Knowledge and Attitudes About Male Circumcision for HIV-1 Prevention among Heterosexual HIV-1 Serodiscordant Partnerships in Kampala, Uganda

Male circumcision for HIV-1 prevention will require high uptake among at-risk populations. 318 HIV-1 serodiscordant couples in Kampala, Uganda [155 (48.7%) with HIV-1 uninfected male partners] were interviewed about male circumcision for HIV-1 prevention. 77.1% of men and 89.6% of women were aware that circumcision reduces men’s risk for HIV-1 acquisition. Almost all understood the partial protective efficacy of circumcision for HIV-1 acquisition and lack of reduced HIV-1 transmission from circumcising HIV-1 infected men. Among couples with uncircumcised HIV-1 negative men (n = 92), 53.3% of men and 88.1% of female partners expressed interest in male circumcision. Previous discussion within the couple about circumcision for HIV-1 prevention was significantly associated with interest in the procedure. HIV-1 serodiscordant couples in Uganda demonstrated a high level of understanding of the partial protective effect of male circumcision for HIV-1 prevention, but only half of HIV-1 uninfected uncircumcised men expressed interest in the procedure.     

Implementing Smoking Cessation Guidelines for Hospitalized Veterans: Effects on Nurse Attitudes and Performance

BACKGROUND

A minority of hospitalized smokers actually receives assistance in quitting during hospitalization or cessation counseling following discharge. This study aims to determine the impact of a guideline-based intervention on 1) nurses’ delivery of the 5A’s (Ask-Advise-Assess-Assist-Arrange follow-up) in hospitalized smokers, and 2) nurses’ attitudes toward the intervention.

METHODS

We conducted a pre-post guideline implementation trial involving 205 hospitalized smokers on the inpatient medicine units at one US Department of Veterans Affairs (VA) medical center. The intervention included: 1) academic detailing of nurses on delivery of brief cessation counseling, 2) modification of the admission form to facilitate 5A’s documentation, and 3) referral of motivated inpatients to receive proactive telephone counseling. Based on subject interviews, we calculated a nursing 5A’s composite score for each patient (ranging from 0 to 9). We used linear regression with generalized estimating equations to compare the 5A’s composite score (and logistic regression to compare individual A’s) across periods. We compared 29 nurses’ ratings of their self-efficacy and decisional balance (“pros” and “cons”) with regard to cessation counseling before and after guideline implementation. Following implementation, we also interviewed a purposeful sample of nurses to assess their attitudes toward the intervention.

RESULTS

Of 193 smokers who completed the pre-discharge interview, the mean nursing 5A’s composite score was higher after guideline implementation (3.9 vs. 3.1, adjusted difference 1.0, 95 % CI 0.5–1.6). More patients were advised to quit (62 vs. 48 %, adjusted OR?=?2.1, 95 % CI?=?1.2–3.5) and were assisted in quitting (70 vs. 45 %, adjusted OR?=?2.9, 95 % CI?=?1.6–5.3) by a nurse during the post-implementation period. Nurses’ attitudes toward cessation counseling improved following guideline implementation (35.3 vs. 32.7 on “pros” subscale, p?=?0.01), without significant change on the “cons” subscale.

CONCLUSIONS

A multifaceted intervention including academic detailing and adaptation of the nursing admission template is an effective strategy for improving nurses’ delivery of brief cessation counseling in medical inpatients.     

An Instrument for Measuring Coping Behaviours in Hospitalized Alcoholics: Implications for Relapse Prevention Treatment

The results of a principal components analysis of the Coping Behaviours Inventory administered to 256 hospitalized alcoholic patients are compared with a reanalysis of data obtained from a different group of patients five years ago. These results indicate that the factor structure of the Inventory is stable over time and with different alcoholic patient populations. The four factors emerging from the present study, which account for 54% of the variance, were:

• (i) Positive Thinking
• (ii) Negative Thinking
• (iii) Avoidance/Distraction
• (iv) Seeking Social Support

The possible uses of this instrument in monitoring and informing some types of alcoholism-treatment programmes are discussed.     

新疆喀什地区黑热病预防与控制的思考

黑热病(内脏利什曼病)是由杜氏利什曼原虫引起,通过媒介白蛉传播的一种慢性地方性寄生虫传染病.新疆喀什地区是我国黑热病的重点流行区之一.喀什地区地域广阔,由于独特的地理和生态环境,存在着人源型黑热病和荒漠型黑热病(自然疫源性黑热病)两种.荒漠型黑热病为人兽共患的自然疫源性疾病,流行范围广,传播媒介和保存宿主比较复杂,目前尚无有效的预防控制手段.     

