Ebm@school – a curriculum of critical health literacy for secondary school students: results of a pilot study

Objectives:  Increasingly, patients and consumers are taking responsibility for their diagnostic and therapeutic decisions. This requires a certain amount of health literacy in order to critically assess the various procedures and products. The aim of this study was to develop and pilot test a curriculum of critical health literacy for secondary school students. Methods:  The curriculum is based on the concept of evidence-based medicine and consists of six modules. Development and pilot testing was performed with two classes of secondary school students (n = 45) in Grade 11. The Metaplan method was used to document feedback regarding teaching methods, worksheets, satisfaction and individually perceived benefits. Additionally, systematic observations by researchers were documented and students’ presentations assessed. A sample of untrained students (n = 218) served as a control group. The Critical Health Competency Test was employed for evaluating competencies in critical health literacy. Data were analyzed qualitatively and person parameters were calculated. Results:  Overall, the pilot courses were well-accepted and have been proven to be feasible. Students’ feedback guided revision of the curriculum. Trained students achieved significantly higher person parameters (± SD) than the control group: 597 (± 79) versus 483 (± 94), p < 0.01, indicating enhancement of critical health competencies. Conclusion:  Teaching critical health literacy to secondary school students is feasible and is likely to enhance the competence of critical health literacy. Further studies are needed to show the effectiveness of the intervention. Submitted: 31 March 2007; revised: 11 February 2008, 13 June 2008, 26 August 2008; accepted: 26 August 2008     

Educational DVD for parents of children with congenital heart disease – a pilot study

Parental knowledge regarding their child’s congenital heart defect (CHD) is limited. This study developed and evaluated an interactive DVD that helped parents to understand their child’s CHD. A DVD describing four cardiac abnormalities was created using videos and Adobe Flash. The parents’ knowledge was assessed via a questionnaire before and after receiving the DVD. A control group did not receive the DVD. The DVDs were successfully created and improved the parental knowledge of their child’s cardiac anomaly. The pilot study suggests the need for further development of DVDs to describe additional abnormalities, whilst incorporating local management and outcomes.     

Challenges of teaching mathematics within the frame of a story – a case study

This article will focus on early childhood education and pedagogy in the new millennium. The context is Sweden and Swedish preschool, where a change in the school law a few years ago also resulted in a revision of the preschool curriculum. ‘Teaching’ is one of the new notions that has not previously been used in the preschool context. In this empirical article, we will look specifically at what happens in a teaching situation where the teacher has an intended object of learning and manages to involve all five children in an active dialogue about the mathematical notions of half and whole. From the analysis, we discern three features important in the teacher's use of a story as a basis for teaching children: (1) shared attention, (2) reasoning about meaning, and (3) creating a demarcated space for learning a specific content.     

Trans-placental exposure of neonates to acrylamide—a pilot study

Objectives Acrylamide (AA) (CAS No 79-06-1) has most recently been identified as a food-borne toxicant generated during the heating process of starch-containing foods. It was the aim of the present study to investigate the trans-placental exposure of newborn infants to this possible human carcinogen by analysis of the specific haemoglobin adduct of AA (N-2-carbamoylethylvaline, AAV) in the blood of mothers and the corresponding umbilical cord blood of neonates as a parameter of biochemical effects.Methods We investigated the blood of 11 women advanced in pregnancy (one smoker, ten non-smokers) and the corresponding umbilical cord blood of neonates for the N-terminal haemoglobin adducts of AA (AAV) and the smoking-specific adduct of acrylonitrile (CAS No 107-13-1) (N-cyanoethylvaline, CEV). The limit of detection (LOD) was 5 pmol/g globin for AAV and 4 pmol/g globin for CEV.Results AAV could be determined in all blood samples of the mothers (median 21 pmol/g globin, range 18–104 pmol/g globin) as well as in the umbilical cord blood of neonates (median 10 pmol/g globin, range 6–43 pmol/g globin). The highest values were detected in the blood of the smoking mother and her child. CEV was detected only in the blood of the smoking mother (185 pmol/g globin) and the corresponding umbilical cord blood (69 pmol/g globin).Discussion AAV adduct levels in non-smoking mothers and neonates showed a good correlation (r=0.859). The concentration of AA adducts in the blood of neonates is approximately 50% of the adduct level found in the blood of the mother. In view of the shorter life span of neonatal erythrocytes and the lower body weight of newborn infants, the relative internal dose of AA in neonates (in microgrammes per kilogramme body weight) must be assumed to be at least equal to that of the mother. Because of the high cell-replication rates during foetal development, trans-placental exposure of neonates to AA might raise concerns. Neonates of smoking mothers take up much higher doses of AA than those of non-smoking mothers.     

