style method called the Fast Interview Track (FIT) to predict an applicant's ‘fit’ within an individual residency program. Methods Applicants meet with up to five residents and are asked one question by each. Residents score the applicant using a Likert scale from 1 to 5 on two questions: ‘How well does the applicant think on his/her feet?’ and ‘How well do you think the applicant will fit in here?’. To assess how well these questions predicted a resident's ‘fit’, current residents scored fellow residents on these same questions. These scores were compared with the residents’ interview FIT scores. A postmatch survey of applicants who did not match at this program solicited applicants’ attitudes toward the FIT sessions. Results Among the junior class, the correlation between interview and current scores was significant for question 1 (rho=0.5192 [p=0.03]) and question 2 (rho=0.5753 [p=0.01]). Among seniors, Spearman's rho was statistically significant for question 2, though not statistically significant for question 1. The chi-square measure of high scores (4–5) versus low scores (1–3) found a statistically significant association between interview and current scores for interns and juniors. Of the 29 responses to the postmatch survey, 16 (55%) felt FIT sessions provided a good sense of the program's personality and only 6 (21%) disagreed. Nine (31%) felt FIT sessions positively impacted our program's ranking and 11 (38%) were ‘Neutral’. Only two (7%) reported that FIT sessions negatively impacted their ranking of our program. Conclusions FIT provided program leadership with a sense of an applicant's ‘fit’ within this program. Interview day scores correlated with scores received during residency. Most applicants report a positive experience with FIT sessions. FIT provides a useful tool to recruit applicants who fit with the residency program. PMID:26842824

Emotional reaction to diagnosis of infertility in Kuwait and successful clients' perception of nurses' role during treatment

PubMed Central

2010-01-01

Background The unfulfilled desire of millions of infertile couples worldwide to have their own biological children results in emotional distress. This study evaluated the emotional reactions of couples attending a combined infertility clinic in Kuwait and successful clients' perception of nurses. Methods Quantitative and qualitative methods were used. The first phase was by structured interview using two standardized psychological scales: the 25-item Hopkins Symptom Checklist and Modified Fertility Adjustment Scale. Data were collected from 268 couples attending the combined infertility clinic, between October 2002 and September 2007. The second phase was a semi-structured interview of 10 clients who got pregnant following treatment. The interview explored their feelings and perception of the nurses' role. Interviews were transcribed verbatim and analyzed. Results The average duration of infertility was 4 years; 65.7% of the women and 76.1% of men suffered from primary infertility. Emotional reactions experienced were: anxiety in women (12.7%) and men (6%), depression in women (5.2%) and men (14.9%) and reduced libido in women (6.7%) and men (29.9%). Also in men, 14.9% experienced premature ejaculation, 5.2% weak ejaculation and 7.9% had impotence although 4.9% were transient. In the semi-structured interviews, the emotions expressed were similar and in addition to anger, feelings of devastation, powerlessness, sense of failure and frustration. In the survey, 12.7% of the men were found to show more anxiety than women (6%). Although all the 10 women interviewed confirmed they were anxious; only 4 of their partners were reported to be sad or anxious. Successful clients' perception of nurses' roles included nurses carrying out basic nursing procedures, communicating, educating about investigative and treatment procedures, providing emotional support by listening, encouraging, reassuring and being empathetic. Conclusions This study illuminates the emotional reactions of infertile clients. Fertility nurses in Kuwait can provide emotional support through communication. The need for additional and continuous training for nurses employed in fertility settings in Kuwait is paramount. PMID:20298604

The participants' perspective: how biographic-narrative intervention influences identity negotiation and quality of life in aphasia.

PubMed

Corsten, Sabine; Schimpf, Erika J; Konradi, Jürgen; Keilmann, Annerose; Hardering, Friedericke

2015-01-01

People with aphasia experience a pronounced decrease in quality of life (QoL). Beyond that identity negotiation is hindered, which is crucial for QoL. Biographic-narrative approaches use life story telling to support identity (re)development after disruptive events like stroke. Because of the language deficits inherent in aphasia such 'talk-based' approaches have to be modified for an optimal use. To evaluate an adapted interdisciplinary biographic-narrative intervention using quantitative measures of health-related quality of life (HRQL) and mood. Additionally, semi-structured interviews were conducted to gain a deeper understanding of identity development processes in people with aphasia. Twenty-seven participants with various types of chronic aphasia were enrolled. The biographic narrative intervention consisted of five face-to-face in-depth interviews and seven group sessions conducted over 10 weeks in a mixed-method design with pre- and post-tests and a follow-up assessment 3 months post-intervention. For quantitative evaluation the Aachen Life Quality Inventory (ALQI), the Satisfaction with Life Scale (SWLS) and the Visual Analog Mood Scales (VAMS) were used. Semi-structured interviews were conducted post-treatment, including questions concerning the participants' experiences with the intervention and identity change. Results were analysed using interpretative principles from Grounded Theory. For all 27 participants, we found significant and stable growth in HRQL. Self-reported states of mood also improved. As expected, overall cognitively based life satisfaction did not change. The interviews revealed two main categories: 'evaluation of the face-to-face interviews' and 'evaluation of the group sessions'. Further analysis found four overlapping main themes which were identified as identity issues: agency, control, disease concept and doing things. Our quantitative and qualitative results demonstrated the benefits associated with the biographic-narrative intervention. The participants' sense of self changed through the approach. The findings provide foundations for future work using biographic narrative interventions to influence QoL and identity renegotiation in people with aphasia. © 2015 Royal College of Speech and Language Therapists.

Pre-Sepsis Depressive Symptoms Are Associated with Incident Cognitive Impairment in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

PubMed Central

Davydow, Dimitry S.; Hough, Catherine L.; Langa, Kenneth M.; Iwashyna, Theodore J.

2012-01-01

Objectives To test the hypothesis that pre-sepsis depressive symptoms are associated with an increased risk of new cognitive impairment in severe sepsis survivors. Design Prospective longitudinal cohort study. Setting Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998–2006). Participants 447 patients with normal pre-sepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview. Measurements Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively with a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status (TICS). We used logistic regression with robust standard errors to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (either mild or moderate-to-severe cognitive impairment) at any interview after sepsis. Results The prevalence of substantial depressive symptoms in those with normal cognition before sepsis was 38% (95%Confidence Interval [CI]: 34%, 42%). After severe sepsis, 18% (95%CI: 15%, 20%) of survivors had incident cognitive impairment. In unadjusted analyses, pre-sepsis substantial depressive symptoms were associated with post-sepsis incident cognitive impairment (Odds Ratio [OR] 2.56, 95%CI: 1.53, 4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and pre-sepsis TICS scores, pre-sepsis substantial depressive symptoms remained the strongest factor associated with post-sepsis incident cognitive impairment (OR 2.58, 95%CI: 1.45, 4.59). Conclusion Pre-sepsis substantial depressive symptoms are independently associated with incident post-sepsis cognitive impairment. Depressed older adults may be particularly at risk for developing cognitive impairment after a serious medical illness. PMID:23176643

Disability and comorbidity among major depressive disorder and double depression in African-American adults.

PubMed

Torres, Elisa R

2013-09-25

Few studies have examined differences in disability and comorbity among major depressive disorder (MDD), dysthymia, and double depression in African-Americans (AA). A secondary analysis was performed on AA in the National Survey of American Life. Interviews occurred 2001-2003. A four stage national area probability sampling was performed. DSM-IV-TR diagnoses were obtained with a modified version of the World Health Organization's expanded version of the Composite International Diagnostic Interview. Disability was measured by interview with the World Health Organization's Disability Assessment Schedule II. Compared to non-depressed AA, AA endorsing MDD (t=19.0, p=0.0001) and double depression (t=18.7, p=0.0001) reported more global disability; AA endorsing MDD (t=8.5, p=0.0063) reported more disability in the getting around domain; AA endorsing MDD (t=19.1, p=0.0001) and double depression (t=12.1, p=0.0014) reported more disability in the life activities domain. AA who endorsed double depression reported similar disability and comorbidities with AA who endorsed MDD. Few AA endorsed dysthymia. This was a cross-sectional study subject to recall bias. The NSAL did not measure minor depression. The current study supports the idea of deleting distinct chronic subtypes of depression and consolidating them into a single category termed chronic depression. © 2013 Elsevier B.V. All rights reserved.

Development of Intensive Motivational Interviewing (IMI) and Modifications for Treating Women with Alcohol Use Disorders.

PubMed

Polcin, Douglas L; Korcha, Rachael; Nayak, Madhabika

2018-06-01

Women have greater vulnerability to alcohol problems than men. They become intoxicated after drinking half as much as men, develop cirrhosis of the liver more rapidly, and have a greater risk of dying from alcohol-related accidents. Despite more serious consequences related to their drinking, treatment for women with alcohol use disorders has been understudied relative to treatment for men. Intensive motivational interviewing (IMI) is a recent psychotherapeutic intervention for substance abuse problems that draws on the principles of brief motivational interviewing (1-2 session). However, the intervention includes 9 sessions designed to enable therapists to have maximum flexibility to facilitate factors known to be important for women with substance use disorders, such as active facilitation of client-therapist collaboration, empowerment, and affirmation of strengths. This paper reviews the development of IMI, initial favorable findings for women with co-occurring methamphetamine and alcohol problems, and the design of an ongoing longitudinal study assessing the effects of MI for women with alcohol problems over a 12-month time period. Relational Theory is used as a conceptual framework for understanding IMI for women. The theory emphasizes understanding, building, and modifying interpersonal relationships as a central goal. From this perspective, self-efficacy, self-esteem, and reduction in drinking are enhanced through interpersonal connections with others. Plans for additional study of IMI are described along with suggestions for therapists.

American Indian identity in mental health services utilization data from a rural midwestern sample.

PubMed

Hack, Samantha M; Larrison, Christopher R; Gone, Joseph P

2014-01-01

The governing bodies for psychiatry, psychology, and social work all publicly support culturally competent mental health care and have called for increased awareness of the importance of racial, ethnic, and cultural identity in mental health treatment and outcomes. However, since 1960 the population of people identifying as American Indian in the United States has grown faster than can be explained by birth rates, raising questions about the personal meaning of identity for newly self-designated American Indians. For this research, interviews were conducted with 14 self-identified American Indian clients receiving rural mental health care services in the Midwest. The goal was to assess clients' cultural connection to their racial identity and to understand what impact their American Indian identity had on their mental health care experiences. A modified Consensual Qualitative Research (CQR) method was used to develop the interview protocol and code responses. Interview data revealed that clients primarily based their racial identity on family stories of an American Indian ancestor and the majority did not feel their identification as American Indian was relevant to their mental health care. Regardless of lack of cultural connection, participants often reported feeling personal pride associated with identifying as American Indian. Implications for both researchers collecting self-reported race data and for mental health practitioners who might serve self-identified American Indian clients are discussed.

Establishing the cultural equivalence of the Young Children’s Participation and Environment Measure (YC-PEM) for use in Singapore

PubMed Central

Lim, Chun Yi; Law, Mary; Khetani, Mary; Pollock, Nancy; Rosenbaum, Peter

2016-01-01

Aims Establishing the cultural equivalence of clinical assessments is critical to ensuring culturally competent care. Developed in North America, the Young Children’s Participation and Environment Measure (YC-PEM) is a caregiver questionnaire of participation in home, preschool, and community activities and perceptions of environmental impact on participation. The purpose of this study is to establish the cultural equivalence of YC-PEM content for use in Singapore. Methods We conducted semi-structured interviews with 10 early childhood and healthcare providers and cognitive interviews with 10 parents in Singapore to examine the relevance of original YC-PEM content (activities, environmental factors, item wording). Interviews were transcribed, summarized and categorized according to item, semantic, conceptual, and operational dimensions of the Applied Cultural Framework that served as a decision-making guide to keep, modify or delete the items. Results Providers and parents agreed on conceptual, item and semantic changes but less on operational changes. Significant changes were made to improve comprehension of the YC-PEM. Conclusions Despite using the same language, the majority of the YC-PEM items needed modification to be relevant to the Singapore culture. Cultural adaptation of the YC-PEM is important because there are cultural differences in children’s participation, their environments as well as the way people understand words. PMID:26642891

Qualitative Evaluation of Pediatric Pain-Behavior, -Quality and -Intensity Item Candidates and the PROMIS Pain Domain Framework in Children with Chronic Pain

PubMed Central

Jacobson, C. Jeffrey; Kashikar-Zuck, Susmita; Farrell, Jennifer; Barnett, Kimberly; Goldschneider, Ken; Dampier, Carlton; Cunningham, Natoshia; Crosby, Lori; DeWitt, Esi Morgan

2015-01-01

As initial steps in a broader effort to develop and test pediatric Pain Behavior and Pain Quality item banks for the Patient Reported Outcomes Measurement Information System (PROMIS®), we employed qualitative interview and item review methods to 1) evaluate the overall conceptual scope and content validity of the PROMIS pain domain framework among children with chronic /recurrent pain conditions, and 2) develop item candidates for further psychometric testing. To elicit the experiential and conceptual scope of pain outcomes across a variety of pediatric recurrent/chronic pain conditions, we conducted semi-structured individual (32) and focus-group interviews (2) with children and adolescents (8–17 years), and parents of children with pain (individual (32) and focus group (2)). Interviews with pain experts (10) explored the operational limits of pain measurement in children. For item bank development, we identified existing items from measures in the literature, grouped them by concept, removed redundancies, and modified remaining items to match PROMIS formatting. New items were written as needed and cognitive debriefing was completed with children and their parents, resulting in 98 Pain Behavior (47 self, 51 proxy), 54 Quality and 4 Intensity items for further testing. Qualitative content analyses suggest that reportable pain outcomes that matter to children with pain are captured within and consistent with the pain domain framework in PROMIS. PMID:26335990

The development of the PARENTS: a tool for parents to assess residents' non-technical skills in pediatric emergency departments.

PubMed

Moreau, Katherine A; Eady, Kaylee; Tang, Kenneth; Jabbour, Mona; Frank, Jason R; Campbell, Meaghan; Hamstra, Stanley J

2017-11-14

Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and (c) capturing parents' perspectives to improve the preparation of future physicians.

[Descriptive epidemiology of the vascular risk factors in Bañeres. Study group 'Bañeres Project'].

PubMed

Mulet, M J; Sánchez-Pérez, R M; Moltó, J M; Adam, A; Blanquer, J; López-Arlandis, J

Epidemiological studies of the risk factors of cerebrovascular disease are of great interest, particularly the identification of factors which may be modified. Previous studies carried out in the Alcoi region of Alicante province, showed a high prevalence of cerebrovascular disease. The town of Bañeres was therefore chosen for confirmation of this data and identification of the frequency of vascular risk factors. To compare the group of patients with cerebrovascular disease with the remainder of the population interviewed. In a door-to-door study in Bañeres 1,832 people were interviewed as part of the Bañeres Project. The population aged over 45 years was interviewed and filled in a questionnaire for diagnosis of transient ischemic accidents. Arterial hypertension: estimated prevalence 500/1,000 inhabitants, relative risk 3.24; diabetes mellitus: estimated prevalence 195/1,000, relative risk 2.18; coronary artery disease: estimated prevalence 58/1,000, relative risk 1.88; peptic ulcer: estimated prevalence 75/1,000, relative risk 1.23; smoking: estimated prevalence 110/1,000, relative risk 0.46; complete arrhythmia: prevalence 73/1,000, relative risk 5.23. Family histories of cerebrovascular accident, arterial hypertension, diabetes and coronary artery disease were not significant. Arterial hypertension, diabetes mellitus and arrhythmia were significantly more prevalent amongst patients with vascular disease in our setting. We found no association with the other risk factors analyzed.

Technology concept in the view of Iranian nurses.

PubMed

Mehraban, Marzieh Adel; Hassanpour, Marzieh; Yazdannik, Ahmadreza; Ajami, Sima

2013-05-01

Over the years, the concept technology has modified, especially from the viewpoint of the development of scientific knowledge as well as the philosophical and artistic aspects. However, the concept of technology in nursing are still poorly understood. Only small qualitative studies, especially in Iran, have investigated this phenomenon and they just are about information technology. The aim of this study is to gain a better understanding of the concept of technology in the view of Iranian nurses. This study was qualitative explorative study which was done with a purposeful sampling of 23 nurses (staffs, supervisors and chief nurse managers) working in Isfahan hospitals. Unstructured interviews were including 13 individual interviews and 2 focused-group interviews. In addition to this, filed notes and memos were used in data collection. After this data transcribing was done and then conventional content analysis was used for data coding and classification. The results showed that there are various definitions for technology among nurses. In the view of nurses, technology means using new equipment, computers, information technology, etc). Data analysis revealed that nurses understand technology up to three main concepts: Change, Equipment and Knowledge. In deep overview on categories, we found that the most important concept about technology in nursing perspective is equipment. Therefore, it is necessary to develop deep understanding about the possible concepts technology among nurses. We suppose that technology concepts must be defined separately in all disciplines.

“I’m still raring to go”: Successful Aging Among Lesbian, Gay, Bisexual, and Transgender Older Adults

PubMed Central

Driskell, Jeff; Bradford, Judith

2012-01-01

While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for “traditional success” characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and were categorized in one of two gradations on a continuum of successful aging: “surviving and thriving” and “working at it.” A small number was “ailing”: not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being. PMID:23273552

Anxiety After Stroke

PubMed Central

Whiteley, William N.; Dennis, Martin S.; Mead, Gillian E.; Carson, Alan J.

2018-01-01

Background and Purpose— Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack. Methods— We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale. Results— Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45–0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94–9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3–5, [anxiety] 55% versus [no anxiety] 29%; P<0.0005), had poorer quality of life on EQ-5D5L, and restricted participation (Work and Social Adjustment Scale: median, interquartile range, [anxiety] 19.5, 10–27 versus [no anxiety] 0, 0–5; P<0.001). Conclusions— Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety. PMID:29437982

Anxiety After Stroke: The Importance of Subtyping.

PubMed

Chun, Ho-Yan Yvonne; Whiteley, William N; Dennis, Martin S; Mead, Gillian E; Carson, Alan J

2018-03-01

Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack. We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale. Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45-0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94-9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3-5, [anxiety] 55% versus [no anxiety] 29%; P <0.0005), had poorer quality of life on EQ-5D5L, and restricted participation (Work and Social Adjustment Scale: median, interquartile range, [anxiety] 19.5, 10-27 versus [no anxiety] 0, 0-5; P <0.001). Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety. © 2018 The Authors.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal

PubMed Central

2013-01-01

Background Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. Method The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. Results The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. Conclusion The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources. PMID:23849617

Lifestyle and semen quality: role of modifiable risk factors.

PubMed

Jurewicz, Joanna; Radwan, Michał; Sobala, Wojciech; Ligocka, Danuta; Radwan, Paweł; Bochenek, Michał; Hanke, Wojciech

2014-02-01

The relationship between exposure to lifestyle factors and adverse effects on human reproductive health is debated in the scientific literature and these controversies have increased public and regulatory attention. The aim of the study was to examine the association between modifiable lifestyle factors and main semen parameters, sperm morphology, and sperm chromatin structure. The study population consisted of 344 men who were attending an infertility clinic for diagnostic purposes with normal semen concentration of 20-300 M/ml or with slight oligozoospermia (semen total concentration of 15-20 M/ml) [WHO 1999]. Participants were interviewed and provided semen samples. The interview included questions about demographics, socio-economic status, medical history, lifestyle factors (consumption of alcohol, tobacco, coffee intake, cell phone and sauna usage), and physical activity. The results of the study suggest that lifestyle factors may affect semen quality. A negative association was found between increased body mass index (BMI) and semen volume (p = 0.03). Leisure time activity was positively associated with sperm concentration (p = 0.04) and coffee drinking with the percentage of motile sperm cells, and the percentage of sperm head and neck abnormalities (p = 0.01, p = 0.05, and p = 0.03, respectively). Drinking red wine 1-3 times per week was negatively related to sperm neck abnormalities (p = 0.01). Additionally, using a cell phone more than 10 years decreased the percentage of motile sperm cells (p = 0.02). Men who wore boxer shorts had a lower percentage of sperm neck abnormalities (p = 0.002) and percentage of sperm with DNA damage (p = 0.02). These findings may have important implications for semen quality and lifestyle.

Applicability of the Telephone Interview for Cognitive Status (Modified) in a community sample with low education level: association with an extensive neuropsychological battery.

PubMed

Castanho, Teresa Costa; Portugal-Nunes, Carlos; Moreira, Pedro Silva; Amorim, Liliana; Palha, Joana Almeida; Sousa, Nuno; Correia Santos, Nadine

2016-02-01

To explore the applicability of a Portuguese (PT) version of the Telephone Interview for Cognitive Status (TICS), with a delayed recall item [modified (M)], here termed TICSM-PT, against an extensive (in-person) battery of neuropsychological instruments, in a sample of older individuals with low educational level and without clinically manifest/diagnosed cognitive impairment. Following translation/back-translation and pilot testing in 33 community dwellers, 142 community dwellers aged 52 to 84 years (mean = 67.45, SD = 7.91) were selected from local health care centres for the study (convenience sampling; stratified age and gender). Cronbach's alpha was used to assess internal consistency, and convergent validity was evaluated through the correlation between TICSM-PT and the Mini Mental State Examination (MMSE), as well as with a comprehensive battery of cognitive instruments. Divergent/discriminant validity was assessed through a battery of psychological instruments. The receiver operating curve was determined for TICSM-PT to classify participants with and without possible indication of cognitive impairment. TICSM-PT showed a satisfactory internal consistency (Cronbach's alpha = 0.705), convergent validity and discriminant validity. TICSM-PT presented a positive association with the global cognitive measures Mini Mental State Examination and the Montreal Cognitive Assessment, and also with most neuropsychological parameters. Receiver operating curve curves presented a sensitivity of 90.6% and specificity of 73.7%. The area under the curve statistic yielded a threshold score equal or below 13.5 for cognitive impairment. TICSM-PT is a practical tool for rapid cognitive assessment among older individuals with low educational background. Copyright © 2015 John Wiley & Sons, Ltd.

Parents' perceptions of staff competency in a neonatal intensive care unit.

PubMed

Cescutti-Butler, Luisa; Galvin, Kathleen

2003-09-01

* The aim of this study was to explore and describe parents' perceptions of staff competency in a neonatal intensive care unit (NICU). The study set out to use a grounded theory approach that was modified because of a number of constraints. Eight parents whose babies met a number of inclusion criteria were interviewed using focused conversational interviews. They were then transcribed and thematically analysed. The research approach was modified as the study developed because of practical and ethical access reasons: the sampling strategy and lack of opportunity to exploit fully the constant comparative method. * Four key themes which conceptualize competency as caring emerged from the data: parents are facilitated to integrate into the unit and do not feel a burden; parents feel in control whilst in the unit; parents have a choice to opt out from observing tasks and procedures on their baby; parents and the interprofessional team communicate well and provide appropriate information. These are discussed in the context of available literature. * In conclusion, the results of the study serve to highlight how parents' perceptions of competence in a professional are not based solely on skills and tasks but on many caring behaviours. The grounded theory approach has generated a number of areas for exploration, in particular, ideas about the conceptual basis of caring in an NICU context and its links to competence. The caring behaviours involve learning to share responsibility with families. The findings suggest that when there is 'a handing over' of control to parents and a greater emphasis on parent support, they feel less like 'guests'. These ideas are supported by the available literature. A number of methodological issues are raised.

LOST TO FOLLOW-UP: FAILURE TO ENGAGE CHILDREN IN CARE IN THE FIRST THREE MONTHS OF DIAGNOSIS

PubMed Central

Gillespie, Susan L.; Homedes, Nuria; Selwyn, Beatrice J.; Ross, Michael W.; Anabwani, Gabriel; Schutze, Gordon; Kline, Mark W.

2016-01-01

Loss to follow-up (LTFU) is a critical factor in determining clinical outcomes in HIV treatment programs. Identifying modifiable factors of LTFU is fundamental for designing effective patient retention interventions. We analyzed factors contributing to children LTFU from a treatment program to identify those that can be modified. A case-control study involving 313 children was used to compare the sociodemographic and clinical characteristics of children LTFU (cases) with those remaining in care (controls) at a large pediatric HIV care setting in Botswana. We traced children through caregiver contacts and those we found, we conducted structured interviews with patients’ caregivers. Children < 5 years were nearly twice as likely as older children to be LTFU (57·8% versus 30·9%, p<0·01). Approximately half (47·6%, n=51) of LTFU patients failed to further engage in care after just one clinic visit, as compared to less than 1% (n=2) in the control group (p<0·01). Children LTFU were more likely than controls to have advanced disease, greater immunosuppression, and not to be receiving ART. Among interviewed patient caregivers, psychosocial factors (e.g. stigma, religious beliefs, child rebellion, disclosure of HIV status) were characteristic of patients LTFU, but not of controls. Socioeconomic factors (e.g. lack of transportation, school-related activities, forgetting appointments) were cited predominantly by the controls. Pediatric patients and their caregivers need to be targeted and engaged at their initial clinic visit, with special attention to children <5 years. Possible interventions include providing psychosocial support for issues that deter patients from engaging with the clinic. Collaboration with community-based organizations focused on reducing stigma may be useful in addressing these complex issues. PMID:27160542

Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study.

PubMed

Smekal, Michelle D; Tam-Tham, Helen; Finlay, Juli; Donald, Maoliosa; Benterud, Eleanor; Thomas, Chandra; Quinn, Robert R; Tam, Kin; Manns, Braden J; Tonelli, Marcello; Bello, Aminu; Tangri, Navdeep; Hemmelgarn, Brenda R

2018-01-01

The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care. We aimed to describe patient, family, and health care provider's perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input. We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey. Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants' feedback. We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal.

PubMed

Adhikari, Shiva Raj; Supakankunti, Siripen; Khan, M Mahmud

2013-07-12

Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources.

Contextual influences on health worker motivation in district hospitals in Kenya

PubMed Central

Mbindyo, Patrick; Gilson, Lucy; Blaauw, Duane; English, Mike

2009-01-01

Background Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals. Methods Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255–66) model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses. Results Study settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards. Conclusion Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change. PMID:19627590

Simulated Donor Family Encounters at Organ Transplantation Coordinators In-Service Training Course: Process and Impact Evaluation.

PubMed

Karabilgin, Ö S; Altuğ, N; Çalışkan, S A; Bozoklar, C A; Durak, H I; Demiral Yılmaz, N

2015-06-01

This study introduced the modified version of the Organ Transplantation Coordinator course including simulated donor family encounters (SDFEs) and communication skills. It also evaluated participants' opinions and achievement levels, and how they implemented what they learned in the course in their work settings. The course used the modified Analysis, Design, Development, Implementation, and Evaluation model and was evaluated in 3 steps. The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the posttest and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through telephone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly utilize their communication and empathy skills during donor family encounters. The participants' mean posttest score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters. Copyright © 2015 Elsevier Inc. All rights reserved.

At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction

PubMed Central

Fusar-Poli, Paolo; Cappucciati, Marco; Rutigliano, Grazia; Schultze-Lutter, Frauke; Bonoldi, Ilaria; Borgwardt, Stefan; Riecher-Rössler, Anita; Addington, Jean; Perkins, Diana; Woods, Scott W; McGlashan, Thomas H; Lee, Jimmy; Klosterkötter, Joachim; Yung, Alison R; McGuire, Philip

2015-01-01

An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR+ and CHR−). The reference index was psychosis onset over time in both CHR+ and CHR− subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan’s nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR+: N=1,359; CHR−: N=1,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR+ subjects in the total sample. Fagan’s nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide. PMID:26407788

Injury episodes and circumstances: National Health Interview Survey, 1997-2007.

PubMed

Chen, Li Hui; Warner, Margaret; Fingerhut, Lois; Makuc, Diane

2009-09-01

The National Health Interview Survey (NHIS) provides estimates of nonfatal, medically attended injuries and poisonings occurring in the United States. The objectives of this report are to 1) document changes in the injury and poisoning section of NHIS from 1997 through 2007; 2) provide guidance on summarizing data across the 11-year study period; and 3) present detailed national estimates of nonfatal injury and poisoning episodes for the time period. NHIS samples the civilian, noninstitutionalized population of the United States living in households. NHIS data from the years 1997-2007 were used in this report. Some questions related to injury and poisoning episodes were modified in 2000 and 2004. During the period 1997-2004, many NHIS injury and poisoning questions were improved as a result of cognitive interviewing, data analysis, and feedback from interviewers and data users. Revisions to the NHIS injury and poisoning section pose some difficulties for trend analysis. However, some questions remained the same during the 11-year period, despite the questionnaire revisions. The injury and poisoning section has not been revised since 2004 and, where possible, analyses should be limited to 2004 and beyond. For analyses that require a longer time period, this report provides information on changes to questions and statistics that illustrate the effect of these changes on injury estimates. in 2007, the medically attended injury and poisoning episode rate among the U.S. civilian, noninstitutionalized population was 115.7 per 1,000 population. Despite differences in some questions during the period 1997-2007, NHIS data for these years show falls as the leading cause of injury and the home as the leading place that injury occurred.

Qualitative Evaluation of Pediatric Pain Behavior, Quality, and Intensity Item Candidates and the PROMIS Pain Domain Framework in Children With Chronic Pain.

PubMed

Jacobson, C Jeffrey; Kashikar-Zuck, Susmita; Farrell, Jennifer; Barnett, Kimberly; Goldschneider, Ken; Dampier, Carlton; Cunningham, Natoshia; Crosby, Lori; DeWitt, Esi Morgan

2015-12-01

As initial steps in a broader effort to develop and test pediatric pain behavior and pain quality item banks for the Patient-Reported Outcomes Measurement Information System (PROMIS), we used qualitative interview and item review methods to 1) evaluate the overall conceptual scope and content validity of the PROMIS pain domain framework among children with chronic/recurrent pain conditions, and 2) develop item candidates for further psychometric testing. To elicit the experiential and conceptual scope of pain outcomes across a variety of pediatric recurrent/chronic pain conditions, we conducted 32 semi-structured individual and 2 focus-group interviews with children and adolescents (8-17 years), and 32 individual and 2 focus-group interviews with parents of children with pain. Interviews with pain experts (10) explored the operational limits of pain measurement in children. For item bank development, we identified existing items from measures in the literature, grouped them by concept, removed redundancies, and modified the remaining items to match PROMIS formatting. New items were written as needed and cognitive debriefing was completed with the children and their parents, resulting in 98 pain behavior (47 self, 51 proxy), 54 quality, and 4 intensity items for further testing. Qualitative content analyses suggest that reportable pain outcomes that matter to children with pain are captured within and consistent with the pain domain framework in PROMIS. PROMIS pediatric pain behavior, quality, and intensity items were developed based on a theoretical framework of pain that was evaluated by multiple stakeholders in the measurement of pediatric pain, including researchers, clinicians, and children with pain and their parents, and the appropriateness of the framework was verified. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Understanding the Early Signs of Chronic Disease by Investigating the Overlap of Mental Health Needs and Adolescent Obesity.

PubMed

Smith, Tyler C; Smith, Besa

2015-01-01

Childhood obesity has reached epidemic proportions with two to three-fold increases in prevalence in the past three decades. Sedentary lifestyles and nutrition have been linked to these increases though little is known about mental health illnesses in children and teens which may be precursors to negative modifiable health risk factors. The objective of this study was to investigate for a potentially more clinically practical indicator of depression over a multi-item screen in respect to reporting of overweight and obesity in adolescents. This study further investigated modifiers to this association and stability of association. This cross-sectional study aggregated 2007/2009 California Health Interview Survey data (n = 6,917 adolescents). Univariate analyses of population characteristics and modifiable behaviors with obesity/overweight and depression are presented. Multivariable weighted logistic regression was used to compare the adjusted odds of overweight and obesity for those children with reported depression. After controlling for gender, race/ethnicity, age, and modifiable behaviors, there was a statistically significant relationship between reported depression and overweight/obesity (OR = 1.24; 95% CI = 1.04, 1.49). This effect size was consistent in hierarchical models overall and stratified by gender. Overweight and obesity in adolescents should be understood clinically in the context of depression and other mental health illness. This study highlights a routine primary care or parental screening assessment that could indicate tendencies in adolescent boys and girls which may be precursors to overweight or obesity. Further research should be conducted to identify ways for integrating adolescent mental health screens into primary care.

A competency framework for colonoscopy training derived from cognitive task analysis techniques and expert review.

PubMed

Zupanc, Christine M; Burgess-Limerick, Robin; Hill, Andrew; Riek, Stephan; Wallis, Guy M; Plooy, Annaliese M; Horswill, Mark S; Watson, Marcus O; Hewett, David G

2015-12-01

Colonoscopy is a difficult cognitive-perceptual-motor task. Designing an appropriate instructional program for such a task requires an understanding of the knowledge, skills and attitudes underpinning the competency required to perform the task. Cognitive task analysis techniques provide an empirical means of deriving this information. Video recording and a think-aloud protocol were conducted while 20 experienced endoscopists performed colonoscopy procedures. "Cued-recall" interviews were also carried out post-procedure with nine of the endoscopists. Analysis of the resulting transcripts employed the constant comparative coding method within a grounded theory framework. The resulting draft competency framework was modified after review during semi-structured interviews conducted with six expert endoscopists. The proposed colonoscopy competency framework consists of twenty-seven skill, knowledge and attitude components, grouped into six categories (clinical knowledge; colonoscope handling; situation awareness; heuristics and strategies; clinical reasoning; and intra- and inter-personal). The colonoscopy competency framework provides a principled basis for the design of a training program, and for the design of formative assessment to gauge progress towards attaining the knowledge, skills and attitudes underpinning the achievement of colonoscopy competence.

Factors affecting retention of allied health professionals working with people with disability in rural New South Wales, Australia: discrete choice experiment questionnaire development.

PubMed

Gallego, Gisselle; Dew, Angela; Bulkeley, Kim; Veitch, Craig; Lincoln, Michelle; Bundy, Anita; Brentnall, Jennie

2015-04-21

This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas. Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison. Six attributes that may influence AHPs working with people with disability in rural areas to continue to do so were inductively identified: travel arrangements, work flexibility, professional support, professional development, remuneration, and autonomy of practice. The qualitative research information was combined with a policy review to define these retention factors and ensure that they are amenable to policy changes. The use of various qualitative research methods allowed the development of a policy-relevant DCE questionnaire that was grounded in the experience of the target population (AHPs).

Another breed of "service" animals: STARS study findings about pet ownership and recovery from serious mental illness.

PubMed

Wisdom, Jennifer P; Saedi, Goal Auzeen; Green, Carla A

2009-07-01

This study elucidates the role of pets in recovery processes among adults with serious mental illness. Data derive from interviews with 177 HMO members with serious mental illness (52.2% women, average age 48.8 years) in the Study of Transitions and Recovery Strategies (STARS). Interviews and questionnaires addressed factors affecting recovery processes and included questions about pet ownership. Data were analyzed using a modified grounded theory method to identify the roles pets play in the recovery process. Primary themes indicate pets assist individuals in recovery from serious mental illness by (a) providing empathy and "therapy"; (b) providing connections that can assist in redeveloping social avenues; (c) serving as "family" in the absence of or in addition to human family members; and (d) supporting self-efficacy and strengthening a sense of empowerment. Pets appear to provide more benefits than merely companionship. Participants' reports of pet-related contributions to their well-being provide impetus to conduct more formal research on the mechanisms by which pets contribute to recovery and to develop pet-based interventions.

Multiple dimensions of peer influence in adolescent romantic and sexual relationships: a descriptive, qualitative perspective.

PubMed

Suleiman, Ahna Ballonoff; Deardorff, Julianna

2015-04-01

Adolescents undergo critical developmental transformations that increase the salience of peer influence. Peer interactions (platonic and romantic) have been found to have both a positive and negative influence on adolescent attitudes and behaviors related to romantic relationships and sexual behavior. This study used qualitative methodology to explore how peers influence romantic and sexual behavior. Forty adolescents participated in individual semi-structured interviews. All interviews were audio recorded and transcribed, and analyzed using a modified grounded theory approach. The concept of peer influence on romantic relationships and sexual behavior emerged as a key theme. Youth described that platonic peers (friends) influenced their relationships and sexual behavior including pressuring friends into relationships, establishing relationships as currency for popularity and social status, and creating relationship norm and expectations. Romantic peers also motivated relationship and sexual behavior as youth described engaging in behavior to avoid hurting and successfully pleasing their partners. Future research should explore multiple types of peer influence in order to better inform interventions to improve the quality of adolescents' romantic and sexual relationships.

