Pharmacy Students’ Use of and Beliefs About Traditional Healthcare

Health professional students come from many different cultural backgrounds, and may be users of traditional healthcare (also known as ethnomedicine or folk medicine). This study aimed to explore New Zealand pharmacy students’ knowledge and beliefs about traditional healthcare, and to examine whether these changed during the course. A questionnaire was administered to students in 2011 and again in 2013. Students were from a wide range of ethnic groups. Their reported use of traditional healthcare increased (from 48 % in 2011 to 61 % in 2013) and was usually for minor illness or prevention. Non New Zealand European students were more likely to use traditional healthcare. Use of traditional healthcare was relatively common, and after exposure to a biomedical curriculum students seemed to be more, rather than less likely to report using traditional healthcare. Education about traditional healthcare should not be based on the assumption that all healthcare students are unfamiliar with, or non-users of, traditional healthcare.     

Factors Affecting Students’ Evaluation in a Community Service-Learning Program

A community service-learning curriculum was established to give students opportunities to understand the interrelationship between family and community health, the differences between community and hospital medicine, and to be able to identify and solve community health problems. Students were divided into small groups to participate in community health works such as home visits etc. under supervision. This study was designed to evaluate the community service-learning program and to understand how students’ attitude and learning activities affected students’ satisfaction. The results revealed that most medical students had a positive attitude towards social service and citizenship but were conservative towards taking the role to serve people in the community. Students had achieved what they were required to learn especially the training in communication skills and ability to identify social issues. Students’ attitude towards social service did not affect their opinions on the quality of the program and subjective rating on their achievement. The quality of the program was related to the quality of learning rated by the students.     

Norwegians’ Opinions of a Healthy Diet in Different Stages of Life

The purpose of this study was to contribute to a deeper understanding of Norwegian consumers’ opinions of food and health and to discuss this in the light of nutritional guidelines. The data were collected through personal interviews and a precoded questionnaire on a random sample of 1048 persons representative of the Norwegian population. The results show that vegetables, potatoes, fruits, and fish have a strong position in the notion of a healthy diet. Even though the opinions about these foods were quite uniform, older consumers were more inclined than younger consumers to emphasize these foods (p < .01).The official advice to reduce dietary fat was less uniformly reflected in the opinions about foods rich in fat. Socioeconomic factors and variables expressing “trust in experts” and “feeling of uncertainty” were related to the opinions about fat- and protein-rich foods. Those who had small children in their households responded more often than others that they failed to buy the foods they considered to be healthy (p < .05).This study shows that it is important that nutritional advice be directed toward the different life situations of consumers, and that a special focus should be directed toward parents of small children.     

Students’ Assessment of Problems in a Problem-Based Learning Pharmacology Course

Problem-based learning has been widely employed in Medical Education. One of its main components is that students construct their knowledge working with problems. Therefore, in literature special attention has been given to the design of problems, while assessment has not received the same emphasis. To assess problems implies determining to which extent the resulting work fulfills the purposes that the designers of problems had planned, based on theoretical rationale. This study was developed to determine: if working with the problems allowed the students to carry out the expected learning activities; if the conditions in which they worked were suitable and if the problems were correctly structured. Participants were second-year medical students, enrolled in a problem-based learning pharmacology course. They were asked to assess each problem they used, by means of a questionnaire. The results suggest that when students worked with the problems they carried out activities related to elaboration of knowledge and activation of prior knowledge. They reported to have doubts after working with problems; this can probably be attributed to deficiencies in the students' prior knowledge. Furthermore, the type of problem in which students had low preference were those where they have to analyze tables and charts taken from pharmacological experiment reports; neither the time available to gather the information and to prepare the study issues was sufficient, nor was to study for other subjects. The information produced by assessment is useful for the designers of problems and as feedback to the educational process. The students' participation in the evaluation phase is a way to keep the congruence with a student-centered approach.     

Healthcare Utilization After a Children’s Health Insurance Program Expansion in Oregon

Objective The future of the Children’s Health Insurance Program (CHIP) is uncertain after 2017. Survey-based research shows positive associations between CHIP expansions and children’s healthcare utilization. To build on this prior work, we used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon’s 2009–2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance. Methods Using EHR data from 154 Oregon community health centers, we conducted a retrospective cohort study of pediatric patients (2–18 years old) who gained public insurance coverage during the Oregon expansion (n = 3054), compared to those who were continuously publicly insured (n = 10,946) or continuously uninsured (n = 10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also conducted longitudinal analysis of monthly visit rates, comparing the three insurance groups. Results After Oregon’s 2009–2010 CHIP expansions, newly insured patients’ utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94–2.26) for primary care visits to 2.77 (2.56–2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group. Conclusions This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children’s access to public health insurance in the United States.     

Do Nuts Have a Place in a Healthful Diet?

A wealth of nutrition information has been published during the past decade on the healthful nature of nuts. As nut consumption increases, cardiovascular disease risk decreases. This cardioprotective effect of nut consumption is beyond what would be predicted from the fatty acid profile alone. Nuts are a rich source of many other nutrients and bioactive compounds, similar to other whole-plant foods, such as fruits and vegetables. Additional studies during the next decade will delineate additional healthful nutrients of these foods.     

