A Cross-Sectional Survey of Internal Medicine Residents’ Knowledge,Attitudes, and Current Practices Regarding Patient Transitions to Post-Acute Care

ObjectivesPrior studies have found suboptimal knowledge about post-acute care (PAC) among inpatient providers and poor communication at discharge that can lead to unsafe discharge transitions, but little is known about residents and the PAC transition. The aim of this study is to assess internal medicine residents’ knowledge, attitudes, and current practice regarding patient transitions to PAC.DesignA multisite, cross-sectional 36-question survey.Setting and ParticipantsInternal Medicine and Medicine-Pediatrics residents at 3 university-based Internal Medicine training programs in the United States. Methods: Survey delivered electronically to residents in 2018 and 2019. Survey responses were described by collapsing 4-point Likert responses into dichotomous variables, and thematic content analysis was used to evaluate free text responses. Results: Of 482 residents surveyed, 236 responded (49%). Despite high reported confidence in their ability to transition patients to PAC, only 31% of residents knew how often patients received skilled therapies at skilled nursing facilities (SNFs) and 23% knew how frequently nursing services are provided. The majority of residents (79%) identified the discharge summary as the main way they communicated care instructions to the SNF, but only 55% reported always completing it prior to discharge. Upper-level residents were more likely to know how much therapy patients received at a SNF, but resident knowledge about PAC did not vary by residency year in other domains. Residents who experienced a clinical rotation at a SNF had higher levels of knowledge compared to residents who did not.ConclusionsThis national survey of internal medicine residents identified common knowledge gaps regarding PAC. These knowledge gaps did not improve throughout residency without deliberate exposure to PAC environments. This suggests a need for dedicated curriculum development as discharges to PAC continue to rise exponentially.     

How Much Does Gender Explain in Sexual Attitudes and Behaviors? A Survey of Canadian Adults

While it is common for gender to be included as a predictor variable in studies of sexuality, this is not the case for other demographic variables. This study examined the predictive value of gender, along with other demographic variables, including age, marital status, education, religiosity, and geographic region using data from a national survey of Canadian adults over the age of 18 (N = 1479). The survey was conducted by the COMPAS survey organization using computer assisted telephone technology. The outcome variables examined included frequency of sexual thoughts, oral sex, age at first intercourse, number of sexual partners, and casual sex intentions. For each of the variables, men were more sexually permissive and more sexually active than were women. Other demographic variables increased the explanatory power of the models but gender still remained a significant predictor of sexual attitudes and behaviors despite statistical control for other demographic variables. The findings demonstrate the influence of gender on sexuality but also illustrate the value of taking into account other demographic variables when analyzing gender differences in sexuality.     

Advance Care Planning in Asia: A Systematic Narrative Review of Healthcare Professionals’ Knowledge,Attitude, and Experience

ObjectiveThe value of advance care planning (ACP) for patients with life-limiting illnesses is widely recognized but Asian health care professionals' (HCPs') perspectives on ACP have received little systematic attention. We aim to synthesize evidence regarding Asian HCPs’ knowledge of, attitudes toward, and experiences with ACP.DesignSystematic review with narrative synthesis and stepwise thematic analysis.Setting and ParticipantsHCPs in southern, eastern, and southeastern Asia.MethodsStudies from inception to September 2019 were identified from English-language searches of Embase, MEDLINE, Web of Science, and Google Scholar with reference-chaining and hand-searching. Two investigators independently screened and assessed the risk of bias in all original studies reporting HCPs’ knowledge of, attitudes toward, and experiences with ACP, including their perspectives toward barriers and facilitators of ACP.ResultsFifty-one studies were included; 42 were quantitative, 43 had been conducted in high-income countries, and 36 were of good quality. Twenty-six studies operationalized ACP as the completion of an advance directive rather than a value-exploration process. Thirteen studies reported knowledge, 44 attitudes, 29 experiences, and 36 barriers and facilitators of ACP. Asian HCPs addressed the essential role of families in ACP. They acknowledge the importance of ACP but rarely engage the patient in it. They considered ACP difficult to initiate, partly because of their lack of knowledge and skills in ACP, personal uneasiness to conduct ACP, fear of conflicts with family members and their legal consequences, and the lack of a standard system for ACP. Most studies indicated HCPs’ low engagement and late initiation of ACP.Conclusions and ImplicationsDespite acknowledging its importance, Asian HCPs felt that engaging in ACP is challenging. Capacity building for ACP in Asia should focus on culturally adapting ACP models concerning the essential role of the family in Asia, education for HCPs and the public, and providing institutional support for ACP.     