Using a Research-based Approach to Transform Upper-division Courses in Classical and Quantum Mechanics and E&M

NASA Astrophysics Data System (ADS)

Pollock, Steven

2013-04-01

At most universities, including the University of Colorado, upper-division physics courses are taught using a traditional lecture approach that does not make use of many of the instructional techniques that have been found to improve student learning at the introductory level. We are transforming several upper-division courses using principles of active engagement and learning theory, guided by the results of observations, interviews, and analysis of student work at CU and elsewhere. In this talk I outline these transformations, including the development of faculty consensus learning goals, clicker questions, tutorials, modified homeworks, and more. We present evidence of the effectiveness of these transformations relative to traditional courses, based on student grades, interviews, and through research-based assessments of student conceptual mastery and student attitudes. Our results suggest that many of the tools that have been effective in introductory courses are effective for our majors, and that further research is warranted in the upper-division environment. (See www.colorado.edu/sei/departments/physics.htm for materials)

School Experiences of Adolescents With Attention-Deficit/Hyperactivity Disorder.

PubMed

Wiener, Judith; Daniels, Lesley

2016-11-01

This article reports on a qualitative study of the school experiences of adolescents with attention-deficit/hyperactivity disorder (ADHD) in the context of quantitative research on teacher attitudes and practices, adolescent self-appraisals, and social and family relationships. Twelve adolescents with ADHD participated in in-depth, semistructured interviews addressing major aspects of school life. Using a modified grounded theory framework, researchers coded these interviews. Three themes emerged: (a) support for a performance deficit, (b) academic and social engagement, and (c) moving from dependence to independence. What is most striking is the low level of agency students demonstrated; that is, rather than acting with purpose on their environments, they seemed to react to things that happened to them. These findings suggest that teachers of adolescents with ADHD know about the nature of the disorder, understand that students' difficulties with organization and academic performance are not typically intentional, use evidence-based interventions to support students, and provide the monitoring and scaffolding needed for academic achievement. The students also provide specific suggestions for parents and peers regarding the supports they need to be successful. © Hammill Institute on Disabilities 2015.

Police Officer Schema of Sexual Assault Reports: Real Rape, Ambiguous Cases, and False Reports.

PubMed

Venema, Rachel M

2016-03-01

While extensive research has studied sexual assault reporting behaviors and described negative experiences with the criminal justice system among victim-survivors, fewer studies have explored police officer attitudes, knowledge, and thought processes that may affect victims' perceptions of negative interactions and unsatisfactory outcomes within reported sexual assault cases. This study explores police officer understanding of the definition of sexual assault and characteristics that influence their perceptions and response. Ten police officers were interviewed within one police department in a midsized city in the Great Lakes region. The study uses a modified grounded theory approach. Findings suggest that officers employ distinct schema of reported sexual assaults. Case characteristics, perceived credibility of the victim, and types of evidence formed categorizations of false reports, ambiguous cases, and legitimate sexual assaults. Police officers describe the ways in which perceptions of the case may or may not influence the response and point to areas for improvement within police procedure. The study findings provide insight into recommendations for improved police interviewing and response to reported sexual assaults. © The Author(s) 2014.

Psychiatric disorders and other health dimensions among Holocaust survivors 6 decades later.

PubMed

Sharon, Asaf; Levav, Itzhak; Brodsky, Jenny; Shemesh, Annarosa Anat; Kohn, Robert

2009-10-01

No previous community-based epidemiological study has explored psychiatric disorders among those who survived the Holocaust. To examine anxiety and depressive disorders, sleep disturbances, other health problems and use of services among individuals exposed and unexposed to the Holocaust. The relevant population samples were part of the Israel World Mental Health Survey. The interview schedule included the Composite International Diagnostic Interview and other health-related items. The Holocaust survivor group had higher lifetime (16.1%; OR = 6.8, 95% CI 1.9-24.2) and 12-month (6.9%; OR = 22.5, 95% CI 2.5-204.8) prevalence rates of anxiety disorders, and more current sleep disturbances (62.4%; OR = 2.5, 95% CI 1.4-4.4) and emotional distress (P<0.001) than their counterparts, but did not have higher rates of depressive disorders or post-traumatic stress disorder. Early severe adversity was associated with psychopathological disorder long after the end of the Second World War, but not in all survivors. Age during the Holocaust did not modify the results.

Translating questionnaire items for a multi-lingual worker population: the iterative process of translation and cognitive interviews with English-, Spanish-, and Chinese-speaking workers.

PubMed

Fujishiro, Kaori; Gong, Fang; Baron, Sherry; Jacobson, C Jeffery; DeLaney, Sheli; Flynn, Michael; Eggerth, Donald E

2010-02-01

The increasing ethnic diversity of the US workforce has created a need for research tools that can be used with multi-lingual worker populations. Developing multi-language questionnaire items is a complex process; however, very little has been documented in the literature. Commonly used English items from the Job Content Questionnaire and Quality of Work Life Questionnaire were translated by two interdisciplinary bilingual teams and cognitively tested in interviews with English-, Spanish-, and Chinese-speaking workers. Common problems across languages mainly concerned response format. Language-specific problems required more conceptual than literal translations. Some items were better understood by non-English speakers than by English speakers. De-centering (i.e., modifying the English original to correspond with translation) produced better understanding for one item. Translating questionnaire items and achieving equivalence across languages require various kinds of expertise. Backward translation itself is not sufficient. More research efforts should be concentrated on qualitative approaches to developing useful research tools. Published 2009 Wiley-Liss, Inc.

Introducing assistive technology into the existing homes of older people: feasibility, acceptability, costs and outcomes.

PubMed

Tinker, Anthea; Lansley, Peter

2005-01-01

We examined how far, and at what cost, the housing stock could be modified to accommodate the assistive technology (AT) necessary to enable older people to remain in their own homes. A multidisciplinary team devised seven hypothetical user profiles for 10 case study areas, with five local authorities and five housing associations in England and Wales. Each profile was considered at two times, five years apart, with the users' functional abilities deteriorating in between. In addition, in-depth interviews were carried out with a sample of 67 older people in the case study areas about their use and experience of a wide range of AT. The interviews showed the need to listen to older people and that they welcomed AT when it addressed a perceived need. The results showed that the extent of adaptation required of buildings to accommodate a user's needs varied greatly. It was also found that there was confusion about the terminology of AT, including the idea of the 'smart house'. The study shows that the adaptability of the housing depends on a range of factors and costs.

Parental perspectives on inpatient versus outpatient management of pediatric febrile neutropenia.

PubMed

Diorio, Caroline; Martino, Julia; Boydell, Katherine Mary; Ethier, Marie-Chantal; Mayo, Chris; Wing, Richard; Teuffel, Oliver; Sung, Lillian; Tomlinson, Deborah

2011-01-01

To describe parent preference for treatment of febrile neutropenia and the key drivers of parental decision making, structured face-to-face interviews were used to elicit parent preferences for inpatient versus outpatient management of pediatric febrile neutropenia. Parents were presented with 4 different scenarios and asked to indicate which treatment option they preferred and to describe reasons for this preference during the face-to-face interview. Comments were recorded in writing by research assistants. A consensus approach to thematic analysis was used to identify themes from the written comments of the research assistants. A total of 155 parents participated in the study. Of these, 80 (51.6%) parents identified hospital-based intravenous treatment as the most preferred treatment scenario for febrile neutropenia. The major themes identified included convenience/disruptiveness, physical health, emotional well-being, and modifiers of parental decision making. Most parents preferred hospital-based treatment for febrile neutropenia. An understanding of issues that influence parental decision making may assist health care workers in planning program implementation and further support families in their decision-making process.

An investigation of the practice activities and coaching behaviors of professional top-level youth soccer coaches.

PubMed

Partington, M; Cushion, C

2013-06-01

The aim of this study was to investigate the coaching behaviors of elite English youth soccer coaches in different practice settings and gain insight into the coaches' cognitive processes underpinning these behaviors. The practice setting was split into two types of activities, "training form" and "playing form," and behavioral data were collected using a modified version of the Coach Analysis and Intervention System. Interpretive interview data were triangulated with the behavioral data to ensure that both the "what" and the "why" of the coaches' behavior and practice were considered. The results showed the coaches using more "training form" activities than "playing form," and using high levels of prescriptive instruction, regardless of practice type, in contrast to a stated desire to "developing the whole player," creating "decision makers," and being a "facilitator of knowledge creation." The interviews revealed that the coaches had a low self-awareness about their behavior, with an epistemological gap identified between understanding and practice, with statements of intent not being matched by knowledge and action. © 2011 John Wiley & Sons A/S.

An investigation of the effect of athletes' age on the coaching behaviours of professional top-level youth soccer coaches.

PubMed

Partington, Mark; Cushion, Christopher; Harvey, Stephen

2014-01-01

The aim of the study was to investigate the behaviours, cognitive processes and practice activities of 12 English youth professional soccer coaches across 6 different age groups. Systematic observation data were collected using a modified version of the Coach Analysis and Intervention System which provided a detailed analysis of coaching behaviours performed during practice. Interpretive interviews were then triangulated with the behavioural data to identify the cognitive processes underlying the behaviours performed. The behavioural results showed that the coaches of the younger age groups used more instruction and the coaches of the older age groups used more divergent questioning and significantly more total feedback and punitive behaviours. The coaches of the younger age groups used more training form activities than the coaches of the older age groups who used more playing form activities. However, the interviews revealed that instead of the age of athletes' directly affecting the cognitive process of coaches it was in fact the coaches underlying beliefs about coaching, their previous experiences and perceived pressures from the context that determined the behaviours performed.

Another Breed of “Service” Animals: STARS Study Findings about Pet Ownership and Recovery from Serious Mental Illness

PubMed Central

Wisdom, Jennifer P.; Saedi, Goal Auzeen; Green, Carla A.

2010-01-01

This study elucidates the role of pets in recovery processes among adults with serious mental illness. Data derive from interviews with 177 HMO members with serious mental illness (52.2% women, average age 48.8). Interviews and questionnaires addressed factors affecting recovery processes and included questions about pet ownership. Data were analyzed using a modified grounded theory method to identify the roles pets play in the recovery process. Primary themes indicate pets assist individuals in recovery from serious mental illness by (a) providing empathy and “therapy”; (b) providing connections that can assist in redeveloping social avenues; (c) serving as “family” in the absence of or in addition to human family members; and (d) supporting self-efficacy and strengthening a sense of empowerment. Pets appear to provide more benefits than merely companionship. Participants’ reports of pet-related contributions to their well-being provide impetus to conduct more formal research on the mechanisms by which pets contribute to recovery and to develop pet-based interventions. PMID:19839680

Leadership Strategies for Maintaining Profitability in a Volatile Crude Oil Market

NASA Astrophysics Data System (ADS)

Braimoh, Lucky Anderson

Volatile crude oil prices significantly affect the profitability of crude oil firms. The purpose of this single case study was to explore strategies some crude oil and gas business leaders used to remain profitable during periods of crude oil price volatility. The target population comprised 8 crude oil and gas business leaders located in Calgary, Canada, whose company remained profitable despite crude oil price volatility. The transformational leadership theory formed the conceptual framework for the study. Data were collected through the use of semistructured face-to-face interviews, company reports, and field notes. Data analysis involved a modified Van Kamm method, which included descriptive coding, a sequential review of the interview transcripts, and member checking. Based on methodological triangulation and thematic analysis, 5 themes emerged from the study, including communication and engagement; motivation and empowerment; measurement, monitoring, and control; self-awareness and humility; and efficiency and optimization. The implications for social change include the potential for crude oil and gas companies in Calgary, Canada to manage production costs, ensure earnings and profitability, and thus improve the socioeconomic well-being of Calgary indigenes through improved employment opportunities.

An exploratory study of the socio-cultural risk influences for cigarette smoking among Southern Nigerian youth.

PubMed

Egbe, Catherine O; Petersen, Inge; Meyer-Weitz, Anna; Oppong Asante, Kwaku

2014-11-22

The increase in smoking prevalence in developing countries including Nigeria has been mainly blamed on the aggressive marketing strategies of big tobacco companies. There is a paucity of research on other socio-cultural risk factors for smoking among the youth. The main objective of this study is to explore and describe socio-cultural risk factors influencing cigarette smoking among the youth in Southern Nigeria. A total of 27 respondents (5 community leaders, 4 political analysts and 18 young cigarette smokers) were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyse the data. Social-cultural practices fuelling early usage and exposure of children to cigarettes and the promotional activities of tobacco companies were identified as possible factors influencing youth's smoking behaviour in Southern Nigeria. Tobacco control policies should include cultural interventions to modify current traditional practices and social norms which fuel the use of tobacco in the society. Such interventions must target specific groups, subpopulations and subcultures more exposed to the cultural risk influences for smoking.

Factors Related to Continuation of Health Behaviours among Stroke Survivors

PubMed Central

Kudo, Makoto

2011-01-01

Abstract Purpose: This study investigated stroke survivors' perspectives of health behaviours after stroke. We aimed to explore the actual process by which stroke survivors changed their health behaviours. Method: Semi-structured interviews were conducted with 40 people in a 1-year prospective study in the regional city of Chiba, Japan. Interviews covered views of health behaviours in order to explore why patients change their risk factors. Data were analysed using the principles of modified grounded theory. Results: Six categories related to practising health behaviours were identified: cause of stroke, antithetic thinking, awareness of the body, fear of disease progression, view of health, and psychological meaning of practise. Stroke survivors constructed a meaning of practise for each health behaviour. The recognition of previous lifestyle as cause of stroke, hope for recovery, and fear of future progression influenced health behaviours. Conclusions: The key finding of this study is that when cognitive behavioural therapy principles are enforced, an important aspect is that stroke survivors recognize the possibility that previous lifestyle was a cause of stroke and appreciate the necessity of preventing a new stroke. PMID:25792892

Managing the stigma: Exploring body image experiences and self-presentation among people with spinal cord injury.

PubMed

Bailey, K Alysse; Gammage, Kimberley L; van Ingen, Cathy; Ditor, David S

2016-01-01

Using modified constructivist grounded theory, the purpose of this study was to explore body image experiences in people with spinal cord injury. Nine participants (five women, four men) varying in age (21-63 years), type of injury (C3-T7; complete and incomplete), and years post-injury (4-36 years) took part in semi-structured in-depth interviews. The following main categories were found: appearance, weight concerns, negative functional features, impact of others, body disconnection, hygiene and incontinence, and self-presentation. Findings have implications for the health and well-being of those living with a spinal cord injury.

Undergraduate Students' Perceptions of an Inquiry-Based Physics Course

NASA Astrophysics Data System (ADS)

Ballone Duran, Lena; McArthur, Julia; van Hook, Stephen

2004-04-01

The purpose of this study was to examine middle childhood students'' perceptions of the learning environment in a reform-based physics course. A lecture-style, introductory physics course was modified into an inquiry-based course designed for preservice middle childhood teachers through the collaborative efforts of faculty in the Colleges of Education and Arts and Sciences. Focus group interviews were conducted to examine students'' perceptions. The results suggested that the students initially felt a level of frustration with a new constructivist experience; however, they were able to embrace the inquiry method and expressed a desire for additional specialized content courses for preservice teachers.

Adolescent and Young Adult Cancer Survivors' Perspectives on Their Internet Use for Seeking Information on Healthy Eating and Exercise.

PubMed

Mooney, Ryan; Samhouri, Mahasen; Holton, Avery; Devine, Katie A; Kirchhoff, Anne C; Wright, Jennifer; Wu, Yelena P

2017-06-01

To explore adolescent and young adult (AYA) cancer survivors' internet use in seeking healthy lifestyle behavior (HLB) information on diet and exercise. Twenty-five AYA cancer survivors participated in focus groups or interviews. Data were analyzed using qualitative content analysis. Most survivors (92%) sought HLB information from internet sources. Key issues included the following: (1) too much information available, (2) information not meeting survivors' unique needs, and (3) concerns about trustworthiness of information. Although AYA cancer survivors use the internet to seek HLB information, internet resources could be modified to better meet the needs of AYA cancer survivors.

Modified prepubic TVT-obturator tape procedure versus the conventional method: a preliminary study.

PubMed

Long, Cheng-Yu; Wu, Ming-Ping; Wang, Chiu-Lin; Lin, Kun-Ling; Liu, Cheng-Min; Wu, Shu-Hui; Juan, Yung-Shun

2013-12-01

To compare the efficacy and safety of the modified prepubic tension-free vaginal tape-obturator (PTVT-O) system procedure with the original TVT-O methods. One hundred and ninety women with urodynamic stress incontinence (USI) were included in this study (93 cases in the TVT-O group and 97 in the PTVT-O group). Clinical assessments before and one year after surgery included urinalyses, 1-h pad tests, urodynamic studies, and a personal interview with the overactive bladder symptom score (OABSS) questionnaire. There were no differences between the two groups in mean age, parity, menopausal status, mean operative time and subjective cure rates (P>0.05), but the efficacy of surgery (cure and improvement) in the PTVT-O group was significantly higher than that in the TVT-O group (P=0.038). Complication rates and visual analog scale (VAS) scores were found to be similar (P>0.05). OABSS decreased significantly after surgery in both groups (P<0.05) although all urodynamic parameters revealed no significant difference after both procedures (P>0.05). Our modified procedure is a safe and effective treatment for female USI. It has an advantage over the original TVT-O with better surgical efficacy and comparable postoperative pain, although the follow-up times in this study are different. Copyright © 2013. Published by Elsevier Ireland Ltd.

Modified-Symbol Digit Modalities Test for African Americans, Caribbean Black Americans and Non-Latino Whites: Nationally Representative Normative Data from the National Survey of American Life

PubMed Central

González, Hector M.; Whitfield, Keith E.; West, Brady T.; Williams, David R.; Lichtenberg, Peter; Jackson, James S.

2007-01-01

Normative neuropsychological data for U.S. racial/ethnic minorities is limited. Extant norms are based on small, regional groups that may not be nationally representative. The objectives of this study were to 1) provide norms for a modified Symbol Digit Modalities Test (M-SDMT) based on a nationally representative sample of African Americans, Caribbean Blacks and non-Latino Whites (NLW) living in areas with large populations of Blacks, and 2) determine significant correlates of M-SDMT performance. The M-SDMT was administered to a subset of respondents from the National Survey of American Life in standard, face-to-face interviews. M-SDMT performance was influenced by race/ethnicity, age, education, and gender. African Americans and NLW groups had similar M-SDMT performances, which differed from Caribbean Blacks. The Black ethnic differences in M-SDMT were not explained by the sociodemographic factors considered in this study. Unlike previous work, this study supports the consideration of Black ethnicity when evaluating Black neuropsychological test performance. PMID:17493782

Using software-modified smartphones to validate self-reported mobile phone use in young people: A pilot study.

PubMed

Goedhart, Geertje; Vrijheid, Martine; Wiart, Joe; Hours, Martine; Kromhout, Hans; Cardis, Elisabeth; Eastman Langer, Chelsea; de Llobet Viladoms, Patricia; Massardier-Pilonchery, Amelie; Vermeulen, Roel

2015-10-01

A newly developed smartphone application was piloted to characterize and validate mobile phone use in young people. Twenty-six volunteers (mean age 17.3 years) from France, Spain, and the Netherlands used a software-modified smartphone for 4 weeks; the application installed on the phone recorded number and duration of calls, data use, laterality, hands-free device usage, and communication system used for both voice calls and data transfer. Upon returning the phone, participants estimated their mobile phone use during those 4 weeks via an interviewer-administered questionnaire. Results indicated that participants on average underestimated the number of calls they made, while they overestimated total call duration. Participants held the phone for about 90% of total call time near the head, mainly on the side of the head they reported as dominant. Some limitations were encountered when comparing reported and recorded data use and speaker use. When applied in a larger sample, information recorded by the smartphone application will be very useful to improve radiofrequency (RF) exposure modeling from mobile phones to be used in epidemiological research. © 2015 Wiley Periodicals, Inc.

[Reliability and validity of the modified Perceived Health Competence Scale (PHCS) Japanese version].

PubMed

Togari, Taisuke; Yamazaki, Yoshihiko; Koide, Syotaro; Miyata, Ayako

2006-01-01

In community and workplace health plans, the Perceived Health Competence Scale (PHCS) is employed as an index of health competency. The purpose of this research was to examine the reliability and validity of a modified Japanese PHCS. Interviews were sought with 3,000 randomly selected Japanese individuals using a two-step stratified method. Valid PHCS responses were obtained from 1,910 individuals, yielding a 63.7% response rate. Reliability was assessed using Cronbach's alpha coefficient (henceforth, alpha) to evaluate internal consistency, and by employing item-total correlation and alpha coefficient analyses to assess the effect of removal of variables from the model. To examine content validity, we assessed the correlation between the PHCS score and four respondent attribute characteristics, that is, sex, age, the presence of chronic disease, and the existence of chronic disease at age 18. The correlation between PHCS score and commonly employed healthy lifestyle indices was examined to assess construct validity. General linear model statistical analysis was employed. The modified Japanese PHCS demonstrated a satisfactory alpha coefficient of 0.869. Moreover, reliability was confirmed by item-total correlation and alpha coefficient analyses after removal of variables from the model. Differences in PHCS scores were seen between individuals 60 years and older, and younger individuals. These with current chronic disease, or who had had a chronic disease at age 18, tended to have lower PHCS scores. After controlling for the presence of current or age 18 chronic disease, age, and sex, significant correlations were seen between PHCS scores and tobacco use, dietary habits, and exercise, but not alcohol use or frequency of medical consultation. This study supports the reliability and validity, and hence supports the use, of the modified Japanese PHCS. Future longitudinal research is needed to evaluate the predictive power of modified Japanese PHCS scores, to examine factors influencing the development of perceived health competence, and to assess the effects of interventions on perceived health competence.

Investigating the Increase in Domestic Violence Post Disaster: An Australian Case Study.

PubMed

Parkinson, Debra

2017-03-01

Interviews with 30 women in two shires in Victoria, Australia, confirmed that domestic violence increased following the catastrophic Black Saturday bushfires on February 7, 2009. As such research is rare, it addresses a gap in the disaster and interpersonal violence literature. The research that exists internationally indicates that increased violence against women is characteristic of a postdisaster recovery in developing countries. The relative lack of published research from primary data in developed countries instead reflects our resistance to investigating or recognizing increased male violence against women after disasters in developed countries. This article begins with an overview of this literature. The primary research was qualitative, using in-depth semistructured interviews to address the research question of whether violence against women increased in the Australian context. The sample of 30 women was aged from 20s to 60s. Recruitment was through flyers and advertisements, and interviews were audio-recorded, transcribed, and checked by participants. Analysis was inductive, using modified grounded theory. Seventeen women gave accounts of new or increased violence from male partners that they attribute to the disaster. A key finding is that, not only is there both increased and new domestic violence but formal reporting will not increase in communities unwilling to hear of this hidden disaster. Findings are reported within a framework of three broad explanations. In conclusion, although causation is not claimed, it is important to act on the knowledge that increased domestic violence and disasters are linked.

Healthcare Experiences Among Young Adults Who Identify as Genderqueer or Nonbinary.

PubMed

Lykens, James E; LeBlanc, Allen J; Bockting, Walter O

2018-04-01

Research on healthcare among gender-diverse populations has largely focused on people who describe their gender in binary terms, either as trans men or trans women. This qualitative study examined the healthcare experiences of young adults who identify as genderqueer or nonbinary (GQ/NB). Participants (N = 10) were interviewed about experiences seeking and accessing healthcare. All were young adults (ages 23-33) in the San Francisco Bay area who had accessed healthcare at least once in the prior 6 months. A semistructured interview guide elicited conversations about gender identity and experiences of healthcare. Interview transcripts were analyzed using emergent coding analysis to identify themes. Participants faced unique challenges even at clinics specializing in gender-affirming healthcare. They felt misunderstood by providers who approached them from a binary transgender perspective and consequently often did not receive care sensitive to nonbinary identities. In response to this perceived bias, participants sometimes "borrowed" a binary transgender label to receive care, modified the healthcare they were prescribed, or went without healthcare. The GQ/NB young adults in our study regularly felt disrespected and frustrated as they sought and accessed healthcare. Participants felt that the binary transgender narrative pressured them to conform to binary medical narratives throughout healthcare interactions. GQ/NB young adults have unique healthcare needs but often do not feel understood by their providers. There is a need for existing healthcare systems to serve GQ/NB young adults more effectively.

Sun protection education for diverse audiences: need for skin cancer pictures.

PubMed

Guevara, Yanina; Gaber, Rikki; Clayman, Marla L; Gordon, Elisa J; Friedewald, John; Robinson, June K

2015-03-01

Sun protection education is needed for kidney transplant recipients, whose increased risk of skin cancer could be ameliorated with sun protection. Cognitive interviews with 24 participants equally stratified among non-Hispanic White, non-Hispanic Black, and Hispanic/Latino kidney transplant recipients were performed to evaluate a sun protection education workbook. Study participants were recruited over the phone using a registry of 700 kidney transplant recipients. Participants included 12 women and 12 men with a median age of 52. In 16 of the cognitive interviews with non-Hispanic Blacks and Hispanic/Latinos, pictures of skin cancer were requested by the participants in order to see the appearance of skin cancer. Kidney transplant recipients with skin of color did not consider themselves at risk to develop skin cancer and wanted to see examples of skin cancer occurring on people with skin of color. Based on these results, the workbook was modified to include pictures of squamous cell carcinoma on varying skin tones. Then, 8 participants evaluated the revised workbook in cognitive interviews and found the photographs acceptable and necessary to demonstrate the severity of skin cancer and personalize their risk of developing skin cancer. The participants progressed from having knowledge of skin cancer to believing that they could develop skin cancer because they observed skin cancers on people with their skin tone. Using pictures of skin cancers occurring on people with similar skin tone may heighten a kidney transplant recipients' sense of vulnerability and possibly improve the use of sun protection.

[Electronic medical records: Evolution of physician-patient relationship in the Primary Care clinic].

PubMed

Pérez-Santonja, T; Gómez-Paredes, L; Álvarez-Montero, S; Cabello-Ballesteros, L; Mombiela-Muruzabal, M T

2017-04-01

The introduction of electronic medical records and computer media in clinics, has influenced the physician-patient relationship. These modifications have many advantages, but there is concern that the computer has become too important, going from a working tool to the centre of our attention during the clinical interview, decreasing doctor interaction with the patient. The objective of the study was to estimate the percentage of time that family physicians spend on computer media compared to interpersonal communication with the patient, and whether this time is modified depending on different variables such as, doctor's age or reason for the consultation. An observational and descriptive study was conducted for 10 weeks, with 2 healthcare centres involved. The researchers attended all doctor- patient interviews, recording the patient time in and out of the consultation. Each time the doctor fixed his gaze on computer media the time was clocked. A total of 436 consultations were collected. The doctors looked at the computer support a median 38.33% of the total duration of an interview. Doctors of 45 years and older spent more time fixing their eyes on computer media (P<.05). Family physicians used almost 40% of the consultation time looking at computer media, and depends on age of physician, number of queries, and number of medical appointments. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Food choices made by low-income households when feeding their pre-school children: a qualitative study.

PubMed

Lovelace, Sally; Rabiee-Khan, Fatemeh

2015-10-01

The growing concern about poor dietary practices among low-income families has led to a 'victim blaming' culture that excludes wider social and environmental factors, which influence household food choices. This small-scale qualitative study investigated influences on the diets of young children in families on a low income in the West Midlands, UK. Using semi-structured interview schedule, rich data was gathered through individual interviews with 11 mothers of pre-school children. Information was collected about the type and range of food given following the introduction of solid foods including factors influencing parent's knowledge and diet, sources of nutrition advice and financial constraints. Food accessibility and storage issues were also explored. Interviews were audio-recorded, transcribed and analysed using a modified grounded theory approach. Findings highlighted that parents and professionals may have different interpretations about 'cooking from scratch'. The results indicated that some parents have poor understanding of what constitutes a healthy diet. However, most parents included fruit and vegetables to varying degrees and were motivated to give their children healthy foods, suggesting that, with adequate support and information, the diets of these children could be improved. There was evidence that when striving to improve the diet of their children, many parents' diets also improved. The findings from this small-scale in-depth study highlighted a number of issues for local and national policy and practice in the area of nutrition and child health in the early years. © 2013 John Wiley & Sons Ltd.

Developing a palliative care service model for Muslim Middle Eastern countries.

PubMed

Al-Awamer, Ahmed; Downar, James

2014-12-01

Palliative Care (PC) was first introduced to Muslim Middle Eastern (MME) countries in 1992, but growth of PC has been slow and access to PC is still limited in the region. While most PC models have been developed in Western countries, MME societies have different cultural and religious values that are not incorporated in Western models. We conducted a qualitative study to look at these differences, in order to inform a culturally acceptable model of PC that meets the needs of MME patients and their families. We conducted semi-structured interviews of PC physicians and nurses with experience in both Western and MME countries. Participants were identified by snowball sampling. Interviews were transcribed and analyzed using a modified grounded-theory approach. We achieved conceptual saturation after 13 interviews. Participants identified four differences between PC practice in Western and MME countries including: cultural differences, legal and policy differences, stances on PC philosophy, and the availability of resources and support for PC. Participants identified five barriers to advancing PC in the MME: shortage of resources, unclear laws and policies, healthcare system barriers, unfamiliarity with the role and benefits of PC, and cultural barriers. Respondents suggested many facilitators at the institutional, regional, and societal levels. We identified a number of important differences in PC practice, as well as common barriers and facilitators for developing PC services in MME countries. This information can help clinicians who are developing PC services in a MME country.

Cracking the code for maintaining quality training in Olympic distance triathlon: lessons learnt from a squad of elite Scandinavian athletes

PubMed Central

Myburgh, Corrie; Hansen, Tobias; Holm Beck, Anders; Boyle, Eleanor

2017-01-01

Objective High-quality training is a key determinant of performance in the Olympic distance triathlon and is potentially influenced by a unique array of context-specific biopsychosocial factors. Our objective was to explore and describe these factors among squad members of a university-based, elite Olympic distance triathlete developmental programme. Method A qualitative investigation using a visual communication tool-assisted focus group and longitudinal semistructured individual interviews was conducted. Responses were solicited from the University of Southern Denmark’s elite triathlon team (n=8), and inductive coding from the focus group formed the basis of questions for the two rounds of individual interviews 11 months apart. All interviews were transcribed verbatim and then analysed thematically. Results Seventeen context-relevant factors were identified and 10 themes emerged, these being ‘the cold weather ritual’, ‘digestive system conditioning’, ‘the curse of the night owl’, ‘the strings attached to sponsorship’, ‘my coach—my rock’, ‘mood maintenance’, ‘the asynchronous training rhythm’, ‘psychological slavery’, ‘the legacy of the asphalt tattoo’ and ‘the tension of family and friends’. Conclusions By reflecting on their personal training vortex, elite triathletes were able to provide context-relevant insights into the maintenance of training quality over the course of a competitive season. Further research is required to elucidate whether and how biopsycholosocial factors can be modified to optimise the achievement of training goals. PMID:29071114

Determinants of career satisfaction among pediatric hospitalists: a qualitative exploration

PubMed Central

Leyenaar, JoAnna K.; Capra, Lisa A.; O'Brien, Emily R.; Leslie, Laurel K.; Mackie, Thomas I.

2014-01-01

Objectives To characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings, and to develop a framework to conceptualize factors influencing career satisfaction. Methods Semi-structured interviews were conducted with community and tertiary care hospitalists, using purposeful sampling to attain maximum response diversity. We employed close- and open-ended questions to assess levels of career satisfaction and its determinants. Interviews were conducted by telephone, recorded, and transcribed verbatim. Emergent themes were identified and analyzed using an inductive approach to qualitative analysis. Results A total of 30 interviews were conducted with community and tertiary care hospitalists, representing 20 hospital medicine programs and 7 Northeastern states. Qualitative analysis yielded 657 excerpts which were coded and categorized into four domains and associated determinants of career satisfaction: (i) professional responsibilities; (ii) hospital medicine program administration; (iii) hospital and healthcare systems; and (iv) career development. While community and tertiary care hospitalists reported similar levels of career satisfaction, they expressed variation in perspectives across these four domains. While the role of hospital medicine program administration was consistently emphasized by all hospitalists, community hospitalists prioritized resource availability, work schedule and clinical responsibilities while tertiary care hospitalists prioritized diversity in non-clinical responsibilities and career development. Conclusions We illustrate how hospitalists in different organizational settings prioritize both consistent and unique determinants of career satisfaction. Given associations between physician satisfaction and healthcare quality, efforts to optimize modifiable factors within this framework, at both community and tertiary care hospitals, may have broad impacts. PMID:24976348

Stability of parental understanding of random assignment in childhood leukemia trials: an empirical examination of informed consent.

PubMed

Greenley, Rachel Neff; Drotar, Dennis; Zyzanski, Stephen J; Kodish, Eric

2006-02-20

To examine stability versus change in parental understanding of random assignment in randomized clinical trials (RCTs) for pediatric leukemia and to identify factors associated with changes in understanding. Eighty-four parents of children diagnosed with acute lymphoblastic leukemia or acute myeloid leukemia who were enrolled onto a pediatric leukemia RCT at one of six US children's hospitals participated. Parents were interviewed twice, once within 48 hours after the Informed Consent Conference (ICC; time 1 [T1]) and again 6 months later (time 2 [T2]). Interviews focused on parental understanding of key components of the RCT, including random assignment. Interviews were audiotaped, transcribed, and later analyzed. Changes in understanding of random assignment occurred in 19% of parents, with 17% of parents deteriorating in understanding from T1 to T2. Forty-nine percent of parents failed to understand random assignment at both times. Factors associated with understanding at both times included majority ethnicity, high socioeconomic status, parental reading of consent document, and presence of a nurse during the ICC. Physician discussion of specific components of the RCT was also associated with understanding at both times. Female caregivers and parents of low socioeconomic status were overrepresented among those who showed decay in understanding from T1 to T2. Parents showed little gain in understanding over time. Factors that predicted understanding at diagnosis as well as sustained understanding over time may be important intervention targets. Attention to both modifiable and nonmodifiable barriers is important for clinical practice.

Validity and relative validity of a novel digital approach for 24-h dietary recall in athletes

PubMed Central

2014-01-01

Background We developed a digital dietary analysis tool for athletes (DATA) using a modified 24-h recall method and an integrated, customized nutrient database. The purpose of this study was to assess DATA’s validity and relative validity by measuring its agreement with registered dietitians’ (RDs) direct observations (OBSERVATION) and 24-h dietary recall interviews using the USDA 5-step multiple-pass method (INTERVIEW), respectively. Methods Fifty-six athletes (14–20 y) completed DATA and INTERVIEW in randomized counter-balanced order. OBSERVATION (n = 26) consisted of RDs recording participants’ food/drink intake in a 24-h period and were completed the day prior to DATA and INTERVIEW. Agreement among methods was estimated using a repeated measures t-test and Bland-Altman analysis. Results The paired differences (with 95% confidence intervals) between DATA and OBSERVATION were not significant for carbohydrate (10.1%, -1.2–22.7%) and protein (14.1%, -3.2–34.5%) but was significant for energy (14.4%, 1.2–29.3%). There were no differences between DATA and INTERVIEW for energy (-1.1%, -9.1–7.7%), carbohydrate (0.2%, -7.1–8.0%) or protein (-2.7%, -11.3–6.7%). Bland-Altman analysis indicated significant positive correlations between absolute values of the differences and the means for OBSERVATION vs. DATA (r = 0.40 and r = 0.47 for energy and carbohydrate, respectively) and INTERVIEW vs. DATA (r = 0.52, r = 0.29, and r = 0.61 for energy, carbohydrate, and protein, respectively). There were also wide 95% limits of agreement (LOA) for most method comparisons. The mean bias ratio (with 95% LOA) for OBSERVATION vs. DATA was 0.874 (0.551-1.385) for energy, 0.906 (0.522-1.575) for carbohydrate, and 0.895(0.395-2.031) for protein. The mean bias ratio (with 95% LOA) for INTERVIEW vs. DATA was 1.016 (0.538-1.919) for energy, 0.995 (0.563-1.757) for carbohydrate, and 1.031 (0.514-2.068) for protein. Conclusion DATA has good relative validity for group-level comparisons in athletes. However, there are large variations in the relative validity of individuals’ dietary intake estimates from DATA, particularly in athletes with higher energy and nutrient intakes. DATA can be a useful athlete-specific, digital alternative to conventional 24-h dietary recall methods at the group level. Further development and testing is needed to improve DATA’s validity for estimations of individual dietary intakes. PMID:24779565

Validity and relative validity of a novel digital approach for 24-h dietary recall in athletes.