An Examination of Attitudes About Old Age in a Sample of Elementary School Children

A sample of 318 elementary school children, divided into an experimental and control group, was the basis for an examination of the effects of classroom instruction on attitudes about aging. After a month-long experiment with a film series and class discussions, the attitudes of the experimental group were not significantly different from those of the control group. The implications of these findings, along with some reservations about the measurements used, are discussed.     

Attitudes About Treatment of Coronary Heart Disease Among Women and Men Presenting for Exercise Testing

To assess attitudes that could contribute to gender differences in the use of coronary procedures, we surveyed 322 patients presenting for exercise testing at a major teaching hospital. Adjusting for sociodemographic and clinical factors, women and men did not differ significantly in their willingness to seek a second opinion, reduce physical activity, or take drugs to avoid major cardiac surgery, but men were more likely than women to describe themselves as risk takers on a three-item personality measure (adjusted odds ratio 2.5; 95% confidence interval 1.4–4.6). Patients' attitudes about risk should be explored further in studies of gender differences in the use of coronary procedures.
KEY WORDS: gender (sex); attitude to health; exercise test; coronary angiography; coronary artery bypass.     

Attitudes,Knowledge, and Practices Regarding Malaria Prevention and Treatment among Pregnant Women in Eastern India

We explored views toward and use of malaria prevention and treatment measures among pregnant women in Jharkhand, India. We conducted 32 in-depth interviews and six focus group discussions (total = 73 respondents) with pregnant women in urban, semi-urban, and rural locations in a region with moderate intensity malaria transmission. Most respondents ranked malaria as an important health issue affecting pregnant women, had partially correct understanding of malaria transmission and prevention, and reported using potentially effective prevention methods, usually untreated bed nets. However, most conveyed misinformation and described using unproven prevention and/or treatment methods. Many described using different ineffective traditional malaria remedies. The majority also showed willingness to try new prevention methods and take medications if doctor-prescribed. Misconceptions and use of unproven prevention and treatment methods are common among pregnant women in eastern India. Policy makers should focus on improving knowledge and availability of effective malaria control strategies in this population.     

Attitudes About Health and Health-Related Behaviors in Patients With Cardiovascular Disease or at Elevated Risk for Cardiovascular Disease

This study evaluated whether positive health attitudes were associated with healthy behaviors in individuals with cardiovascular disease (CVD) or moderate coronary heart disease (CHD) risk. Self-reported health attitudes and behaviors were assessed in the US Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD) for respondents with CVD and type 2 diabetes mellitus (very high risk), CVD and no diabetes (high risk), or moderate CHD risk. CVD was defined as a diagnosis of heart disease/heart attack, stroke, obstructed coronary arteries, or revascularization. Moderate CHD risk was defined as ≥2 Framingham risk factors. Comparisons across very high-risk (n=1177), high-risk (n=2202), and moderate-risk (n=6802) respondents were made using analysis of variance. The proportion of respondents reporting excellent or very good current health decreased with increasing risk (37% of moderate-risk, 21% of high-risk, and 13% of very high-risk respondents). The proportion concerned that their health problems might worsen increased with increasing risk (55%, 63%, and 74%). With increasing risk, 28%, 26%, and 31% exercised regularly and 58%, 52%, and 54% maintained their desired weight for >6 months. Respondents with positive health attitudes were more likely to exercise regularly and maintain desired weight compared with respondents with negative health attitudes (P<.01). Respondents had an average of 3 or 4 family doctor office visits in the past year. Most respondents with CVD or moderate CHD risk had negative health attitudes and were not employing healthy behaviors with regard to exercise and weight management. Frequent family doctor visits are an opportunity to improve the delivery of personalized health education and intervention programs.     

Knowledge, Attitudes, and Practices of Primary Care Physicians About Irritable Bowel Syndrome in Northern Saudi Arabia

Background/Aim:

Primary health care (PHC) physicians manage most patients with irritable bowel syndrome (IBS). In Saudi Arabia, there are limited data on their knowledge, attitudes, and practices about this disorder. This study aimed to assess knowledge, attitudes, and practices of primary care physicians about IBS.