Underlying Cause and Place of Death Among Patients With Amyotrophic Lateral Sclerosis in Taiwan: A Population-Based Study, 2003–2008

Background

Few studies have assessed cause of death among patients with amyotrophic lateral sclerosis (ALS). We investigated underlying cause and place of death among patients with ALS in Taiwan during 2003–2008.

Methods

The data source was the Taiwan National Health Insurance database for the period 2003–2008. In total, 751 patients older than 15 years with a primary diagnosis of ALS were included and followed until 2008 in the national mortality database. Crude mortality rates (per 100 person-years) and standardized mortality ratios (SMRs) were calculated in relation to cause of death, sex, and age group (15–44, 45–64, 65+ years).

Results

In total, 297 (39.6%) patients died during the follow-up period, an age- and sex-standardized mortality rate 13 times (95% CI, 10.6–15.6) that of the Taiwanese general population. The leading cause of death among the patients was respiratory diseases, and the second most frequent cause was cardiovascular diseases. During the first year after an ALS diagnosis, suicide was much more frequent (SMR, 6.9; 95% CI, 1.9–17.6) than among the general population.

Conclusions

During 2003–2008, respiratory diseases and cardiovascular diseases were the most frequent causes of death among Taiwanese patients with ALS. In addition, our findings indicate that suicide prevention is an urgent priority during the period soon after an ALS diagnosis.Key words: amyotrophic lateral sclerosis, cause of death, respiratory disease, suicide     

Adults’ Knowledge of Child Development in Alberta,Canada: Comparing the Level of Knowledge of Adults in Two Samples in 2007 and 2013

Parents and non-parental adults who interact with children influence child development. This study evaluates the knowledge of child development in two large and diverse samples of adults from Alberta in 2007 and 2013. Telephone interviews were completed by two random samples (1,443 in 2007; 1,451 in 2013). Participants were asked when specific milestones in physical, cognitive, emotional and social domains typically occur (age birth to six years). Data were analysed using univariate and multivariate techniques. Linear logistic regression models were used to examine factors associated with knowledge and differences between the two samples while adjusting for differences and covariates. Adults’ knowledge was overall poor (<25% correct responses), but notably higher for physical (48% in 2007, 44% in 2013) than social, cognitive or emotional milestones (≤21% in all cases). Knowledge was lower in the 2013 than the 2007 sample (23% in 2007, 21% in 2013), and in particular for mothers after adjusting for location and income (24% in 2007, 22% in 2013). Evidence of low knowledge may have important education and policy implications. Factors such as availability of child development evidence-based information, parental stress and access to quality childcare might play a role in the low levels of knowledge.     

What Do Healthcare Providers Know About Nutrition Support? A Survey of the Knowledge,Attitudes, and Practice of Pharmacists and Doctors Toward Nutrition Support in Malaysia

Background and Aims: Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers' inadequate knowledge. The aim of this study was to evaluate the self‐reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. Methods: A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. Result: Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients' nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the “average” score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. Conclusion: Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established.     

