To work or not to work: combination therapies and HIV

The authors describe the labor force experiences of people living with HIV and AIDS (PHAs) who are taking combination therapies using information from in-depth interviews conducted in 1999 and 2000 in the Windsor and Essex County region of Canada with 35 PHAs. They analyze labor force experience contextually, setting it within the contexts of personal illness experience (including disease trajectory and treatment history), workplace structure and discrimination, the labor market, and the structure of health and social service systems. Barriers to returning to or remaining in the labor force are numerous and require a specific commitment to overcome. Existing workplace and government policies and programs and labor market conditions impede labor force participation for PHAs who have recovered from serious illness and are now able and willing to work.     

To tell or not to tell: the ethical dilemmas of HIV test notification in epidemiologic research.

Epidemiologic studies involving HIV (human immunodeficiency virus) antibody testing create ethical dilemmas, particularly about notifying asymptomatic seropositive subjects. Four study designs address this problem: mandatory notification, optional notification, anonymous testing, and blind testing. No single design consistently optimizes the trade-off between valid and ethical research. Each strategy differs substantially from the others in its effect on response rates, bias, ability to perform longitudinal studies, numbers of subjects who learn their test results, and the number of subjects counseled about HIV risk reduction. Both local institutional review boards and potential subjects of study (and their sexual partners) should participate in decisions regarding the conduct of sensitive AIDS (acquired immunodeficiency syndrome) research.     

To screen or not to screen, when clinical guidelines disagree: primary care physicians' use of the PSA test

BACKGROUND: Clinical guidelines for using the prostate-specific antigen (PSA) test as a population-based screening tool vary considerably. This study qualitatively explored primary care physicians' PSA screening practices and their understanding of the PSA screening controversy. METHODS: Fourteen telephone focus groups were conducted with 75 primary care physicians practicing in 35 US states. Data were coded around three major topics: PSA screening practices, factors influencing these practices, and familiarity with clinical guidelines. RESULTS: Two practice patterns emerged. Most participants recommended regular PSA screening beginning around age 50 for asymptomatic men with no known risk factors and at least a 10-year life expectancy. These "routine screeners" attributed their approach to experience that supported the benefit of PSA screening and to patient demand for the test. Other physicians discussed the implications of PSA screening with patients before offering the test, but neither recommended for or against it. The approach of these "nonroutine screeners" was primarily guided by the lack of scientific evidence documenting the benefit of PSA screening. CONCLUSIONS: The observed practice patterns reflect both sides of the PSA screening controversy. While routine and nonroutine screeners differ in their approach, both reported high rates of PSA screening.     

To report or not to report: a psychosocial investigation aimed at improving early detection of avian influenza outbreaks

The aim of this study was to identify difficulties and barriers to reporting clinically suspect situations, possibly caused by avian influenza (AI), and to explore possible incentives to reporting such situations, with the ultimate aim of facilitating early detection of AI outbreaks. Focus group sessions were held with policy-makers from the competent authority, representatives of veterinary practitioners and poultry farmers. Personal interviews with a group of poultry farmers and practitioners were held to ascertain the difficulties and barriers they perceived and their proposed solutions. An electronic questionnaire was put on the websites of a poultry farmer union and the Royal Dutch Veterinary Association to investigate perceptions and attitudes concerning AI-suspect situations in The Netherlands. Six themes emerged identifying factors that hinder the reporting of a clinically suspect situation: lack of knowledge and uncertainty about clinical signs of AI; guilt, shame and prejudice; negative opinion of control measures; dissatisfaction with post-reporting procedures; lack of trust in veterinary authorities; lack of transparency in reporting procedures and uncertainty about the notification process. Recommendations to facilitate early detection of AI are discussed.     

Student nurses' reasons behind the decision to receive or decline influenza vaccine: A cross-sectional survey

This cross-sectional questionnaire survey examined influenza vaccination among 430 student nurses. Only 12.2% (95% CI 9.1-15.3%) of student nurses received the seasonal vaccine regularly with 27.6% (95% CI 23.3-31.8%) ever having received seasonal or pandemic H1N1 vaccine. Intention to be vaccinated was associated with having previously been vaccinated (p<0.001) but not whether the vaccine was perceived as beneficial (p=0.36). Previous influenza illness was associated with having the influenza vaccine (p<0.001). The most frequently reported reason for receiving the seasonal influenza vaccine was being deemed at risk (42.4%) and for H1N1 vaccine was because it was offered for free (32.6%). For both vaccines the most reported reason for not being vaccinated was a perception of it not being needed. Student nurses form a substantial and influential part of the future healthcare workforce but to translate the widely held acceptance that influenza vaccine is beneficial into actual uptake, a more targeted and persuasive message is needed.     

To work or not to work: that is the question

Medical publications contain numerous references to obstacles or disincentives confronting patients who wish to return to work after illness or injury. Current developments of importance to this aspect of medical practice and four recent studies, conducted in Edinburgh, that may contribute to the continuing debate about how best to deal with such problems are reviewed. The studies concern measurement of rehabilitation status, identification of potential to benefit from rehabilitation, medical contributions to occupational assessment of accident victims, and patients' patterns of involvement with medical and vocational rehabilitation services. It is concluded that coordination between services is still a major problem and is likely to remain so if more effective bridging between medical and vocational aspects of rehabilitation is not achieved.     