PubMed

Baker, Lindsay B; Heaton, Lisa E; Stein, Kimberly W; Nuccio, Ryan P; Jeukendrup, Asker E

2014-04-30

We developed a digital dietary analysis tool for athletes (DATA) using a modified 24-h recall method and an integrated, customized nutrient database. The purpose of this study was to assess DATA's validity and relative validity by measuring its agreement with registered dietitians' (RDs) direct observations (OBSERVATION) and 24-h dietary recall interviews using the USDA 5-step multiple-pass method (INTERVIEW), respectively. Fifty-six athletes (14-20 y) completed DATA and INTERVIEW in randomized counter-balanced order. OBSERVATION (n = 26) consisted of RDs recording participants' food/drink intake in a 24-h period and were completed the day prior to DATA and INTERVIEW. Agreement among methods was estimated using a repeated measures t-test and Bland-Altman analysis. The paired differences (with 95% confidence intervals) between DATA and OBSERVATION were not significant for carbohydrate (10.1%, -1.2-22.7%) and protein (14.1%, -3.2-34.5%) but was significant for energy (14.4%, 1.2-29.3%). There were no differences between DATA and INTERVIEW for energy (-1.1%, -9.1-7.7%), carbohydrate (0.2%, -7.1-8.0%) or protein (-2.7%, -11.3-6.7%). Bland-Altman analysis indicated significant positive correlations between absolute values of the differences and the means for OBSERVATION vs. DATA (r = 0.40 and r = 0.47 for energy and carbohydrate, respectively) and INTERVIEW vs. DATA (r = 0.52, r = 0.29, and r = 0.61 for energy, carbohydrate, and protein, respectively). There were also wide 95% limits of agreement (LOA) for most method comparisons. The mean bias ratio (with 95% LOA) for OBSERVATION vs. DATA was 0.874 (0.551-1.385) for energy, 0.906 (0.522-1.575) for carbohydrate, and 0.895(0.395-2.031) for protein. The mean bias ratio (with 95% LOA) for INTERVIEW vs. DATA was 1.016 (0.538-1.919) for energy, 0.995 (0.563-1.757) for carbohydrate, and 1.031 (0.514-2.068) for protein. DATA has good relative validity for group-level comparisons in athletes. However, there are large variations in the relative validity of individuals' dietary intake estimates from DATA, particularly in athletes with higher energy and nutrient intakes. DATA can be a useful athlete-specific, digital alternative to conventional 24-h dietary recall methods at the group level. Further development and testing is needed to improve DATA's validity for estimations of individual dietary intakes.

Alcohol use and abuse in young adulthood: do self-control and parents' perceptions of friends during adolescence modify peer influence? The TRAILS study.

PubMed

Visser, Leenke; de Winter, Andrea F; Veenstra, René; Verhulst, Frank C; Reijneveld, Sijmen A

2013-12-01

To assess the influence of peer alcohol use during adolescence on young adults' alcohol use and abuse, and to assess to what extent parents' perception of their adolescent child's friends and adolescent's self-control modify this influence. We analyzed data from the first, third, and fourth wave of a population-based prospective cohort study of 2230 adolescents conducted between 2001 and 2010 (mean ages: 11.1, 16.3, and 19.1, respectively). Alcohol use and abuse were measured at T4 by self-report questionnaires and by the Composite International Diagnostics Interview (CIDI), respectively. Peer alcohol use, self-control, and parents' perception of their adolescent child's friends were measured at T3. We adjusted for gender, age, socioeconomic-status, parental alcohol use, and adolescent baseline alcohol use. Peer alcohol use during adolescence was related to young adults' alcohol use and abuse [odds ratio (95% confidence interval): 1.31 (1.11-1.54) and 1.50 (1.20-1.87), respectively]. Neither parents' perception of their adolescent child's friends nor self-control modified this relationship. Alcohol abusers were more likely to have low self-control than alcohol users. No differences were found between alcohol users and abusers regarding their parents' perception of their friends and peer alcohol use. Peer alcohol use during adolescence affects young adults' alcohol use and abuse. We found that self-control was only related to alcohol abuse. Peer influence was not modified by parents' perception of peers or by self-control. Peer alcohol use and self-control should thus be separate targets in the prevention of alcohol use/abuse. © 2013.

Stress and medicine use for headache: does sense of coherence modify the association?

PubMed

Koushede, Vibeke; Holstein, Bjørn E; Andersen, Anette; Hansen, Ebba Holme

2011-10-01

Medicine use as a strategy for coping with daily stressors is an under-studied issue. Studies show that stress is associated with use of over-the-counter medicine, but the underlying mechanisms are not well understood. The aim of this study was to examine whether sense of coherence (SOC) modifies the association between perceived stress and medicine use for headache. National cross-sectional study in Denmark. men and women aged 25-44 years, n = 990. The survey was conducted by web-based questionnaires and telephone interviews. The outcome measure was medicine use for headache. The independent variable was perceived stress. SOC and gender were investigated as moderators. Social class, headache prevalence and severity, and response method were included as co-variates. Our study showed that SOC modified the association between stress and medicine use for headache (only statistically significant among women). The odds for medicine use among women who felt stressed were 2.30 (1.39-3.79) compared to women who did not feel stressed; among men who felt stressed the equivalent odds were 1.46 (0.80-2.66). In analysis stratified by SOC, the odds for medicine use when stressed were 2.09 (0.71-6.21) among women with high SOC, 2.21 (1.10-4.41) among women with medium SOC and 3.69 (1.09-12.47) among women with low SOC. The equivalent odds for men were 1.29 (0.33-5.04), 1.33 (0.59-3.04) and 2.47 (0.57-10.64), respectively. SOC modifies the association between stress and medicine use especially among women. Individuals with fewer coping resources may be more likely to use medicine beyond indication to treat stress.

Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death.

PubMed

Hodkinson, Peter; Argent, Andrew; Wallis, Lee; Reid, Steve; Perera, Rafael; Harrison, Sian; Thompson, Matthew; English, Mike; Maconochie, Ian; Ward, Alison

2016-01-01

Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors. The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children. The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.

A case-crossover study on transient risk factors of work-related eye injuries.

PubMed

Chen, S-Y; Fong, P-C; Lin, S-F; Chang, C-H; Chan, C-C

2009-08-01

To investigate modifiable risk and preventive factors of work-related eye injuries. A case-crossover study conducted to explore the associations between transient risk factors and work-related eye injuries. Patients seen at seven medical centres in Taiwan with work-related eye injuries over a 4-year period were enrolled in the study. Clinical information was collected from medical charts and detailed information on exposure to eight potentially modifiable factors during the 60 minutes prior to the occurrence of each injury, as well as during the same time interval on the last work day prior to the injury, were obtained using questionnaire surveys. Matched-pair interval analysis was adopted to assess the odds ratios (ORs) for work-related eye injuries given exposure to the eight modifiable factors. A total of 283 subjects were interviewed. Most of these injured workers were young, male, and self-employed or small enterprise workers. The most common injury type was photokeratitis (33.2%), mainly caused by welding (30.4%). The OR for a work-related eye injury was increased with the performance of an unfamiliar task (57.0), operation of a faulty tool or piece of equipment (48.5), distractions (24.0), being rushed (13.0), or fatigued (10.0), and a poor work environment (4.3). Wearing eye protection devices was found to have a significant protective effect on workers who might otherwise have been exposed to eye injuries (OR = 0.4; 95% CI 0.2 to 0.7). Potential modifiable risk and preventive factors for work-related eye injuries were identified using a case-crossover study. This information should be helpful in the development of preventive strategies.

Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda.

PubMed

Tsai, Alexander C; Bangsberg, David R; Frongillo, Edward A; Hunt, Peter W; Muzoora, Conrad; Martin, Jeffrey N; Weiser, Sheri D

2012-06-01

Depression is common among people living with HIV/AIDS and contributes to a wide range of worsened HIV-related outcomes, including AIDS-related mortality. Targeting modifiable causes of depression, either through primary or secondary prevention, may reduce suffering as well as improve HIV-related outcomes. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support. Quarterly data were collected by structured interviews and blood draws. The primary outcome was depression symptom severity, measured by a modified Hopkins Symptom Checklist for Depression. The primary explanatory variables were food insecurity, measured with the Household Food Insecurity Access Scale, and social support, measured with a modified version of the Functional Social Support Questionnaire. We found that food insecurity was associated with depression symptom severity among women but not men, and that social support buffered the impacts of food insecurity on depression. We also found that instrumental support had a greater buffering influence than emotional social support. Interventions aimed at improving food security and strengthening instrumental social support may have synergistic beneficial effects on both mental health and HIV outcomes among PLWHA in resource-limited settings. Copyright © 2012 Elsevier Ltd. All rights reserved.

Simulations of Plasmasheet Electrons in a Model Magnetosphere with AMIE Potentials: Implications for Diffuse Aurora

NASA Astrophysics Data System (ADS)

Chen, M. W.; Schulz, M.; Lu, G.

2001-12-01

We obtain distributions of precipitating electrons by tracing drift shells of plasmasheet electrons in the limit of strong pitch angle diffusion in Dungey's model magnetosphere, which consists of a dipolar magnetic field plus a uniform southward field. Under strong pitch-angle diffusion particles drift so as to conserve an adiabatic invariant Λ equal to the enclosed phase-space volume (i.e., the cube of the particle momentum p times the occupied flux-tube volume per unit magnetic flux). In the past we applied a quiescent Stern-Volland electric-field model with a cross-tail potential drop of 25 kV and added to it a storm-associated Brice-Nishida cross-magnetospheric electric field with impulses to represent substorm effects. For the present study we use the more realistic Assimilative Model of Ionospheric Electrodynamics (AMIE). We use an analytical expansion to express the AMIE ionospheric potential as a function of latitude and magnetic local time. We map this AMIE potential to latitudes >= 50^o to magnetospheric field lines with (L \\ge 2.5) in Dungey's magnetic field model. We trace the bounce-averaged drift motion of representative plasmasheet electrons for values of \\Lambda corresponding to energies of 0.25-64 keV on field lines of equatorial radial distance r = 6 R_E (L = 5.7), which maps to \\approx 65^o$ latitude in the ionosphere. We use the simulation results to map stormtime phase space distributions taking into account loss due to precipitation. We consider 2 models of electron scattering: (1) the limit of strong scattering everywhere, and (2) an MLT-dependent scattering that is less than everywhere strong in the plasma sheet. From the phase space distributions we calculate the total precipitating electron energy flux into the ionosphere. For this study we focus on the October 19, 1998, storm. We compare qualitatively the simulated energy flux with X-ray intensity from Polar/PIXIE images during this storm.

The influence of melt composition on the partitioning of REEs, Y, Sc, Zr and Al between forsterite and melt in the system CMAS

NASA Astrophysics Data System (ADS)

Evans, Thomas M.; O'Neill, Hugh St. C.; Tuff, James

2008-12-01

Partition coefficients for a range of Rare Earth Elements (REEs), Y, Sc, Al and Zr were determined between forsteritic olivine (nearly end-member Mg 2SiO 4) and ten melt compositions in the system CaO-MgO-Al 2O 3-SiO 2 (CMAS) at 1 bar and 1400 °C, with concentrations of the trace elements in the olivine and the melt measured by laser-ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The REEs and Sc were added at levels sufficient to ensure that concentrations in the olivine were well above the detection limits. The REE partition coefficients (DREEol/melt) decrease with increasing silica in the melt, indicating strong bonding between REEO 1.5 and SiO 2 in the melt. The variation of DREEol/melt as a function of ionic radius is well described by the Brice equation for each composition, although a small proportion of this variation is due to the increase in the strength of the REEO 1.5-SiO 2 interactions in the melt with ionic radius. Scandium behaves very similarly to the REEs, but a global fit of the data from all ten melt compositions suggests that DScol/melt deviates somewhat from the parabolas established by the REE and Y, implying that Sc may substitute into olivine differently to that of the REEs. In contrast to the behaviour of the large trivalent cations, the concentration of Al in olivine is proportional to the square root of its concentration in the melt, indicating a coupled substitution in olivine with a high degree of short-range order. The lack of any correlation of REE partition coefficients with Al in olivine or melt suggests that the REE substitution in olivine is charge-balanced by cation vacancies. The partition coefficient of the tetravalent trace element Zr, which is highly incompatible in olivine, depends on the CaO content of the melt.

Effect of the Solar UV/EUV Heating on the Intensity and Spatial Distribution of Jupiter's Synchrotron Radiation

NASA Astrophysics Data System (ADS)

Kita, Hajime; Misawa, H.; Tsuchiya, F.; Tao, C.; Morioka, A.

2012-10-01

Jupiter's synchrotron radiation (JSR) is the emission from relativistic electrons, and it is the most effective probe for remote sensing of Jupiter's radiation belt from the Earth. Recent observations reveal short term variations of JSR with the time scale of days to weeks. Brice and McDonough (1973) proposed that the solar UV/EUV heating for Jupiter's upper atmosphere causes enhancement of total flux density. If such a process occurs at Jupiter, it is also expected that diurnal wind system produces dawn-dusk asymmetry of the JSR brightness distribution. Preceding studies confirmed that the short term variations in total flux density correspond to the solar UV/EUV. However, the effect of solar UV/EUV heating on the brightness distribution has not been confirmed. Hence, the purpose of this study is to confirm the solar UV/EUV heating effect on total flux density and brightness distribution. We made radio imaging analysis using the National Radio Astronomy Observatory (NRAO) archived data of the Very Large Array (VLA) obtained in 2000, and following results were shown. 1, Total flux density varied corresponding to the solar UV/EUV. 2, Dawn side emission was brighter than dusk side emission almost every day. 3, Variations of the dawn-dusk asymmetry did not correspond to the solar UV/EUV. In order to explain the second result, we estimate the diurnal wind velocity from the observed dawn-dusk ratio by using the model brightness distribution of JSR. Estimated neutral wind velocity is 46+/-11 m/s, which reasonably corresponds to the numerical simulation of Jupiter's upper atmosphere. In order to explain the third result, we examined the effect of the global convection electric field driven by tailward outflow of plasma in Jupiter's magnetosphere. As the result, it is suggested that typical fluctuation of the convection electric field strength was enough to cause the observed variations of the dawn-dusk asymmetry.

Community of Practice: A Path to Strategic Learning

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

Nancy M. Carlson

2003-04-01

To explore the concept of community of practice, the research initially concentrates on a strategic business process in a research and applied engineering laboratory discovering essential communication tools and processes needed to cultivate a high functioning cross-disciplinary team engaged in proposal preparation. Qualitative research in the human ecology of the proposal process blends topic-oriented ethnography and grounded theory and includes an innovative addition to qualitative interviewing, called meta-inquiry. Meta-inquiry uses an initial interview protocol with a homogeneous pool of informants to enhance the researcher's sensitivity to the unique cultures involved in the proposal process before developing a formal interview protocol.more » In this study the preanalysis process uses data from editors, graphic artists, text processors, and production coordinators to assess, modify, enhance, and focus the formal interview protocol with scientists, engineers, and technical managers-the heterogeneous informants. Thus this human ecology-based interview protocol values homogeneous and heterogeneous informant data and acquires data from which concepts, categories, properties, and both substantive and formal theory emerges. The research discovers the five essential processes of owning, visioning, reviewing, producing, and contributing for strategic learning to occur in a proposal community of practice. The apprenticeship, developmental, and nurturing perspectives of adult learning provide the proposal community of practice with cohesion, interdependence, and caring, while core and boundary practices provide insight into the tacit and explicit dimensions of the proposal process. By making these dimensions explicit, the necessary competencies, absorptive capacity, and capabilities needed for strategic learning are discovered. Substantive theory emerges and provides insight into the ability of the proposal community of practice to evolve, flourish, and adapt to the strategic advantage of the laboratory. The substantive theory explores the dimensions of owning, visioning, reviewing, producing, and contributing and their interrelationship to community learning dynamics. Through dialogue, creative tension, and imagination, the proposal community of practice focuses on actionable goals linked by proactively participating in practice, creating possibilities, evaluating and enhancing potential, producing a valued product, and confirming strategic value. Lastly, a formal theory emerges linking competency-capacity-capability, cohesion, interdependence, and caring as essential attributes of strategic learning communities.« less

Opening the Conversation on REU Assessment and Evaluation

NASA Astrophysics Data System (ADS)

Pressley, S. N.; LeBeau, J. E.

2015-12-01

Project evaluation is a key component to ensuring success of any Research Experience for Undergraduates (REU) program. The Washington State University (WSU) Regional Atmospheric Chemistry: State-of-the-art Measurement and Modeling in the Pacific Northwest REU Site employs a mixed method approach to determine what is working well and what can use improvement (formative evaluation) and to determine impact and effectiveness of the project in reaching the stated goals (summative evaluation). Quantitative data is collected via a pre-/post-test measuring participants' research self-efficacy (RSE), motivation, background information, extent of socialization, and their interpretation of the value of the REU experience. Qualitative data is gathered through individual interviews with the REU students (at the beginning and end of the program) and faculty mentors (at the end). Beginning interviews focus on expectations for the REU program and student backgrounds. End interviews focus on student RSE development, interpretations of their experience, and the value of the experience. Faculty mentors are interviewed to gather insight on student performance in the program and perspectives on the overall success of the program in meeting the proposed goals. Students are provided an opportunity to comment on the strengths and weaknesses of workshops, providing critical feedback to the particular instructor and enabling the faculty to modify the workshop content and activities in future years. Finally, research results are evaluated during the final poster presentation, and faculty are interviewed to report on their perception of how each student learned and gained knowledge during the program. To evaluate the retention of students in engineering and science and identify chosen career paths, a longitudinal survey was created and it is administered via email each year. Many REU programs also employ the Undergraduate Research Students Self-Assessment (URSSA) online tool designed for evaluating REU experiences (University of Colorado at Boulder). Information presented in this presentation will include a discussion of the current tools used as described above as well as a discussion of the pros/cons of using URSSA. One of the concerns with using URSSA in conjunction with the other assessment tools is "survey fatigue".

Patients' initial steps to cancer diagnosis in Denmark, England and Sweden: what can a qualitative, cross-country comparison of narrative interviews tell us about potentially modifiable factors?

PubMed

MacArtney, John; Malmström, Marlene; Overgaard Nielsen, Trine; Evans, Julie; Bernhardson, Britt-Marie; Hajdarevic, Senada; Chapple, Alison; Eriksson, Lars E; Locock, Louise; Rasmussen, Birgit; Vedsted, Peter; Tishelman, Carol; Andersen, Rikke Sand; Ziebland, Sue

2017-11-19

To illuminate patterns observed in International Cancer Benchmarking Programme studies by extending understanding of the various influences on presentation and referral with cancer symptoms. Cross-country comparison of Denmark, England and Sweden with qualitative analysis of in-depth interview accounts of the prediagnostic process in lung or bowel cancer. 155 women and men, aged between 35 and 86 years old, diagnosed with lung or bowel cancer in 6 months before interview. Participants recruited through primary and secondary care, social media and word of mouth. Interviews collected by social scientists or nurse researchers during 2015, mainly in participants' homes. Participants reported difficulties in interpreting diffuse bodily sensations and symptoms and deciding when to consult. There were examples of swift referrals by primary care professionals in all three countries. In all countries, participants described difficulty deciding if and when to consult, highlighting concerns about access to general practitioner appointments and overstretched primary care services, although this appears less prominent in the Swedish data. It was not unusual for there to be more than one consultation before referral and we noted two distinct patterns of repeated consultation: (1) situations where the participant left the primary care consultation with a plan of action about what should happen next; (2) participants were unclear about under which conditions to return to the doctors. This second pattern sometimes extended over many weeks during which patients described uncertainty, and sometimes frustration, about if and when they should return and whether there were any other feasible investigations. The latter pattern appeared more evident in the interviews in England and Denmark than Sweden. We suggest that if clear action plans, as part of safety netting, were routinely used in primary care consultations then uncertainty, false reassurance and the inefficiency and distress of multiple consultations could be reduced. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Adolescent and Young Adult Cancer Survivors' Perspectives on Their Internet Use for Seeking Information on Healthy Eating and Exercise

PubMed Central

Mooney, Ryan; Samhouri, Mahasen; Holton, Avery; Devine, Katie A.; Kirchhoff, Anne C.; Wright, Jennifer

2017-01-01

Purpose: To explore adolescent and young adult (AYA) cancer survivors' internet use in seeking healthy lifestyle behavior (HLB) information on diet and exercise. Methods: Twenty-five AYA cancer survivors participated in focus groups or interviews. Data were analyzed using qualitative content analysis. Results: Most survivors (92%) sought HLB information from internet sources. Key issues included the following: (1) too much information available, (2) information not meeting survivors' unique needs, and (3) concerns about trustworthiness of information. Conclusion: Although AYA cancer survivors use the internet to seek HLB information, internet resources could be modified to better meet the needs of AYA cancer survivors. PMID:27845844

Futurescapes: evidence expectations in the USA for comparative effectiveness research for drugs in 2020.

PubMed

Messner, Donna A; Mohr, Penny; Towse, Adrian

2015-08-01

Explore key factors influencing future expectations for the production of evidence from comparative effectiveness research for drugs in the USA in 2020 and construct three plausible future scenarios. Semistructured key informant interviews and three rounds of modified Delphi with systematic scenario-building methods. Most influential key factors were: health delivery system integration; electronic health record development; exploitation of very large databases and mixed data sources; and proactive patient engagement in research. The scenario deemed most likely entailed uneven development of large integrated health systems with pockets of increased provider risk for patient care, enhanced data collection systems, changing incentives to do comparative effectiveness research and new opportunities for evidence generation partnerships.

Managing the stigma: Exploring body image experiences and self-presentation among people with spinal cord injury

PubMed Central

Bailey, K Alysse; Gammage, Kimberley L; van Ingen, Cathy; Ditor, David S

2016-01-01

Using modified constructivist grounded theory, the purpose of this study was to explore body image experiences in people with spinal cord injury. Nine participants (five women, four men) varying in age (21–63 years), type of injury (C3-T7; complete and incomplete), and years post-injury (4–36 years) took part in semi-structured in-depth interviews. The following main categories were found: appearance, weight concerns, negative functional features, impact of others, body disconnection, hygiene and incontinence, and self-presentation. Findings have implications for the health and well-being of those living with a spinal cord injury. PMID:28070405

Role development of nurses for technology-dependent children attending mainstream schools in Japan.

PubMed

Shimizu, Fumie; Suzuki, Machiko

2015-04-01

To describe the role development of nurses caring for medical technology-dependent children attending Japanese mainstream schools. Semi-structured interviews with 21 nurses caring for technology-dependent children were conducted and analyzed using the modified grounded theory approach. Nurses developed roles centered on maintaining technology-dependent children's physical health to support children's learning with each other, through building relationships, learning how to interact with children, understanding the children and the school community, and realizing the meaning of supporting technology-dependent children. These findings support nurses to build relationships of mutual trust with teachers and children, and learn on the job in mainstream schools. © 2015, Wiley Periodicals, Inc.

Attitudes and beliefs regarding depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females

PubMed Central

Brawner, Bridgette M.

2012-01-01

Individuals’ attitudes and beliefs toward behaviors are key indicators of behavioral performance. The purpose of this study was to elucidate attitudes and beliefs about depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females and to develop an understanding of their context for HIV risk. For this descriptive qualitative inquiry, semi-structured interviews and surveys were employed (N = 24). The narratives reveal that behavioral sequelae of depression (i.e. loneliness) can produce risk for HIV. These findings may guide psychiatric nurse educators, scientists, and practitioners to modify HIV risk among clinically depressed African American adolescent females. PMID:23164403

Study on Public Flood Risk Cognition and Behavioral Response Based on IEC Strategy

NASA Astrophysics Data System (ADS)

Shen, Xin; Xu, Xiaofeng; Zhou, Guilin; Pan, Shaolin; Mi, Tengfei

2017-11-01

In order to disseminate knowledge and information on flood risks in flood-prone areas, raise public awareness of flood risks and reduce possible damage to the public, a questionnaire survey was coducted among 260 residents of nine selected communities in Jiaozhou City to learn the public awareness and behavioral response to flood risks at different early warning levels. IEC key information of flood risk awareness was modified and formulated through group discussions, in-depth individual interviews and on-site observation. The awareness of residents in the project area was enhanced through the public participation, environmental management and flood management training, which plays a very important role in reducing flood losses.

Qatari women living with cardiovascular diseases-challenges and opportunities to engage in healthy lifestyles.

PubMed

Donnelly, Tam Truong; Al Suwaidi, Jassim; Al Enazi, Noora Rashid; Idris, Zeinab; Albulushi, Asma Mohammad; Yassin, Khadra; Rehman, Asma Mohammad; Hassan, Asma Hassan Abu

2012-01-01

In Qatar, cardiovascular diseases are the leading causes of morbidity and mortality. Cardiovascular diseases can be prevented and controlled by modifying lifestyle risk behaviors. In this qualitative study, we investigate ways to increase participation in physical activity, and to promote a healthy diet, and nonsmoking behavior in Qatari women. Individual in-depth interviews were conducted with 50 Arabic women. Participation in physical activity, observing a healthy diet, and abstinence from smoking are desirable lifestyle practices among Qatari women. Social support networks, cultural values, religion, changing sociodemographic and economic conditions, heart disease, and a harsh climate affect the ability of these women to pursue a healthy lifestyle.

Affordable house designs to improve health in rural Africa: a field study from northeastern Tanzania.

PubMed

von Seidlein, Lorenz; Ikonomidis, Konstantin; Mshamu, Salum; Nkya, Theresia E; Mukaka, Mavuto; Pell, Christopher; Lindsay, Steven W; Deen, Jacqueline L; Kisinza, William N; Knudsen, Jakob B

2017-08-01

The population of sub-Saharan Africa is currently estimated to be 1245 million and is expected to quadruple by the end of the century, necessitating the building of millions of homes. Malaria remains a substantial problem in this region and efforts to minimise transmission should be considered in future house planning. We studied how building elements, which have been successfully employed in southeast Asia to prevent mosquitos from entering and cooling the house, could be integrated in a more sustainable house design in rural northeastern Tanzania, Africa, to decrease mosquito density and regulate indoor climate. In this field study, six prototype houses of southeast Asian design were built in in the village of Magoda in Muheza District, Tanga Region, Tanzania, and compared with modified and unmodified, traditional, sub-Saharan African houses. Prototype houses were built with walls made of lightweight permeable materials (bamboo, shade net, or timber) with bedrooms elevated from the ground and with screened windows. Modified and unmodified traditional African houses, wattle-daub or mud-block constructions, built on the ground with poor ventilation served as controls. In the modified houses, major structural problems such as leaking roofs were repaired, windows screened, open eaves blocked with bricks and mortar, cement floors repaired or constructed, and rain gutters and a tank for water storage added. Prototype houses were randomly allocated to village households through a free, fair, and transparent lottery. The lottery tickets were deposited in a bucket made of transparent plastic. Each participant could draw one ticket. Hourly measurements of indoor temperature and humidity were recorded in all study houses with data loggers and mosquitoes were collected indoors and outdoors using Furvela tent traps and were identified with standard taxonomic keys. Mosquitoes of the Anopheles gambiae complex were identified to species using PCR. Attitudes towards the new house design were assessed 6-9 months after the residents moved into their new or modified homes through 15 in-depth interviews with household heads of the new houses and five focus group discussions including neighbours of each group of prototype housing. Between July, 2014, and July, 2015, six prototype houses were constructed; one single and one double storey building with each of the following claddings: bamboo, shade net, and timber. The overall reduction of all mosquitoes caught was highest in the double-storey buildings (96%; 95% CI 92-98) followed closely by the reduction found in single-storey buildings (77%; 72-82) and lowest in the modified reference houses (43%; 36-50) and unmodified reference houses (23%; 18-29). The indoor temperature in the new design houses was 2·3°C (95% CI 2·2-2·4) cooler than in the reference houses. While both single and two-storey buildings provided a cooler indoor climate than did traditional housing, two-story buildings provided the biggest reduction in mosquito densities (96%, 95% CI 89-100). Seven people who moved into the prototype houses and seven of their neighbours (three of whom had their houses modified) participated in in-depth interviews. After living in their new prototype houses for 6-9 months, residents expressed satisfaction with the new design, especially the second-storey sleeping area because of the privacy and security of upstairs bedrooms. The new design houses had fewer mosquitoes and were cooler than modified and unmodified traditional homes. New house designs are an underused intervention and hold promise to reduce malaria transmission in sub-Saharan Africa and keep areas malaria-free after elimination. Ruth W Jensens Foundation, Copenhagen and Hanako Foundation, Singapore. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

"We never thought of a vasectomy": a qualitative study of men and women's counseling around sterilization.

PubMed

Shih, Grace; Dubé, Kate; Dehlendorf, Christine

2013-09-01

Sterilization is the most commonly used method of contraception in the United States; however, little is known about how providers counsel about these procedures or the information patients desire. In this study, we explore male and female experiences of sterilization counseling and their perspectives on ideal sterilization counseling. In-depth individual and group interviews were conducted with 37 heterosexual couples between the ages of 25 and 55 years. Each couple had reached their desired family size. Interviews were recorded and transcribed using NVivo software and analyzed using modified grounded theory. Men and women differed in their experiences of sterilization counseling. Women commonly received counseling on female sterilization but not vasectomy, while men rarely discussed either form of sterilization with their providers. Both men and women desired more information about sterilization. Contraceptive counseling of couples who have completed childbearing does not routinely include men or the option of vasectomy, despite the advantages of this method with respect to safety, efficacy and cost. Family planning and primary care providers have an important role in ensuring that couples are aware of all their options and can make an informed decision about their contraception. Copyright © 2013 Elsevier Inc. All rights reserved.

A comparative study of self-efficacy, outcome expectancy, and retention of beginning urban science teachers

NASA Astrophysics Data System (ADS)

Klein, Nina

The purpose of the multi-tiered study presented is to compare the effect of credentialing route on the self-efficacy, outcome expectancy, and retention of beginning urban science teachers serving students in a large urban school district in Southern California. Candidates from one traditional, university-based teacher education program and from two alternative programs, the Teach for America and District Intern Programs, were surveyed and interviewed during the second semester of their first year of teaching. To determine the potential of a difference in self-efficacy and outcome expectancy, the study gave teachers a modified version of the Science Teachers' Efficacy Belief Instrument (STEBI), developed and validated by Riggs and Enochs (1989). Two representative candidates from each program were then interviewed in order to probe for deeper understanding of possible sources of their efficacy and outcome expectancy. The final part of the study is an evaluation of retention data from the three programs, each to triangulate this information with data collected from the surveys, and comparing these retention rates with published data. The study provides data on unresearched questions about traditionally and alternatively credentialed science teachers in urban settings in California.

Initial public perceptions of deep geological and oceanic disposal of carbon dioxide.

PubMed

Palmgren, Claire R; Morgan, M Granger; Bruine de Bruin, Wändi; Keith, David W

2004-12-15

Two studies were conducted to gauge likely public perceptions of proposals to avoid releasing carbon dioxide from power plants to the atmosphere by injecting it into deep geological formations or the deep ocean. Following a modified version of the mental model interview method, Study 1 involved face-to-face interviews with 18 nontechnical respondents. Respondents shared their beliefs after receiving basic information about the technologies and again after getting specific details. Many interviewees wanted to frame the issue in the broader context of alternative strategies for carbon management, but public understanding of mitigation strategies is limited. The second study, administered to a sample of 126 individuals, involved a closed-form survey that measured the prevalence of general beliefs revealed in study 1 and also assessed the respondent's views of these technologies. Study results suggest that the public may develop misgivings about deep injection of carbon dioxide because it can be seen as temporizing and perhaps creating future problems. Ocean injection was seen as more problematic than geological injection. An approach to public communication and regulation that is open and respectful of public concerns is likely to be a prerequisite to the successful adoption of this technology.

Injury perceptions of bombing survivors--interviews from the Oklahoma City bombing.

PubMed

Glenshaw, Mary T; Vernick, Jon S; Frattaroli, Shannon; Brown, Sheryll; Mallonee, Sue

2008-01-01

Bombings, including the 1995 Oklahoma City bombing, remain an important public health threat. However, there has been little investigation into the impressions of injury risk or protective factors of bombing survivors. This study analyzes Oklahoma City bombing survivors' impressions of factors that influenced their risk of injury, and validates a hazard timeline outlining phases of injury risk in a building bombing. In-depth, semi-structured interviews were conducted within a sample of Oklahoma City bombing survivors. Participants included 15 injured and uninjured survivors, who were located in three buildings surrounding the detonation site during the attack. Risk factor themes included environmental glass, debris, and entrapment. Protective factors included knowledge of egress routes, shielding behaviors to deflect debris, and survival training. Building design and health status were reported as risk and protective factors. The hazard timeline was a useful tool, but should be modified to include a lay rescue phase. The combination of a narrative approach and direct questioning is an effective method of gathering the perceptions of survivors. Investigating survivors' impressions of building bombing hazards is critical to capture injury exposures, behavior patterns, and decision-making processes during actual events, and to identify interventions that will be supported by survivors.

Understanding women's burdens: preliminary findings on psychosocial health among Datoga and Iraqw women of northern Tanzania.

PubMed

Pike, Ivy L; Patil, Crystal L

2006-09-01

This preliminary, community-based study examines major stressors identified by Iraqw and Datoga women of Mbulu District, Tanzania, and describes steps in creating a culturally specific questionnaire to assess mental health burdens. This area of Tanzania is remote, with limited access to goods and services, and is undergoing dramatic social and economic changes. Iraqw and Datoga reside in close proximity and often intermarry but have different cultural and subsistence responses to this rapid social change. Data were collected from May to October 2002, with 49 Datoga women and 64 Iraqw women interviewed. In-home interviews were conducted to have women (1) free-list their primary concerns and (2) answer questions from a translated (in Datoga and Iraqw) and modified standardized mental health questionnaire. Both groups of women identified hunger, the lack of animals, particularly cattle, and health/illnesses as the most common major stressors. Other frequently cited stressors included crop failure, general fears of violence, paying taxes, and no money for basic needs. Additional refinements are required for the mental health questionnaire, with strengths and limitations discussed. Such data, while preliminary, augment efforts to analyze the emotional burdens associated with dramatic social change.

Medicine shortages in Fiji: A qualitative exploration of stakeholders' views.

PubMed

Walker, Josephine; Chaar, Betty B; Vera, Numa; Pillai, Alvish S; Lim, Jessy S; Bero, Lisa; Moles, Rebekah J

2017-01-01

Medicine access is a human right; yet, concerningly, there are international instances of shortages. Quantitative data has allowed WHO to propose global solutions; however, individualised understanding of specific regions is still required to work towards national solutions. Fiji has an established issue with medication supply and the aim of this study was to use qualitative methods to gain a fuller understanding of this context. Semi-structured interviews were used to gain the perspective of key stakeholders involved in the Fijian medicine supply chain in regards to causes, impacts and possible solutions of medicine shortages. Thematic analysis was used to analyse the interview data. In total, 48 stakeholders participated and the information was synthesised into three main themes, causes, impacts and solutions and the sub-themes including; political, system and patient causes, adverse health effects on patients, professional dissatisfaction, monetary loss and loss of faith in the health system, workarounds, operation improvements, government intervention and education and training. The situation in Fiji is not dissimilar to other instances of shortages around the world and hence international solutions like that proposed by WHO are feasible; however, they must be modified to be uniquely Fijian to work in this context.

Nutrition Knowledge and Practices of Varsity Coaches at a Canadian University.