What Do We Know About Knowledge Translation in the Care of Older Adults? A Scoping Review

ObjectivesThe recent emphasis on knowledge translation (KT) in health care is based on the premise that quality of care improves when research findings are translated into practice. This study aimed to identify the extent, nature, and settings of KT research pertaining to the care of older adults.Design and MethodsWe searched Medline, CINAHL, The Cochrane Library, and EMBASE for systematic reviews related to KT using the terms knowledge translation, research use, evidence-based practice, clinical practice guidelines, or diffusion of innovations. Then we searched the systematic reviews to identify included articles related to older adults. We used quantitative content analysis to summarize the information.ResultsTwo of the 53 systematic reviews about KT focused on the care of older adults. One examined the impact of quality systems on care processes and outcomes for long term care residents. The other studied the effectiveness of active-mode learning programs on physician behavior. Sixty-one of the 1709 primary research articles (3.6%) pertained to the care of older adults. Thirty of these were conducted in long term care facilities, 26 in outpatient clinics, 2 in hospitals, and 3 in multiple settings. Most studies focused on KT interventions targeting professionals (eg, prescribing medications). Organizational interventions (eg, modifying roles) were few; financial and regulatory interventions were rare.ConclusionWe identified a gap in KT research pertaining to the care of older adults. KT intervention research focusing on organizational, financial, and regulatory areas is warranted. The connection between geriatrics and KT is fertile ground for future research.     

Mothers’ Preferences and Willingness to Pay for Human Papillomavirus Vaccination for Their Daughters: A Discrete Choice Experiment in Hong Kong

Objectives

To determine the preference of mothers in Hong Kong and their willingness to pay (WTP) for human papillomavirus (HPV) vaccination for their daughters.

Associations of Alcoholic Beverage Consumption with Dietary Intake,Waist Circumference,and Body Mass Index in US Adults: National Health and Nutrition Examination Survey 2003-2012

Background

Findings from studies of alcohol and obesity measures (eg, waist circumference [WC] and body mass index [BMI; calculated as kg/m²]) are conflicting. Residual confounding by dietary intake, inconsistent definitions of alcohol consumption across studies, and the inclusion of former drinkers in the nondrinking comparison group can contribute to the mixed literature.

Do Smoking Knowledge,Attitudes and Behaviors Change with Years of Schooling? A Comparison of Medical with Non-Medical Students in China

This study aimed to compare the tobacco-related knowledge, attitudes and smoking behavior among Chinese medical and non-medical students across three grades from freshmen to juniors. Survey data were collected among 8,138 students using a paper-and-pencil questionnaire. Study findings indicate that compared to non-medical students, medical students in the sophomore and junior years reported significantly higher levels of knowledge regarding tobacco toxicants and tobacco-related diseases, and had stronger attitudes against smoking as personal rights and stronger attitudes in favor of smoking ban. The differences between medical and non-medical students remained after controlling for a number of covariates. However the prevalence rates of cigarette smoking were similar between medical and non-medical students across grades even after adjusted smoking initiation before entering college. Despite increases in tobacco related knowledge, approximately 40% of junior-year medical students did not recognize carbon monoxide as a toxicant from tobacco, and 30–40% of them were unknown of tobacco smoking as a risk factor for several diseases, including hypertension, stroke, and gastric ulcer. Findings of this study suggest the need for immediate action to enhance tobacco-related education in formal medical training in China to prepare future doctors for smoking prevention and to assist millions of smokers to quit.     

Exposure to particulate air pollution at different living locations and respiratory symptoms in Hong Kong – an application of satellite information

Respiratory ill-health effects due to particulate air exposure at different geographical locations in Hong Kong that aggregate individual living locations were estimated based on satellite information. We assessed the presence of respiratory symptoms of a frequent cough or sputum in school students aged 11–20 years old (n = 9,881). Daily particulate air pollution levels at students' living locations were derived from the surface extinction coefficients measured by satellite and measurements from the air pollutant monitoring stations at ground level. Adjusted odds ratio (OR) [95% CI] of respiratory symptoms was 1.047 [1.005, 1.091] per 10 μg m^?3 increase in PM₁₀ concentration. Specificity tests showed that adjusted OR of having other symptoms is not significant (p = 0.20–0.94). Exposures to PM₁₀ at different geographical locations is associated with increased odds of having respiratory symptoms (cough or sputum) but not with other symptoms unrelated to air pollution.     