Patients’ Preferences for Healthcare System Reforms in Hungary

Objectives: To illustrate how conjoint analysis can be used to identify patient preferences for healthcare policies, and to measure preferences for healthcare reforms in Hungary. Data source/study setting: Data was collected via a mail-based survey and a direct survey administered in a rheumatology out-patient centre in Flór Ferenc County Hospital, Budapest, Hungary (n = 86). Study design: We designed and administered a conjoint analysis to the study population. Attributes and attribute levels were developed on the basis of key informant interviews and a literature review. Additional demographic, occupation and healthcare utilisation data were also collected using surveys. A mixed effects linear probability model was estimated holding respondent characteristics constant and correcting for clustering. Data collection: Conjoint analysis questionnaires were administered by a physician to 50 consecutive rheumatology patients in a clinic and an additional 36 were mailed by post. Principal findings: The response rate for the physician-administered survey was 98% (but 18% of these were excluded for inconsistent preferences) and 53% for the mail survey, leaving a final sample of 59. Regression results (R² = 56.8%) indicated that patients preferred a health system that was not cost constrained (p = 0.003), was based on solidarity (p < 0.001) and where patients were empowered (p = 0.024). Further, they would choose a system with no choice of provider to avoid co-payments (p = 0.005). Conclusions: This study demonstrates that patients have clear preferences for healthcare system policy. In order to develop evidence-based healthcare policy and to empower patients in the healthcare system, methods such as conjoint analysis offer a simple yet theoretically grounded basis for policy making.     

Face-to-Face and Online Networks: College Students’ Experiences in a Weight-Loss Trial

This study aimed to understand how college students participating in a 2-year randomized controlled trial (Project SMART: Social and Mobile Approach to Reduce Weight; N = 404) engaged their social networks and used social and mobile technologies to try and lose weight. Participants in the present study (n = 20 treatment, n = 18 control) were approached after a measurement visit and administered semi-structured interviews. Interviews were analyzed using principles from grounded theory. Treatment group participants appreciated the timely support provided by the study and the integration of content across multiple technologies. Participants in both groups reported using non-study-designed apps to help them lose weight, and many participants knew one another outside of the study. Individuals talked about weight-loss goals with their friends face to face and felt accountable to follow through with their intentions. Although seeing others’ success online motivated many, there was a range of perceived acceptability in talking about personal health-related information on social media. The findings from this qualitative study can inform intervention trials using social and mobile technologies to promote weight loss. For example, weight-loss trials should measure participants’ use of direct-to-consumer technologies and interconnectivity so that treatment effects can be isolated and cross-contamination accounted for.     

I’m a Doctor. Can I Help?

Medical school does not prepare trainees for the reality of the practice of medicine, where book knowledge takes second place to the more pragmatic skills of time management, conflict resolution, and damage control. Junior residents, overwhelmed by the demands of daily floor work, can easily lose sight of the reasons that they went into medicine to begin with. Taken out of the context of the hospital, though, the opportunity to care for a patient one-on-one can be a vital reminder of the gift that is to know how to heal the sick. Reflecting on the opportunity to care for an accident victim at the scene, rather than in the hospital, reinforces to one young physician the remarkable thing that it is to be a physician.     

Parental Mediation in the Digital Era: Increasing Children’s Critical Thinking May Help Decrease Positive Attitudes toward Alcohol

We demonstrate in our research that discussion-based parental mediation may successfully decrease the negative effects that youth’s engagement with alcohol brands on social media may have on attitudes toward alcohol through its effects on critical thinking. A clear pattern was found with positive mediation leading to unhealthy outcomes and negative mediation predicting healthier behaviors. Youth whose parents critiqued media messages reported more critical thinking skills, which predicted less interaction with alcohol brands on social media and fewer expectancies toward alcohol. On the other hand, youth whose parents endorsed media portrayals of drinking reported fewer critical thinking skills and were thus more likely to interact with alcohol brands on social media. Including a media literacy component in alcohol education that target parental strategies and that are conducive to discussion may lead to beneficial health outcomes in the digital era.     

Turkish University Students’ Beliefs in Sexual Myths

Sexual myths are exaggerated and unscientific ideas on sexual topics that people mistakenly believe to be true. Sex education is the most cost effective intervention to prevent sexual problems and to promote high standards concerning the quality of sexual life. In this study, the sexual beliefs of Turkish university students were evaluated. A 33-question survey form was administered to 290 females and 308 males (total of 598) senior university students. A greater proportion of females than males had received formal education about sexuality. Approximately one-third of the males believed that providing sex education encouraged sexual behavior. More than half of the students believed that marrying a virgin increased sexual satisfaction and that circumcision was important for cleanliness of the penis. The percentages of students who accepted or rejected these myths were similar regardless of whether they were studying social sciences, physical science, and health sciences. Studying the sexual beliefs of adolescents and young people will be beneficial in planning sex education programs as well as determining their content within academic and medical environments.     