PubMed

Danaher, Kavanagh; Curley, Tristaca

2014-12-01

Coaches' sports nutrition knowledge and subsequent nutrition recommendations can have an impact on athletes' health and performance. The purpose of this study was to determine sports nutrition knowledge and nutrition recommendation practices of varsity coaches at one Canadian university and to determine if the coaches' nutrition knowledge influenced nutrition recommendations to athletes. The coaches' accessibility to sports dietitians was also examined. Coaches (n = 5) completed a modified psychometrically validated nutrition knowledge questionnaire and a semi-structured interview. Mean scores were calculated for questionnaire answers based on the correct answer and the coach's degree of certainty in their answer. Interviews were analyzed using thematic analysis. Results showed a low nutrition knowledge, yet all coaches made nutrition recommendations to their athletes for fluid needs, dietary supplementation, and weight management; areas that may be potentially detrimental to the health of athletes. In addition, they made recommendations with regard to fluid needs, training diet, precompetition diet, recovery diet (i.e., post training or competition), dietary supplementation, and weight management; areas that could have potentially negative performance consequences to the athlete. It was determined that coaches had low nutrition knowledge scores and still made nutrition recommendations to athletes. The importance of sports dietitian involvement in varsity athletics is emphasized.

Prevalence of Fatigue and Associated Factors in a Spinal Cord Injury Population: Data from an Internet-Based and Face-to-Face Surveys.

PubMed

Cudeiro-Blanco, Javier; Onate-Figuérez, Ana; Soto-León, Vanesa; Avendaño-Coy, Juan; Mordillo-Mateos, Laura; Brocalero-Camacho, Angela; Esclarin-Ruz, Ana; Rotondi, Mario; Aguilar, Juan; Arias, Pablo; Oliviero, Antonio

2017-08-01

Fatigue has a profound impact on patients with spinal cord injury (SCI), but only limited treatments are available. The aim of this study was to determine the prevalence of fatigue in SCI and its association with clinical and demographic factors. We used an internet-based survey and a face-to-face interview to estimate the prevalence of fatigue in a SCI population. Fatigue was measured using the Fatigue Severity Scale (FSS). Clinically significant fatigue was defined as FSS scores greater than or equal to four. A total of 253 participants with SCI were included in the study. Clinically significant fatigue was present in one third of our sample. There was no relationship between fatigue and injury level or completeness. We found significant correlations between depression, pain, and level of injury. The relation of fatigue with completeness of injury and spasticity is less clear. Moreover, the online survey and the standard face-to-face interview showed similar results concerning fatigue evaluation. Several factors may contribute to fatigue, however. Future studies should be conducted to clarify which are the most relevant ones and, if possible, to determine which factors are modifiable.

Physical factors that influence patients' privacy perception toward a psychiatric behavioral monitoring system: a qualitative study.

PubMed

Zakaria, Nasriah; Ramli, Rusyaizila

2018-01-01

Psychiatric patients have privacy concerns when it comes to technology intervention in the hospital setting. In this paper, we present scenarios for psychiatric behavioral monitoring systems to be placed in psychiatric wards to understand patients' perception regarding privacy. Psychiatric behavioral monitoring refers to systems that are deemed useful in measuring clinical outcomes, but little research has been done on how these systems will impact patients' privacy. We conducted a case study in one teaching hospital in Malaysia. We investigated the physical factors that influence patients' perceived privacy with respect to a psychiatric monitoring system. The eight physical factors identified from the information system development privacy model, a comprehensive model for designing a privacy-sensitive information system, were adapted in this research. Scenario-based interviews were conducted with 25 patients in a psychiatric ward for 3 months. Psychiatric patients were able to share how physical factors influence their perception of privacy. Results show how patients responded to each of these dimensions in the context of a psychiatric behavioral monitoring system. Some subfactors under physical privacy are modified to reflect the data obtained in the interviews. We were able to capture the different physical factors that influence patient privacy.

A qualitative assessment of cross-cultural adaptation of intermediate measures for schizophrenia in multisite international studies.

PubMed

Gonzalez, Jodi M; Rubin, Maureen; Fredrick, Megan M; Velligan, Dawn I

2013-04-30

In this substudy of the Measurement and Treatment Research to Improve Cognition in Schizophrenia we examined qualitative feedback on the cross-cultural adaptability of four intermediate measures of functional outcome (Independent Living Scales, UCSD Performance-Based Skills Assessment, Test of Adaptive Behavior in Schizophrenia, and Cognitive Assessment Interview). Feedback was provided by experienced English-fluent clinical researchers at 31 sites in eight countries familiar with medication trials. Researchers provided feedback on test subscales and items which were rated as having adaptation challenges. They noted the specific concern and made suggestions for adaptation to their culture. We analyzed the qualitative data using a modified Grounded Theory approach guided by the International Testing Commission Guidelines model for test adaptation. For each measure except the Cognitive Assessment Interview (CAI), the majority of subscales were reported to require major adaptations in terms of content and concepts contained in the subscale. In particular, social, financial, transportation and health care systems varied widely across countries-systems which are often used to assess performance capacity in the U.S. We provide suggestions for how to address future international test development and adaptation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Medicine shortages in Fiji: A qualitative exploration of stakeholders’ views

PubMed Central

Chaar, Betty B.; Vera, Numa; Pillai, Alvish S.; Lim, Jessy S.; Bero, Lisa; Moles, Rebekah J.

2017-01-01

Objectives Medicine access is a human right; yet, concerningly, there are international instances of shortages. Quantitative data has allowed WHO to propose global solutions; however, individualised understanding of specific regions is still required to work towards national solutions. Fiji has an established issue with medication supply and the aim of this study was to use qualitative methods to gain a fuller understanding of this context. Methods Semi-structured interviews were used to gain the perspective of key stakeholders involved in the Fijian medicine supply chain in regards to causes, impacts and possible solutions of medicine shortages. Thematic analysis was used to analyse the interview data. Results In total, 48 stakeholders participated and the information was synthesised into three main themes, causes, impacts and solutions and the sub-themes including; political, system and patient causes, adverse health effects on patients, professional dissatisfaction, monetary loss and loss of faith in the health system, workarounds, operation improvements, government intervention and education and training. Conclusions The situation in Fiji is not dissimilar to other instances of shortages around the world and hence international solutions like that proposed by WHO are feasible; however, they must be modified to be uniquely Fijian to work in this context. PMID:28582409

Impulse-control disorders in a college sample: results from the self-administered Minnesota Impulse Disorders Interview (MIDI).

PubMed

Odlaug, Brian L; Grant, Jon E

2010-01-01

This study sought to examine the prevalence rates of and gender differences among impulse-control disorders in a college sample. During the fall semester of 2006, 791 college students from 2 private colleges in the Midwest completed a self-administered, modified version of the Minnesota Impulse Disorders Interview to assess lifetime rates of DSM-IV-TR-diagnosed impulse-control disorders. Participation was voluntary and anonymous. The mean age of the sample was 20.0 +/- 1.25 years, with females comprising 67.9% of the respondents. Of the individuals, 10.4% (n = 82) met criteria for at least 1 lifetime impulse-control disorder. The most common disorders were trichotillomania (3.91%) and compulsive sexual behavior (3.66%). Kleptomania was the least common (0.38%). Males were significantly more likely to screen positive for pathological gambling (P = .003) and compulsive sexual behavior (P = .002). Females were more likely to have compulsive buying (P = .033). Impulse-control disorders appear to be common among college students. The high rates indicate that these disorders may be incipient during late adolescence and early adulthood and should be addressed prior to onset of clinical versions of the impulse-control disorder.

Effects of Intrinsic Motivation on Feedback Processing During Learning

PubMed Central

DePasque, Samantha; Tricomi, Elizabeth

2015-01-01

Learning commonly requires feedback about the consequences of one’s actions, which can drive learners to modify their behavior. Motivation may determine how sensitive an individual might be to such feedback, particularly in educational contexts where some students value academic achievement more than others. Thus, motivation for a task might influence the value placed on performance feedback and how effectively it is used to improve learning. To investigate the interplay between intrinsic motivation and feedback processing, we used functional magnetic resonance imaging (fMRI) during feedback-based learning before and after a novel manipulation based on motivational interviewing, a technique for enhancing treatment motivation in mental health settings. Because of its role in the reinforcement learning system, the striatum is situated to play a significant role in the modulation of learning based on motivation. Consistent with this idea, motivation levels during the task were associated with sensitivity to positive versus negative feedback in the striatum. Additionally, heightened motivation following a brief motivational interview was associated with increases in feedback sensitivity in the left medial temporal lobe. Our results suggest that motivation modulates neural responses to performance-related feedback, and furthermore that changes in motivation facilitates processing in areas that support learning and memory. PMID:26112370

Late-life depressive symptoms, religiousness, and mood in the last week of life.

PubMed

Braam, Arjan W; Klinkenberg, Marianne; Galenkamp, Henrike; Deeg, Dorly J H

2012-01-01

Aim of the current study is to examine whether previous depressive symptoms modify possible effects of religiousness on mood in the last week of life. After-death interviews with proxy respondents of deceased sample members of the Longitudinal Aging Study Amsterdam provided information on depressed mood in the last week of life, as well as on the presence of a sense of peace with the approaching end of life. Other characteristics were derived from interviews with the sample members when still alive. Significant interactions were identified between measures of religiousness and previous depressive symptoms (CES-D scores) in their associations with mood in the last week of life. Among those with previous depressive symptoms, church-membership, church-attendance and salience of religion were associated with a greater likelihood of depressed mood in the last week of life. Among those without previous depressive symptoms, church-attendance and salience of religion were associated with a higher likelihood of a sense of peace. For older adults in the last phase of life, supportive effects of religiousness were more or less expected. Fore those with recent depressive symptoms, however, religiousness might involve a component of existential doubt.

Late-Life Depressive Symptoms, Religiousness, and Mood in the Last Week of Life

PubMed Central

Braam, Arjan W.; Klinkenberg, Marianne; Galenkamp, Henrike; Deeg, Dorly J. H.

2012-01-01

Aim of the current study is to examine whether previous depressive symptoms modify possible effects of religiousness on mood in the last week of life. After-death interviews with proxy respondents of deceased sample members of the Longitudinal Aging Study Amsterdam provided information on depressed mood in the last week of life, as well as on the presence of a sense of peace with the approaching end of life. Other characteristics were derived from interviews with the sample members when still alive. Significant interactions were identified between measures of religiousness and previous depressive symptoms (CES-D scores) in their associations with mood in the last week of life. Among those with previous depressive symptoms, church-membership, church-attendance and salience of religion were associated with a greater likelihood of depressed mood in the last week of life. Among those without previous depressive symptoms, church-attendance and salience of religion were associated with a higher likelihood of a sense of peace. For older adults in the last phase of life, supportive effects of religiousness were more or less expected. Fore those with recent depressive symptoms, however, religiousness might involve a component of existential doubt. PMID:22844587

Factors associated with compliance with viscosity-modified diet among dysphagic patients.

PubMed

Shim, Jae Seong; Oh, Byung-Mo; Han, Tai Ryoon

2013-10-01

To investigate compliance with a viscosity-modified diet among Korean dysphagic patients and to determine which factors are associated with compliance. We retrospectively reviewed medical records of patients who had been recommended to use thickeners in the previous videofluoroscopic swallowing study (VFSS). Among 68 patients, 6 were excluded because tube feeding was required due to deterioration in their medical condition. Finally, 62 patients were included in the study. Patient compliance was assessed using their medical records by checking whether he or she had maintained thickener use until the next VFSS. To determine which factors affect compliance, the relationship between thickener use and patient characteristics, such as sex, age, inpatient/outpatient status, severity of dysphagia, aspiration symptoms, follow-up interval of VFSS, and current swallowing therapy status were assessed. For noncompliers, reasons for not using thickeners were investigated by telephone interview. Among 62 patients, 35 (56.5%) were compliers, and 27 (43.5%) were noncompliers. Eighteen (90%) of 20 inpatients had followed previous recommendations; however, only 17 (40.5%) of 42 outpatients had been using thickeners. Of patient characteristics, only admission status was significantly correlated with compliance. When asked about the reason why they had not used thickeners, noncompliers complained about dissatisfaction with texture and taste, greater difficulty in swallowing, and inconvenience of preparing meals. Among Korean dysphagic patients, compliance with a viscosity-modified liquid diet was only about 50%. Betterments of texture and taste along with patient education might be necessary to improve compliance with thickener use.

Changes in Problem-Solving Capacity and Association With Spontaneous Brain Activity After a Single Electroconvulsive Treatment in Major Depressive Disorder.

PubMed

Du, Lian; Qiu, Haitang; Liu, Haixia; Zhao, Wenjing; Tang, Yong; Fu, Yixiao; Li, Xirong; Qiu, Tian; Hu, Hua; Meng, Huaqing; Luo, Qinghua

2016-03-01

Modified electroconvulsive therapy (MECT) has been regarded as the most effective antidepressant therapy, despite its cognitive side effects. However, how MECT influences problem-solving capacity in major depressive disorder (MDD), as well as its underlying neurobiological mechanisms, remains unclear. The present study aimed to assess alterations in problem-solving capacity after MECT and to explore spontaneous brain activity using amplitudes of low-frequency fluctuations (ALFF)/fractional ALFF. Thirteen first-episode, treatment-naive MDD patients treated by MECT were recruited. We collected resting-state functional magnetic resonance imaging, and we evaluated their Modified Card Sorting Test performance before and after single-session MECT. Another 11 MDD patients without MECT were also recruited and interviewed with Modified Card Sorting Test twice as a control group. After a single MECT, MDD patients showed significantly decreased ALFF in the right cerebellar posterior lobe. Compared to the control group, perseverative errors significantly decreased after MECT, controlling for practice effects. Some cognitive functional changes significantly correlated to changed ALFF in several brain regions, including Brodmann areas BA9, BA19, BA 21, and BA48, right thalamus, left cerebellum, and right postcentral gyrus. The MECT could improve problem-solving capacity, even after controlling for practice effects, and it could induce changes in spontaneous brain activity. These changes in cognitive functioning might result from changes in the cerebral functions of some regions, including frontal cortex, a key region for problem-solving capacity.

The role of walkers' needs and expectations in supporting maintenance of attendance at walking groups: a longitudinal multi-perspective study of walkers and walk group leaders.

PubMed

Kassavou, Aikaterini; Turner, Andrew; French, David P

2015-01-01

There is good evidence that when people's needs and expectations regarding behaviour change are met, they are satisfied with that change, and maintain those changes. Despite this, there is a dearth of research on needs and expectations of walkers when initially attending walking groups and whether and how these needs and expectations have been satisfied after a period of attendance. Equally, there is an absence of research on how people who lead these groups understand walkers' needs and walk leaders' actions to address them. The present study was aimed at addressing both of these gaps in the research. Two preliminary thematic analyses were conducted on face-to-face interviews with (a) eight walkers when they joined walking groups, five of whom were interviewed three months later, and (b) eight walk leaders. A multi-perspective analysis building upon these preliminary analyses identified similarities and differences within the themes that emerged from the interviews with walkers and walk leaders. Walkers indicated that their main needs and expectations when joining walking groups were achieving long-term social and health benefits. At the follow up interviews, walkers indicated that satisfaction with meeting similar others within the groups was the main reason for continued attendance. Their main source of dissatisfaction was not feeling integrated in the existing walking groups. Walk leaders often acknowledged the same reasons for walkers joining and maintaining attendance at walking. However, they tended to attribute dissatisfaction and drop out to uncontrollable environmental factors and/or walkers' personalities. Walk leaders reported a lack of efficacy to effectively address walkers' needs. Interventions to increase retention of walkers should train walk leaders with the skills to help them modify the underlying psychological factors affecting walkers' maintenance at walking groups. This should result in greater retention of walkers in walking groups, thereby allowing walkers to receive the long-term social and health benefits of participation in these groups.

Life Experience of Patients With Unilateral Vocal Fold Paralysis.

PubMed

Francis, David O; Sherman, Ariel E; Hovis, Kristen L; Bonnet, Kemberlee; Schlundt, David; Garrett, C Gaelyn; Davies, Louise

2018-05-01

Clinicians and patients benefit when they have a clear understanding of how medical conditions influence patients' life experiences. Patients' perspectives on life with unilateral vocal fold paralysis have not been well described. To promote patient-centered care by characterizing the patient experiences of living with unilateral vocal fold paralysis. This study used mixed methods: surveys using the voice and dysphagia handicap indexes (VHI and DHI) and semistructured interviews with adults with unilateral vocal cord paralysis recruited from a tertiary voice center. Recorded interviews were transcribed, coded using a hierarchical coding system, and analyzed using an iterative inductive-deductive approach. Symptom domains of the patient experience. In 36 patients (26 [72%] were female, and the median age and interquartile range [IQR] were 63 years [48-68 years]; median interview duration, 42 minutes), median VHI and DHI scores were 96 (IQR, 77-108) and 55.5 (IQR, 35-89) at the time of interviews, respectively. Frustration, isolation, fear, and altered self-identity were primary themes permeating patients' experiences. Frustrations related to limitations in communication, employment, and the medical system. Sources of fear included a loss of control, fear of further dysfunction or permanent disability, concern for health consequences (eg, aspiration pneumonia), and/or an inability to call for help in emergency situations. These experiences were modified by the following factors: resilience, self-efficacy, perceived sense of control, and social support systems. Effects of unilateral vocal fold paralysis extend beyond impaired voice and other somatic symptoms. Awareness of the extent to which these patients experience frustration, isolation, fear, and altered self-identity is important. A patient-centered approach to optimizing unilateral vocal fold paralysis treatment is enhanced by an understanding of both the physical dimension of this condition and how patients cope with the considerable emotional and social consequences. Recognizing the psychosocial dimensions of disease allows clinicians to communicate more effectively, be more empathetic, and to better personalize treatment plans, which may lead to improved patient care and patient satisfaction.

Improving care coordination between nephrology and primary care: a quality improvement initiative using the renal physicians association toolkit.

PubMed

Haley, William E; Beckrich, Amy L; Sayre, Judith; McNeil, Rebecca; Fumo, Peter; Rao, Vijaykumar M; Lerma, Edgar V

2015-01-01

Individuals at risk for chronic kidney disease (CKD), including those with diabetes mellitus and hypertension, are prevalent in primary care physician (PCP) practices. A major systemic barrier to mitigating risk of progression to kidney failure and to optimal care is failure of communication and coordination among PCPs and nephrologists. Quality improvement. Longitudinal practice-level study of tool-based intervention in nephrology practices and their referring PCP practices. 9 PCP and 5 nephrology practices in Philadelphia and Chicago. Tools from Renal Physicians Association toolkit were modified and provided for use by PCPs and nephrologists to improve identification of CKD, communication, and comanagement. CKD identification, referral to nephrologists, communication among PCPs and nephrologists, comanagement processes. Pre- and postimplementation interviews, questionnaires, site visits, and monthly teleconferences were used to ascertain practice patterns, perceptions, and tool use. Interview transcripts were reviewed for themes using qualitative analysis based on grounded theory. Chart audits assessed CKD identification and referral (PCPs). PCPs improved processes for CKD identification, referral to nephrologists, communication, and execution of comanagement plans. Documentation of glomerular filtration rate was increased significantly (P=0.01). Nephrologists improved referral and comanagement processes. PCP postintervention interviews documented increased awareness of risk factors, the need to track high-risk patients, and the importance of early referral. Final nephrologist interviews revealed heightened attention to communication and comanagement with PCPs and increased levels of satisfaction among all parties. Nephrology practices volunteered to participate and recruit their referring PCP practices. Audit tools were developed for quality improvement assessment, but were not designed to provide statistically significant estimates. The use of specifically tailored tools led to enhanced awareness and identification of CKD among PCPs, increased communication between practices, and improvement in comanagement and cooperation between PCPs and nephrologists. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Healthcare professional and patient codesign and validation of a mechanism for service users to feedback patient safety experiences following a care transfer: a qualitative study

PubMed Central

Scott, Jason; Heavey, Emily; Waring, Justin; Jones, Diana; Dawson, Pamela

2016-01-01

Objective To develop and validate a mechanism for patients to provide feedback on safety experiences following a care transfer between organisations. Design Qualitative study using participatory methods (codesign workshops) and cognitive interviews. Workshop data were analysed concurrently with participants, and cognitive interviews were thematically analysed using a deductive approach based on the developed feedback mechanism. Participants Expert patients (n=5) and healthcare professionals (n=11) were recruited purposively to develop the feedback mechanism in 2 workshops. Workshop 1 explored principles underpinning safety feedback mechanisms, and workshop 2 included the practical development of the feedback mechanism. Final design and content of the feedback mechanism (a safety survey) were verified by workshop participants, and cognitive interviews (n=28) were conducted with patients. Results Workshop participants identified that safety feedback mechanisms should be patient-centred, short and concise with clear signposting on how to complete, with an option to be anonymous and balanced between positive (safe) and negative (unsafe) experiences. The agreed feedback mechanism consisted of a survey split across 3 stages of the care transfer: departure, journey and arrival. Care across organisational boundaries was recognised as being complex, with healthcare professionals acknowledging the difficulty implementing changes that impact other organisations. Cognitive interview participants agreed the content of the survey was relevant but identified barriers to completion relating to the survey formatting and understanding of a care transfer. Conclusions Participatory, codesign principles helped overcome differences in understandings of safety in the complex setting of care transfers when developing a safety survey. Practical barriers to the survey's usability and acceptability to patients were identified, resulting in a modified survey design. Further research is required to determine the usability and acceptability of the survey to patients and healthcare professionals, as well as identifying how governance structures should accommodate patient feedback when relating to multiple health or social care providers. PMID:27406641

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors.

PubMed

Stewart, M J; Neufeld, A; Harrison, M J; Spitzer, D; Hughes, K; Makwarimba, E

2006-07-01

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.

Automated interviews on clinical case reports to elicit directed acyclic graphs.

PubMed

Luciani, Davide; Stefanini, Federico M

2012-05-01

Setting up clinical reports within hospital information systems makes it possible to record a variety of clinical presentations. Directed acyclic graphs (Dags) offer a useful way of representing causal relations in clinical problem domains and are at the core of many probabilistic models described in the medical literature, like Bayesian networks. However, medical practitioners are not usually trained to elicit Dag features. Part of the difficulty lies in the application of the concept of direct causality before selecting all the causal variables of interest for a specific patient. We designed an automated interview to tutor medical doctors in the development of Dags to represent their understanding of clinical reports. Medical notions were analyzed to find patterns in medical reasoning that can be followed by algorithms supporting the elicitation of causal Dags. Clinical relevance was defined to help formulate only relevant questions by driving an expert's attention towards variables causally related to nodes already inserted in the graph. Key procedural features of the proposed interview are described by four algorithms. The automated interview comprises questions on medical notions, phrased in medical terms. The first elicitation session produces questions concerning the patient's chief complaints and the outcomes related to diseases serving as diagnostic hypotheses, their observable manifestations and risk factors. The second session focuses on questions that refine the initial causal paths by considering syndromes, dysfunctions, pathogenic anomalies, biases and effect modifiers. A case study concerning a gastro-enterological problem and one dealing with an infected patient illustrate the output produced by the algorithms, depending on the answers provided by the doctor. The proposed elicitation framework is characterized by strong consistency with medical background and by a progressive introduction of relevant medical topics. Revision and testing of the subjectively elicited Dag is performed by matching the collected answers with the evidence included in accepted sources of biomedical knowledge. Copyright © 2011 Elsevier B.V. All rights reserved.

The Geoscience Concept Test: A New Assessment Tool Based on Student Misconceptions

NASA Astrophysics Data System (ADS)

Libarkin, J.; Anderson, S. W.; Boone, W. J.; Beilfuss, M.; Dahl, J.

2002-12-01

We developed and began pilot testing of an earth science assessment tool called the geoscience concept test (GCT). The GCT uses student misconceptions as distractors in a 30 item multiple-choice instrument. Student misconceptions were first assessed through the analysis of nearly 300 questionnaires administered in introductory geology courses at three institutions. Results from the questionnaires guided the development of an interview protocol that was used by four interviewers at four different institutions. Over 100 in-depth student interviews lasting from 0.5 to 1 hour probed topics related to the Earth's interior, geologic time, and the formation of Earth surface features such as mountains and volcanoes to better define misconceptions. Thematic content analysis of the interviews identified a number of widely held misconceptions, which were then incorporated into the GCT as multiple-choice distractors (wrong answers). For content validity, the initial GCT was reviewed by seven experts (3 geoscientists and 4 science educators) and revised before pilot testing. Approximately 100 introductory and non-science major college students from four institutions were assessed with the GCT pilot in the spring of 2002. Rasch model analysis of this data showed that students found the pilot test difficult, and the level of difficulty was consistent between the four institutions. Analysis of individual items showed that students had fewer misconceptions regarding the locations of earthquakes, and many misconceptions regarding the locations of volcanoes on the Earth's surface, suggesting a disconnect in their understanding of the role of plate tectonics in these phenomena. Analysis of the misfit statistic for each item showed that none of the questions misfit, although we dropped one question and modified the wording of another for clarity in the next round of piloting. A second round of piloting scheduled for the fall of 2002 includes nearly 3000 students from 34 institutions in 19 states.

Quality of life in late-life disability: "I don't feel bitter because I am in a wheelchair".

PubMed

King, Jennifer; Yourman, Lindsey; Ahalt, Cyrus; Eng, Catherine; Knight, Sara J; Pérez-Stable, Eliseo J; Smith, Alexander K

2012-03-01

To determine perceived quality of life in a diverse population of elderly adults with late-life disability. Qualitative cross-sectional study. Community-dwelling participants were recruited from San Francisco's On Lok Lifeways program, the first Program of All-inclusive Care for the Elderly. On Lok enrollees meet Medicaid criteria for nursing home placement. Sixty-two elderly adults with a mean age of 78 and a mean 2.4 activity of daily living dependencies and 6.6 instrumental activity of daily living dependencies were interviewed. Respondents were 63% female, 24% white, 19% black, 18% Latino, 32% Chinese American, and 6% other race. Elderly adults who scored higher than 17 points on the Mini-Mental State Examination were interviewed. Interviews were conducted in English, Spanish, and Cantonese. Respondents were asked to rate their overall quality of life on a 5-point scale. Open-ended questions explored positive and negative aspects of participants' daily experiences. Interviews were analyzed using modified grounded theory and digital coding software. Eighty-seven percent of respondents rated their quality of life in the middle range of the quality-of-life spectrum (fair to very good). Themes were similar across ethnic groups. Most themes could be grouped into four domains that dependent elderly adults considered important to their quality of life: physical (e.g., pain), psychological (e.g., depression), spiritual or religious (e.g., religious coping), and social (e.g., life-space). Dignity and a sense of control were identified as themes that are the most closely tied to overall quality of life. Factors that influence quality of life in late-life disability were similar across ethnic groups. As the number of elderly adults from diverse backgrounds with late life disability increases in the United States, interventions should be targeted to maximize daily sense of control and dignity. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Implementation Processes and Pay for Performance in Healthcare: A Systematic Review.

PubMed

Kondo, Karli K; Damberg, Cheryl L; Mendelson, Aaron; Motu'apuaka, Makalapua; Freeman, Michele; O'Neil, Maya; Relevo, Rose; Low, Allison; Kansagara, Devan

2016-04-01

Over the last decade, various pay-for-performance (P4P) programs have been implemented to improve quality in health systems, including the VHA. P4P programs are complex, and their effects may vary by design, context, and other implementation processes. We conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of P4P. We searched PubMed, PsycINFO, and CINAHL through April 2014, and reviewed reference lists. We included trials and observational studies of P4P implementation. Two investigators abstracted data and assessed study quality. We interviewed P4P researchers to gain further insight. Among 1363 titles and abstracts, we selected 509 for full-text review, and included 41 primary studies. Of these 41 studies, 33 examined P4P programs in ambulatory settings, 7 targeted hospitals, and 1 study applied to nursing homes. Related to implementation, 13 studies examined program design, 8 examined implementation processes, 6 the outer setting, 18 the inner setting, and 5 provider characteristics. Results suggest the importance of considering underlying payment models and using statistically stringent methods of composite measure development, and ensuring that high-quality care will be maintained after incentive removal. We found no conclusive evidence that provider or practice characteristics relate to P4P effectiveness. Interviews with 14 KIs supported limited evidence that effective P4P program measures should be aligned with organizational goals, that incentive structures should be carefully considered, and that factors such as a strong infrastructure and public reporting may have a large influence. There is limited evidence from which to draw firm conclusions related to P4P implementation. Findings from studies and KI interviews suggest that P4P programs should undergo regular evaluation and should target areas of poor performance. Additionally, measures and incentives should align with organizational priorities, and programs should allow for changes over time in response to data and provider input.

Impact of partial participation in integrated family planning training on medical knowledge, patient communication and professionalism.

PubMed

Steinauer, Jody E; Turk, Jema K; Preskill, Felisa; Devaskar, Sangita; Freedman, Lori; Landy, Uta

2014-04-01

Obstetrics and gynecology residency programs are required to provide access to abortion training, but residents can opt out of participating for religious or moral reasons. Quantitative data suggest that most residents who opt out of doing abortions participate and gain skills in other aspects of the family planning training. However, little is known about their experience and perspective. Between June 2010 and June 2011, we conducted semistructured interviews with current and former residents who opted out of some or all of the family planning training at ob-gyn residency programs affiliated with the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning. Residents were either self-identified or were identified by their Ryan Program directors as having opted out of some training. The interviews were transcribed and coded using modified grounded theory. Twenty-six physicians were interviewed by telephone. Interviewees were from geographically diverse programs (35% Midwest, 31% West, 19% South/Southeast and 15% North/Northeast). We identified four dominant themes about their experience: (a) skills valued in the family planning training, (b) improved patient-centered care, (c) changes in attitudes about abortion and (d) miscommunication as a source of negative feelings. Respondents valued the ability to partially participate in the family planning training and identified specific aspects of their training which will impact future patient care. Many of the effects described in the interviews address core competencies in medical knowledge, patient care, communication and professionalism. We recommend that programs offer a spectrum of partial participation in family planning training to all residents, including residents who choose to opt out of doing some or all abortions. Learners who morally object to abortion but participate in training in family planning and abortion, up to their level of comfort, gain clinical and professional skills. We recommend that trainers should offer a range of participation levels to maximize the educational opportunities for these learners. Copyright © 2014 Elsevier Inc. All rights reserved.

Development of the conceptual framework for the Eye-Drop Satisfaction Questionnaire (EDSQ) in glaucoma using a qualitative study.

PubMed

Nordmann, Jean-Philippe; Denis, Philippe; Vigneux, Marc; Trudeau, Elyse; Guillemin, Isabelle; Berdeaux, Gilles

2007-08-06

Compliance is a major issue in glaucoma care. It is usually poor in glaucomatous patients, and may ultimately result in an acceleration of the disease progression and a risk of blindness. Reasons for this poor compliance are complex and multifactorial, amongst which patient satisfaction can be counted. The objective of this study was to develop a questionnaire to assess patient satisfaction and compliance with eye-drop treatment. A qualitative study was carried out to develop the questionnaire. An interview guide was developed based on a literature review. Structured interviews of fifteen French and English patients with primary open-angle glaucoma or intraocular hypertension were conducted by trained interviewers of the native language of the interviewees. General concepts and subconcepts were identified from the transcripts. The questionnaire was developed using the patient verbatim, and submitted to six patients (French and English) for cognitive debriefing. Following patients' comments, items were modified and restructured, and a pilot questionnaire was designed. Analysis of data from the interviews with patients and clinicians resulted in the elicitation of concepts related to patient satisfaction and compliance with glaucomatous treatment. These were further refined and used to generate a test questionnaire, which consisted of 46 items grouped into 6 domains: patient characteristics, treatment characteristics, patient-clinician relationship, patient experience with the disease and the treatment, interaction between the patient and the treatment, and patient knowledge of the disease and the treatment. The Eye-Drop Satisfaction Questionnaire (EDSQ) conceptual framework and items were developed simultaneously in French and in English. This questionnaire could be used to evaluate patient satisfaction and compliance with eye-drop treatment and would facilitate the identification of patients at risk of being non-compliant prior to clinical trials or innovative device tests. A psychometric study is under way to validate the questionnaire.

Identifying cases of undiagnosed, clinically significant COPD in primary care: qualitative insight from patients in the target population

PubMed Central

Leidy, Nancy K; Kim, Katherine; Bacci, Elizabeth D; Yawn, Barbara P; Mannino, David M; Thomashow, Byron M; Barr, R Graham; Rennard, Stephen I; Houfek, Julia F; Han, Meilan K; Meldrum, Catherine A; Make, Barry J; Bowler, Russ P; Steenrod, Anna W; Murray, Lindsey T; Walsh, John W; Martinez, Fernando

2015-01-01

Background: Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations. Aims: This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care. Methods: Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening. Results: Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews. Conclusions: Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD. PMID:26028486

Sorting Through the Spheres of Influence: Using Modified Pile Sorting to Describe Who Influences Dairy Farmers' Decision-Making About Safety.

PubMed

Bendixsen, Casper; Barnes, Kathrine; Kieke, Burney; Schenk, Danielle; Simich, Jessica; Keifer, Matthew

2017-01-01

The primary goal of this study was to describe the mutually perceived influence of bankers and insurers on their agricultural clients' decision-making regarding health and safety. Semistructured interviews were conducted with 10 dairy farmers, 11 agricultural bankers, and 10 agricultural insurers from central Wisconsin. Three of the interview questions involved pile sorting. Pile sorting included 5-point Likert-like scales to help participants sort through 32 index cards. Each card represented an individual or group that was thought to possibly affect farmers' decision-making, both generally and about health and safety. Results (photographs of piles of cards quantified into spread sheets, fieldnotes, and interview transcripts) were analyzed with SAS and NVivo. All three groups expressed moderate-to-strong positive opinions about involving agricultural bankers (x2(2) = 2.8155, p = 0.2695), although bankers qualitatively expressed apprehension due to regulations on the industry. Insurance agents received more positive support, particularly from bankers but also from dairy farmers themselves, and expressed more confidence in being involved in designing and implementing a farm safety program. Agricultural bankers and insurers can influence individual farmer's decision-making about health and safety. Both are believed to be good purveyors of safety programs and knowledge, especially when leveraging financial incentives. Insurance agents are thought to be more critical in the design of safety programs. Insurers and bankers being financially tied to safety programs may prove both positive and negative, as farmers may be skeptical about the intention of the incentives, making messaging critical.

A qualitative assessment of the supportive care and resource needs of patients undergoing craniotomy for benign brain tumours.

PubMed

Wong, Janice; Mendelsohn, Daniel; Nyhof-Young, Joyce; Bernstein, Mark

2011-11-01

As past literature has focused on support needs of patients with malignant brain tumours, the support needs of patients with benign brain tumours have largely been overlooked. The purpose of this study was to evaluate the supportive care and resource needs of patients undergoing craniotomy for benign brain tumours. Individual, semi-structured interviews were conducted with patients who had undergone craniotomy for a benign brain tumour within the past 2 years. Interviews were audio-recorded, transcribed, anonymized and subjected to descriptive thematic analysis by multiple investigators in the grounded theory tradition. Twenty-nine patients (20 women, 20-88 years of age) with World Health Organization grade I brain tumours (25 meningioma) were interviewed. Five overarching themes emerged: (1) need for formal support from diagnosis onwards; (2) complexity of supportive needs during postoperative recovery; (3) importance of regular long-term monitoring by physicians; (4) influence of psychosocial factors on supportive needs; and (5) existence of barriers to equal access to available supports. Patients' supportive care needs are temporally dependent on disease course and treatment, and modifiable by demographic and psychosocial factors. Findings of this study show that patients with benign tumours lacked but needed many supportive care resources currently available to cancer patients. Many of the potential solutions to this current gap in supportive care involve extending support resources already available for cancer patients to patients with benign brain tumours. We thus suggest recommendations to improve service gaps and reduce disparities in supportive care for patients with benign brain tumours.

South Asian American perspectives on overweight, obesity, and the relationship between weight and health.

PubMed

Tang, Joyce W; Mason, Maryann; Kushner, Robert F; Tirodkar, Manasi A; Khurana, Neerja; Kandula, Namratha R

2012-01-01

Compared with other racial groups, South Asian adults develop type 2 diabetes and cardiovascular disease at a lower body mass index (BMI). Perceptions of weight and the effect of weight on health can influence weight-loss attempts but are not well described in this population. The objective of this study was to examine perceptions of weight appropriateness and the effect of weight on health among South Asian Americans. We recruited 75 South Asian American adults from a single metropolitan area in the Midwestern United States. During individual, face-to-face interviews, we asked participants what they think about their weight and how weight affects their health. We measured their weight and height and calculated BMI. Each interview was audiotaped, transcribed verbatim, and translated into English. We conducted analyses using NVivo software. A second investigator coded 20% of interviews to verify coding consensus. Sixty-seven percent of participants were overweight or obese; 40% of overweight participants and 12% of obese participants perceived themselves to be normal weight or underweight. Forty-eight percent of overweight and 82% of obese participants believed their weight affected their health. Participants commonly cited physical problems as being associated with their weight, but few connected their weight with risk for chronic diseases. South Asian Americans may underestimate their weight status and the effect of their weight on their risk for chronic diseases. Interventions to promote weight loss among South Asian Americans should focus on modifying perceptions of normal weight and personalizing the relationship between overweight and chronic diseases.