To accept,or not to accept,that is the question: citizen reactions to rationing

Background The publicly financed health service in Sweden has come under increasing pressure, forcing policy makers to consider restrictions. Objective To describe different perceptions of rationing, in particular, what citizens themselves believe influences their acceptance of having to stand aside for others in a public health service. Design Qualitative interviews, analysed by phenomenography, describing perceptions by different categories. Setting and participants Purposeful sample of 14 Swedish citizens, based on demographic criteria and attitudes towards allocation in health care. Results Participants expressed high awareness of limitations in public resources and the necessity of rationing. Acceptance of rationing could increase or decrease, depending on one’s (i) awareness that healthcare resources are limited, (ii) endorsement of universal health care, (iii) knowledge and acceptance of the principles guiding rationing and (iv) knowledge about alternatives to public health services. Conclusions This study suggests that decision makers should be more explicit in describing the dilemma of resource limitations in a publicly funded healthcare system. Openness enables citizens to gain the insight to make informed decisions, i.e. to use public services or to ‘opt out’ of the public sector solution if they consider rationing decisions unacceptable.     

Educational and economic determinants of food intake in Portuguese adults: a cross-sectional survey

Background

Understanding the influences of educational and economic variables on food consumption may be useful to explain food behaviour and nutrition policymaking. The aim of this study was to evaluate the importance of educational and economic factors in determining food pattern in Portuguese adults.

Methods

A cross-sectional study in a representative sample of Portuguese adults (20977 women and 18663 men). Participants were distributed in four categories according to years of education (≤4, 5–9, 10–12, and >12) and income (≤314 euros, 315–547 euros, 548–815 euros, and >815 euros). Logistic regression models were fitted to estimate the magnitude of the association between food groups and education/income, adjusting for confounders.

Results

In both genders, the odds favouring milk, vegetable soup, vegetables, fruit, and fish consumption, increased significantly with education, for those having >12 years of education compared to those with ≤4 years; the odds favouring wine, and spirits consumption decreased significantly with education, for those having >12 years of education compared to those with ≤4 years. In males, the odds favouring starchy foods and meat consumption decreased significantly with income, while for milk, the odds increased with higher income (those having >815 euros compared to those with ≤314 euros).

Conclusions

The low and high income groups are or tend to be similar in regard to several food groups consumption, and access to education/information appears to be the key element to a better food pattern as indicated by higher frequency of milk, vegetable soup, vegetables, fruit, and fish consumption.

     

Interview to study the determinants of hypertension in older adults in Taiwan: a population based cross-sectional survey

The aim of the study was to assess the association of socioeconomic, anthropometric and lifestyle factors with self-reported hypertension in older adults in Taiwan. The data were part of the "1999 Survey of Health and Living Status of the Elderly in Taiwan". The survey was conducted in-home, face-to-face, by interviews of 4440 men and women, 53 years or older, in a population-based cross-sectional study. The prevalence of self-reported hypertension was 31.1% for men and 38.0% for women. A logistic regression model showed a higher probability of self-reported hypertension for female gender, older age, and greater BMI, and lower probability for increased consumption of leguminous foods. No association was observed with cigarette smoking, alcohol consumption or physical activity. Current cigarette smokers and alcohol-drinkers underreported their hypertension status. Compared to the medically measured hypertension of a sub-sample study of the same cohort, only about 60% of medically-substantiated hypertensive patients self-reported their hypertensive status, indicating that the interview survey underestimated the prevalence of hypertension in this Taiwanese elderly population. The interview survey appears to identify associations of hypertension with age, gender, BMI and some food patterns, but does not recognize the likely associations with the candidate risk factors of physical inactivity, cigarette smoking, alcohol consumption and limited education, at least in this Taiwanese population. Thus caution must be applied where interview alone categorises individual older Taiwanese as hypertensive or not. A survey which has validation or cross-checking questions about the medical diagnosis of hypertension and the likelihood of its memory and appreciation by the patient (such as method, definition, communication with patient, recall and follow-up, lifestyle advice or pharmaco-therapy, presence of cognitive impairment) may clarify the significance of the discrepancy between self-reporting and medical record. In turn, this would allow a more robust evaluation of blood pressure determinants in such populations. Nevertheless, there is a role for community-based surveys that utilise self-reporting in the identification, prioritization and surveillance of putative contributors to hypertension; this is the case where, as in the Taiwanese elderly, it assumes major importance in the burden of disease and premature mortality.     

To cry or not to cry: physicians and emotions at the bedside

Whether it is appropriate for physicians to display their emotions in front of a patient is a question that has no easy answer. Some physicians may consider it an expression of empathy, while others caution against doing so. This article describes the findings of a survey of blood and marrow transplant physicians who were asked whether it is OK to cry in front of patients.     

To work or not to work: that is the question.

Medical publications contain numerous references to obstacles or disincentives confronting patients who wish to return to work after illness or injury. Current developments of importance to this aspect of medical practice and four recent studies, conducted in Edinburgh, that may contribute to the continuing debate about how best to deal with such problems are reviewed. The studies concern measurement of rehabilitation status, identification of potential to benefit from rehabilitation, medical contributions to occupational assessment of accident victims, and patients' patterns of involvement with medical and vocational rehabilitation services. It is concluded that coordination between services is still a major problem and is likely to remain so if more effective bridging between medical and vocational aspects of rehabilitation is not achieved.     

To round or not to round: that is the question!

Bedside rounding and clinical examination has been an integral part of medical education and patient care for centuries. With the advent of computers and regulatory requirements for documentation by insurance carriers and third party providers, bedside rounding time has consistently decreased over the past several decades. Several studies have attempted to address the most effective way of bedside rounding, but no definite conclusion has been reached. We suggest multi-center broad base studies of key stakeholders to address this challenging issue.