Exploration of Dietetics Graduate Students’ Experience in a Flipped Course Using Learning Reflections

ObjectiveEvaluate graduate students’ experience in a flipped metabolism course using periodic learning reflections.MethodsTwo cohorts of graduate students (n = 17, total) were recruited from an advanced metabolism course using a flipped learning approach during the fall 2016 and 2017 semesters. After course completion, 2 investigators used content analysis to develop themes from 8 structured learning reflections.ResultsFour themes were developed from the reflections: responsibility for learning, metacognition, team-based learning, and transfer of skills. Resistance to flipped learning peaked at week 4 of the semester. By the end of the semester, students seemed to embrace the flipped approach and self-directed learning.Conclusions and ImplicationsDespite reporting being better self-directed learners by the end of the semester, students may struggle with the flipped learning format early in the semester. Thus, instructors may need to adopt supportive techniques with students initially.     

Patient Preferences Versus Physicians’ Judgement: Does it Make a Difference in Healthcare Decision Making?

Clinicians and public health experts make evidence-based decisions for individual patients, patient groups and even whole populations. In addition to the principles of internal and external validity (evidence), patient preferences must also influence decision making. Great Britain, Australia and Germany are currently discussing methods and procedures for valuing patient preferences in regulatory (authorization and pricing) and in health policy decision making. However, many questions remain on how to best balance patient and public preferences with physicians’ judgement in healthcare and health policy decision making. For example, how to define evaluation criteria regarding the perceived value from a patient’s perspective? How do physicians’ fact-based opinions also reflect patients’ preferences based on personal values? Can empirically grounded theories explain differences between patients and experts—and, if so, how? This article aims to identify and compare studies that used different preference elicitation methods and to highlight differences between patient and physician preferences. Therefore, studies comparing patient preferences and physician judgements were analysed in a review. This review shows a limited amount of literature analysing and comparing patient and physician preferences for healthcare interventions and outcomes. Moreover, it shows that methodology used to compare preferences is diverse. A total of 46 studies used the following methods—discrete-choice experiments, conjoint analyses, standard gamble, time trade-offs and paired comparisons—to compare patient preferences with doctor judgements. All studies were published between 1985 and 2011. Most studies reveal a disparity between the preferences of actual patients and those of physicians. For most conditions, physicians underestimated the impact of intervention characteristics on patients’ decision making. Differentiated perceptions may reflect ineffective communication between the provider and the patient. This in turn may keep physicians from fully appreciating the impact of certain medical conditions on patient preferences. Because differences exist between physicians’ judgement and patient preferences, it is important to incorporate the needs and wants of the patient into treatment decisions.     

What Drives Women Veterans’ Trust in VA Healthcare Providers?

IntroductionLittle is known about women veterans’ trust in Veterans Affairs (VA) health care and what factors promote trust in VA providers. We examined provider behaviors and characteristics of women veterans associated with trust in their VA providers.MethodsWe used a 2015 survey of women veterans who were routine users of primary care at 12 VA medical centers (n = 1,395). Patient trust in their VA provider was measured on a seven-item scale. We used multiple logistic regression to examine associations of patient-provider communication and gender appropriateness with complete trust in VA provider (100 [complete trust] vs. <100 [less than complete trust]), controlling for patient characteristics.ResultsOn average, 39.7% of women veterans reported complete trust in their VA providers. Those with complete trust reported greater patient-provider communication and gender appropriateness of VA services than those with less-than-complete trust (all ps ≤ .001). In multiple logistic regression models, higher ratings of provider communication (adjusted odds ratio, 2.37), gender-appropriate care (adjusted odds ratio, 1.93), and trauma-sensitive communication (adjusted odds ratios, 1.79–6.08) were associated with a higher likelihood of reporting complete trust in their VA provider.ConclusionsWomen veterans reported high levels of trust in their VA providers. Provider communication, gender-appropriate care, and trauma-sensitive communication were associated with greater patient trust. Although it is important to highlight the steps already taken by VA to increase the quality of care for women veterans, current findings suggest that women veterans’ trust may be further increased by interventions to improve trauma-informed care by VA providers.     

Fat,Sugar or Gut Microbiota in Reducing Cardiometabolic Risk: Does Diet Type Really Matter?

The incidence of cardiometabolic diseases, such as obesity, diabetes, and cardiovascular diseases, is constantly rising. Successful lifestyle changes may limit their incidence, which is why researchers focus on the role of nutrition in this context. The outcomes of studies carried out in past decades have influenced dietary guidelines, which primarily recommend reducing saturated fat as a therapeutic approach for cardiovascular disease prevention, while limiting the role of sugar due to its harmful effects. On the other hand, a low-carbohydrate diet (LCD) as a method of treatment remains controversial. A number of studies on the effect of LCDs on patients with type 2 diabetes mellitus proved that it is a safe and effective method of dietary management. As for the risk of cardiovascular diseases, the source of carbohydrates and fats corresponds with the mortality rate and protective effect of plant-derived components. Additionally, some recent studies have focused on the gut microbiota in relation to cardiometabolic diseases and diet as one of the leading factors affecting microbiota composition. Unfortunately, there is still no precise answer to the question of which a single nutrient plays the most important role in reducing cardiometabolic risk, and this review article presents the current state of the knowledge in this field.