Determining patient and primary care delay in the diagnosis of cancer – lessons from a pilot study of patients referred for suspected cancer

Background

Migraine is considered to have a negative influence on sex life. The present study was to analyse the perceptions of importance of and satisfaction with sex life as well as the expression of interest in sex among people having migraines in a prospective follow-up mail survey in 1998 and 2003.

Methods

The random sample was stratified according to gender and age in four age groups (20–24, 30–34, 40–44, and 50–54 years). Altogether 25 898 individuals responded to the baseline and 19 626 to the follow-up questionnaire (75.8% response rate). We examined as to how the perceptions of sex life of those suffering from migraine changed during a 5-year follow-up. Conditional logistic regression was used to analyse the data of the responses on self-reported migraine in the baseline and follow-up surveys (N = 2 977, 79.2% women). Each person with migraine was assigned a gender- and age-matched control in the analysis.

Results

All three outcome variables tended to decrease in value. Importance of sex life was higher among men with migraine than among their controls. Among women migraine lessened interest in sex life.

Conclusion

Our findings suggested that migraine has a different impact on sex life among women from that among men.     

Effects of a soy milk supplement on plasma cholesterol levels and oxidative DNA damage in men – a pilot study

Summary Background: Phytoestrogens are a major component of Asian diets and may be protective against certain hormone-dependent cancers (breast and prostate) and coronary heart disease. They may also have antioxidant function in scavenging potentially harmful free radicals and thus decreasing oxidative attack on DNA. Aims of the study: A pilot study to determine the effects of a phytoestrogen supplement, in the form of soy milk, on plasma LDL and HDL cholesterol levels and DNA damage in men. Methods: Ten healthy men participated in the study and were assigned to one of three groups consuming 1 litre of either soy milk, rice dream (vegetable protein control) or semi-skimmed cow's milk (animal protein control) each day for 4 weeks. Results: The soy supplement caused significant increases in plasma genistein and daidzein concentrations despite considerable interindividual variation (P<0.001). Supplementation with soy resulted in a decrease in oxidative damage to DNA bases detected using the comet assay compared with controls (P<0.05). However, there was no significant effect of the soy supplement on plasma cholesterol or triglyceride levels in comparison with control groups. Conclusions: A 4 week soy milk supplementation in healthy volunteers does not alter serum cholesterol levels but can have a protective effect against oxidative DNA damage in lymphocytes. Received: 29 December 1998, Accepted: 24 March 1999     

Motor planning in preschool children – the use of a visual cue to test the end-state comfort effect: a preliminary study

The end-state comfort effect has been observed in grip selections of adult humans and other species of primates, but few studies have explored this effect in young children. The present study investigated the effect of a visual cue on the sensitivity to exhibit end-state comfort. Preschool children (N?=?17) completed the task of picking up an overturned cup, turning it right-side up, and pouring water into it. Each child performed three trials of this task in both visual cue and non-visual cue conditions. Results revealed no significant difference between the two visual cue conditions in using a thumb-down or end-state comfort grip, χ ² (1)?=?0.12, p?>?0.05. The findings offer practical implications regarding young children's ability to plan movement along with the potential role of early learning centres in creating environments that promote motor planning.     

Who are "the homeless"? Reconsidering the stability and composition of the homeless population.

