‘I believe high blood pressure can kill me:’ using the PEN-3 Cultural Model to understand patients’ perceptions of an intervention to control hypertension in Ghana

Objectives: Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients’ perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana.

Design: Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data.

Results: Emergent themes included patients’ perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes.

Conclusions: This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.     

The Health Belief Model in predicting healthcare workers' intention for influenza vaccine uptake in Jordan

BackgroundTheories of health behavior change are being inadequately adopted to understand the reasons behind low influenza vaccination rates among healthcare workers (HCWs). The Theory of Planned Behavior (TPB) is being used to predict intention-behavior relationship while the Health Belief Model (HBM) is being employed to predict actual behavior. The purpose of this study was to test a conceptual model based on the HBM’s constructs to predict Jordanian HCWs’ intentions for influenza vaccine uptake as an alternative to the TPB.MethodA cross-sectional questionnaire-based study was conducted in 2016 in a tertiary teaching hospital in Amman-Jordan including a convenience sample of 477 HCWs with direct patient contact. The study instrument was tested for validity and reliability. A conceptual regression model was proposed incorporating the constructs of the primary HBM with some modifications in the threat construct as well as an additional variable about explicit past vaccination behavior (in the past year and/or any previous history of influenza vaccine uptake).ResultsAlmost all the constructs of the HBM demonstrated significant differences between participants intending and those who did not intend to vaccinate against influenza. After adjusting for the confounding variables in the final conceptual regression model, past vaccination behavior (OR= 4.50, 95%Confidence Interval 3.38–6.00, P< 0.0005) and the perceived benefit scale (OR= 1.19, 95% Confidence Interval 1.11–1.28, P< 0.0005) were the only significant predictors of intentions to vaccinate against influenza in the next season.ConclusionTaking into consideration the altruistic beliefs of HCWs and their explicit past vaccination history augments the utility of the original HBM tool in predicting HCWs’ intentions to vaccinate against influenza in a way that is consistent with the predictive ability of the Theory of Planned Behavior.     

Influence of Fine Grains on the Bending Fatigue Behavior of Two Implant Titanium Alloys

By means of the ultrasonic surface impact (amplitude of 30 μm, strike number of 48,000 times/mm²), nanograins have been achieved in the surfaces of both Ti6Al4V(TC4) and Ti3Zr2Sn3Mo25Nb(TLM) titanium alloys, mainly because of the dislocation motion. Many mechanical properties are improved, such as hardness, residual stress, and roughness. The rotating–bending fatigue limits of TC4 and TLM subjected to ultrasonic impact are improved by 13.1% and 23.7%, separately. Because of the bending fatigue behavior, which is sensitive to the surface condition, cracks usually initiate from the surface defects under high stress amplitude. By means of an ultrasonic impact tip with the size of 8 mm, most of the inner cracks present at the zone with a depth range of 100~250 μm in the high life region. The inner crack core to TC4 usually appears as a deformed long and narrow α-phase, while the cracks in TLM specimens prefer to initiate at the triple grain boundary junctions. This zone crosses the grain refined layer and the deformed coarse grain layer. With the gradient change of elastic parameters, the model shows an increase of normal stress at this zone. Combined with the loss of plasticity and toughness, it is easy to understand these fatigue behaviors.     

从武汉抗疫看中医药文化认同与新的医学模式

从武汉抗疫中医药的投入使用情况,反思现代临床和国人所呈现出的中医药文化认同和就医习惯,探索其历史文化根源及社会因素与医学发展的内在关联。回顾历史,中医屡次临危受命,不负重托,如今大疫当前,中医药再次发挥了重要作用。故新时代探讨如何遵循中医药发展规律,传承精华、守正创新,坚持中医药原创优势,形成中医药学科优势整体化呈现的新模式医学,对提升全社会的中医药认知度具有重要意义。     

3D打印模型在儿童先天性脊柱侧凸治疗中的应用研究

目的探讨3D打印模型在儿童先天性脊柱侧凸治疗中的应用疗效。方法回顾性分析2015年12月至2016年12月于首都医科大学附属北京儿童医院接受手术治疗的83例先天性脊柱侧凸患儿临床及影像学资料,根据是否使用3D打印模型分为试验组(n=44)和对照组(n=39),比较两组手术时间、术中透视次数、置钉准确性、矫形效果及并发症情况。结果本研究共纳入83例先天性脊柱侧凸患儿,其中男童47例,女童36例,平均手术年龄5.98 (1.5~13)岁。行半椎体切除术40例,Ponte截骨术31例,经椎弓根截骨术8例,全脊椎切除术4例。随访时间24~35个月。试验组患儿手术时间短于对照组[(180.92±16.74) min (201.51±27.60) min],差异有统计学意义(t=2.798,P<0.05),试验组术中出血量[(340.23±89.52) mL vs.(392.64±100.41) mL]及术中透视次数(4.36±0.89 6.05±1.28)明显少于对照组,差异有统计学意义(P<0.05);试验组置钉准确率高于对照组(93.55%vs 79.91%)(X^2=218.00,P<0.05),平均置钉时间明显短于对照组[(4.24±1.05) min vs.(8.35±2.29) min],差异有统计学意义(t=10.71,P<0.05)。两组患儿矫形率无明显差异(t=-1.135,P=0.272)。试验组与对照组患儿术后胸膜损伤、硬膜损伤发生率无明显差异(P>0.05)。结论 3D打印模型能清晰、直观显示先天性脊柱侧凸患儿的脊柱结构及形态,为制定手术计划及手术置钉提供帮助,从而提高置钉准确率,减少术中透视次数,缩短手术时间,减少术中出血量。     

中华传统文化视角下疾病终末期患者尊严模型解析

目的:解析加拿大Chochinov疾病终末期患者尊严模型在中华文化情境下的适用性,并基于此对模型进行调适。方法:采用内容分析法,按照选定分析范围、抽取样本、确定分析单位和分析框架、资料分析四步完成。首先检索中、英文数据库中以中华文化背景下临终尊严为主题的文献,然后以尊严模型为框架对文献内容进行编码、归纳和分析。结果:尊严模型包含的多数主题符合我国临终患者的认知,如身体功能、医疗不确定性、死亡焦虑、隐私界限、照护要旨、他人负担、后事担忧等。但也出现了矛盾的主题,如忍受痛苦、自主性等,以及新的主题,包括家庭支持、病耻感和财务担忧。结论:加拿大版疾病终末期患者尊严模型并不完全符合中国文化,调适后的尊严模型更具我国文化特色,但仍需实证研究对模型进行验证。     

Health Implications and Counseling Considerations for Individuals With Piercings and Tattoos

Body art has become common and mainstream. Tattoos and body piercings represent highly individual expressions of identity and personal values. Health care services are enhanced when clinicians understand the anatomy and physiology, common discomforts, and real but rare serious risks of body modification and are prepared to provide compassionate support for individuals’ choices. Special consideration must be given to the needs of childbearing women. By opening channels of communication, clinicians can engage with clients in shared decision making to help those who possess or desire body art take steps to reduce the risk of adverse effects and obtain prompt and effective medical care when problems arise. Through respectful discussion of existing body art, the therapeutic relationship is strengthened, and greater insight into an individual’s health needs may be achieved.