Long-term intake of nuts in relation to cognitive function in older women.

PubMed

O'Brien, J; Okereke, O; Devore, E; Rosner, B; Breteler, M; Grodstein, F

2014-05-01

Nuts contain nutrients that may benefit brain health; thus, we examined long-term intake of nuts in relation to cognition in older women. Population-based prospective cohort study. Academic research using data from the Nurses' Health Study. Nut intake was assessed in a food-frequency questionnaire beginning in1980, and approximately every four years thereafter. Between 1995-2001, 16,010 women age 70 or older (mean age = 74 years) without a history of stroke were administered 4 repeated telephone-based cognitive interviews over 6 years. Our final sample included 15,467 women who completed an initial cognitive interview and had complete information on nut intake. The Telephone Interview for Cognitive Status (TICS), a global score averaging the results of all tests (TICS, immediate and delayed verbal recall, category fluency, and attention), and a verbal memory score averaging the results of tests of verbal recall. In multivariable-adjusted linear regression models, higher long-term total nut intake was associated with better average cognitive status for all cognitive outcomes. For the global composite score combining all tests, women consuming at least 5 servings of nuts/week had higher scores than non-consumers (mean difference=0.08 standard units, 95% confidence interval 0.00-0.15; p-trend=0.003). This mean difference of 0.08 is equivalent to the mean difference we find between women 2 years apart in age. Long-term intake of nuts was not associated with rates of cognitive decline. Higher nut intake may be related to better overall cognition at older ages, and could be an easily-modifiable public health intervention.

Caregiver perceptions about mental health services after child sexual abuse.

PubMed

Fong, Hiu-fai; Bennett, Colleen E; Mondestin, Valerie; Scribano, Philip V; Mollen, Cynthia; Wood, Joanne N

2016-01-01

The objective of this study was to describe caregiver perceptions about mental health services (MHS) after child sexual abuse (CSA) and to explore factors that affected whether their children linked to services. We conducted semi-structured, in-person interviews with 22 non-offending caregivers of suspected CSA victims<13 years old seen at a child advocacy center in Philadelphia. Purposive sampling was used to recruit caregivers who had (n=12) and had not (n=10) linked their children to MHS. Guided by the Health Belief Model framework, interviews assessed perceptions about: CSA severity, the child's susceptibility for adverse outcomes, the benefits of MHS, and the facilitators and barriers to MHS. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory. Recruitment ended when thematic saturation was reached. Caregivers expressed strong reactions to CSA and multiple concerns about adverse child outcomes. Most caregivers reported that MHS were generally necessary for children after CSA. Caregivers who had not linked to MHS, however, believed MHS were not necessary for their children, most commonly because they were not exhibiting behavioral symptoms. Caregivers described multiple access barriers to MHS, but caregivers who had not linked reported that they could have overcome these barriers if they believed MHS were necessary for their children. Caregivers who had not linked to services also expressed concerns about MHS being re-traumatizing and stigmatizing. Interventions to increase MHS linkage should focus on improving communication with caregivers about the specific benefits of MHS for their children and proactively addressing caregiver concerns about MHS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Parent and Clinician Perspectives on Sustained Behavior Change after a Prenatal Obesity Program: A Qualitative Study.

PubMed

Gregory, Emily F; Goldshore, Matthew A; Showell, Nakiya N; Genies, Marquita C; Harding, Mariel E; Henderson, Janice L

2017-04-01

Infants of obese women are at a high risk for development of obesity. Prenatal interventions targeting gestational weight gain among obese women have not demonstrated consistent benefits for infant growth trajectories. To better understand why such programs may not influence infant growth, qualitative semi-structured interviews were conducted with 19 mothers who participated in a prenatal nutrition intervention for women with BMI 30 kg/m 2 or greater, and with 19 clinicians (13 pediatric, 6 obstetrical). Interviews were transcribed and coded with themes emerging inductively from the data, using a grounded theory approach. Mothers were interviewed a mean of 18 months postpartum and reported successful postnatal maintenance of behaviors that were relevant to the family food environment (Theme 1). Ambivalence around the importance of postnatal behavior maintenance (Theme 2) and enhanced postnatal healthcare (Theme 3) emerged as explanations for the failure of prenatal interventions to influence child growth. Mothers acknowledged their importance as role models for their children's behavior, but they often believed that body habitus was beyond their control. Though mothers attributed prenatal behavior change, in part, to additional support during pregnancy, clinicians had hesitations about providing children of obese parents with additional services postnatally. Both mothers and clinicians perceived a lack of interest or concern about infant growth during pediatric visits (Theme 4). Prenatal interventions may better influence childhood growth if paired with improved communication regarding long-term modifiable risks for children. The healthcare community should clarify a package of enhanced preventive services for children with increased risk of developing obesity.

Addressing physical inactivity in Omani adults: perceptions of public health managers.

PubMed

Mabry, Ruth M; Al-Busaidi, Zakiya Q; Reeves, Marina M; Owen, Neville; Eakin, Elizabeth G

2014-03-01

To explore barriers and solutions to addressing physical inactivity and prolonged sitting in the adult population of Oman. Qualitative study involving semi-structured interviews that took place from October 2011 to January 2012. Participants were recruited through purposive sampling. Data collection and analysis was an iterative process; later interviews explored emerging themes. Interviews were audio-recorded and transcribed and continued until data saturation; this occurred by the tenth interviewee. Thematic content analysis was carried out, guided by an ecological model of health behaviour. Muscat, Oman. Ten mid-level public health managers. Barriers for physical inactivity were grouped around four themes: (i) intrapersonal (lack of motivation, awareness and time); (ii) social (norms restricting women's participation in outdoor activity, low value of physical activity); (iii) environment (lack of places to be active, weather); and (iv) policy (ineffective health communication, limited resources). Solutions focused on culturally sensitive interventions at the environment (building sidewalks and exercise facilities) and policy levels (strengthening existing interventions and coordinating actions with relevant sectors). Participants' responses regarding sitting time were similar to, but much more limited than those related to physical inactivity, except for community participation and voluntarism, which were given greater emphasis as possible solutions to reduce sitting time. Given the increasing prevalence of chronic disease in Oman and the Arabian Gulf, urgent action is required to implement gender-relevant public health policies and programmes to address physical inactivity, a key modifiable risk factor. Additionally, research on the determinants of physical inactivity and prolonged sitting time is required to guide policy makers.

Changes Observed in Views of Nature of Science During a Historically Based Unit

NASA Astrophysics Data System (ADS)

Rudge, David Wÿss; Cassidy, David Paul; Fulford, Janice Marie; Howe, Eric Michael

2014-09-01

Numerous empirical studies have provided evidence of the effectiveness of an explicit and reflective approach to the learning of issues associated with the nature of science (NOS) (c.f. Abd-El-Khalick and Lederman in J Res Sci Teach 37(10):1057-1095, 2000). This essay reports the results of a mixed-methods association study involving 130 preservice teachers during the course of a three class unit based upon the history of science using such an approach. Within the unit the phenomenon of industrial melanism was presented as a puzzle for students to solve. Students were explicitly asked to reflect upon several NOS issues as they developed and tested their own explanations for the "mystery phenomenon". NOS views of all participants were characterized by means of surveys and follow-up interviews with a subsample of 17 participants, using a modified version of the VNOS protocol (c.f. Lederman et al. in J Res Sci Teach 39(6):497-521, 2002). An analysis of the survey results informed by the interview data suggests NOS views became more sophisticated for some issues, e.g., whether scientific knowledge requires experimentation; but not others, e.g., why scientists experiment. An examination of the interview data informed by our experiences with the unit provides insight into why the unit may have been more effective with regard to some issues than others. This includes evidence that greater sophistication of some NOS issues was fostered by the use of multiple, contextualized examples. The essay concludes with a discussion of limitations, pedagogical implications, and avenues for further research.

Improving Patients’ Understanding of Terms and Phrases Commonly Used in Self-Reported Measures of Sexual Function

PubMed Central

Alexander, Angel M.; Flynn, Kathryn E.; Hahn, Elizabeth A.; Jeffery, Diana D.; Keefe, Francis J.; Reeve, Bryce B.; Schultz, Wesley; Reese, Jennifer Barsky; Shelby, Rebecca A.; Weinfurt, Kevin P.

2014-01-01

Introduction There is a significant gap in research regarding the readability and comprehension of existing sexual function measures. Patient-reported outcome measures may use terms not well understood by respondents with low literacy. Aim To test comprehension of words and phrases typically used in sexual function measures to improve validity for all individuals, including those with low literacy. Methods We recruited 20 men and 28 women for cognitive interviews on version 2.0 of the PROMIS Sexual Function and Satisfaction measures. We assessed participants’ reading level using the word reading subtest of the Wide Range Achievement Test (WRAT). Sixteen participants were classified as having low literacy. Main Outcome Measures In the first round of cognitive interviews, each survey item was reviewed by 5 or more people, at least 2 of whom had lower than a ninth-grade reading level (low literacy). Patient feedback was incorporated into a revised version of the items. In the second round of interviews, an additional 3 or more people (at least 1 with low literacy) reviewed each revised item. Results Participants with low literacy had difficulty comprehending terms such as aroused, orgasm, erection, ejaculation, incontinence, and vaginal penetration. Women across a range of literacy levels had difficulty with clinical terms like labia and clitoris. We modified unclear terms to include parenthetical descriptors or slang equivalents, which generally improved comprehension. Conclusions Common words and phrases used across measures of self-reported sexual function are not universally understood. Researchers should appreciate these misunderstandings as a potential source of error in studies using self-reported measures of sexual function. PMID:24902984

Contrasting Parents' and Pediatricians' Perspectives on Shared Decision-Making in ADHD

PubMed Central

Hughes, Cayce C.; Gafen, Angela; Guevara, James P.; Barg, Frances K.

2011-01-01

OBJECTIVE: The goal was to compare how parents and clinicians understand shared decision-making (SDM) in attention-deficit/hyperactivity disorder (ADHD), a prototype for SDM in pediatrics. METHODS: We conducted semi-structured interviews with 60 parents of children 6 to 12 years of age with ADHD (50% black and 43% college educated) and 30 primary care clinicians with varying experience. Open-ended interviews explored how pediatric clinicians and parents understood SDM in ADHD. Interviews were taped, transcribed, and then coded. Data were analyzed by using a modified grounded theory approach. RESULTS: Parents and clinicians both viewed SDM favorably. However, parents described SDM as a partnership between equals, with physicians providing medical expertise and the family contributing in-depth knowledge of the child. In contrast, clinicians understood SDM as a means to encourage families to accept clinicians' preferred treatment. These findings affected care because parents mistrusted clinicians whose presentation they perceived as biased. Both groups discussed how real-world barriers limit the consideration of evidence-based options, and they emphasized the importance of engaging professionals, family members, and/or friends in SDM. Although primary themes did not differ according to race, white parents more commonly received support from medical professionals in their social networks. CONCLUSIONS: Despite national guidelines prioritizing SDM in ADHD, challenges to implementing the process persist. Results suggest that, to support SDM in ADHD, modifications are needed at the practice and policy levels, including clinician training, incorporation of decision aids and improved strategies to facilitate communication, and efforts to ensure that evidence-based treatment is accessible. PMID:21172996

A longitudinal study of the aftermath of rape among rural South African women.

PubMed

Wyatt, Gail E; Davhana-Maselesele, Mashudu; Zhang, Muyu; Wong, Lauren H; Nicholson, Fiona; Sarkissian, Alissa Der; Makhado, Lufuno; Myers, Hector F

2017-05-01

Sexual assaults against women are a global health crisis, with alarmingly high rates in South Africa. However, we know very little about the circumstances and the aftermath of these experiences. Further, there is limited information about how factors specific to the rape (e.g., fighting back) versus those that are specific to the individual-and potentially modifiable-influence mental health outcomes. This study examined how situational characteristics of rape as well as individual and situational factors confer risk for symptoms of depression, posttraumatic stress disorder (PTSD), and dysfunctional sexual behavior at 12-month follow-up. Two hundred nine (N = 209) South African women were recruited from rural rape clinics in the Limpopo Province (LP) and North West Province (NWP) of South Africa. Interviews were conducted at baseline (within 6 months of the rape incident) and at 6 and 12 months by trained staff at the clinics in English or the women's native languages. Women were interviewed after services were provided in a private room. One hundred thirty-two (n = 132) women were lost to follow-up at 12 months, resulting in 77 women with interview data for all time points. Undermining by the survivor's social support system and an increased belief in myths about rape were associated with increased dysfunctional sexual practices and symptoms of depression. These findings demonstrate the need for interventions that address the most pervasive effects of rape over time. These behaviors can increase risks for revictimization and reduce psychological well-being in the aftermath of rape. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma

PubMed Central

Mammen, Jennifer R.; Rhee, Hyekyun; Norton, Sally A.; Butz, Arlene M.

2016-01-01

Background Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors. Objectives To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms. Methods A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N=28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) two-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis. Results Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens’ decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms. Conclusions Teen’s perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns. PMID:27337035

Understanding burden of illness for child growth hormone deficiency.

PubMed

Brod, Meryl; Alolga, Suzanne Lessard; Beck, Jane F; Wilkinson, Lars; Højbjerre, Lise; Rasmussen, Michael Højby

2017-07-01

Research demonstrates that children and adolescents with growth hormone deficiency (GHD) are impacted in multiple ways beyond their short stature; however, there are no disease-specific measures to assess these impacts. The purpose of this study was to examine the burden of GHD on children and adolescents, and to conduct concept elicitation to develop a model of the impact of GHD to support a disease-specific outcome measure. Four focus groups and 52 telephone interviews were conducted with children with GHD and parents/guardians of children with GHD to understand the experience and impacts from the child's perspective, reported by children or parent-observers about the impact on the child. The interviews and focus groups were conducted in Germany, the United Kingdom, and the United States. Interview transcripts were analyzed thematically based on modified grounded theory principles. There were 73 descriptions of patient's experiences elicited from 70 respondents, as three respondents spoke for two children each. A majority of GHD descriptive narratives refer to boy children (n = 51, 69.9%) and a majority of children had taken GHD treatment (n = 64, 89%). Analysis identified four major areas of GHD impact: Signs and Symptoms (beyond short stature), Physical Aspects of Daily Life, Social Well-Being, and Emotional Well-Being. The burden of GHD in children and adolescents is considerable and not limited to short stature. The severity of GHD impact on children and adolescents appears to be variable and individualized, but these data indicate that early identification and growth hormone treatment may lead to fewer impacts.

Cultural adaptation of the Latin American version of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) (v 3.0) for use in Spain.

PubMed

Navarro-Mateu, Fernando; Morán-Sánchez, Inés; Alonso, Jordi; Tormo, Ma José; Pujalte, Ma Luisa; Garriga, Ascensión; Aguilar-Gaxiola, Sergio; Navarro, Carmen

2013-01-01

To develop a Spanish version of the WHO-Composite International Diagnostic Interview (WHO-CIDI) applicable to Spain, through cultural adaptation of its most recent Latin American (LA v 20.0) version. A 1-week training course on the WHO-CIDI was provided by certified trainers. An expert panel reviewed the LA version, identified words or expressions that needed to be adapted to the cultural or linguistic norms for Spain, and proposed alternative expressions that were agreed on through consensus. The entire process was supervised and approved by a member of the WHO-CIDI Editorial Committee. The changes were incorporated into a Computer Assisted Personal Interview (CAPI) format and the feasibility and administration time were pilot tested in a convenience sample of 32 volunteers. A total of 372 questions were slightly modified (almost 7% of approximately 5000 questions in the survey) and incorporated into the CAPI version of the WHO-CIDI. Most of the changes were minor - but important - linguistic adaptations, and others were related to specific Spanish institutions and currency. In the pilot study, the instrument's mean completion administration time was 2h and 10min, with an interquartile range from 1.5 to nearly 3h. All the changes made were tested and officially approved. The Latin American version of the WHO-CIDI was successfully adapted and pilot-tested in its computerized format and is now ready for use in Spain. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

The evaluation of pharmaceutical pictograms among elderly patients in community pharmacy settings – a multicenter pilot study

PubMed Central

Balcerzak, Marcin; Drelich, Ewelina; Białoszewska, Katarzyna; Cwalina, Natalia; Krysinski, Jerzy; Pouliot, Annie; Vaillancourt, Regis

2018-01-01

Introduction The search for new ways to optimize the use of medications by patients has led the pharmaceutical community to promote the idea of introducing pictograms into routine practice. The main intention of pictograms is to ease patient adherence and to reduce potential risks or errors associated with the use of medications. Purpose To evaluate a series of pharmaceutical pictograms for patient comprehension. Patients and methods The study was conducted in community pharmacies within a European Union country that belongs to the professional research network. Structured interviews were used to evaluate the pictograms for patient comprehension. This consisted of an assessment of the following: the transparency and translucency of the pictograms, health literacy, and pictogram recall. Participants were also given the opportunity to provide feedback on how to improve the pictograms. The primary endpoint was pictogram comprehension. Secondary outcomes included recall of the pictograms and pictogram translucency. Results The study included 68 patients with whom face-to-face interviews were performed. Low transparency results (≤25%) and extensive patient feedback in initial interviews led to the withdrawal of certain pictograms (n=15) from the evaluation. Among the pictograms included in the final stage of our research, 22 pictograms (62.8%) obtained an acceptable transparency level ≥66%. All pictograms passed the short-term recall test with positive results. Conclusion A majority of the designed and modified pictograms reached satisfactory guess-ability scores. Feedback from patients enabled modification of the pictograms and proved that patients have an important voice in the discussion regarding the design of additional pictograms. PMID:29497281

A qualitative study of diverse experts' views about barriers and strategies to improve the diets and health of Supplemental Nutrition Assistance Program (SNAP) beneficiaries.

PubMed

Leung, Cindy W; Hoffnagle, Elena E; Lindsay, Ana C; Lofink, Hayley E; Hoffman, Vanessa A; Turrell, Sophie; Willett, Walter C; Blumenthal, Susan J

2013-01-01

The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, currently serves 44.7 million Americans with a budget of $75 billion in 2011. This study engaged leading experts for in-depth, semi-structured interviews to explore their opinions concerning the existing challenges and barriers to eating nutritiously in SNAP. Experts also proposed strategies for improving nutritional status among SNAP recipients. Twenty-seven individuals were interviewed from advocacy, government, industry, and research organizations. Interviews were recorded, transcribed, coded, and analyzed for thematic content. The high cost of nutrient-rich foods, inadequate SNAP benefits, limited access to purchasing healthy foods, and environmental factors associated with poverty were identified as barriers that influence nutrition among low-income households in the United States. Six themes emerged among respondents from diverse sectors about how to address these challenges, including providing SNAP participants with incentives to purchase nutrient-rich food consistent with the 2010 Dietary Guidelines for Americans, restricting the purchase of nutrient-poor foods and beverages with program benefits, modifying the frequency of SNAP benefit distribution, enhancing nutrition education, improving the SNAP retailer environment, and increasing state and federal level coordination and consistency of program implementation. Given the recent dramatic increase in SNAP enrollment, policymakers must address existing barriers as well as consider new strategies to improve nutrition policies in SNAP so that the program can continue to address food insecurity needs as well as provide a healthful diet for SNAP beneficiaries. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

A Qualitative Study of Diverse Experts’ Views About Barriers and Strategies to Improve the Diets and Health of Supplemental Nutrition Assistance Program (SNAP) Beneficiaries

PubMed Central

Leung, Cindy W.; Hoffnagle, Elena E.; Lindsay, Ana C.; Lofink, Hayley E.; Hoffman, Vanessa A.; Turrell, Sophie; Willett, Walter C.; Blumenthal, Susan J.

2012-01-01

The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, currently serves 44.7 million Americans with a budget of $75 billion in 2011. This study engaged leading experts for in-depth, semi-structured interviews to explore their opinions concerning the existing challenges and barriers to eating nutritiously in SNAP. Experts also proposed strategies for improving nutritional status among SNAP recipients. Twenty-seven individuals were interviewed from advocacy, government, industry, and research organizations. Interviews were recorded, transcribed, coded and analyzed for thematic content. The high cost of nutrient-rich foods, inadequate SNAP benefits, limited access to purchasing healthy foods, and environmental factors associated with poverty were identified as barriers that influence nutrition among low-income households in the United States. Six themes emerged among respondents from diverse sectors about how to address these challenges including: 1) providing SNAP participants with incentives to purchase nutrient-rich food consistent with the 2010 Dietary Guidelines for Americans; 2) restricting the purchase of nutrient-poor foods and beverages with program benefits; 3) modifying the frequency of SNAP benefit distribution; 4) enhancing nutrition education; 5) improving the SNAP retailer environment and 6) increasing state and federal level coordination and consistency of program implementation. Given the recent dramatic increase in SNAP enrollment, policymakers must address existing barriers as well as consider new strategies to improve nutrition policies in SNAP so that the program can continue to address food insecurity needs as well as provide a healthful diet for SNAP beneficiaries. PMID:23260725

Rural Latino caregivers' beliefs and behaviors around their children's salt consumption.

PubMed

Hoeft, Kristin S; Guerra, Claudia; Gonzalez-Vargas, M Judy; Barker, Judith C

2015-04-01

Prevalence of high blood pressure has been increasing in U.S. children, with implications for long term health consequences. Sodium consumption, a modifiable risk factor for high blood pressure, is above recommended limits and increasing. Very little is known about Latino caregiver beliefs and behaviors around their children's salt consumption. In California's Central Valley, qualitative interviews in Spanish investigated low-income caregivers' views and understandings of their children's dietary salt consumption. Thirty individual interviews and 5 focus groups were conducted (N=61). Interview transcripts were translated and transcribed, coded and thematically analyzed. Seven primary topic areas around children's salt intake and its impact on health were identified: children's favorite foods, children's dietary salt sources, superiority of home-cooked foods, salty and sweet foods, managing salt for health, developing children's tastes, and adding salt added at the table. Parents recognize common sources of sodium such as "junk food" and processed food and made efforts to limit their children's consumption of these foods, but may overlook other significant sodium sources, particularly bread, cheese, prepared soups and sports drinks. Caregivers recognize excess salt as unhealthy for children, but don't believe health problems (like high blood pressure) can occur in young children. Nevertheless, they made efforts to limit how much salt their children consumed through a variety of strategies; school meals were a source of high sodium that they felt were outside of their control. Latino caregivers are concerned about their children's salt intake and attempt to limit consumption, but some common sources of sodium are under-recognized. Copyright © 2014 Elsevier Ltd. All rights reserved.

Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma.

PubMed

Mammen, Jennifer R; Rhee, Hyekyun; Norton, Sally A; Butz, Arlene M

2017-03-01

Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors. To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms. A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N = 28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) 2-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis. Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens' decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms. Teen's perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns.

A day in the life of women with a serious mental illness: a qualitative investigation.

PubMed

Borba, Christina P C; Depadilla, Lara; Druss, Benjamin G; McCarty, Frances A; von Esenwein, Silke A; Sterk, Claire E

2011-01-01

Few studies have taken a holistic perspective to the lives of women with a serious mental illness (SMI). This qualitative study of women with an SMI describes and interprets women's experiences and provides a new understanding about the nature and needs of these women. A convenience sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited from an ongoing National Institutes of Mental Health study. Data collection involved face-to-face, in-depth interviews. The interviews were audio-recorded and transcribed verbatim. Data analysis occurred concurrently with data collection using a modified constant comparative method. The majority of the women self-identified as African American, single, having completed high school, and at the time of the interview were either unemployed or on disability. The most common SMI was major depression. A common topic in the women's reflections on their lives was that of social disadvantage both before being diagnosed as well as after to their diagnosis with an SMI. Salient themes of their stories included social isolation, experiencing loss, and having a lack of control over one's own life decisions. The findings from this study revealed varied experiences among these women as well as the complexity of their situation. The enhanced understanding of women's situation will allow mental health professionals to improve the quality of life for women with an SMI by taking a contextual approach to the treatment of their mental illness. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Measuring health literacy among low literate people: an exploratory feasibility study with the HLS-EU questionnaire.

PubMed

Storms, Hannelore; Claes, Neree; Aertgeerts, Bert; Van den Broucke, Stephan

2017-05-19

Health literacy (HL) is defined as necessary competencies to make well-informed decisions. As patients' decision making is a key element of patient-centered health care, insight in patients' HL might help healthcare professionals to organize their care accordingly. This is particularly true for people in a vulnerable situation, potentially with limited HL, who are, for instance, at greater risk of having limited access to care [1, 2]. As HL correlates with education, instruments should allow inclusion of low literate people. To that end, the relatively new instrument, HLS-EU-Q47, was subjected to a comprehensibility test, its shorter version, HLS-EU-Q16, was not. Therefore, the goal of this study was to examine feasibility of HLS-EU-Q16 (in Dutch) for use in a population of people with low literacy. Purposive sampling of adults with low (yearly) income (< €16,965.47) and limited education (maximum high school), with Dutch language proficiency. Exclusion criteria were: psychiatric, neurodegenerative diseases or impairments. To determine suitability (length, comprehension and layout) participants were randomly distributed either HLS-EU-Q16 or a modified version and were interviewed directly afterwards by one researcher. To determine feasibility a qualitative approach was chosen: cognitive interviews were carried out using the verbal probing technique. Thirteen participants completed HLS-EU-Q16 (n = 7) or the modified version (n = 6). Questions about 'disease prevention' or 'appraisal' of information are frequently reported to be incomprehensible. Difficulties are attributed to vocabulary, sentence structure and the decision process (abstraction, distinguishing 'appraising' from 'applying' information, indecisive on the appropriate response). HLS-EU-Q16 is a suitable instrument to determine HL in people with limited literacy. However, to facilitate the use and interpretation, some questions would benefit from minor adjustments: by simplifying wording or providing explanatory, contextual information.

Parental understanding and self-blame following sudden infant death: a mixed-methods study of bereaved parents' and professionals' experiences

PubMed Central

Griffiths, Frances; Sidebotham, Peter

2016-01-01

Objectives Improvements in our understanding of the role of modifiable risk factors for sudden infant death syndrome (SIDS) mean that previous reassurance to parents that these deaths were unpreventable may no longer be appropriate. This study aimed to learn of bereaved parents' and healthcare professionals' experiences of understanding causes of death following detailed sudden unexpected death in infancy (SUDI) investigations. The research questions were: How do bereaved parents understand the cause of death and risk factors identified during detailed investigation following a sudden unexpected infant death? What is the association between bereaved parents' mental health and this understanding? What are healthcare professionals' experiences of sharing such information with families? Design This was a mixed-methods study using a Framework Approach. Setting Specialist paediatric services. Participants Bereaved parents were recruited following detailed multiagency SUDI investigations; 21/113 eligible families and 27 professionals participated giving theoretical saturation of data. Data collection We analysed case records from all agencies, interviewed professionals and invited parents to complete the Hospital Anxiety and Depression Scale (HADS) and questionnaires or in-depth interviews. Results Nearly all bereaved parents were able to understand the cause of death and several SIDS parents had a good understanding of the relevant modifiable risk factors even when these related directly to their actions. Paediatricians worried that discussing risk factors with parents would result in parental self-blame and some deliberately avoided these discussions. Over half the families did not mention blame or blamed no one. The cause of death of the infants of these families varied. 3/21 mothers expressed overwhelming feelings of self-blame and had clinically significant scores on HADS. Conclusions Bereaved parents want detailed information about their child's death. Our study suggests parents want health professionals to explain the role of risk factors in SIDS. We found no evidence that sharing this information is a direct cause of parental self-blame. PMID:27198994

User-centered development and testing of a monitoring system that provides feedback regarding physical functioning to elderly people

PubMed Central

Vermeulen, Joan; Neyens, Jacques CL; Spreeuwenberg, Marieke D; van Rossum, Erik; Sipers, Walther; Habets, Herbert; Hewson, David J; de Witte, Luc P

2013-01-01

Purpose To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study. Methods and participants The iterative user-centered development process consisted of the following phases: (1) selection of user representatives; (2) analysis of users and their context; (3) identification of user requirements; (4) development of the interface; and (5) evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ); higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system. Results The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in) weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5.2 (standard deviation 0.90) on the modified PSSUQ. The interviews revealed that most participants liked using the system and appreciated that it signaled changes in their physical functioning. However, usability was negatively influenced by a few technical errors. Conclusion Involvement of elderly users during the development process resulted in an interface with good usability. However, the technical functioning of the monitoring system needs to be optimized before it can be used to support elderly people in their self-management. PMID:24039407

Improving care standards for patients with spinal trauma combining a modified e-Delphi process and stakeholder interviews: a study protocol.

PubMed

Sharwood, Lisa N; Stanford, Ralph; Middleton, James W; Burns, Brian; Joseph, Anthony; Flower, Oliver; Rigby, Oran; Ball, Jonathon; Dhaliwal, Shelly

2017-01-19

Around 300 people sustain a new traumatic spinal cord injury (TSCI) in Australia each year; a relatively low incidence injury with extremely high long-term associated costs. Care standards are inconsistent nationally, lacking in consensus across important components of care such as prehospital spinal immobilisation, timing of surgery and timeliness of transfer to specialist services. This study aims to develop 'expertly defined' and agreed standards of care across the majority of disciplines involved for these patients. A modified e-Delphi process will be used to gain consensus for best practice across specific clinical early care areas for the patient with TSCI; invited participants will include clinicians across Australia with relevant and significant expertise. A rapid literature review will identify available evidence, including any current guidelines from 2005 to 2015. Level and strength of evidence identified, including areas of contention, will be used to formulate the first round survey questions and statements. Participants will undertake 2-3 online survey rounds, responding anonymously to questionnaires regarding care practices and indicating their agreement or otherwise with practice standard statements. Relevant key stakeholders, including patients, will also be interviewed face to face. Ethics approval for this study was obtained by the NSW Population & Health Services Research Ethics Committee on 14 January 2016 (HREC/12/CIPHS/74). Seeking comprehensive understanding of how the variation in early care pathways and treatment can be addressed to achieve optimal patient outcomes and economic costs; the overall aim is the agreement to a consistent approach to the triage, treatment, transport and definitive care of acute TSCI victims. The agreed practice standards of care will inform the development of a Clinical Pathway with practice change strategies for implementation. These standards will offer a benchmark for state-wide and potentially national policy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

NEGOTIATING STRUCTURAL VULNERABILITY FOLLOWING REGULATORY CHANGES TO A PROVINCIAL METHADONE PROGRAM IN VANCOUVER, CANADA: A QUALITATIVE STUDY

PubMed Central

McNeil, Ryan; Kerr, Thomas; Anderson, Solanna; Maher, Lisa; Keewatin, Chereece; Milloy, MJ; Wood, Evan; Small, Will

2015-01-01

While regulatory frameworks governing methadone maintenance therapy (MMT) require highly regimented treatment programs that shape treatment outcomes, little research has examined the effects of regulatory changes to these programs on those receiving treatment, and located their experiences within the wider context of socialstructural inequities. In British Columbia (BC), Canada, provincial regulations governing MMT have recently been modified, including: replacing the existing methadone formulation with Methadose® (pre-mixed and 10 times more concentrated); prohibiting pharmacy delivery of methadone; and, prohibiting pharmacies incentives for methadone dispensation. We undertook this study to examine the impacts of these changes on a structurally vulnerable population enrolled in MMT in Vancouver, BC. Qualitative interviews were conducted with 34 people enrolled in MMT and recruited from two ongoing observational prospective cohort studies comprised of drug-using individuals in the six-month period in 2014 following these regulatory changes. Interview transcripts were analyzed thematically, and by drawing on the concept of ‘structural vulnerability’. Findings underscore how these regulatory changes disrupted treatment engagement, producing considerable health and social harms. The introduction of Methadose® precipitated increased withdrawal symptoms. The discontinuation of pharmacy delivery services led to interruptions in MMT and codispensed HIV medications due to constraints stemming from their structural vulnerability (e.g., poverty, homelessness). Meanwhile, the loss of pharmacy incentives limited access to material supports utilized by participants to overcome barriers to MMT, while diminishing their capacity to assert some degree of agency in negotiating dispensation arrangements with pharmacies. Collectively, these changes functioned to compromise MMT engagement and increased structural vulnerability to harm, including re-initiation of injection drug use and participation in high-risk incomegenerating strategies. Greater attention to the impacts of social-structural inequities on MMT engagement is needed when modifying MMT programs, especially as other jurisdictions are adopting similar changes. Comprehensive environmental supports should be provided to minimize adverse outcomes during transitional periods. PMID:25875323

Feasibility and Acceptability of an Internet-Based, African Dance-Modified Yoga Program for African-American Women with or at Risk for Metabolic Syndrome

PubMed Central

Johnson, Candace C; Taylor, Ann Gill; Anderson, Joel G; Jones, Randy A; Whaley, Diane E

2014-01-01

African-American (AA) women are the segment of the population that experiences the highest mortality from metabolic syndrome (MetS). Yoga decreases risk of MetS, yet there have been no yoga studies of AA women with or at risk for MetS. The purpose of this 4-week study was to test the feasibility and acceptability of a culturally tailored, Internet-based intervention, yogic dance (YD), using digital videos in a sample of AA women (ages 35-64) at risk for or with MetS. The investigators examined the rates of accrual, attrition, and reasons for attrition; the feasibility of using the Internet to deliver the intervention; the acceptability of the intervention as structured; and any other benefits and/or limitations of YD. The study used a single-group, mixed-methods design underpinned by social constructivist theory and Pender's Health Promotion Model. Twenty-four women provided consent to enroll in the study. After completing in-person semi-structured interviews and Internet-based measures, including the Physical Activity Readiness Questionnaire, and the modified International Physical Activity Questionnaire, consented participants engaged in 4-weeks of the yogic dance intervention via daily video-based instructions located on the study Web site. After the intervention, four women participated in focus groups to voice their perceptions of barriers to and benefits from YD and the acceptability of using the YD intervention. The investigators analyzed focus group data using content/thematic analysis and validated themes with baseline semi-structured interviews. The majority of the women (79%) found YD acceptable. Themes that emerged from the descriptive data include: (1) Culture is an important aspect of yogic dance; and (2) Increased social support would enhance yogic dance participation. The integrated results from this feasibility study will inform research exploring the complex correlates that influence health behaviors in AA women. PMID:25593785

Adaptation and Latent Structure of the Swahili Version of Beck Depression Inventory-II in a Low Literacy Population in the Context of HIV.

PubMed

Abubakar, Amina; Kalu, Raphael Birya; Katana, Khamis; Kabunda, Beatrice; Hassan, Amin S; Newton, Charles R; Van de Vijver, Fons

2016-01-01

We set out to adapt the Beck Depression Inventory (BDI)-II in Kenya and examine its factorial structure. In the first phase we carried out in-depth interviews involving 29 adult members of the community to elicit their understanding of depression and identify aspects of the BDI-II that required adaptation. In the second phase, a modified version of BDI-II was administered to 221 adults randomly selected from the community to allow for the evaluation of its psychometric properties. In the third phase of the study we evaluated the discriminative validity of BDI-11 by comparing a randomly chosen community sample (n = 29) with caregivers of adolescents affected by HIV (n = 77). A considerable overlap between the BDI symptoms and those generated in the interviews was observed. Relevant idioms and symptoms such as 'thinking too much' and 'Kuchoka moyo (having a tired heart)' were identified. The administration of the BDI had to be modified to make it suitable for the low literacy levels of our participants. Fit indices for several models (one factorial, two-factor model and a three factor model) were all within acceptable range. Evidence indicated that while multidimensional models could be fitted, the strong correlations between the factors implied that a single factor model may be the best suited solution (alpha [0.89], and a significant correlation with locally identified items [r = 0.51]) confirmed the good psychometric properties of the adapted BDI-II. No evidence was found to support the hypothesis that somatization was more prevalent. Lastly, caregivers of HIV affected adolescents had significantly higher scores compared to adults randomly selected from the community F(1, 121) = 23.31, p < .001 indicating the discriminative validity of the adapted BDI = II. With an adapted administration procedure, the BDI-II provides an adequate measure of depressive symptoms which can be used alongside other measures for proper diagnosis in a low literacy population.