OBJECTIVES: This study assessed the extent to which the use of point-prevalence samples biases conclusions drawn about homeless people. METHODS: Three data sets and published research were used to examine the degree to which conditions leading to point-prevalence bias (turnover in the homeless population, variability in the persistence of homelessness, and associations between personal characteristics and persistence) characterize the homeless population. Results were compared from point-prevalence studies concerning persistence of homelessness and characteristics of homeless people with those from a study of formerly homeless people. RESULTS: Conditions leading to point-prevalence bias strongly characterize the homeless population. Moreover, profiles of homeless people differed dramatically between point-prevalence studies and the study of formerly homeless people. In the former, average duration of homelessness was longer, and samples included higher proportions of men, minorities, non-high school graduates, and people with histories of psychiatric hospitalization, incarceration, and detoxification. CONCLUSIONS: Reliance on point-prevalence samples, when such samples are generalized beyond the currently homeless population, leads to overestimations of the persistence of homelessness, the demographic distinctiveness of the homeless population, and the prevalence of personal disabilities and deviant lifestyles among homeless people.     

Eradication of MRSA in chronic wounds of outpatients with leg ulcers is accelerated by antiseptic washes – Results of a pilot study

Whereas several studies evaluate MRSA in inpatients, for outpatients there are merely expert recommendations, but no systematic studies. Mostly, MRSA in outpatients is tolerated but not eradicated. Particularly, for risk patients with chronic wounds some experts postulate that MRSA-eradication is even impossible. For the first time, this pilot study systematically searched for the results of an eradication of MRSA in chronic leg ulcers of outpatients. 38 outpatients with a MRSA colonized leg ulcer were included in the survey and retrospective data analysis. Additionally to a wound therapy with silver-containing wound dressings, all patients were recommended to apply antiseptic eradication measures in accordance with the recommendations for inpatient treatment. MRSA was considered to be persistent, if it was detectable in the wound after at least one month of recommended eradication therapy. In 16 patients the MRSA could be successfully eradicated (MRSA-E), in 22 it could not (MRSA-P). Results showed a significant benefit of antiseptic body washes during the decontamination (MRSA-E 62.5%, MRSA-P 22.7%; p=0.0082). Other antiseptic measures like daily change of clothes and linen or disinfections of personal things and surroundings did not show significance. In conclusion, this pilot study shows that eradication of MRSA in chronic wounds is possible in outpatients. Antiseptic measurements, even administered by the patients themselves, seem to have a positive influence. Their efficacy has to be proven in larger, placebo-controlled studies for outpatient eradication.     

Transition of care: experiences and preferences of patients across the primary/secondary interface – a qualitative study

Background  

Coordination between care providers of different disciplines is essential to improve the quality of care, in particular for patients with chronic diseases. The way in which general practitioners (GP's) and medical specialists interact has important implications for any healthcare system in which the GP plays the role of gatekeeper to specialist care. Patient experiences and preferences have proven to be increasingly important in discussing healthcare policy. The Dutch government initiated the development of a special website with information for patients on performance indicators of hospitals as well as information on illness or treatment.     

Age-related macular degeneration: Effects of a short-term intervention with an oleaginous kale extract—a pilot study

ObjectiveAge-related macular degeneration (AMD) is a multifactorial degenerative disease of the retina, which accounts for slowly progressive visual impairment in the elderly. An increased dietary intake of xanthophylls is suggested to be inversely related to the risk of macular disease.MethodsThe present study was designed as a randomized, double-blind, placebo-controlled, parallel trial examining the influence of a short-term intervention with an oleaginous extract of Brassica oleracea var. sabellica L. (kale) on plasma xanthophyll concentrations and the optical density of the macular pigment xanthophylls (MPOD). Twenty patients with non-exudative AMD were recruited for a 10-wk study period (2-wk run-in, 4-wk intervention, 4-wk washout). All participants received 50 mL of a beverage containing either an oleaginous extract of kale (kale) or refined rapeseed oil (placebo). The verum product provides 10 mg lutein and 3 mg zeaxanthin per day.ResultsThe concentrations of the xanthophylls in plasma and the MPOD increased significantly in the kale group after 4 wk of intervention. The successive washout period resulted in a significant decline of the values in plasma and macula. The values at the end of the study were still significantly higher than the initial values. Nevertheless, the improvements did not persist over 4 wk of washout.ConclusionThe distribution of the xanthophylls in the macula seems to be more dynamic than originally assumed.     