A Population-Based Study Evaluating Family Physicians’ HIV Experience and Care of People Living With HIV in Ontario

PURPOSE

Greater physician experience managing human immunodeficiency virus (HIV) infection has been associated with better HIV-specific outcomes. The objective of this study was to evaluate whether the HIV experience of a family physician modifies the association between the model of care delivery and the quality of care for people living with HIV.

METHODS

We retrospectively analyzed data from a population-based observational study conducted between April 1, 2009, and March 31, 2012. A total of 13,417 patients with HIV in Ontario were stratified into 5 possible patterns or models of care. We used multivariable hierarchical logistic regression analyses, adjusted for patient characteristics and pairwise comparisons, to evaluate the modification of the association between care model and indicators of quality of care (receipt of antiretroviral therapy, cancer screening, and health care use) by level of physician HIV experience (≤5, 6–49, ≥50 patients during study period).

RESULTS

The majority of HIV-positive patients (52.8%) saw family physicians exclusively for their care. Among these patients, receipt of antiretroviral therapy was significantly lower for those receiving care from family physicians with 5 or fewer patients and 6–49 patients compared with those with 50 or more patients (mean levels of adherence [95% CIs] were 0.34 [0.30–0.39] and 0.40 [0.34–0.45], respectively, vs 0.77 [0.74–0.80]). Patients’ receipt of cancer screenings and health care use were unrelated to family physician HIV experience.

CONCLUSIONS

Family physician HIV experience was strongly associated with receipt of antiretroviral therapy by HIV-positive patients, especially among those seeing only family physicians for their care. Future work must determine the best models for integrating and delivering comprehensive HIV care among diverse populations and settings.     

A Profile of Black and Latino Older Adults Receiving Care in Nursing Homes: 2011–2017

ObjectiveTo identify if disparate trends in the access and use of nursing home (NH) services among Black and Latino older adults compared with White older adults persist. Access was operationalized as the NHs that served Black, Latino, and White residents. Use was operationalized as the utilization of NH services by Black, Latino, and White residents.DesignThis was an observational study analyzing facility-level data from LTCfocus for 2011 to 2017.Setting and ParticipantsAll NH residents present in US NHs participating in the Centers for Medicare and Medicaid Services program on the first Thursday in April in the years 2011 to 2017. NHs with fewer than 4500 bed-days per year are excluded in the LCTfocus dataset. Black, Latino, and White were the racial/ethnic groups of interest.MethodsWe calculated the mean percentage of each racial/ethnic group in NHs (Black, Latino, White) annually along with the number of NHs that provided care for these groups. We conducted a simple trend analysis using ordinary least squares to estimate the change in NH access and use by racial/ethnic group over time.ResultsOur NH sample ranged from 15,564 in 2011 to 14,956 in 2017. Latino residents' use of NHs increased by 20.47% and Black residents increased by 11.42%, whereas there was a 1.36% decrease in White residents’ use of NHs. In this 7-year span, there was a 4.44% and 6.41% decline in the number of NHs that serve any Black and Latino older adults, respectively, compared with a 2.26% decline in NHs that serve only White older adults (access).Conclusions and ImplicationsOur findings reveal a continued disproportionate rise in Black and Latino older adults’ use of NHs while the number of NHs that serve this population have declined. This work can inform federal and state policies to ensure access to long-term care services and supports in the community for all older adults and prevent inappropriate NH closures.     