Household food insecurity as a determinant of overweight and obesity among low-income Hispanic subgroups: Data from the 2011-2012 California Health Interview Survey.

PubMed

Smith, Teresa M; Colón-Ramos, Uriyoán; Pinard, Courtney A; Yaroch, Amy L

2016-02-01

An estimated 78% of Hispanics in the United States (US) are overweight or obese. Household food insecurity, a condition of limited or uncertain access to adequate food, has been associated with obesity rates among Hispanic adults in the US. However, the Hispanic group is multi-ethnic and therefore associations between obesity and food insecurity may not be constant across Hispanic country of origin subgroups. This study sought to determine if the association between obesity and food insecurity among Hispanics is modified by Hispanic ancestry across low-income (≤200% of poverty level) adults living in California. Data are from the cross-sectional 2011-12 California Health Interview Survey (n = 5498). Rates of overweight or obesity (BMI ≥ 25), Calfresh receipt (California's Supplemental Nutrition Assistance Program), and acculturation were examined for differences across subgroups. Weighted multiple logistic regressions examined if household food insecurity was significantly associated with overweight or obesity and modified by country of origin after controlling for age, education, marital status, country of birth (US vs. outside of US), language spoken at home, and Calfresh receipt (P < .05). Significant differences across subgroups existed for prevalence of overweight or obesity, food security, Calfresh receipt, country of birth, and language spoken at home. Results from the adjusted logistic regression models found that food insecurity was significantly associated with overweight or obesity among Mexican-American women (β (SE) = 0.22 (0.09), p = .014), but not Mexican-American men or Non-Mexican groups, suggesting Hispanic subgroups behave differently in their association between food insecurity and obesity. By highlighting these factors, we can promote targeted obesity prevention interventions, which may contribute to more effective behavior change and reduced chronic disease risk in this population. Copyright © 2015 Elsevier Ltd. All rights reserved.

The SMS, Phone, and medical Examination sports injury surveillance system is a feasible and valid approach to measuring handball exposure, injury occurrence, and consequences in elite youth sport.

PubMed

Møller, M; Wedderkopp, N; Myklebust, G; Lind, M; Sørensen, H; Hebert, J J; Attermann, J

2018-04-01

Current methods of sports injury surveillance are limited by lack of medical validation of self-reported injuries and/or incomplete information about injury consequences beyond time loss from sport. The aims of this study were to (a) evaluate the feasibility of the SMS, Phone, and medical Examination injury surveillance (SPEx) system (b) to evaluate the proportion of injuries and injury consequences reported by SPEx when compared to outcomes from a modified version of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. We followed 679 elite adolescent handball players over 31 weeks using the SPEx system. During the last 7 weeks, we also implemented a modified OSTRC questionnaire in a subgroup of 271 players via telephone interviews. The weekly response proportions to the primary SPEx questions ranged from 85% to 96% (mean 92%). SMS responses were received from 79% of the participants within 1 day. 95% of reported injuries were classified through the telephone interview within a week, and 67% were diagnosed by medical personnel. Comparisons between reported injuries from SPEx and OSTRC demonstrated fair (κ = 39.5% [25.1%-54.0%]) to substantial prevalence-adjusted bias-adjusted kappa (PABAK = 66.8% [95% CI 58.0%-75.6%]) agreement. The average injury severity score difference between SPEx and the OSTRC approach was -0.2 (95% CI -3.69-3.29) of possible 100 with 95% limits of agreement from(-14.81-14.41). These results support the feasibility and validity of the SPEx injury surveillance system in elite youth sport. Future studies should evaluate the external validity of SPEx system in different cohorts of athletes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Does Stroke Contribute to Racial Differences in Cognitive Decline?

PubMed Central

Levine, Deborah A.; Kabeto, Mohammed; Langa, Kenneth M.; Lisabeth, Lynda D.; Rogers, Mary A.M.; Galecki, Andrzej T.

2015-01-01

Background and Purpose It is unknown whether blacks’ elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition. Methods Among 4908 black and white participants aged ≥65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998–2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time. Results We identified 34 of 453 (7.5%) blacks and 300 of 4455 (6.7%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black–white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; P<0.001) corresponding to ≈7.9 years of cognitive aging. The effect of incident stroke on cognition did not statistically differ by race (P=0.52). Conclusions In this population-based cohort of older adults, incident stroke did not explain black–white differences in cognitive decline or impact cognition differently by race. PMID:25999389

Validation of the modified Parenting Strategies for Eating and Physical Activity Scale-Diet (PEAS-Diet) in Latino children.

PubMed

Soto, Sandra C; Arredondo, Elva M; Horton, Lucy A; Ayala, Guadalupe X

2016-03-01

Research shows that Latino parenting practices influence children's dietary and weight outcomes. Most studies use parent-reported data, however data from children may provide additional insight into how parents influence their children's diet and weight outcomes. The Parenting Strategies for Eating and Activity Scale (PEAS) has been validated in Latino adults, but not in children. This study evaluated the factor structure and concurrent and predictive validity of a modified version of the PEAS (PEAS-Diet) among Latino children. Data were collected from 361 children ages 7-13 from Imperial County, California, enrolled in a randomized controlled trial to promote healthy eating. The PEAS-Diet included 25 candidate items targeting six parenting practices pertaining to children's eating behaviors: (a) monitoring; (b) disciplining; (c) control; (d) permissiveness; (e) reinforcing; and (f) limit-setting. Children were on average ten years old (±2), 50% boys, 93% self-identified as Latino, 81% were US-born, and 55% completed English versus Spanish-language interviews. Using varimax rotation on baseline data with the total sample, six items were removed due to factor loadings <.40 and/or cross-loading (>.32 on more than one component). Parallel analysis and interpretability suggested a 5-factor solution explaining 59.46% of the variance. The subscale "limit-setting" was removed from the scale. The final scale consisted of 19 items and 5 subscales. Internal consistency of the subscales ranged from α = .63-.82. Confirmatory factor analyses provided additional evidence for the 5-factor scale using data collected 4 and 6 months post-baseline among the control group (n = 164, n = 161, respectively). Concurrent validity with dietary intake was established for monitoring, control, permissiveness, and reinforcing subscales in the expected directions. Predictive validity was not established. Results indicated that with the reported changes, the interview-administered PEAS-Diet is valid among Latino children aged 7-13 years. Copyright © 2015 Elsevier Ltd. All rights reserved.

Policy options for responding to the growing challenge from obesity (PorGrow) in Poland.

PubMed

Szponar, L; Ciok, J; Dolna, A; Oltarzewski, M

2007-05-01

To explore the perspectives of stakeholders towards a range of policy options to respond to obesity in Poland, a multi-criteria mapping method was used. During structured interviews, stakeholders were invited to appraise policy options by reference to criteria of their own choosing. They also provided relative weightings to their criteria, generating overall rankings of the policy options in relation to each other. Efficacy, feasibility and societal benefits were the groups of criteria deemed most important. There was most consensus in favour of options related to health education, particularly in schools, compared with options that aimed at modifying the environment to prevent obesity, i.e. options around physical activity, modifying the supply and demand for food products, and information-related options. There was little support for technological solutions or institutional reforms. There was broad consensus that to reverse the rising trend in the incidence of obesity, it will be necessary to implement a portfolio of measures, but options related to behaviour change through education are most highly regarded. It will also be necessary to invest in improved surveillance and monitoring of Polish dietary practices, levels of physical activity and obesity in terms of data on height, weight and body mass indexes.

Willingness-to-accept and purchase genetically modified rice with high folate content in Shanxi Province, China.

PubMed

De Steur, H; Gellynck, X; Storozhenko, S; Liqun, G; Lambert, W; Van Der Straeten, D; Viaene, J

2010-02-01

Neural-tube defects (NTDs) are considered to be the most common congenital malformations. As Shanxi Province, a poor region in the North of China, has one of the highest reported prevalence rates of NTDs in the world, folate fortification of rice is an excellent alternative to low intake of folate acid pills in this region. This paper investigates the relations between socio-demographic indicators, consumer characteristics (knowledge, consumer perceptions on benefits, risks, safety and price), willingness-to-accept and willingness-to-pay genetically modified (GM) rice. The consumer survey compromises 944 face-to-face interviews with rice consumers in Shanxi Province, China. Multivariate analyses consist of multinomial logistic regression and multiple regression. The results indicate that consumers generally are willing-to-accept GM rice, with an acceptance rate of 62.2%. Acceptance is influenced by objective knowledge and consumers' perceptions on benefits and risks. Willingness-to-pay GM rice is influenced by objective knowledge, risk perception and acceptance. Communication towards the use of GM rice should target mainly improving knowledge and consumers' perceptions on high-risk groups within Shanxi Province, in particular low educated women. 2009 Elsevier Ltd. All rights reserved.

[Concept extraction of graduate research by modified grounded theory approach and creating of rubric oriented to performance evaluation].

PubMed

Yasuhara, Tomohisa; Sone, Tomomichi; Kohno, Takeyuki; Ogita, Kiyokazu

2015-01-01

  A revised core curriculum model for pharmaceutical education, developed on the basis of the principles of outcome-based education, will be introduced in 2015. Inevitably, appropriate assessments of students' academic achievements will be required. Although evaluations of the cognitive domain can be carried out by paper tests, evaluation methods for the attitude domain and problem-solving abilities need to be established. From the viewpoint of quality assurance for graduates, pharmaceutical education reforms have become vital to evaluation as well as learning strategies. To evaluate student academic achievements on problem-solving abilities, authentic assessment is required. Authentic assessment is the evaluation that mimics the context tried in work and life. Specifically, direct evaluation of performances, demonstration or the learners' own work with integrated variety knowledge and skills, is required. To clarify the process of graduate research, we obtained qualitative data through focus group interviews with six teachers and analyzed the data using the modified grounded theory approach. Based on the results, we clarify the performance students should show in graduate research and create a rubric for evaluation of performance in graduate research.

Genetic polymorphisms of PPAR gamma, arsenic methylation capacity and breast cancer risk in Mexican women.

PubMed

Pineda-Belmontes, Cristina P; Hernández-Ramírez, Raúl U; Hernández-Alcaraz, César; Cebrián, Mariano E; López-Carrillo, Lizbeth

2016-04-01

To evaluate whether the presence of polymorphisms of peroxisome proliferator-activated receptor gamma PPARγ (Pro 1 2Ala) and PPARGC1B (Ala203Pro) modifies the association between the inorganic arsenic (iAs) methylation capacity and breast cancer (BC). Mexican women were interviewed, and blood and urine samples were collected from them (cases/controls= 197/220). The concentration of urinary arsenic species and the polymorphisms of interest were determined by high-performance liquid chromatography with inductively coupled plasma mass spectrometry (HPLC-ICP-MS) and polymerase chain reaction (PCR), respectively. In women with a high %MMA (urinary monomethyl arsenic) and high primary methylation ratio (PM = MMA/iAs), the risk of BC was increased (odds ratio [OR]%MMA T3 vs.T1= 3.60: 95% confidence interval [CI] 2.02-6.41, ORPMI T3 vs.T1= 3.47: 95%CI 1.95-6.17), which was maintained after adjusting for polymorphisms. No significant interactions were observed between the polymorphisms and the arsenic variables on the risk of BC. Pro 12Ala and Ala203Pro polymorphisms did not modify the association between the iAs methylation capacity and BC.

Eating routines: Embedded, value based, modifiable, and reflective

PubMed Central

Jastran, Margaret; Bisogni, Carole A.; Sobal, Jeffery; Blake, Christine; Devine, Carol M.

2009-01-01

Eating routines are a compelling issue because recurring eating behaviors influence nutrition and health. As non-traditional and individualized eating patterns have become more common, new ways of thinking about routine eating practices are needed. This study sought to gain conceptual understanding of working adults' eating routines. Forty-two purposively sampled US adults reported food intake and contextual details about eating episodes in qualitative 24-hour dietary recalls conducted over 7 consecutive days. Using the constant comparative method, researchers analyzed interview transcripts for recurrent ways of eating that were either explicitly reported by study participants as “routines” or emergent in the data. Participants' eating routines included repetition in food consumption as well as eating context, and also involved sequences of eating episodes. Eating routines were embedded in daily schedules for work, family, and recreation. Participants maintained purposeful routines that helped balance tension between demands and values, but they modified routines as circumstances changed. Participants monitored and reflected upon their eating practices and tended to assess their practices in light of their personal identities. These findings provide conceptual insights for food choice researchers and present a perspective from which practitioners who work with individuals seeking to adopt healthful eating practices might usefully approach their tasks. PMID:18835305

Comprehension and Use of Nutrition Facts Tables among Adolescents and Young Adults in Canada.

PubMed

Hobin, Erin; Shen-Tu, Grace; Sacco, Jocelyn; White, Christine; Bowman, Carolyn; Sheeshka, Judy; Mcvey, Gail; O'Brien, Mary Fodor; Vanderlee, Lana; Hammond, David

2016-06-01

Limited evidence exists on the comprehension and use of Nutrition Facts tables (NFt) among adolescents and young adults. This study provides an account of how young people engage with, understand, and apply nutrition information on the current and modified versions of the NFt to compare and choose foods. Participants aged 16-24 years (n = 26) were asked to "think aloud" while viewing either the current or 1 of 5 modified NFts and completing a behavioural task. The task included a questionnaire with 9 functional items requiring participants to define, compare, interpret, and manipulate serving size and percentage daily value (%DV) information on NFts. Semi-structured interviews were conducted to further probe thought processes and difficulties experienced in completing the task. Equal serving sizes on NFts improved ability to accurately compare nutrition information between products. Most participants could define %DV and believed it can be used to compare foods, yet some confusion persisted when interpreting %DVs and manipulating serving-size information on NFts. Where serving sizes were unequal, mathematical errors were often responsible for incorrect responses. Results reinforce the need for equal serving sizes on NFts of similar products and highlight young Canadians' confusion when using nutrition information on NFts.

Personality traits and risk of cognitive impairment and dementia.

PubMed

Terracciano, Antonio; Stephan, Yannick; Luchetti, Martina; Albanese, Emiliano; Sutin, Angelina R

2017-06-01

We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N > 10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample. Copyright © 2017 Elsevier Ltd. All rights reserved.

Inter-expert agreement and similarity analysis of traditional diagnoses and acupuncture prescriptions in textbook- and pragmatic-based practices.

PubMed

Alvim, Danielle Terra; Ferreira, Arthur Sá

2018-02-01

This study examined (1) the agreement of acupuncture experts with textbook prescriptions and among themselves, and (2) the association between similar traditional diagnoses and textbook acupuncture prescriptions, examining whether pragmatic practice (i.e., modifying prescriptions according to personal clinical practice) alters such an association. A computational analysis quantified the diagnosis-prescription association from a textbook. Eight acupuncture experts were independently interviewed. Experts modified the textbook prescriptions according to their pragmatic practice. Experts mostly agreed (19-90%) or strongly agreed (0-29%) with the textbook prescriptions, with no-better-than-chance agreement on their ratings (Light's κ = 0.036, CI 95%  = [0.003; 0.081]). The number of manifestations in traditional diagnoses weakly explains the variability (Spearman's ρ = 0.260, p = 0.038) of the number of acupoints in prescriptions. The association between similar traditional diagnoses and acupuncture prescriptions is strong in the textbook (γ = 0.720, CI 95%  = [0.658, 0.783]), whereas pragmatic practice had little effect on this association (γ = 0.724-0.769). Copyright © 2017 Elsevier Ltd. All rights reserved.

Bonding and expressed emotion: two interlinked concepts?

PubMed

Duclos, Jeanne; Maria, Anne-Solène; Dorard, Géraldine; Curt, Florence; Apfel, Alexandre; Vibert, Sarah; Rein, Zoé; Perdereau, Fabienne; Godart, Nathalie

2013-01-01

Bonding and expressed emotion (EE) are two concepts modeling family relationships. Two studies, with contradictory results, have explored whether these concepts and their corresponding instruments [the Parental Bonding Instrument (PBI) and the Camberwell Family Interview] do indeed measure the same aspects of family relationships. Our first objective was to compare the adolescents' perceptions of family relationships using the PBI, and the parental viewpoint using the Five-Minute Speech Sample (FMSS-EE). Secondly, we compared the PBI scores and EE levels of the parents. Sixty adolescent girls with anorexia nervosa completed the PBI. The FMSS and a modified version of the PBI were administered to parents separately. No significant link was identified between adolescent PBI scores and parental EE levels. However, a link between maternal 'modified' PBI scores and maternal EE was observed: when mothers registered a high Final EE, they were more likely to deny their daughter's psychological autonomy compared to mothers with lower EE. Our empirical results do not support the hypothesis of an overlap between the two concepts. Indeed bonding and EE measure the same object, i.e. the quality of family relationships, but time scales differ and so do the perspectives (patient vs. parental viewpoint). Copyright © 2012 S. Karger AG, Basel.

Potentially modifiable pre-, peri-, and postdeployment characteristics associated with deployment-related posttraumatic stress disorder among ohio army national guard soldiers.

PubMed

Goldmann, Emily; Calabrese, Joseph R; Prescott, Marta R; Tamburrino, Marijo; Liberzon, Israel; Slembarski, Renee; Shirley, Edwin; Fine, Thomas; Goto, Toyomi; Wilson, Kimberly; Ganocy, Stephen; Chan, Philip; Serrano, Mary Beth; Sizemore, James; Galea, Sandro

2012-02-01

To evaluate potentially modifiable deployment characteristics-- predeployment preparedness, unit support during deployment, and postdeployment support-that may be associated with deployment-related posttraumatic stress disorder (PTSD). We recruited a sample of 2616 Ohio Army National Guard (OHARNG) soldiers and conducted structured interviews to assess traumatic event exposure and PTSD related to the soldiers' most recent deployment, consistent with DSM-IV criteria. We assessed preparedness, unit support, and postdeployment support by using multimeasure scales adapted from the Deployment Risk and Resilience Survey. The prevalence of deployment-related PTSD was 9.6%. In adjusted logistic models, high levels of all three deployment characteristics (compared with low) were independently associated with lower odds of PTSD. When we evaluated the influence of combinations of deployment characteristics on the development of PTSD, we found that postdeployment support was an essential factor in the prevention of PTSD. Results show that factors throughout the life course of deployment-in particular, postdeployment support-may influence the development of PTSD. These results suggest that the development of suitable postdeployment support opportunities may be centrally important in mitigating the psychological consequences of war. Copyright © 2012 Elsevier Inc. All rights reserved.

Efficacy of a medical food in mild Alzheimer's disease: A randomized, controlled trial.

PubMed

Scheltens, Philip; Kamphuis, Patrick J G H; Verhey, Frans R J; Olde Rikkert, Marcel G M; Wurtman, Richard J; Wilkinson, David; Twisk, Jos W R; Kurz, Alexander

2010-01-01

To investigate the effect of a medical food on cognitive function in people with mild Alzheimer's disease (AD). A total of 225 drug-naïve AD patients participated in this randomized, double-blind controlled trial. Patients were randomized to active product, Souvenaid, or a control drink, taken once-daily for 12 weeks. Primary outcome measures were the delayed verbal recall task of the Wechsler Memory Scale-revised, and the 13-item modified Alzheimer's Disease Assessment Scale-cognitive subscale at week 12. At 12 weeks, significant improvement in the delayed verbal recall task was noted in the active group compared with control (P = .021). Modified Alzheimer's Disease Assessment Scale-cognitive subscale and other outcome scores (e.g., Clinician Interview Based Impression of Change plus Caregiver Input, 12-item Neuropsychiatric Inventory, Alzheimer's disease Co-operative Study-Activities of Daily Living, Quality of Life in Alzheimer's Disease) were unchanged. The control group neither deteriorated nor improved. Compliance was excellent (95%) and the product was well tolerated. Supplementation with a medical food including phosphatide precursors and cofactors for 12 weeks improved memory (delayed verbal recall) in mild AD patients. This proof-of-concept study justifies further clinical trials. 2010 The Alzheimer's Association. All rights reserved.

Surgical management of canine refractory retrobulbar abscesses: six cases.

PubMed

Tremolada, G; Milovancev, M; Culp, W T N; Bleedorn, J A

2015-11-01

To report the clinical presentation, surgical treatment and outcomes of dogs with retrobulbar abscesses refractory to intra-oral lancing and antibiotics. Medical records from January 2006 through September 2014 were reviewed and dogs with retrobulbar abscesses failing treatment with antibiotics and intra-oral lancing were included. Clinicopathologic, imaging and surgical details were extracted from the medical records. Referring veterinarians and owners were interviewed via telephone for follow-up data. A total of six dogs were included in the study. The most common clinical signs were pain upon opening of the mouth, exophthalmos and prolapsed nictitans. Computed tomography was performed in five dogs, ultrasound in four and magnetic resonance imaging in one. Imaging identified an abscess in all dogs, with a suspected foreign body in four dogs. Surgical approach was a modified lateral orbitotomy in five dogs. No foreign body was identified during surgery in all dog. All dogs surviving to discharge did not have recurrence of clinical signs (follow-up time range: 27 to 95 months). Dogs with retrobulbar abscesses refractory to standard therapy can experience long-term resolution of clinical signs with surgical treatment, most commonly via a modified lateral orbitotomy. © 2015 British Small Animal Veterinary Association.

Changes in self-regulatory driving among older drivers over time.

PubMed

Braitman, Keli A; Williams, Allan F

2011-12-01

The primary goal of the study was to identify to what extent older people modify their driving, what influences them to do so, and how self-regulatory behavior changes over time in relation to changes in perceived impairments and lifestyle characteristics. Participants 65 and older (n = 2650) were recruited while renewing their driver's licenses in Connecticut, Kentucky, and Rhode Island and were interviewed by telephone about current driving patterns, recent changes in driving, functional abilities related to driving (i.e., vision, memory, physical mobility, diagnosed medical conditions), crash involvements, and lifestyle characteristics. Participants were called annually to participate in follow-up telephone interviews; 2057 completed a second interview, 1698 completed 3 interviews, and 1437 completed all 4 interviews. Stepwise regression analyses examined how changes in impairments and life events (i.e., retiring, becoming widowed or divorced) related to changes in the number of miles driven during a typical week and in the number of driving situations avoided. Based on information provided in the initial survey, participants who completed all 4 surveys were slightly younger, more likely to be married, slightly less impaired in terms of physical mobility and medical conditions, and drove more weekly miles and avoided fewer driving situations compared with those who dropped out. Participants who completed all 4 interviews reported driving an average of 94 miles per week in year 1 compared with 78 miles in year 4. Reported impairments generally were low to moderate and changed little. Analyses comparing years 1 and 4 indicated that drivers drove 35 fewer miles per week if they retired or lost their job and 61 fewer miles if they moved from a retirement home to a private home or assisted living. They drove 25 more miles per week on average if they became widowed or divorced. Small increases in the number of driving situations avoided were associated with increasing impairments in memory and mobility. Lifestyle changes such as becoming widowed or divorced or retiring were associated with changes in mileages. Older drivers with worsening memory and physical mobility regulated their driving to some extent by avoiding more driving situations, confirming the hypothesis that some older drivers do take steps to compensate for increases in some perceived impairments. However, during the 3-year study period, reported changes were not large, perhaps because older drivers with larger changes were among those who dropped out (46% of those who took the first survey).

To continue, modify or relinquish driving: findings from a longitudinal study of healthy ageing.

PubMed

Unsworth, Carolyn A; Wells, Yvonne; Browning, Colette; Thomas, Shane A; Kendig, Hal

2007-01-01

The number and proportion of drivers among people entering later life continues to rise. More information on patterns of driving for older adults is required to improve service provision and traffic planning. To map the changes in driving status for a sample of drivers aged 65 years or older over the period 1994-2000, and to identify factors associated with older people continuing, modifying or relinquishing their status as drivers. The 752 participants were drawn from the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA) program, a longitudinal study of people aged 65 years and older living in the community. Participants were interviewed or contacted for follow-up in 1994, 1996, 1998 and 2000 on a range of topics including their health, functional independence and driving status. Although the number of recent drivers was smaller as participants died or were admitted to nursing homes over the 6-year data collection period, relatively few participants relinquished driving while remaining in the community. Many drivers reported modifying their driving habits over time, including decisions to restrict their driving to their local area during daylight only. Relationships were explored between driving status and the key variables of age, gender, marital status, instrumental activities of daily living (IADL) independence and self-rated measures of income, health, eyesight and hearing. Multivariate analyses indicated that drivers were more likely to modify their driving habits if they were older, dependent in IADL, and rated their eyesight as poor. Similar factors predicted relinquishing driving, but in addition, women were three times more likely to relinquish driving than men (even when health and disability were taken into account) and people who rated their incomes as 'comfortable' were more likely to relinquish driving than those with lower incomes. This study confirmed previous evidence that older drivers self-regulate by modifying their driving behavior as they age. However, since few drivers voluntarily relinquish driving, further research is required to identify ways of supporting older drivers to continue to drive safely. Copyright 2007 S. Karger AG, Basel.

Predictors of recent HIV testing among male street laborers in urban Vietnam.

PubMed

Nguyen, Huy V; Dunne, Michael P; Debattista, Joseph

2014-08-01

This study assessed the prevalence of and factors associated with HIV testing among male street laborers. In a cross-sectional survey, social mapping was done to recruit and interview 450 men aged 18-59 years in Hanoi. Although many of these men engaged in multiple risk behaviors for HIV, only 19.8 percent had been tested for HIV. A modified theoretical model provided better fit than the conventional Information-Motivation-Behavioral Skills model, as it explained much more variance in HIV testing. This model included three Information-Motivation-Behavioral components and four additional factors, namely, the origin of residence, sexual orientation, the number of sexual partners, and the status of condom use. © The Author(s) 2013.

Processes linking adolescent well-being, marital love, and coparenting.

PubMed

Baril, Megan E; Crouter, Ann C; McHale, Susan M

2007-12-01

This study examined coparenting in a sample of 177 two-parent families with firstborn adolescents by using annual home interview data from mothers, fathers, and adolescents. With a path-analytic approach and with earlier problem behaviors controlled for, coparenting conflict predicted relative increases in adolescent risky behavior over 2 years. In addition, evidence for 2 types of mediation was found. Marital love mediated the link between adolescents' early risky behavior and coparenting 1 year later, and coparenting conflict mediated the link between marital love and adolescents' risky behavior 1 year later. Linkages did not emerge for coparenting cooperation or triangulation. Interventions that are focused on the marital and coparental relationships in families with adolescents may modify trajectories of adolescent risky behavior.

The primary prevention of cardiovascular disease: nurse practitioners using behaviour modification strategies.

PubMed

Farrell, Todd Charles; Keeping-Burke, Lisa

2014-01-01

Cardiovascular disease (CVD) places great financial strain on the health care system and dramatically affects individual quality of life. As primary health care providers, nurse practitioners (NPs) are ideally positioned to advise clients on risk factor and lifestyle modifications that ameliorate the impact of CVD. While the lifestyle targets for CVD prevention are established, the most effective means of achieving these goals remain uncertain. Behaviour modification strategies, including motivational interviewing (MI) and the transtheoretical model (TTM), have been suggested, but neither approach is established as being more efficacious than the other. In this paper, evidence on the effectiveness of the two approaches for modifying smoking, diet, and exercise behaviour are presented, and a recommendation for NP practice is made.

Needs of disabled children and their families.

PubMed Central

Milner, J; Bungay, C; Jellinek, D; Hall, D M

1996-01-01

In the new NHS those who provide services for disabled children need to measure and demonstrate their effectiveness, but there are no easily available outcome measures for use by child development centres and teams. The development of an alternative approach, using a series of statements of good practice, is described. Parents of children with cerebral palsy were asked to participate in semistructured interviews, to ascertain the value and relevance of these quality statements. Parents were most concerned about the standard of news breaking and early follow up, the sharing of information, and the supply and repair of equipment. The findings were used to modify the quality checklist and it is proposed that this should form the basis of a "charter for disabled children and their families'. PMID:8957952

The use of a questionnaire and simple exercise test in the preoperative assessment of vascular surgery patients.

PubMed

McGlade, D P; Poon, A B; Davies, M J

2001-10-01

We aimed to assess the reliability of patients as historians in terms of the self assessment of functional capacity and also examined the usefulness of a simple ward exercise tolerance test. One hundred consecutive elective vascular surgery patients were interviewed preoperatively using a modified Duke Activity Status Index (DASI) questionnaire. To test reliability in reference to an independent observer, the questionnaire concerning the patient was also applied to each patient's closest relative who was blinded to the patient's responses. Patients were then asked to walk up two flights of stairs and the time taken to complete the task or the reason for failing to complete the task was recorded. The D

Separating Judicial from Legislative Reasoning in Moral Dilemma Interviews.

PubMed

Langford, Peter E

1997-12-01

Unlike previous studies of the development of reasoning about moral dilemmas, the 2 studies reported separated judicial reasoning (the application of rules) from legislative reasoning (the justification of rules), as well as attending to other aspects of context, using a modification of the weakly interpretive scoring method of Langford and D'Cruz. This assigns justifications to relatively simple conceptually defined categories. Findings were in accord with substantially modified versions of the views of Piaget and Kohlberg, according to which legislative reasoning can be divided into 3 main types of stages in the period 7-21 years: heteronomy (Piaget) or egocentrism (Kohlberg); local groups (attention to group interests, harmony, and reciprocity in local groups), wider groups (attention to these thing in wider groups). Findings contradicted Gibbs's theory.

Singh's verbal autopsy questionnaire for the assessment of causes of death, social autopsy, tobacco autopsy and dietary autopsy, based on medical records and interview.

PubMed

Singh, Ram B; Fedacko, Jan; Vargova, Viola; Kumar, Adarsh; Mohan, Varun; Pella, Daniel; De Meester, Fabien; Wilson, Douglas

2011-08-01

The exact causes of death in India are not known because autopsy studies are difficult to conduct due to religious considerations. There are rapid changes in diet and lifestyle amongst social classes causing changes in the pattern of risk factors and mortality. In the present study, we attempt to develop a verbal autopsy questionnaire based on medical records and interview of a family member, for the assessment of causes of death, social class, tobacco consumption and dietary intakes among urban decedents in north India. For the period 1999-2001, we studied the randomly selected records of death of 2222 (1385 men and 837 women) decedents, aged 25-64 years, out of 3034 death records overall from the records at the Municipal Corporation, Moradabad. Families of these decedents were contacted individually to find out the causes of death, by scientist- administered, informed-consented, verbal autopsy questionnaire, completed with the help of the spouse and local treating doctor practicing in the appropriate health care region. Clinical data and causes of death were assessed by a questionnaire based on available hospital records and a modified WHO verbal autopsy questionnaire. Dietary intakes of the dead individuals were estimated by finding out the food intake of the spouse from 3-day dietary diaries and by asking probing questions about differences in food intake by the decedents. Tobacco consumption of the victim was studied by a questionnaire administered to family members. Social classes were assessed by a questionnaire based on attributes of per capita income, occupation, education, housing and ownership of consumer luxury items in the household. The diagnoses of overweight and obesity were based on the new WHO and International College of Nutrition criteria. Cardiac diseases (23.4%, n = 520) including coronary artery disease (10%), valvular heart disease (7.2%, n = 160), diabetic heart disease (2.2%, n = 49), sudden cardiac death and inflammatory cardiac disease, each (2.0%, n = 44) were the most common causes of deaths as reported using the modified verbal autopsy questionnaire. Brain diseases including stroke (7.8%, n = 175) and inflammatory brain disease were reported amongst 1.9% (n = 42) victims.Thus, NCDs (37.0%, n = 651); circulatory diseases (31.2%, n = 695) including stroke and cardiac diseases, and malignant neoplasms (5.8%, n = 131) emerged as the most common causes of death. Injury and accidents (14.0%, n = 313) including fire, falls and poisonings were also common. Miscellaneous causes of death were observed amongst 8.5% (n = 189) of victims. Pregnancy and perinatal causes (0.72%, n = 15) were not commonly recorded in our study. Renal diseases (11.2%, n = 250), pulmonary diseases (22.3%, n = 495) and liver diseases (4.8%, n =107) were also commonly recorded causes of death. It is clear that causes of death related to various body systems can be more accurately assessed by the modified verbal autopsy questionnaire. Circulatory diseases as the cause of mortality were significantly more common among higher social classes (1-3) than in lower social classes (4 and 5) who died more often, due to infections. Death due to coronary disease, stroke, hypertension, diabetes and obesity were significantly more common among higher social classes 1-3 and among victims with higher body mass index (BMI) compared to social class 4 and 5 who had lower BMI. This study indicates that causes of death, social class, tobacco and dietary intakes, can be accurately assessed by a modified verbal autopsy questionnaire based on medical records and by interview of family members. Circulatory diseases, injury-accidents and maligant diseases have become the major causes of death in India, apart from infections.

[Clinical experience and academic thoughts of Professor LIU Feng-bin on case series of gastroesophageal reflux disease based on data mining].

PubMed

Hou, Zheng-Kun; Li, Ji-Ping; Chen, Zhuo-Qun; Liu, Feng-Bin

2018-03-01

To analyze and summarize Professor LIU Feng-bin's clinical experience and academic thoughts on gastroesophageal reflux disease (GERD), the study group adopted the retrospective study for case series and expert interview, extracted the retrospective data, including the herbs, diseases, syndrome type, medical expense and quantity of herbs of GERD patients attended the First Affiliated Hospital of Guangzhou University of Chinese Medicine. Statistical description and binary Logistic regression were used for the identification and modification of syndrome type and initial core herbs. After expert interviews were performed for the syndrome type and herbs, the final scheme were formed. A total of 112 GERD patients ages（48.97±13.13）y; male: 35 (31.3%), female: 77(68.7%) were enrolled. The numbers of patients with liver and stomach incoordination syndrome, heat stagnation of liver and stomach syndrome, syndrome of dual deficiency of Qi and Yin, syndrome of spleen deficiency and dampness-heat, spleen-stomach disharmony syndrome were 40, 26, 19, 17 and 10, respectively. The patients used totally 80 herbs, and 26 of them had significant differences among different syndrome groups. According to the logistic regression analysis on the 23 herbs used by 112 patients, the herbs scheme was modified for the second time. After the expert interviews and modification, the final consensus was reached. The main causes for GERD were dietary irregularities, moodiness, and weak constitution. The basic mechanism of GERD was spleen deficiency with Qi adverseness. The spleen-stomach disharmony syndrome was deleted by expert interviews. The 10 core herbs for GERD treatment were Taizishen(Pseudostellariae Radix), Fuling(Poria), Baizhu(Atractylodismacrocephalae Rhizoma), Gancao(Glycyrrhizae Radix Et Rhizoma), Zhebeimu(Fritillariae Thunbergii Bulbus), Haipiaoxiao(Sepiae Endoconcha), Zhiqiao(Aurantii Fructus), Chenxiang(Alosewood), Pugongying(Taraxaci Herba), Zhizitan(Cape Jasmine Fruit). The modification and psychological and diet interventions were also identified. This study summarized Professor LIU Feng-bin's clinical experience and academic thoughts of chronic atrophic gastritis based on data mining of case series and expert interviews. The quality of methodologies and report were both well. The results provide a foundation and ideas for further study on the complex intervention for GERD, and can be directly applied in clinical practice. Copyright© by the Chinese Pharmaceutical Association.

The importance of dietary change for men diagnosed with and at risk of prostate cancer: a multi-centre interview study with men, their partners and health professionals.