The effect of stress on the onset and progression of Creutzfeldt–Jakob disease: Results of a German pilot case–control study

The association between Creutzfeldt–Jakob disease (CJD) and stressful life events was examined in a pilot case–control study in Germany. The study sample consisted of 37 CJD cases and 37 controls, both groups were frequency-matched for age and sex. In standardised interviews of close relatives of the cases and the controls, all stressful life events were assessed and subsequently grouped into one of the following three subgroups: psychosocial stress events, medical operations with hospitalisation, and other serious medical examinations. A significantly higher proportion of CJD cases experienced stressful life events during the last six months before disease onset than controls (65% vs. 32%, p=0.01), yielding an odds ratio (OR) of 3.85 (95% confidence interval (CI): 1.33–11.30). We found the clearest distinction between cases and controls for the subgroup of medical operations where an OR of 6.97 (95% CI: 0.76–329.20) was observed. Further data indicated that stressful events seem to influence not only the onset of CJD but also the progression of the disease. Although based on a rather small study sample, this pilot case–control investigation suggests evidence that stressful life events in the last six months before disease onset may influence CJD occurrence and may modify the course of disease. This stress hypothesis, which is in line with findings from other epidemiological and experimental studies in CJD, is thus a promising direction for future CJD research as it could enlighten the pathophysiological mechanisms and point towards strategies for the prevention and therapy of CJD.     

The spread of medical fake news in social media – The pilot quantitative study

Objectives

Fake news: misinformation and falsehood of health news in social media constitute a potential threat to the public health, but the scope of this issue remains unclear. Our pilot study is an initial attempt to measure a number of the top shared health misinformation stories in the Polish language social media.

Inspectors’ ethical challenges in health care regulation: a pilot study

There is an increasing body of research on what kind of ethical challenges health care professionals experience regarding the quality of care. In the Netherlands the Dutch Health Care Inspectorate is responsible for monitoring and regulating the quality of health care. No research exists on what kind of ethical challenges inspectors experience during the regulation process itself. In a pilot study we used moral case deliberation as method in order to reflect upon inspectors’ ethical challenges. The objective of this paper is to give an overview of the ethical challenges which health care inspectors encounter in their daily work. A thematic qualitative analysis was performed on cases (n = 69) that were collected from health care inspectors in a moral case deliberation pilot study. Eight themes were identified in health care regulation. These can be divided in two categories: work content and internal collaboration. The work of the health care inspectorate is morally loaded and our recommendation is that some form of ethics support is provided for health care inspectors.     

Sleep patterns of cyclic parenteral nutrition,a pilot study: are there sleepless nights?

BACKGROUND: Cyclic home parenteral nutrition (HPN) is 1 of the few medical therapies given during normal nocturnal sleep hours, and it is possible that infusion may alter normal sleep patterns. The aim of this pilot study was to evaluate the sleep patterns of 5 patients receiving HPN. METHODS: An Epworth sleep questionnaire was completed and wrist Actigraph data were collected before admission to the sleep laboratory. Formal overnight polysomnography was then preformed for 3 consecutive nights. The first night served as the acclimatization period. On the second and third nights, patients were randomized to receive either no infusion or infusion of their standard parenteral nutrition. Results were reported as the median and range and were compared with historical aged-matched controls. RESULTS: Five patients (3 women and 2 men) with a mean age of 61 years (40 to 73 years) were studied. Patients had been HPN-dependent for a median of 23 months (4 to 60 months). Patients were receiving HPN because of short bowel syndrome (2), chronic pancreatitis (2), and intestinal pseudoobstruction (1). A 1.5-liter HPN formula, infused over 10 hours, included approximately 25 kcal/kg/d with 30% lipid and 1.0 to 1.5 g/kg/d of protein. All solutions included multiple trace elements and standard multivitamins. During total parenteral nutrition (TPN) infusion, the percent of sleep efficiency was higher than without infusion, 81% versus 72%. Sleep efficiency in age-matched controls was approximately 88%. Sleep latency was longer in patients compared with controls, and longer in patients during infusion than without infusion, 35 versus 28 minutes. During TPN infusion, the percent of stage-1 (2%), stage-2 (52%), slow-wave (24%) and random eye movement (REM) sleep (21%) was similar to values during the night without infusion. Controls had lower slow-wave and REM times. The median Epworth sleep score was 3, which is the normal reported range. CONCLUSIONS: Although sleep quality is reduced in patients receiving HPN compared with aged-matched controls, sleep quality does not seem to be negatively effected by cyclic HPN infusion.