Willingness to Favor Aggressive Care and Live with Disability Following Severe Traumatic Brain Injury: A Survey of Healthy Young Adults in Hawai‘i

Traumatic brain injury (TBI) is a major public health problem that significantly impacts young adults. Since severe TBI patients lack decision-making capacity, the providers and patient surrogates are often faced with the challenging task of deciding whether to continue with aggressive life-prolonging care or to transition to comfort-focused care with an expected outcome of natural death. The assumption is often made that aggressive care is appropriate for young patients who suffer severe TBI despite the high likelihood of a poor outcome. However, the young community''s attitude towards goals of care after severe TBI has not been studied. A questionnaire-based survey study on young healthy adults was conducted to assess their attitude towards aggressive care after a hypothetical case of severe TBI. Logistic regression analysis was performed to determine the factors associated with the decision to favor aggressive care. Among a total of 120 community-dwelling young adults (mean age: 19±1 years) who were surveyed, 79 (66%) were willing to live with severe motor disability, 78 (65%) were willing to live with expressive aphasia, and 53 (44%) were willing to live with receptive aphasia. Despite being presented with a high likelihood of long-term moderately severe-to-severe disability, 65 of the 115 respondents (57%) favored aggressive care. A willingness to live with receptive aphasia was the only independent factor that predicted aggressive care (OR 2.50, 95% CI: 1.15 to 5.46). Even among the young adults, preference of care was divided between aggressive and conservative approaches when presented with a hypothetical case of severe TBI.     

Knowledge, Attitudes and Practices of Barbers Regarding Hepatitis B and C Viral Infection in Sana’a City, Yemen

There is strong evidence that razors, barber's scissors, nail files and body piercing instruments are risk factors for transmission of hepatitis B and C. to investigate the knowledge, attitudes and practices regarding hepatitis B and C virus among barbers in Sana'a city. KAP study was conducted from July-September 2011. Two hundred and thirty four barbershops were surveyed. Out of 234 barber shops, 73.1% heard about viral hepatitis B and C. The awareness of modes of transmission of hepatitis and the different sources/risk factors were moderate, ranging from 51.6% who knew that hepatitis can be transmitted through sexual transmitted to 82.1% who knew that hepatitis can be transmitted through blood transfusion. 54.9% of barbers did not agree that it was essential to have periodic tests for HBV and HCV; however, 67.5%would themselves like to be tested for these infections. 32% washed their hands before attending each client, 59% cleaned instruments with disinfectant between clients, 96.1% washed razors with tap water before use on a new client, 92.6% also washed their razors with an antiseptic solution after every use, 87% used a new blade on new clients and 55% used disinfectants for skin cuts. In Yemen, a large number of barbers are shaving clients with an old style razor with a permanent blade. There is moderate awareness about the various modes of transmission of hepatitis among the barbers.     

Secular trends of nasopharyngeal carcinoma incidence in Singapore,Hong Kong and Los Angeles Chinese populations, 1973–1997

Nasopharyngeal carcinoma (NPC) is a rare cancer in most parts of world, but rather common in Southern China and Southeast Asia. This study used IARC published datasets to explore the secular trends of incidence rates of NPC among different Chinese populations in Singapore, Hong Kong and Los Angeles, over the time period 1973–1997. We observed great disparity in the risks and time trends of NPC in those selected Chinese populations. The highest risk was in Hong Kong where the incidence rates have declined rapidly throughout the whole study period in both males and females. For Singapore Chinese, the incidence rates also dropped recently in both genders, but the low incidence rates in Los Angeles Chinese have remained essentially unchanged over time. We further assessed the contribution of period and cohort effects to the observed trends in Hong Kong and Singapore populations through age-period-cohort modeling and found that an age-cohort model provided the best fit to the data in both populations, although for Singapore females a simple age-drift model fit the data well. There was a statistically significant decrease in the drop in incidence of NPC for cohorts born around 1940 in Hong Kong and 1958 in Singapore. This indicates that environmental and lifestyle changes play an important role in the declining incidence of NPC over time.     