PubMed

Avery, Kerry N L; Donovan, Jenny L; Horwood, Jeremy; Neal, David E; Hamdy, Freddie C; Parker, Chris; Wade, Julia; Lane, Athene

2014-05-03

The diagnosis of prostate cancer (PC) can provide a trigger for dietary change, and there is evidence that healthier diets may improve quality of life and clinical outcomes. However, men's views about dietary change in PC survivorship are largely unknown. This multi-centre qualitative interview study explored men's views about dietary change in PC survivorship, to better understand motivations for, and barriers to, achieving desired changes. The role of radical and active surveillance treatments on dietary change and the influence of men's partners were examined. Focus groups also evaluated stakeholder opinion, including healthcare professionals, about the provision of dietary advice to PC patients. A multi-centre interview study explored views about diet and motivations for, and barriers to, dietary change in men at elevated risk or diagnosed with PC following prostate specific antigen (PSA) testing. 58 men and 11 partners were interviewed. Interviews and focus groups were undertaken with 11 healthcare professionals, 5 patients and 4 partners to evaluate stakeholders' opinions about the feasibility and acceptability of providing dietary advice to PC patients. Data were analysed using methods of constant comparison and thematic analysis. Over half of diagnosed men reported making dietary changes, primarily to promote general or prostate health or facilitate coping, despite their uncertainty about diet-PC links. Interest in dietary advice was high. Information needs varied depending on treatment received, with men on active surveillance more frequently modifying their diet and regarding this as an adjunct therapy. Men considered their partners integral to implementing changes. Provision of dietary advice to men diagnosed with PC was considered by healthcare professionals and men to be feasible and appropriate in the context of a holistic 'care package'. Many men make positive dietary changes after PC diagnosis, which are perceived by men and their partners to bring psychological and general health benefits and could help future dietary intervention trials. Men and their partners desire more and better dietary information that may support PC survivorship, particularly among those embarking on active surveillance/monitoring programmes. There are opportunities for healthcare professionals to support PC patients both clinically and psychologically by the routine integration of healthy eating advice into survivorship care plans.

A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries.

PubMed

Wolinsky, Fredric D; Bentler, Suzanne E; Hockenberry, Jason; Jones, Michael P; Weigel, Paula A; Kaskie, Brian; Wallace, Robert B

2011-09-20

Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function. We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests. Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status. In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

Urban adults' perceptions of factors influencing asthma control.

PubMed

George, Maureen; Keddem, Shimrit; Barg, Frances K; Green, Sarah; Glanz, Karen

2015-02-01

To identify urban adults' perceptions of facilitators and barriers to asthma control, including the role of self-care, medications, environmental trigger remediation, and primary care. Semi-structured open-ended qualitative interviews were conducted. Audio recordings were transcribed verbatim and entered into NVivo 10.0 (QSR International Pty Ltd, Doncaster, Victoria, Australia) for coding, analysis, and integration with demographic and asthma control data. RESULTS were analyzed by the level of asthma control. A modified grounded theory approach was used in the analysis. Thirty-five adults with persistent asthma (94% Black; 71% female; 71% with uncontrolled asthma) from the five West Philadelphia zip codes with the highest asthma burden participated. Generally, all participants understood the roles of inhaled corticosteroid (ICS) and short-acting β-2 agonist (SABA) therapies in asthma self-care although they attributed systemic side effects to topical ICS administration. Compared with participants with controlled asthma, uncontrolled participants reported overusing SABAs, underusing ICS, rejecting medical and trigger remediation advice, having more negative experiences with primary care providers, and preferring more unconventional strategies to prevent or manage asthma symptoms. Personal health beliefs about control can undermine adherence to medical and environmental remediation advice and likely contributes to high rates of uncontrolled asthma in this population. Clinicians need to know whether, and to what degree, these health beliefs can be modified. It is likely that new models of care, such as patient-centered shared decision-making approaches, and new partners, such as community health workers, may be required to modify these beliefs. This would be an important first step to enhance asthma control in vulnerable populations.

Tracheal intubation with rocuronium using a "modified timing principle".

PubMed

Kwon, Min A; Song, Jaegyok; Kim, Ju-Ri

2013-03-01

Rapid sequence induction (RSI) is indicated in various situations. Succinylcholine has been the muscle relaxant of choice for RSI, and rocuronium has become an alternative medicine for patients who cannot be administered succinylcholine for various reasons. Although rocuronium has the most rapid onset time among non-depolarizing muscle relaxants, the standard dose of rocuronium (0.6 mg/kg) takes 60 seconds to achieve appropriate muscle relaxation. We evaluated intubating conditions using the "modified timing principle" with rocuronium and succinylcholine. In this prospective controlled blinded study, all patients received 1.5 µg/kg fentanyl intravenously with preoxygenation for 2 minutes and were randomized to receive 0.6 mg/kg rocuronium followed by 1.5 mg/kg propofol or 1.5 mg/kg propofol and 1.5 mg/kg succinylcholine. The rocuronium group was intubated just after confirming loss of consciousness, and the succinylcholine group was intubated 1 minute after injecting succinylcholine. Intubation condition, timing of events, and complications were recorded. All patients were successfully intubated in both groups. Apnea time of the rocuronium group (38.5 seconds) was significantly shorter than that in the succinylcholine group (100.7 seconds). No significant differences were observed in loss of consciousness time or intubation time. The succinylcholine group tended to show better intubation conditions, but no significant difference was observed. None of the patients complained awareness of the intubation procedure or had respiratory difficulty during a postoperative interview. The modified RSI with rocuronium showed shorter intubation sequence, acceptable intubation conditions, and a similar level of complications compared to those of conventional RSI with succinylcholine.

Perceived sexism as a health determinant in Spain.

PubMed

Borrell, Carme; Artazcoz, Lucia; Gil-González, Diana; Pérez, Glòria; Rohlfs, Izabella; Pérez, Katherine

2010-04-01

The goals of the present study are to explore the association between perceived sexism and self-perceived health, health-related behaviors, and unmet medical care needs among women in Spain; to analyze whether higher levels of discrimination are associated with higher prevalence of poor health indicators and to examine whether these relationships are modified by country of origin and social class. The study is based on a cross-sectional design using data from the 2006 Spanish Health Interview Survey. We included women aged 20-64 years (n = 10,927). Six dependent variables were examined: four of health (self-perceived health, mental health, hypertension, and having had an injury during the previous year), one health behavior (smoking), and another related to the use of the health services (unmet need for medical care). Perceived sexism was the main independent variable. Social class and country of origin were considered as effect modifiers. We obtained the prevalence of perceived sexism. Logistic regression models, adjusted for potential confounders, were fitted to study the association between sexism and poor health outcomes. The prevalence of perceived sexism was 3.4%. Perceived sexism showed positive and consistent associations with four poor health outcomes (poor self-perceived health, poor mental health, injuries in the last 12 months, and smoking). The strength of these associations increased with increased scores for perceived sexism, and the patterns were found to be modified by country of origin and social class. This study shows a consistent association between perceived sexism and poor health outcomes in a country of southern Europe with a strong patriarchal tradition.

Self-esteem as a mediator of the relationship between role functioning and symptoms for individuals with severe mental illness: a prospective analysis of Modified Labeling theory.

PubMed

Davis, Lisa; Kurzban, Seth; Brekke, John

2012-05-01

Despite a growing body of evidence supporting the efficacy of psychosocial rehabilitation for individuals with severe mental illness (SMI), a large proportion of these individuals remain unable to maintain basic social roles such as employee, parent, or spouse. This study investigated whether changes in role functioning over time impact symptom severity indirectly through the mechanism of changes in self-esteem as posited by Modified Labeling theory. The study sample was composed of 148 individuals diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features, and major depression with psychotic features who elected to participate in community-based psychosocial rehabilitation services. Measures of role functioning, self-esteem, and psychiatric symptoms were gathered at baseline and six months through a combination of structured clinical interviews and self-report surveys. SEM results at baseline provided support for a model in which self-esteem fully mediated the relationship between role functioning and psychiatric symptoms. The final model explained 20% of the variance in psychiatric symptoms. Analyses at six months post-baseline (time 2) indicate that changes in self-esteem fully mediated the relationship between changes in role functioning and changes in psychiatric symptoms. The final change model explained 23% of the variance in changes in psychiatric symptoms. Results provide empirical support for the principles underlying Modified Labeling theory. Implications include the need for interventions that focus on social participation as a means of improving self-esteem, thereby decreasing symptom exacerbation and future relapse for people with SMI. Copyright © 2012 Elsevier B.V. All rights reserved.

Characterization of Individuals Seeking Treatment for Caffeine Dependence

PubMed Central

Juliano, Laura M.; Evatt, Daniel P.; Richards, Brian D.; Griffiths, Roland R.

2013-01-01

Previous investigations have identified individuals who meet criteria for DSM-IV-TR substance dependence as applied to caffeine, but there is little research on treatments for caffeine dependence. This study aimed to thoroughly characterize individuals who are seeking treatment for problematic caffeine use. Ninety-four individuals who identified as being psychologically or physically dependent on caffeine, or who had tried unsuccessfully to modify caffeine consumption participated in a face-to-face diagnostic clinical interview. They also completed measures concerning caffeine use and quitting history, reasons for seeking treatment, and standardized self-report measures of psychological functioning. Caffeine treatment seekers (mean age 41 yrs, 55% women) consumed an average of 548 mg caffeine per day. The primary source of caffeine was coffee for 50% of the sample and soft drinks for 37%. Eighty-eight percent reported prior serious attempts to modify caffeine use (mean 2.7 prior attempts) and 43% reported being advised by a medical professional to reduce or eliminate caffeine. Ninety-three percent met criteria for caffeine dependence when generic DSM-IV-TR substance dependence criteria were applied to caffeine use. The most commonly endorsed criteria were withdrawal (96%), persistent desire or unsuccessful efforts to control use (89%), and use despite knowledge of physical or psychological problems caused by caffeine (87%). The most common reasons for wanting to modify caffeine use were health-related (59%) and not wanting to be dependent on caffeine (35%). This investigation reveals that there are individuals with problematic caffeine use who are seeking treatment, and suggests that there is a need for effective caffeine dependence treatments. PMID:22369218

Modifiable risk factors for Alzheimer disease and subjective memory impairment across age groups.

PubMed

Chen, Stephen T; Siddarth, Prabha; Ercoli, Linda M; Merrill, David A; Torres-Gil, Fernando; Small, Gary W

2014-01-01

Previous research has identified modifiable risk factors for Alzheimer's disease (AD) in older adults. Research is limited on the potential link between these risk factors and subjective memory impairment (SMI), which may precede AD and other dementias. Examination of these potential relationships may help identify those at risk for AD at a stage when interventions may delay or prevent further memory problems. The objective of this study was to determine whether risk factors for AD are associated with SMI among different age groups. Trained interviewers conducted daily telephone surveys (Gallup-Healthways) of a representative community sample of 18,614 U.S. respondents, including 4,425 younger (age 18 to 39 years), 6,365 middle-aged (40 to 59 years), and 7,824 older (60 to 99 years) adults. The surveyors collected data on demographics, lifestyles, and medical information. Less education, smoking, hypertension, diabetes, less exercise, obesity and depression, and interactions among them, were examined for associations with SMI. Weighted logistic regressions and chi-square tests were used to calculate odds ratios and confidence intervals for SMI with each risk factor and pairwise interactions across age groups. Depression, less education, less exercise, and hypertension were significantly associated with SMI in all three age groups. Several interactions between risk factors were significant in younger and middle-aged adults and influenced their associations with SMI. Frequency of SMI increased with age and number of risk factors. Odds of having SMI increased significantly with just having one risk factor. These results indicate that modifiable risk factors for AD are also associated with SMI, suggesting that these relationships occur in a broad range of ages and may be targeted to mitigate further memory problems. Whether modifying these risk factors reduces SMI and the eventual incidence of AD and other dementias later in life remains to be determined.

African American men's understanding and perceptions about prostate cancer: why multiple dimensions of health literacy are important in cancer communication.

PubMed

Friedman, Daniela B; Corwin, Sara J; Dominick, Gregory M; Rose, India D

2009-10-01

Prostate cancer (PrCA) is the most diagnosed cancer among men in the United States, especially among African American (AA) men. The purpose of this formative study was to explore the implications of applying Nutbeam's multidimensional health literacy framework to AA men's understanding of PrCA information. Participants were 25 AA men aged 45 and older in South Carolina. Their functional health literacy was assessed using two modified Cloze tests and the Shortened Test of Functional Health Literacy in Adults (S-TOFHLA). Men also participated in interviews or focus groups during which they were asked questions about PrCA risk, prevention, and screening. Transcripts were reviewed for recurrent themes and analyzed qualitatively using NVivo7. Mean S-TOFHLA was 28.28 (+/-1.98), implying "adequate" comprehension. Mean Cloze was .71 (+/-.05) for a Grade 8 document and .66 (+/-.04) for a Grade 13 document, also showing "adequate" comprehension. Cloze scores for the Grade 8 resource were lower for participants with less education (P = .047). Despite having satisfactory literacy test scores, results from interviews and focus groups revealed participants' limited understanding and misconceptions about PrCA risk. Many wanted information about screening and family history delivered word-of-mouth by AA women and church pastors as few of them had ever received or actively sought out PrCA resources. Using Nutbeam's framework, gaps in health literacy which were not adequately captured by the validated tools emerged during the interviews and focus groups. Study findings provide important implications for PrCA communication with AA men to correct misperceptions about cancer risk and motivate preventive behaviors.

A qualitative study of the variable effects of audit and feedback in the ICU.

PubMed

Sinuff, Tasnim; Muscedere, John; Rozmovits, Linda; Dale, Craig M; Scales, Damon C

2015-06-01

Audit and feedback is integral to performance improvement and behaviour change in the intensive care unit (ICU). However, there remain large gaps in our understanding of the social experience of audit and feedback and the mechanisms whereby it can be optimised as a quality improvement strategy in the ICU setting. We conducted a modified grounded theory qualitative study. Seventy-two clinicians from five academic and five community ICUs in Ontario, Canada, were interviewed. Team members reviewed interview transcripts independently. Data analysis used constant comparative methods. Clinicians interviewed experienced audit and feedback as fragmented and variable in its effectiveness. Moreover, clinicians felt disconnected from the process. The audit process was perceived as being insufficiently transparent. Feedback was often untimely, incomplete and not actionable. Specific groups such as respiratory therapists and night-shift clinicians felt marginalised. Suggestions for improvement included improving information sharing about the rationale for change and the audit process, tools and metrics; implementing peer-to-peer quality discussions to avoid a top-down approach (eg, incorporating feedback into discussions at daily rounds); providing effective feedback which contains specific, transparent and actionable information; delivering timely feedback (ie, balancing feedback proximate to events with trends over time) and increasing engagement by senior management. ICU clinicians experience audit and feedback as fragmented communication with feedback being especially problematic. Attention to improving communication, integration of the process into daily clinical activities and making feedback timely, specific and actionable may increase the effectiveness of audit and feedback to affect desired change. 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.

A qualitative study of emergency physicians’ perspectives on PROMS in the emergency department

PubMed Central

Dainty, Katie N; Seaton, Bianca; Laupacis, Andreas; Schull, Michael; Vaillancourt, Samuel

2017-01-01

Introduction There is a growing emphasis on including patients' perspectives on outcomes as a measure of quality care. To date, this has been challenging in the emergency department (ED) setting. To better understand the root of this challenge, we looked to ED physicians' perspectives on their role, relationships and responsibilities to inform future development and implementation of patient-reported outcome measures (PROMs). Methods ED physicians from hospitals across Canada were invited to participate in interviews using a snowballing sampling technique. Semistructured interviews were conducted by phone with questions focused on the role and practice of ED physicians, their relationship with their patients and their thoughts on patient-reported feedback as a mechanism for quality improvement. Transcripts were analysed using a modified constant comparative method and interpretive descriptive framework. Results Interviews were completed with 30 individual physicians. Respondents were diverse in location, training and years in practice. Physicians reported being interested in ‘objective’ postdischarge information including adverse events, readmissions, other physicians’ notes, etc in a select group of complex patients, but saw ‘patient-reported’ feedback as less valuable due to perceived biases. They were unsure about the impact of such feedback mainly because of the episodic nature of their work. Concerns about timing, as well as about their legal and ethical responsibilities to follow-up if poor patient outcomes are reported, were raised. Conclusions Data collection and feedback are key elements of a learning health system. While patient-reported outcomes may have a role in feedback, ED physicians are conflicted about the actionability of such data and ethical implications, given the inherently episodic nature of their work. These findings have important implications for PROM design and implementation in this unique clinical setting. PMID:28183828

Investigating stakeholders' perceptions of the link between high STD rates and the current Baltimore City Public Schools' sex education curriculum

NASA Astrophysics Data System (ADS)

Bolden, Shenell L. T.

The purpose of this exploratory study was to examine key stakeholders' perceptions of the current Baltimore City Public Schools' (BCPS) sex education curriculum and to gain insight into how they believe the curriculum could be modified to be more effective. A mixed methods approach using qualitative and quantitative data collection consisting of a survey, focus group interview, and individual interviews was conducted to gather information on stakeholders' perceptions. The stakeholders included: (1) former students who received their sex education courses in the Baltimore City Public School system (BCPS); (2) teachers in BCPS who were affiliated with the sex education curriculum; (3) health care professionals who screened and/or treated East Baltimore City residents for a sexually transmitted disease (STD) and; (4) one policy maker who was responsible for creating sex education curriculum at the national level. Analysis of the quantitative data from former Baltimore City Public School students revealed a general satisfaction with the current sex education curriculum. However, qualitative data from the same group of stakeholders revealed several changes they thought should be implemented into the program in an effort to improve the current curriculum. Findings from the other groups after qualitative analysis of the interviews suggest three major themes in support of curriculum change: (1) a blended curriculum that integrates both the cognitive and affective learning domains; (2) knowledge of prevention of STD's and pregnancy; and (3) authentic teaching and learning. Results from this study strongly suggest that the Baltimore City Public School system is apathetic to the sexual health needs of students and, therefore, is inadvertently contributing to the high rate of sexually transmitted diseases among young people. Keywords: Abstinence, Affective domain, Indoctrination, Behavior Modification, Cognitive domain, Sex education curriculum, Sexually Transmitted Diseases.

"Sounds a Bit Crazy, But It Was Almost More Personal:" A Qualitative Study of Patient and Clinician Experiences of Physical Therapist-Prescribed Exercise For Knee Osteoarthritis Via Skype.

PubMed

Hinman, R S; Nelligan, R K; Bennell, K L; Delany, C

2017-12-01

To explore the experience of patients and physical therapists with Skype for exercise management of knee osteoarthritis (OA). This was a qualitative study. The Donabedian model for quality assessment in health care (structure, process, and outcomes) informed semistructured individual interview questions. The study involved 12 purposively sampled patients with knee OA who received physical therapist-prescribed exercise over Skype, and all therapists (n = 8) who delivered the intervention in a clinical trial were interviewed about their experiences. Interviews were audio recorded and transcribed. Two investigators undertook coding and analysis using a thematic approach. Six themes arose from both patients and therapists. The themes were Structure: technology (easy to use, variable quality, set-up assistance helpful) and patient convenience (time efficient, flexible, increased access); Process: empowerment to self-manage (facilitated by home environment and therapists focusing on effective treatment) and positive therapeutic relationships (personal undivided attention from therapists, supportive friendly interactions); and Outcomes: satisfaction with care (satisfying, enjoyable, patients would recommend, therapists felt Skype more useful as adjunct to usual practice) and patient benefits (reduced pain, improved function, improved confidence and self-efficacy). A seventh theme arose from therapists regarding process: adjusting routine treatment (need to modify habits, discomfort without hands-on, supported by research environment). Patients and physical therapists described mostly positive experiences using Skype as a service delivery model for physical therapist-supervised exercise management of moderate knee OA. Such a model is feasible and acceptable and has the potential to increase access to supervised exercise management for people with knee OA, either individually or in combination with traditional in-clinic visits. © 2017, American College of Rheumatology.

Translation, cultural adaptation and reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil

PubMed Central

Chiari, Aline; de Souza Sardim, Carla Caires; Natour, Jamil

2011-01-01

OBJECTIVE: To translate, to perform a cultural adaptation of and to test the reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil. METHODS: First, the Cochin Hand Functional Scale questionnaire was translated into Portuguese and was then back-translated into French. These translations were reviewed by a committee to establish a Brazilian version of the questionnaire to be tested. The validity and reproducibility of the Cochin Hand Functional Scale questionnaire was evaluated. Patients of both sexes, who were aged 18 to 60 years and presented with rheumatoid arthritis affecting their hands, were interviewed. The patients were initially interviewed by two observers and were later interviewed by a single rater. First, the Visual Analogue Scale for hand pain, the Arm, Shoulder and Hand Disability questionnaire and the Health Assessment Questionnaire were administered. The third administration of the Cochin Hand Functional Scale was performed fifteen days after the first administration. Ninety patients were assessed in the present study. RESULTS: Two questions were modified as a result of the assessment of cultural equivalence. The Cronbach's alpha value for this assessment was 0.93. The intraclass intraobserver and interobserver correlation coefficients were 0.76 and 0.96, respectively. The Spearman's coefficient indicated that there was a low level of correlation between the Cochin Hand Functional Scale and the Visual Analogue Scale for pain (0.46) and that there was a moderate level of correlation of the Cochin Scale with the Health Assessment Questionnaire (0.66) and with the Disability of the Arm, Shoulder and Hand questionnaire (0.63). The average administration time for the Cochin Scale was three minutes. CONCLUSION: The Brazilian version of the Cochin Hand Functional Scale was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity. PMID:21789372

Sustainability of depression care improvements: success of a practice change improvement collaborative.

PubMed

Nease, Donald E; Nutting, Paul A; Graham, Deborah G; Dickinson, W Perry; Gallagher, Kaia M; Jeffcott-Pera, Michelle

2010-01-01

Long-term sustainment of improvements in care continues to challenge primary care practices. During the 2 years after of our Improving Depression Care collaborative, we examined how well practices were sustaining their depression care improvements. Our study design used a qualitative interview follow-up of a modified learning collaborative intervention. We conducted telephone interviews with practice champions from 15 of the original 16 practices. Interviews were conducted during a 3-month period in 2008, and were recorded and professionally transcribed. Data on each of the depression care improvements and the change management strategy emphasized during the learning collaborative were summarized after review of the primary data and a consensus process to resolve differing interpretations. During the period from 15 months to 3 years since our project began, depression screening or case finding was sustained in 14 of 15 practices. Thirteen practices sustained use of the 9-item Patient Health Questionnaire for depression monitoring, and one additional practice initiated it. Seven practices initiated self-management support and 2 of 3 practices sustained it. In contrast, tracking and case management proved difficult to sustain, with only 4 of 8 practices continuing this activity. Diffusion of use of the 9-item Patient Health Questionnaire to other clinicians in the practice was maintained in all but 3 practices and expanded in one practice. Six of the practices continued to use the change management strategy, including all 4 of the practices that sustained tracking. Practices demonstrated long-term sustained improvement in depression care with the exception of tracking and care management, which may be a more challenging innovation to sustain. We hypothesize that sustaining complex depression care innovations may require active management by the practice.

‘I'll be in a safe place’: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care

PubMed Central

Henson, Lesley A; Higginson, Irene J; Daveson, Barbara A; Ellis-Smith, Clare; Koffman, Jonathan; Morgan, Myfanwy; Gao, Wei

2016-01-01

Objective To explore the decisions of people with advanced cancer and their caregivers to seek emergency department (ED) care, and understand the issues that influence the decision-making process. Design Cross-sectional qualitative study incorporating semistructured patient and caregiver interviews. Methods Between December 2014 and July 2015, semistructured interviews were conducted with 18 people with advanced cancer, all of whom had recently attended the ED of a large university teaching hospital located in south-east London; and six of their caregivers. Interviews were audio recorded, transcribed verbatim and analysed using a constant comparative approach. Padgett and Brodsky's modified version of the ‘Behavioral Model of Health Services Use’ was used as a framework to guide the study. Results Issues influencing the decision-making process included: (1) disease-related anxiety—those with greater anxiety related to their cancer diagnosis interpreted their symptoms as more severe and/or requiring immediate attention; (2) prior patterns of health-seeking behaviour—at times of crisis participants defaulted to previously used services; (3) feelings of safety and familiarity with the hospital setting—many felt reassured by the presence of healthcare professionals and monitoring of their condition; and, (4) difficulties accessing community healthcare services—especially urgently and/or out-of-hours. Conclusions These data provide healthcare professionals and policymakers with a greater understanding of how systems of care may be developed to help reduce ED visits by people with advanced cancer. In particular, our findings suggest that the number of ED visits could be reduced with greater end-of-life symptom support and education, earlier collaboration between oncology and palliative care, and with increased access to community healthcare services. PMID:27807085

LONG-TERM INTAKE OF NUTS IN RELATION TO COGNITIVE FUNCTION IN OLDER WOMEN

PubMed Central

O’BRIEN, J.; OKEREKE, O.; DEVORE, E.; ROSNER, B.; BRETELER, M.; GRODSTEIN, F.

2014-01-01

Objective Nuts contain nutrients that may benefit brain health; thus, we examined long-term intake of nuts in relation to cognition in older women. Design Population-based prospective cohort study. Setting Academic research using data from the Nurses’ Health Study. Participants Nut intake was assessed in a food-frequency questionnaire beginning in1980, and approximately every four years thereafter. Between 1995–2001, 16,010 women age 70 or older (mean age = 74 years) without a history of stroke were administered 4 repeated telephone-based cognitive interviews over 6 years. Our final sample included 15,467 women who completed an initial cognitive interview and had complete information on nut intake. Main Outcome Measures The Telephone Interview for Cognitive Status (TICS), a global score averaging the results of all tests (TICS, immediate and delayed verbal recall, category fluency, and attention), and a verbal memory score averaging the results of tests of verbal recall. Results In multivariable-adjusted linear regression models, higher long-term total nut intake was associated with better average cognitive status for all cognitive outcomes. For the global composite score combining all tests, women consuming at least 5 servings of nuts/week had higher scores than non-consumers (mean difference=0.08 standard units, 95% confidence interval 0.00–0.15; p-trend=0.003). This mean difference of 0.08 is equivalent to the mean difference we find between women 2 years apart in age. Long-term intake of nuts was not associated with rates of cognitive decline. Conclusions Higher nut intake may be related to better overall cognition at older ages, and could be an easily-modifiable public health intervention. PMID:24886736

Rural Latino caregivers’ beliefs and behaviors around their children’s salt consumption

PubMed Central

Hoeft, Kristin S.; Guerra, Claudia; Gonzalez-Vargas, M. Judy; Barker, Judith C.

2015-01-01

Background Prevalence of high blood pressure has been increasing in U.S. children, with implications for long term health consequences. Sodium consumption, a modifiable risk factor for high blood pressure, is above recommended limits and increasing. Very little is known about Latino caregiver beliefs and behaviors around their children’s salt consumption. Methods In California’s Central Valley, qualitative interviews in Spanish investigated low-income caregivers’ views and understandings of their children’s dietary salt consumption. Thirty individual interviews and 5 focus groups were conducted (N=61). Interview transcripts were translated and transcribed, coded and thematically analyzed. Results Seven primary topic areas around children’s salt intake and its impact on health were identified: children’s favorite foods, children’s dietary salt sources, superiority of home-cooked foods, salty and sweet foods, managing salt for health, developing children’s tastes, and adding salt added at the table. Parents recognize common sources of sodium such as “junk food” and processed food and made efforts to limit their children’s consumption of these foods, but may overlook other significant sodium sources, particularly bread, cheese, prepared soups and sports drinks. Caregivers recognize excess salt as unhealthy for children, but don’t believe health problems (like high blood pressure) can occur in young children. Nevertheless, they made efforts to limit how much salt their children consumed through a variety of strategies; school meals were a source of high sodium that they felt were outside of their control. Conclusion Latino caregivers are concerned about their children’s salt intake and attempt to limit consumption, but some common sources of sodium are under-recognized. PMID:25481770

Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.

PubMed

Perdok, Hilde; Jans, Suze; Verhoeven, Corine; Henneman, Lidewij; Wiegers, Therese; Mol, Ben Willem; Schellevis, François; de Jonge, Ank

2016-07-26

This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Qualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected stakeholder representatives participated in individual semi-structured interviews and 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a paediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described. Three main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy. An integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinion among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care are an appropriate payment structure and maintenance of the autonomy of professionals.

Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study

PubMed Central

Eisingerich, Andreas B

2016-01-01

Background Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. Objective The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. Methods We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. Results Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. Conclusions Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond. PMID:27777216

A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis.

PubMed

Harris, Sarah; Gilbert, Matthew; Beasant, Lucy; Linney, Catherine; Broughton, Jessica; Crawley, Esther

2017-01-01

An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. Semi-structured interviews were conducted with adolescents (aged 12-17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible.

A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis

PubMed Central

Harris, Sarah; Gilbert, Matthew; Beasant, Lucy; Linney, Catherine; Broughton, Jessica; Crawley, Esther

2016-01-01

Background: An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. Methods: Semi-structured interviews were conducted with adolescents (aged 12–17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. Results: Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. Conclusions: If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible. PMID:27215228

[Enhancement of quality by employing qualification-oriented staff and team-oriented cooperation].

PubMed

Meyenburg-Altwarg, Iris; Tecklenburg, Andreas

2010-01-01

Taking three practical examples from a university hospital the present article describes how quality can be improved by linking deployment of qualification-oriented staff with team-oriented cooperation, especially with regard to the professional groups of physicians and nurses. In the first example, a cross-professional work group defined tasks which--in a legally acceptable manner--allow selected activities to be transferred from physicians to nurses, improving the work processes of all persons concerned. Work and duty profiles, training and modified work processes were created and implemented according to the PDCA circle-based process. The first evaluation took place after nine months using interviews, questionnaires (patients, physicians, and nurses) as well as CIRS. In the second example, emphasis was placed on offers of supplementary services for private patients resulting in a lightening of the workload on the nursing staff. These supplementary services are intended to enhance the wellbeing of the patients. Special external-service staff provide high standard hotel services. These services consistently receive high ratings from the patients. The methods used for introduction and evaluation are analogous to those used in the first example. The third example is concerned with the extension of nursing care and patient empowerment beyond the boundaries of ward and hospital. The guidelines were the implementation of the national expert standard for discharge management according to the DNQP. The methods of introduction were analogous to those used in example 1. For the evaluation interviews were conducted with all participating groups. In all examples actual quantitative measures (key ratios) are not yet available; however, the data collected from the interviews and questionnaires of all the participants are promising.

Improving safety culture in hospitals: Facilitators and barriers to implementation of Systemic Falls Investigative Method (SFIM).

PubMed

Zecevic, Aleksandra A; Li, Alvin Ho-Ting; Ngo, Charity; Halligan, Michelle; Kothari, Anita

2017-06-01

The purpose of this study was to assess the facilitators and barriers to implementation of the Systemic Falls Investigative Method (SFIM) on selected hospital units. A cross-sectional explanatory mixed methods design was used to converge results from a standardized safety culture survey with themes that emerged from interviews and focus groups. Findings were organized by six elements of the Ottawa Model of Research Use framework. A geriatric rehabilitation unit of an acute care hospital and a neurological unit of a rehabilitation hospital were selected purposefully due to the high frequency of falls. Hospital staff who took part in: surveys (n = 39), interviews (n = 10) and focus groups (n = 12), and 38 people who were interviewed during falls investigations: fallers, family, unit staff and hospital management. Implementation of the SFIM to investigate fall occurrences. Percent of positive responses on the Modified Stanford Patient Safety Culture Survey Instrument converged with qualitative themes on facilitators and barriers for intervention implementation. Both hospital units had an overall poor safety culture which hindered intervention implementation. Facilitators were hospital accreditation, strong emphasis on patient safety, infrastructure and dedicated champions. Barriers included heavy workloads, lack of time, lack of resources and poor communication. Successful implementation of SFIM requires regulatory and organizational support, committed frontline staff and allocation of resources to identify active causes and latent contributing factors to falls. System-wide adjustments show promise for promotion of safety culture in hospitals where falls happen regularly. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Understanding Women's Differing Experiences of Distress after Colposcopy: A Qualitative Interview Study.

PubMed

O'Connor, Mairead; Waller, Jo; Gallagher, Pamela; Martin, Cara M; O'Leary, John J; D'Arcy, Tom; Prendiville, Walter; Flannelly, Grainne; Sharp, Linda

2015-01-01

Women who have an abnormal cervical cytology test may be referred for a colposcopy. Accumulating evidence suggests some women may experience distress after colposcopy. This exploratory study examined women's differing experiences of post-colposcopy distress with the aim of identifying factors that are predictive of, or protective against, distress. We carried out semistructured, qualitative interviews with 23 women who had undergone colposcopies. Interviews were transcribed verbatim, coded, and analyzed thematically. The Framework Approach was used to summarize and organize the data and identify emerging higher order themes. Two forms of post-colposcopy distress emerged: 1) short term and 2) long term. Short-term distress was experienced immediately after the colposcopy and in the days afterward, and was usually related to the physical experience of the colposcopy. Long-term distress typically persisted over time and was related to concerns about fertility, cervical cancer, and sexual intercourse. The drivers of short-term and long-term distress differed. Factors related to short-term distress were feeling unprepared for the procedure, having a negative experience of the procedure, and attending the clinic alone. Factors related to long-term distress were future intentions to have (more) children, having physical after-effects of the procedure that impacted on the woman's life, and being under on-going clinic surveillance. Absence of these factors (e.g., being accompanied to the clinic) was protective against short- and long-term distress. Colposcopy can lead to short- and long-term post-procedural distress for some women. We identified a range of factors, some potentially modifiable, that seem to influence the chances of experiencing distress. These results may inform the development of strategies or interventions aimed at preventing or minimizing distress after colposcopy and related procedures. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Improving patients' understanding of terms and phrases commonly used in self-reported measures of sexual function.

PubMed

Alexander, Angel M; Flynn, Kathryn E; Hahn, Elizabeth A; Jeffery, Diana D; Keefe, Francis J; Reeve, Bryce B; Schultz, Wesley; Reese, Jennifer Barsky; Shelby, Rebecca A; Weinfurt, Kevin P

2014-08-01

There is a significant gap in research regarding the readability and comprehension of existing sexual function measures. Patient-reported outcome measures may use terms not well understood by respondents with low literacy. This study aims to test comprehension of words and phrases typically used in sexual function measures to improve validity for all individuals, including those with low literacy. We recruited 20 men and 28 women for cognitive interviews on version 2.0 of the Patient-Reported Outcome Measurement Information System(®) (PROMIS(®) ) Sexual Function and Satisfaction measures. We assessed participants' reading level using the word reading subtest of the Wide Range Achievement Test. Sixteen participants were classified as having low literacy. In the first round of cognitive interviews, each survey item was reviewed by five or more people, at least two of whom had lower than a ninth-grade reading level (low literacy). Patient feedback was incorporated into a revised version of the items. In the second round of interviews, an additional three or more people (at least one with low literacy) reviewed each revised item. Participants with low literacy had difficulty comprehending terms such as aroused, orgasm, erection, ejaculation, incontinence, and vaginal penetration. Women across a range of literacy levels had difficulty with clinical terms like labia and clitoris. We modified unclear terms to include parenthetical descriptors or slang equivalents, which generally improved comprehension. Common words and phrases used across measures of self-reported sexual function are not universally understood. Researchers should appreciate these misunderstandings as a potential source of error in studies using self-reported measures of sexual function. This study also provides evidence for the importance of including individuals with low literacy in cognitive pretesting during the measure development. © 2014 International Society for Sexual Medicine.

Change in life satisfaction of adults with pediatric-onset spinal cord injury.

PubMed

Chen, Yuying; Anderson, Caroline J; Vogel, Lawrence C; Chlan, Kathleen M; Betz, Randal R; McDonald, Craig M

2008-12-01

To examine the change in life satisfaction over time and potential contributing factors among adults with pediatric-onset spinal cord injury (SCI). Prospective dynamic cohort study. Community. Individuals who sustained a SCI before age 19 years (N=278) were initially interviewed at age 24 years or older and followed on an annual basis between 1996 and 2006. Not applicable. A structured telephone interview was conducted to obtain the measures of Satisfaction with Life Scale (SWLS), physical independence, participation, and psychologic functioning. The hierarchical linear modeling was performed to characterize individual person-specific time paths and estimate the average rate of change in SWLS over time. A total of 1171 interviews were conducted among 184 men and 94 women (89% white; baseline age, 27.1+/-3.4 y; baseline years since injury, 12.8+/-4.9). The initial SWLS score averaged 24.2 and was estimated to increase by 0.14 a year (P=.10). After adjusting for potential confounding factors, the overall life satisfaction was significantly higher for women and those who were married/living with a partner; were employed/students; did not use illicit drugs; and scored high in the FIM, the mental health component of the Short Form-12, and the social integration subscale of the Craig Handicap Assessment and Reporting Technique. The rate of change in life satisfaction did not differ significantly by any personal, medical, and psychosocial characteristics under investigation. The study findings suggest that people who feel unsatisfied with life initially are likely to stay unsatisfied over time if the critical determinant factors remain unchanged in their life. To minimize the risk of decreasing life satisfaction, several modifiable risk factors identified in the present study could be targeted for intervention.