Patients and Methods:

A cross-sectional survey of 70 practitioners aged 36 ± 10.25 years was carried out in primary care centers in AlJouf Province of Saudi Arabia. The physicians were asked to fill a valid questionnaire containing their sociodemographic data, and well-modified questions regarding their knowledge, attitudes, and practices about IBS. Data was processed and analyzed using SPSS (version 15) program, and the level of significance was set at P<0.05.

Results:

A response rate of 92.9% yielded 65 questionnaires for analysis. Majority of physicians surveyed (83.1%) considered IBS as a common health problem in Saudi Arabia, and (55.4%) believed it is underestimated. There was a significant association between physicians’ qualifications and using diagnostic tools to facilitate IBS diagnosis (14.3% vs 35.5%; P<0.05), while utilization of “Rome or Manning criteria” was more frequent by physicians with master''s degree (35.5%) compared to residents (14.3%). Also, 35.4% of physicians (15 males and 8 females) were not sure how to diagnose IBS.

Conclusions:

This study suggested that PHC physicians had a suitable attitude toward IBS, but they lacked knowledge, and their practices toward this condition were inappropriate.     

A Preliminary Study on Educating Hospitalized Geriatric Vascular Patients on the Use of Movement-Induced Computer Games to Improve Exercise Attitudes

A critical challenge confronted by vascular care professionals is developing an effective strategy to motivate patients, who are typically older, to adopt new healthy behaviors that include exercise. Teaching new behaviors is further complicated by a short length of stay (typically less than five days) associated with acute rehabilitation care. This preliminary study, investigated whether a brief (1–2 session) orientation to movement-induced computer games, that were also intrinsically satisfying, effected attitudes toward exercise among vascular patients. Ten vascular patients on a hospital rehabilitation unit were assessed based on their exercise attitudes before and after receiving a movement-induced computer game orientation session using the Outcomes Expectations of Exercise scale (OEE). Post-test scores were also compared with perceived exertion as measured by the BORG-CR10. Statistical significance was found between pre and post OEE scores (p < .001), although there was a weak correlation between OEE and BORG-CR10 scores. The findings suggest that the activity professional can play an important role in teaching intrinsically rewarding movement-induced computer games to vascular patients, which in turn, may have a positive influence on exercise attitudes.     

What Can Long-term Follow-up Teach us About Relapse and Prevention of Relapse in Addiction?

This article reviews the treatment history of 100 hospital-treated heroin addicts and 100 hospital-treated alcohol-dependent individuals. The two cohorts were prospectively followed for 20 and 12 years respectively and factors related to relapse and freedom from relapse were sought. Premorbid social stability, especially stable employment history, proved a more effective predictor of long-term outcome than the severity or chronicity of addiction. Inpatient treatment exerted little effect on long-term course. For both samples, encountering one or more of the following-community compulsory supervision, a substitute dependence, new relationships, and inspirational group membership-appeared associated with freedom from relapse. The challenge of preventing relapse in diabetes is offered as a useful analogy for preventing relapse in the addictions.     

Anxiety and Mood Disorders in Hospitalized Alcoholic Individuals

There is increasing evidence that a subgroup of alcoholic individuals may have coexisting psychiatric disorders, especially anxiety disorders. To test this hypothesis, 49 consecutively admitted male veteran inpatient alcoholic subjects were screened for anxiety and mood disorders via a structured clinical interview. The lifetime prevalence rates of panic disorder (20%), social phobia (24.4%), and mood disorders (34.7%) were significantly higher than reported lifetime prevalence rates in the general population. The implications of these findings are discussed and suggestions for future research are made.     

Sex,Risk and Responsibility: Provider Attitudes and Beliefs Predict HIV Transmission Risk Prevention Counseling in Clinical Care Settings

We examined factors associated with the frequency of HIV “prevention with positives” (PwP) counseling delivered by providers participating in demonstration projects at 26 clinics. Three hundred and fifteen primary care and support service providers completed a survey assessing the frequency of PwP delivered at initial medical care visits and at regular care visits. Providers reported delivering PwP counseling to more patients at initial visits (67%) than to those returning for regular care (53%; t = 11.8, p < 0.001). During initial and regular care visits, providers reporting a sense of responsibility for conducting PwP and those regularly discussing the risk of reinfection with patients reported significantly more frequent PwP counseling. Providers expressing a belief that no matter how much counseling was delivered, some HIV-infected patients would still infect others (prevention fatalism) reported significantly less frequent counseling at all visits. To improve the quality and quantity of HIV PwP counseling, providers training should address attitudinal barriers and facilitators to counseling and the importance of addressing risk routinely.