How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge,Attitudes and Practices? A Global Systematic Review of Qualitative Studies

Promoting healthy eating habits can prevent adolescent obesity in which family may play a significant role. This review synthesized findings from qualitative studies to identify family barriers and facilitators of adolescent healthy eating in terms of knowledge, attitudes, and practices (KAP). A literature search of four databases was completed on 31 July 2020; qualitative studies that explored family factors of adolescent (aged 10 to 19 years) eating habits were included. A total of 48 studies were identified, with the majority being from North America and sampled from a single source. Ten themes on how family influences adolescent dietary KAP were found: Knowledge—(1) parental education, (2) parenting style, and (3) family illness experience; Attitudes—(4) family health, (5) cultivation of preference, and (6) family motivation; Practices—(7) home meals and food availability, (8) time and cost, (9) parenting style, and (10) parental practical knowledge and attitudes. This review highlights five parental characteristics underlying food parenting practices which affect adolescents’ KAP on healthy eating. Adolescents with working parents and who are living in low-income families are more vulnerable to unhealthy eating. There is a need to explore cultural-specific family influences on adolescents’ KAP, especially regarding attitudes and food choices in Asian families.     

Exploring Variations in North American Adults’ Attitudes,Interest, Experience,and Outcomes Related to Mixed-Gender Threesomes: A Replication and Extension

Mixed-gender threesomes (MGTs) are a type of consensually nonmonogamous sexual encounter involving three people of more than one gender. Little research has been conducted on MGTs, and what little work does exist is limited to college students, who may actually be less experienced with MGTs than older adults. The present study investigated attitudes toward, interest in, experiences with, and outcomes of MGTs in two samples (college N?=?231; online N?=?1342), comprised of 907 heterosexual and 666 sexual minority participants in total. Results indicated that participants reported neutral-to-positive attitudes toward and moderate-to-high levels of interest in MGTs (81% indicated some degree of interest). MGTs involving familiar others were preferred to those involving strangers. Men, sexual minority individuals, and participants from the online sample reported more favorable attitudes toward and greater interest in MGTs as compared to women, heterosexual individuals, and participants from the student sample. In addition, 30% of participants indicated having experience with a MGT. Sexual minority individuals reported more experience with MGTs and more positive outcomes than did heterosexual individuals. In addition, on average, participants reported that their MGT experiences “met expectations.” Overall, these results indicate that MGTs are a common sexual behavior that often results in positive outcomes, especially among sexual minority individuals. Additional research on this understudied topic is needed, particularly as it relates to outcomes and the role of MGTs in consensually nonmonogamous relationships.

     

A Survey of Physicians' Attitudes and Practices about the Human Papillomavirus (HPV) Vaccine in Hawai‘i

The human papillomavirus (HPV) vaccine has the potential to decrease the incidence of several cancers that affect women and men. Despite recommendations by the medical and public health community, and the incorporation of the vaccine into the adolescent immunization schedule, uptake of the vaccine remains well below target goals. To understand potential physician barriers to recommendation and provision of the vaccine, a cross-sectional survey was administered to Hawai‘i pediatricians and family physicians from July 2012 to September 2012 on their attitudes, practices, and perceived barriers regarding HPV vaccination. Surveys were mailed to 465 members of the local pediatrics and family medicine professional chapters, and 87 responses were received for a response rate of 19%. After excluding 14 responses, 73 surveys were included in the analysis. Although almost all of the respondents reported stocking and administering the HPV vaccine in their offices, only 71% reported strongly recommending the HPV vaccine to girls 11–12 years, and only 57% strongly recommend the vaccine to boys 11–12 years old. Lack of insurance coverage and other financial considerations were barriers to provision of the vaccine by physicians. Physicians who felt it is necessary to discuss sexuality with patients prior to recommending the vaccine were significantly less likely to strongly recommend the vaccine to boys 11–12 years old. Public health efforts should focus on addressing the financial barriers and encouraging physicians to recommend the HPV vaccine according to the guidelines.