Hospital Versus Home Death: Results from the Mexican Health and Aging Study

PubMed Central

Cárdenas-Turanzas, Marylou; Torres-Vigil, Isabel; Tovalín-Ahumada, Horacio; Nates, Joseph L.

2013-01-01

Context Characterizing where people die is needed to inform palliative care programs in Mexico. Objectives To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics. Methods We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis. Results The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05). Conclusion Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services. PMID:21146354

Developing psychotherapists’ competence through clinical supervision: protocol for a qualitative study of supervisory dyads

PubMed Central

2013-01-01

Background Mental health professionals face unique demands and stressors in their work, resulting in high rates of burnout and distress. Clinical supervision is a widely adopted and valued mechanism of professional support, development, and accountability, despite the very limited evidence of specific impacts on therapist or client outcomes. The current study aims to address this by exploring how psychotherapists develop competence through clinical supervision and what impact this has on the supervisees’ practice and their clients’ outcomes. This paper provides a rationale for the study and describes the protocol for an in-depth qualitative study of supervisory dyads, highlighting how it addresses gaps in the literature. Methods/Design The study of 16–20 supervisor-supervisee dyads uses a qualitative mixed method design, with two phases. In phase one, supervisors who are nominated as expert by their peers are interviewed about their supervision practice. In phase two, supervisors record a supervision session with a consenting supervisee; interpersonal process recall interviews are conducted separately with supervisor and supervisee to reflect in depth on the teaching and learning processes occurring. All interviews will be transcribed, coded and analysed to identify the processes that build competence, using a modified form of Consensual Qualitative Research (CQR) strategies. Using a theory-building case study method, data from both phases of the study will be integrated to develop a model describing the processes that build competence and support wellbeing in practising psychotherapists, reflecting the accumulated wisdom of the expert supervisors. Discussion The study addresses past study limitations by examining expert supervisors and their supervisory interactions, by reflecting on actual supervision sessions, and by using dyadic analysis of the supervisory pairs. The study findings will inform the development of future supervision training and practice and identify fruitful avenues for future research. PMID:23298408

Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study.

PubMed

El-Hilly, Abdulrahman Abdulla; Iqbal, Sheeraz Syed; Ahmed, Maroof; Sherwani, Yusuf; Muntasir, Mohammed; Siddiqui, Sarim; Al-Fagih, Zaid; Usmani, Omar; Eisingerich, Andreas B

2016-10-24

Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond.

Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

PubMed

Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2018-04-01

The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

The foot as a barrier in patients with early rheumatoid arthritis - an interview study among Swedish women and men.

PubMed

Björk, Mathilda; Thyberg, Ingrid; Valtersson, Eva; Östlund, Gunnel; Stenström, Birgitta; Sverker, Annette

2017-12-01

Foot impairments are related to reduced mobility and participation restrictions in daily activities in patients with established rheumatoid arthritis (RA). The new biological medications are effective and reduce disease activity, but not disability to the same extent. Foot impairments are assumed to be related to participation restrictions also in patients with early RA, diagnosed after the introduction of biological medications. The knowledge of foot impairments needs to be more explored after the introduction of biological disease-modifying drugs (bDMARDs). The aim of this study was to explore the patients' perspective of foot impairments related to early RA. The sample included 59 patients (20-63 years) who were interviewed about participation dilemmas in daily life using the Critical Incident Technique. The interviews were audio-recorded and transcribed. Data related to foot impairments were extracted and analyzed thematically. A research partner validated the analysis. The study was approved by the Regional Ethics Committee. Patients with early RA described a variety of participation restrictions related to foot impairments: 1) foot hindrances in domestic life, 2) foot impairments influencing work, 3) leisure activities restricted by one's feet 4) struggling to be mobile 5) foot impairments as an early sign of rheumatic disease. There is a need to focus on foot impairments related to early RA, and for health care professionals to understand these signs. A suggestion for future research is to conduct a longitudinal follow-up of foot impairment related to medication, disease activity and disability in patients diagnosed after the introduction of bDMARDs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury.

PubMed

Ponsford, J; Lee, N K; Wong, D; McKay, A; Haines, K; Alway, Y; Downing, M; Furtado, C; O'Donnell, M L

2016-04-01

Anxiety and depression are common following traumatic brain injury (TBI), often co-occurring. This study evaluated the efficacy of a 9-week cognitive behavioral therapy (CBT) program in reducing anxiety and depression and whether a three-session motivational interviewing (MI) preparatory intervention increased treatment response. A randomized parallel three-group design was employed. Following diagnosis of anxiety and/or depression using the Structured Clinical Interview for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean post-traumatic amnesia 22 days) were randomly assigned to an Adapted CBT group: (1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a (3) waitlist control (WC, n = 23) group. Groups did not differ in baseline demographics, injury severity, anxiety or depression. MI and CBT interventions were guided by manuals adapted for individuals with TBI. Three CBT booster sessions were provided at week 21 to intervention groups. Using intention-to-treat analyses, random-effects regressions controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and NDC + CBT) showed significantly greater reduction in anxiety on the Hospital Anxiety and Depression Scale [95% confidence interval (CI) -2.07 to -0.06] and depression on the Depression Anxiety and Stress Scale (95% CI -5.61 to -0.12) (primary outcomes), and greater gains in psychosocial functioning on Sydney Psychosocial Reintegration Scale (95% CI 0.04-3.69) (secondary outcome) over 30 weeks post-baseline relative to WC. The group receiving MI + CBT did not show greater gains than the group receiving NDC + CBT. Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI.

CBT for Pediatric Migraine: A Qualitative Study of Patient and Parent Experience.

PubMed

Kroon Van Diest, Ashley M; Ernst, Michelle M; Vaughn, Lisa; Slater, Shalonda; Powers, Scott W

2018-03-08

The goal of this study was to determine which cognitive behavioral therapy (CBT-HA) treatment components pediatric headache patient stakeholders would report to be most helpful and essential to reducing headache frequency and related disability to develop a streamlined, less burdensome treatment package that would be more accessible to patients and families. Pediatric migraine is a prevalent and disabling condition. CBT-HA has been shown to reduce headache frequency and related disability, but may not be readily available or accepted by many migraine sufferers due to treatment burden entailed. Research is needed to determine systematic ways of reducing barriers to CBT-HA. Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT-HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were 13-17.5 years of age (M = 15.4, SD = 1.63) and had undergone CBT-HA ∼1-2 years prior to participating in the study. Overall, patients and their parents reported that CBT-HA was helpful in reducing headache frequency and related disability. Although patients provided mixed reports on the effectiveness of different CBT-HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT-HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills. Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable. Results from these qualitative interviews indicate that mind and body CBT-HA relaxation skills emerged as popular and effective based on patient and parent report. Future research examining the effectiveness of streamlined pediatric migraine nonpharmacological interventions should include these patient-preferred skills. © 2018 American Headache Society.

Developing psychotherapists' competence through clinical supervision: protocol for a qualitative study of supervisory dyads.

PubMed

Schofield, Margot J; Grant, Jan

2013-01-08

Mental health professionals face unique demands and stressors in their work, resulting in high rates of burnout and distress. Clinical supervision is a widely adopted and valued mechanism of professional support, development, and accountability, despite the very limited evidence of specific impacts on therapist or client outcomes. The current study aims to address this by exploring how psychotherapists develop competence through clinical supervision and what impact this has on the supervisees' practice and their clients' outcomes. This paper provides a rationale for the study and describes the protocol for an in-depth qualitative study of supervisory dyads, highlighting how it addresses gaps in the literature. The study of 16-20 supervisor-supervisee dyads uses a qualitative mixed method design, with two phases. In phase one, supervisors who are nominated as expert by their peers are interviewed about their supervision practice. In phase two, supervisors record a supervision session with a consenting supervisee; interpersonal process recall interviews are conducted separately with supervisor and supervisee to reflect in depth on the teaching and learning processes occurring. All interviews will be transcribed, coded and analysed to identify the processes that build competence, using a modified form of Consensual Qualitative Research (CQR) strategies. Using a theory-building case study method, data from both phases of the study will be integrated to develop a model describing the processes that build competence and support wellbeing in practising psychotherapists, reflecting the accumulated wisdom of the expert supervisors. The study addresses past study limitations by examining expert supervisors and their supervisory interactions, by reflecting on actual supervision sessions, and by using dyadic analysis of the supervisory pairs. The study findings will inform the development of future supervision training and practice and identify fruitful avenues for future research.

Pathways of undue influence in health policy-making: a main actor's perspective.

PubMed

Hernández-Aguado, Ildefonso; Chilet-Rosell, Elisa

2018-02-01

It is crucial to know the extent to which influences lead to policy capture-by which the policy-making process is shifted away from the public interest towards narrow private interests. Using the case study of Spain, our aim was to identify interactions between public administration, civil society and private companies that could influence health policies. 54 semistructured interviews with key actors related to health policy. The interviews were used to gather information on main policy actors as well as on direct and subtle influences that could modify health policies. The analysis identified and described, from the interviewed persons' experiences, both the inappropriate influences exerted on the actors and those that they exerted. Inappropriate influences were identified at all levels of administration and policy. They included actions for personal benefits, pressure for blocking health policies and pressure from high levels of government in favour of private corporations. The private sector played a significant role in these strategies through bribery, personal gifts, revolving doors, negative campaigns and by blocking unfavourable political positions or determining the knowledge agenda. The interviewees reported subtle forms of influence (social events, offers of technical support, invitations, etc) that contributed to the intellectual and cultural capture of health officials. The health policy decision-making processes in Spain are subject to influences by stakeholders that determine a degree of policy capture, which is avoidable. The private sector uses different strategies, from subtle influences to outright corruption, taking advantage in many cases of flexible legislation. © 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.

Fantasies About Stem Cell Therapy in Chronic Ischemic Stroke Patients

PubMed Central

Kim, Young Seo; Chung, Dan-il; Choi, Hojin; Baek, Wonki; Kim, Hyun Young; Heo, Sung Hyuk; Chang, Dae-Il; Na, Hae Ri; Kim, Seung Hyun

2013-01-01

Stem cell therapy (SCT) has been proposed for the treatment of neurological disorders. Although there is insufficient clinical evidence to support its efficacy, unproven SCTs are being performed worldwide. In this study, we investigated the perspectives and expectations of chronic ischemic stroke patients and physicians about SCTs. A total of 250 chronic ischemic stroke patients were interviewed at 4 hospitals. Structured open and closed questions about SCT for chronic stroke were asked by trained interviewers using the conventional in-person method. In addition, 250 stroke-related physicians were randomly interviewed via an e-mail questionnaire. Of the 250 patients (mean 63 years, 70% male), 121 (46%) responded that they wanted to receive SCT in spite of its unknown side effects. Around 60% of the patients anticipated physical, emotional, and psychological improvement after SCT, and 158 (63%) believed that SCT might prevent strokes. However, physicians had much lower expectations about the effectiveness of SCTs, which was not in line with patient expectations. Multivariate analysis revealed that the male gender [odds ratio (OR): 2.00, 95% confidence interval (CI): 1.10–3.64], longer disease duration (OR: 1.01, 95% CI: 1.00–1.02), higher modified Rankin Scale score (OR: 1.30, 95% CI: 1.06–1.60), and familiarity with stem cells (OR: 1.86, 95% CI: 1.10–3.15) were independently associated with wanting SCT. The major source of information about SCT was television (68%), and the most reliable source was physicians (49%). Patients have unfounded expectations that SCT will improve their functioning. Considering our finding that the major source of information on stem cells is media channels, but not the physician, to decrease patients' inappropriate exposure, doctors should make more effort to educate patients using mass media with accurate information. PMID:22784218

Functional status and use of healthcare facilities in long‐term survivors of transient ischaemic attack or minor ischaemic stroke

PubMed Central

van Wijk, I; Lindeman, E; Kappelle, L J; van Gijn, J; Koudstaal, P J; Gorter, J W; Algra, A

2006-01-01

Background Stroke may have a major effect on survivors and on the healthcare system. Aims To study the functional status and use of healthcare facilities in long‐term survivors of a transient ischaemic attack (TIA) or minor ischaemic stroke (MIS) and evaluate associations with baseline and follow‐up characteristics. Methods Follow‐up of patients who had participated in the Dutch TIA Trial or the European Atrial Fibrillation Trial was extended to a mean period of 15.6 years. Patients were interviewed through a postal questionnaire (n = 468) and a sample of this group was also interviewed at home (n = 198). Demographic data, information on comorbidity, functional status (Barthel Index, Frenchay Activities Index and modified Rankin Scale) and use of healthcare facilities were recorded. Results About one third of the survivors interviewed at home experienced any residual disability and 26% were moderately to severely handicapped. Factors associated with poor functional status were advanced age and the presence of any infarct on a baseline computed tomography scan, the recurrence of a new major stroke or the presence of comorbidity of locomotion. One third of survivors used any kind of professional care, which was predominantly related to the functional status at follow‐up. Conclusions Recurrent stroke and the presence of comorbidity of locomotion are important determinants of long‐term disability of survivors of a TIA or an MIS, which, in turn, is strongly associated with the long‐term use of professional care. The need for measuring comorbidity with regard to functional status is recommended in research on stroke outcome. PMID:16735396

Expanding perspective on music therapy for symptom management in cancer care.

PubMed

Potvin, Noah; Bradt, Joke; Kesslick, Amy

2015-01-01

Symptom management is a frequently researched treatment topic in music therapy and cancer care. Representations in the literature of music interventions for symptom management, however, have often overlooked the human experiences shaping those symptoms. This may result in music therapy being perceived as a linear intervention process that does not take into account underlying experiences that contribute to symptom experiences. This study explored patient experiences underlying symptoms and symptom management in cancer care, and examined the role of music therapy in that clinical process. This study analyzed semi-structured, open-ended exit interviews obtained from 30 participants during a randomized controlled trial investigating the differential impact of music therapy versus music medicine interventions on symptom management in participants with cancer. Interviews were conducted by a research assistant not involved with the clinical interventions. Exit interview transcripts for 30 participants were analyzed using an inductive, latent, constructivist method of thematic analysis. Three themes-Relaxation, Therapeutic relationship, and Intrapersonal relating-capture elements of the music therapy process that (a) modified participants' experiences of adjustments in their symptoms and (b) highlighted the depth of human experience shaping their symptoms. These underlying human experiences naturally emerged in the therapeutic setting, requiring the music therapist's clinical expertise for appropriate support. Symptom management extends beyond fluctuation in levels and intensity of a surface-level symptom to incorporate deeper lived experiences. The authors provide recommendations for clinical work, entry-level training as related to symptom management, implications for evidence-based practice in music therapy, and methodology for future mixed methods research. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Adapting HIV prevention evidence-based interventions in practice settings: an interview study

PubMed Central

2009-01-01

Background Evidence-based interventions that are being delivered in real-world settings are adapted to enhance the external validity of these interventions. The purpose of this study was to examine multiple intervention adaptations made during pre-implementation, implementation, maintenance, and evolution phases of human immunodeficiency virus HIV prevention technology transfer. We examined two important categories of adaptations -- modifications to key characteristics, such as activities or delivery methods of interventions and reinvention of the interventions including addition and deletion of core elements. Methods Study participants were thirty-four community-based organization staff who were implementing evidence-based interventions in Los Angeles, California. Participants were interviewed twice and interviews were professionally transcribed. Transcriptions were coded by two coders with good inter-rater reliability (kappa coefficient = 0.73). Sixty-two open-ended codes for adaptation activities, which were linked to 229 transcript segments, were categorized as modifications of key characteristics or reinvention. Results Participants described activities considered modifications to key characteristics and reinvention of evidence-based interventions during pre-implementation, implementation, and maintenance phases. None of the participants reported accessing technical assistance or guidance when reinventing their interventions. Staff executed many of the recommended steps for sound adaptation of these interventions for new populations and settings. Conclusion Staff reported modifying and reinventing interventions when translating HIV prevention programs into practice. Targeted technical assistance for formative evaluation should be focused on the pre-implementation phase during which frequent modifications occur. Continuous or repeated measurements of fidelity are recommended. Increased technical assistance and guidance are needed to ensure that reinventions are evaluated and consistent with the aims of the original interventions. Providing strategic technical assistance and written guidance can facilitate effective HIV prevention technology transfer of evidence-based interventions. PMID:19930653

Pricing behaviour of pharmacies after market deregulation for OTC drugs: the case of Germany.

PubMed

Stargardt, Tom; Schreyögg, Jonas; Busse, Reinhard

2007-11-01

To examine the price reactions of German pharmacies to changes made to OTC drug regulations in 2004. Prior to these changes, regulations guaranteed identical prices in all German pharmacies. Two years after market deregulation, 256 pharmacies were surveyed to determine the retail prices of five selected OTC drugs. A probit regression model was used to identify factors that increased the likelihood of price changes. In addition, 409 pharmacy consumers were interviewed to gather information on their knowledge of the regulatory changes and to better explain consumer behaviour. Data was collected on a total of 1215 prices. Two years after deregulation, 23.1% of the participating pharmacies had modified the price of at least one of the five OTCs included in our study. However, in total, only 7.5% of the prices differed from their pre-deregulation level. The probit model showed that population density and the geographic concentration of pharmacies were significantly associated with price changes. Interestingly, the association with the geographic concentration of pharmacies was negative. The consumer survey revealed that 47.1% of those interviewed were aware of the deregulation. Our findings indicate that, two years after deregulation, very few pharmacies had made use of individual pricing strategies; price competition between pharmacies in Germany is thus taking place only a very small scale.

Effects of intrinsic motivation on feedback processing during learning.

PubMed

DePasque, Samantha; Tricomi, Elizabeth

2015-10-01

Learning commonly requires feedback about the consequences of one's actions, which can drive learners to modify their behavior. Motivation may determine how sensitive an individual might be to such feedback, particularly in educational contexts where some students value academic achievement more than others. Thus, motivation for a task might influence the value placed on performance feedback and how effectively it is used to improve learning. To investigate the interplay between intrinsic motivation and feedback processing, we used functional magnetic resonance imaging (fMRI) during feedback-based learning before and after a novel manipulation based on motivational interviewing, a technique for enhancing treatment motivation in mental health settings. Because of its role in the reinforcement learning system, the striatum is situated to play a significant role in the modulation of learning based on motivation. Consistent with this idea, motivation levels during the task were associated with sensitivity to positive versus negative feedback in the striatum. Additionally, heightened motivation following a brief motivational interview was associated with increases in feedback sensitivity in the left medial temporal lobe. Our results suggest that motivation modulates neural responses to performance-related feedback, and furthermore that changes in motivation facilitate processing in areas that support learning and memory. Copyright © 2015. Published by Elsevier Inc.

Development of the Knee Numeric-Entity Evaluation Score (KNEES-ACL): a condition-specific questionnaire.

PubMed

Comins, J D; Krogsgaard, M R; Brodersen, J

2013-10-01

Patient-related outcome measures (PROMs) are commonly used to gauge treatment effects in patients with anterior cruciate ligament (ACL) deficiency. Valid measures of specific conditions depend on relevant item content. While item content can be derived either from clinicians (face validity) or from patients, item relevance and comprehensiveness can only be confirmed by the patient (content validity). Focus group and single interviews were conducted with patients' pre- and post-ACL reconstruction in order to construct a condition-specific PROM for the target patients. One hundred fifty-seven items from a previously conducted literature search were used as a basis for content genesis. Content saturation was achieved after three focus groups and seven single interviews. Thirty-eight items from the literature search were directly endorsed, and five modified items were endorsed. Twelve new item themes with verbatim content emerged. Thus, a 55-item pilot PROM consisting of six conceptual domains was assembled. We have constructed a condition-specific PROM for measurement of surgical and non-surgical treatment effects on ACL deficiency. The instrument possesses face and content validity. A pilot survey to assess the psychometric properties will be performed using Rasch measurement theory. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing.

PubMed

Maguire, Erin; Hong, Paul; Ritchie, Krista; Meier, Jeremy; Archibald, Karen; Chorney, Jill

2016-11-04

To describe the process involved in developing a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. A paper-based decision aid prototype was developed using the framework proposed by the International Patient Decision Aids Standards Collaborative. The decision aid focused on two main treatment options: watchful waiting and adenotonsillectomy. Usability was assessed with parents of pediatric patients and providers with qualitative content analysis of semi-structured interviews, which included open-ended user feedback. A steering committee composed of key stakeholders was assembled. A needs assessment was then performed, which confirmed the need for a decision support tool. A decision aid prototype was developed and modified based on semi-structured qualitative interviews and a scoping literature review. The prototype provided information on the condition, risk and benefits of treatments, and values clarification. The prototype underwent three cycles of accessibility, feasibility, and comprehensibility testing, incorporating feedback from all stakeholders to develop the final decision aid prototype. A standardized, iterative methodology was used to develop a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. The decision aid prototype appeared feasible, acceptable and comprehensible, and may serve as an effective means of improving shared decision-making.

Translating the semi-structured assessment for drug dependence and alcoholism in the Western Pacific: rationale, study design and reliability of alcohol dependence.

PubMed

Quinn, Amity E; Rosen, Rochelle K; McGeary, John E; Amoa, Francine; Kranzler, Henry R; Francazio, Sarah; McGarvey, Stephen T; Swift, Robert M

2014-01-01

The aims of this study were to develop a bilingual version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) in English and Samoan and determine the reliability of assessments of alcohol dependence in American Samoa. The study consisted of development and reliability-testing phases. In the development phase, the SSADDA alcohol module was translated and the translation was evaluated through cognitive interviews. In the reliability-testing phase, the bilingual SSADDA was administered to 40 ethnic Samoans, including a sub-sample of 26 individuals who were retested. Cognitive interviews indicated the initial translation was culturally and linguistically appropriate except items pertaining to alcohol tolerance, which were modified to reflect Samoan concepts. SSADDA reliability testing indicated diagnoses of DSM-III-R and DSM-IV alcohol dependence were reliable. Reliability varied by language of administration. The English/Samoan version of the SSADDA is appropriate for the diagnosis of DSM-III-R alcohol dependence, which may be useful in advancing research and public health efforts to address alcohol problems in American Samoa and the Western Pacific. The translation methods may inform researchers translating diagnostic and assessment tools into different languages and cultures. © The Author 2014. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Applying justice and commitment constructs to patient-health care provider relationships.

PubMed

Holmvall, Camilla; Twohig, Peter; Francis, Lori; Kelloway, E Kevin

2012-03-01

To examine patients' experiences of fairness and commitment in the health care context with an emphasis on primary care providers. Qualitative, semistructured, individual interviews were used to gather evidence for the justice and commitment frameworks across a variety of settings with an emphasis on primary care relationships. Rural, urban, and semiurban communities in Nova Scotia. Patients (ages ranged from 19 to 80 years) with varying health care needs and views on their health care providers. Participants were recruited through a variety of means, including posters in practice settings and communication with administrative staff in clinics. Individual interviews were conducted and were audiotaped and transcribed verbatim. A modified grounded theory approach was used to interpret the data. Current conceptualizations of justice (distributive, procedural, interpersonal, informational) and commitment (affective, normative, continuance) capture important elements of patient-health care provider interactions and relationships. Justice and commitment frameworks developed in other contexts encompass important dimensions of the patient-health care provider relationship with some exceptions. For example, commonly understood subcomponents of justice (eg, procedural consistency) might require modification to apply fully to patient-health care provider relationships. Moreover, the results suggest that factors outside the patient-health care provider dyad (eg, familial connections) might also influence the patient's commitment to his or her health care provider.

Scenario-based design: A method for connecting information system design with public health operations and emergency management

PubMed Central

Reeder, Blaine; Turner, Anne M

2011-01-01

Responding to public health emergencies requires rapid and accurate assessment of workforce availability under adverse and changing circumstances. However, public health information systems to support resource management during both routine and emergency operations are currently lacking. We applied scenario-based design as an approach to engage public health practitioners in the creation and validation of an information design to support routine and emergency public health activities. Methods: Using semi-structured interviews we identified the information needs and activities of senior public health managers of a large municipal health department during routine and emergency operations. Results: Interview analysis identified twenty-five information needs for public health operations management. The identified information needs were used in conjunction with scenario-based design to create twenty-five scenarios of use and a public health manager persona. Scenarios of use and persona were validated and modified based on follow-up surveys with study participants. Scenarios were used to test and gain feedback on a pilot information system. Conclusion: The method of scenario-based design was applied to represent the resource management needs of senior-level public health managers under routine and disaster settings. Scenario-based design can be a useful tool for engaging public health practitioners in the design process and to validate an information system design. PMID:21807120

"Everyone has a right to, like, check their box:" findings on a measure of gender identity from a cognitive testing study with adolescents.

PubMed

Conron, Kerith Jane; Scout; Austin, S Bryn

2008-01-01

Efforts to monitor the health of transgender youth, a small but high-risk population, are hindered by a lack of knowledge about how to accurately measure gender identity. Adolescents (n = 30) participated in semistructured qualitative interviews after completing a close-ended transgender-inclusive measure of gender. Interviews explored item comprehension and respondent burden. Participants, who were diverse in age (range = 15-21), gender identity, sexual orientation, and race-ethnicity, were accurately classified as male, female, or transgender. All youth understood transgender as a difference between the physical body and a person's internal sense of self. Nontransgender youth frequently used an example (a woman in a man's body) in their explanations and were largely supportive of the transgender options. Most transgender youth found a response option that they felt was appropriate. Transgender response options were added to a gender measure without impacting the accuracy of nontransgender responses or burdening the nontransgender adolescents in our sample. A modified measure (Gender: male; female; transgender, male-to-female; transgender, female-to-male; transgender, do not identify as exclusively male or female) is recommended for testing in samples that vary by age, race-ethnicity, socioeconomic status, language, and geography. Additional suggestions for research in this area are provided.

Training a Spinal Cord Injury Rehabilitation Team in Motivational Interviewing

PubMed Central

Lusilla-Palacios, Pilar; Castellano-Tejedor, Carmina

2015-01-01

Background. An acute spinal cord injury (ASCI) is a severe condition that requires extensive and very specialized management of both physical and psychological dimensions of injured patients. Objective. The aim of the part of the study reported here was twofold: (1) to describe burnout, empathy, and satisfaction at work of these professionals and (2) to explore whether a tailored program based on motivational interviewing (MI) techniques modifies and improves such features. Methods. This paper presents findings from an intervention study into a tailored training for professionals (N = 45) working in a spinal cord injury (SCI) unit from a general hospital. Rehabilitation professionals' empathy skills were measured with the Jefferson Scale of Physician Empathy (JSPE), burnout was measured with the Maslach Burnout Inventory (MBI), and additional numeric scales were used to assess the perceived job-related stress and perceived satisfaction with job. Results. Findings suggest that professionals are performing quite well and they refer to satisfactory empathy, satisfaction at work, and no signs of burnout or significant stress both before and after the training. Conclusions. No training effect was observed in the variables considered in the study. Some possible explanations for these results and future research directions are discussed in depth in this paper. The full protocol of this study is registered in ClinicalTrials.gov (identifier: NCT01889940). PMID:26770827

Developing and pretesting case studies in dental and dental hygiene education: using the diffusion of innovations model.

PubMed

Cragun, Deborah L; DeBate, Rita DiGioacchino; Severson, Herbert H; Shaw, Tracy; Christiansen, Steve; Koerber, Anne; Tomar, Scott L; Brown, Kelli McCormack; Tedesco, Lisa A; Hendricson, William D

2012-05-01

Case-based learning offers exposure to clinical situations that health professions students may not encounter in their training. The purposes of this study were to apply the Diffusion of Innovations conceptual framework to 1) identify characteristics of case studies that would increase their adoption among dental and dental hygiene faculty members and 2) develop and pretest interactive web-based case studies on sensitive oral-systemic health issues. The formative study spanned two phases using mixed methods (Phase 1: eight focus groups and four interviews; Phase 2: ten interviews and satisfaction surveys). Triangulation of quantitative and qualitative data revealed the following positive attributes of the developed case studies: relative advantage of active learning and modeling; compatibility with a variety of courses; observability of case-related knowledge and skills; independent learning; and modifiability for use with other oral-systemic health issues. These positive attributes are expected to increase the likelihood that dental and dental hygiene faculty members will adopt the developed case study once it is available for use. The themes identified in this study could be applied to the development of future case studies and may provide broader insight that might prove useful for exploring differences in case study use across dental and dental hygiene curricula.

"Becoming bold": alcohol use and sexual exploration among Black and Latino young men who have sex with men (YMSM).

PubMed

Mutchler, Matt G; McDavitt, Bryce; Gordon, Kristie K

2014-01-01

Alcohol use is correlated with unprotected sex, which may place young men who have sex with men (YMSM) who use alcohol with sex at increased risk for contracting HIV. However, little is known about how this link develops. This study used qualitative interviews to explore how alcohol became associated with sex and sexual risk among YMSM. We purposively sampled 20 Black and 20 Latino YMSM (N = 40), ages 21 to 24, who used substances (alcohol, marijuana, and crystal methamphetamine) with sex. Interviews focused on participants' personal histories to trace how these associations developed for each individual. Drawing on sexual script, emotion regulation, and alcohol expectancy theories, analyses followed a modified grounded theory approach. Participants stated that alcohol enabled them to engage in sexual behaviors with men that they wanted to try, allowing them to be more "bold," overcome stigma about homosexuality, and feel increased comfort with their sexual desires and identities. The use of alcohol during sex was helpful to some of the participants but could also lead to sexual risk behaviors. Intervention programs seeking to reduce alcohol misuse and sexual risk should take into account how YMSM conceptualize associations between alcohol and sex. These programs may be more effective if they provide support for sexual identity exploration.

Selective Mutism Questionnaire: measurement structure and validity.

PubMed

Letamendi, Andrea M; Chavira, Denise A; Hitchcock, Carla A; Roesch, Scott C; Shipon-Blum, Elisa; Stein, Murray B

2008-10-01

To evaluate the factor structure, reliability, and validity of the 17-item Selective Mutism Questionnaire (SMQ). Diagnostic interviews were administered via telephone to 102 parents of children identified with selective mutism (SM) and 43 parents of children without SM from varying U.S. geographic regions. Children were between the ages of 3 and 11 inclusive and comprised 58% girls and 42% boys. SM diagnoses were determined using the Anxiety Disorders Interview Schedule for Children-Parent Version; SM severity was assessed using the 17-item SMQ; and behavioral and affective symptoms were assessed using the Child Behavior Checklist. An exploratory factor analysis was conducted to investigate the dimensionality of the SMQ and a modified parallel analysis procedure was used to confirm exploratory factor analysis results. Internal consistency, construct validity, and incremental validity were also examined. The exploratory factor analysis yielded a 13-item solution consisting of three factors: social situations outside of school, school situations, and home and family situations. Internal consistency of SMQ factors and total scale ranged from moderate to high. Convergent and incremental validity was also well supported. Measure structure findings are consistent with the three-factor solution found in a previous psychometric evaluation of the SMQ. Results also suggest that the SMQ provides useful and unique information in the prediction of SM phenomena beyond other child anxiety measures.

Seniors' self-preservation by maintaining established self and defying deterioration - A grounded theory.

PubMed

Eriksson, Jeanette Källstrand; Hildingh, Cathrine; Buer, Nina; Thulesius, Hans

2016-01-01

The purpose of this classic grounded theory study was to understand how seniors who are living independently resolve issues influenced by visual impairment and high fall risk. We interviewed and observed 13 seniors with visual impairment in their homes. We also interviewed six visual instructors with experience from many hundreds of relevant incidents from the same group of seniors. We found that the seniors are resolving their main concern of "remaining themselves as who they used to be" by self-preservation. Within this category, the strategies maintaining the established self and defying deterioration emerged as the most prominent in our data. The theme maintaining the established self is mostly guided by change inertia and includes living the past (retaining past activities, reminiscing, and keeping the home intact) and facading (hiding impairment, leading to avoidance of becoming a burden and to risk juggling). Defying deterioration is a proactive scheme and involves moving (by exercising, adapting activities, using walking aids, driving), adapting (by finding new ways), and networking by sustaining old support networks or finding new networks. Self-preservation is generic human behavior and modifying this theory to other fields may therefore be worthwhile. In addition, health care providers may have use for the theory in fall preventive planning.

Seasonal influenza vaccination of healthcare employees: results of a 4-year campaign.

PubMed

Hirsch, Pamela; Hodgson, Michael; Davey, Victoria

2011-05-01

To document successful substantial increases in healthcare worker influenza vaccination rates and to identify reasons for success and failure. (1) Four-year longitudinal characterization of facility vaccination rates, (2) Web-based facility-level questionnaire for influenza coordinators to identify success factors in year 3, and (3) semistructured telephone interviews of influenza coordinators at facilities with substantial increases or declines in year 4. National single-payer hospital (healthcare) system with 153 hospitals in 5 levels of complexity. Facility leadership staff. (1) Vaccination data collected from management sources (doses from pharmacies, denominator data from payrolls); (2) a Web-based survey aligned with a previously administered instrument (Wisconsin Health Department), piloted in-house, modified to reflect national strategies and improvements; and (3) semistructured telephone interviews with influenza coordinators at facilities that improved or worsened by more than 20% between the 2007-2008 and 2008-2009 influenza seasons. Vaccination acceptance rates improved from 45% of healthcare workers in 2005-2006 to 66.5% in 2008-2009. Facilities with lower complexity had higher vaccination rates. No individual factors were associated with improved performance. Sustained management attention can lead to improvements in healthcare worker influenza vaccination rates. Wavering of attention, though, may lead to rapid loss of effectiveness. Declination statements in this system did not contribute to vaccine acceptance.

Deliberate self-harm as seen in Kampala, Uganda - a case-control study.

PubMed

Kinyanda, Eugene; Hjelmeland, Heidi; Musisi, Seggane

2004-04-01

A study to investigate deliberate self-harm (DSH) in an African context was undertaken in Uganda. A case-control study in which 100 cases of DSH and 300 controls matched on age and sex were recruited from three general hospitals in Kampala and subjected to a structured interview using a modified version of the European Parasuicide Study Interview Schedule I. Among the cases, 63% were males, with a male to female ratio of 1.7:1 and a peak age range of 20-24 years. Higher educational attainment, higher socio-economic class and poor housing were significantly associated with DSH. District of current residence, district of birth, religion, ethnicity, marital status, number of children, current living arrangement, area of usual residence, employment status of respondent and partner were not significantly associated with DSH. Pesticides and medications, mainly antimalarials and diazepam, were the main methods of DSH used. The most commonly reported psychiatric disorders were adjustment disorder, acute stress reactions and depression. DSH in Uganda appears to predominantly afflict the young. Disturbed interpersonal relationships, poverty and loneliness were important factors in the immediate precipitation of this behaviour. The fact that pesticide poisoning is still the predominantly used method in DSH in this area calls for a review of the legislation that controls the sale and availability of these agricultural chemicals.

Cross-cultural adaptation of the Window to Hope: a psychological intervention to reduce hopelessness among U.S. veterans with traumatic brain injury.

PubMed

Matarazzo, Bridget B; Hoffberg, Adam S; Clemans, Tracy A; Signoracci, Gina M; Simpson, Grahame K; Brenner, Lisa A

2014-01-01

To conduct a cross-cultural adaptation of Window to Hope (WtoH), a treatment to reduce hopelessness after traumatic brain injury (TBI), from the Australian civilian context to that of U.S. Veterans. Three-stage mixed-methods approach. Stage 1: Consensus conference with stakeholders to revise the manual. Stage 2: Pilot study of the revised manual with US Veterans to examine acceptability, feasibility and fidelity. Stage 3: Review of results with consensus conference attendees and further revisions. Stage 1: Conference attendees reached 100% consensus regarding changes made to the manual. Stage 2: Qualitative results yielded themes that suggest that participants benefitted from the intervention and that multiple factors contributed to successful implementation (Narrative Evaluation of Intervention Interview, User Feedback Survey-Modified, Post-Treatment Interviews). Therapists achieved 100% treatment fidelity. Quantitative results from the Client Satisfaction Questionnaire-8 suggest that the intervention was acceptable. Stage 3: The culturally adapted manual was finalized. RESULTS of this study suggest that the revised WtoH manual is acceptable and feasible. US therapists exhibited adherence to the protocol. The three-stage methodology was successfully employed to cross-culturally adapt an intervention that is well-suited for a Phase II randomized controlled trial among US military Veterans.