Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?

Background

The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States. As health care providers are important contributors to women's contraceptive use, this study was conducted to assess provider knowledge about contraception.

Study Design

Bivariate and multivariate analyses were performed using data collected from a convenience sample of health care providers (physicians, nurse practitioners and physician assistants) at meetings of the professional societies of family medicine and obstetrics and gynecology.

Results

Younger providers were more knowledgeable, as were obstetrician/gynecologists, female providers and providers who provide intrauterine contraception in their practice.

Conclusions

The lack of consistent and accurate knowledge about contraception among providers has the potential to dramatically affect providers' ability to provide quality contraceptive care for their patients, which could have an impact on their ability to prevent unintended pregnancies.     

Parental safety concerns – a barrier to sport and physical activity in children?

OBJECTIVE: To examine the extent to which parents and carers perceive injury and safety risks as serious enough to prevent or discourage their children, aged 5-12 years, from participating in sports/physical activity and to identify factors that influence these perceptions. METHODS: An analysis of the 2001 New South Wales Child Health Survey. RESULTS: More than one-quarter of parents/ carers of active children aged 5-12 years reported discouraging or preventing children from playing a particular sport (34.7% for boys and 16.6% for girls) because of injury and safety concerns. In boys, the most frequently discouraged sport was rugby league (23.2%), followed by rugby union (7.5%) and Australian rules football (2.8%). Among girls, the most frequently discouraged activities were rollerblading (2.7%), rugby league (2.3%) and soccer (2.1%). Multivariate analysis shows that factors independently associated with parents' decision to prevent/discourage their child from engaging in sport/physical activity include their child's age and gender, language spoken at home, presence of disability, and the respondent's relation to the child. CONCLUSIONS AND IMPLICATIONS: Efforts need to be made to modify some sports/ activities, such as football codes, in order to minimise injury and to ensure that children continue enjoying their favourite activity well into adulthood. Guidelines designed to promote physical activity among children and young adolescents need to take into account parental concerns regarding the associated risk of injury.     

Is employer-based health insurance a barrier to entrepreneurship?

The focus on employer-provided health insurance in the United States may restrict business creation. We address the limited research on the topic of “entrepreneurship lock” by using recent panel data from matched Current Population Surveys. We use difference-in-difference models to estimate the interaction between having a spouse with employer-based health insurance and potential demand for health care. We find evidence of a larger negative effect of health insurance demand on business creation for those without spousal coverage than for those with spousal coverage. We also take a new approach in the literature to examine the question of whether employer-based health insurance discourages business creation by exploiting the discontinuity created at age 65 through the qualification for Medicare. Using a novel procedure of identifying age in months from matched monthly CPS data, we compare the probability of business ownership among male workers in the months just before turning age 65 and in the months just after turning age 65. We find that business ownership rates increase from just under age 65 to just over age 65, whereas we find no change in business ownership rates from just before to just after for other ages 55-75. We also do not find evidence from the previous literature and additional estimates that other confounding factors such as retirement, partial retirement, social security and pension eligibility are responsible for the increase in business ownership in the month individuals turn 65. Our estimates provide some evidence that “entrepreneurship lock” exists, which raises concerns that the bundling of health insurance and employment may create an inefficient level of business creation.     

Nutritional support in patients with advanced cancer: permission to fall out?

Data from the European Society for Parenteral and Enteral Nutrition Home Artificial Nutrition Survey suggest that the use of home parenteral nutrition (HPN) in patients with cancer as the primary diagnosis varies markedly between different countries in Europe, being highest in The Netherlands and low in the UK. This finding is difficult to explain on the basis of cancer incidence. The main indication for HPN remains malignant gastrointestinal tract obstruction, which occurs most frequently in gynaecological and colon cancers. The use of HPN should be planned in the light of the proposed cancer treatment and should be discussed beforehand with the patient. Before HPN is considered, a patient should typically require intravenous fluids to maintain hydration, be capable of self care, be able to control the treatment, have an expected survival of > or = 3 months and have no other available route of feeding. The effect of HPN on quality of life remains controversial, but nutrition is only one of the factors that influence the quality of life in cancer patients. The differing rates of HPN in Europe are probably related to cultural attitudes to incurable cancer as much as to meeting the nutritional needs of the patient.     

Is price a barrier to eating more fruits and vegetables for low-income families?

OBJECTIVE: To determine if price is a barrier to fruit and vegetable consumption for low-income families by comparing the average cost of a market basket of fruits and vegetables from the Thrifty Food Plan and the Dietary Guidelines for Americans 2005 (2005 Dietary Guidelines), investigating variations in price by neighborhood income and by type of supermarket, and estimating the influence of a 2005 Dietary Guidelines fruit and vegetable basket on the food budget of a low-income family. DESIGN: A market basket survey was conducted at 25 supermarkets across three time periods to allow for seasonal variation in produce prices. SETTING: Stores were selected from census tracts with a variety of income levels in Sacramento, CA, and Los Angeles, CA. MAIN OUTCOME MEASURES: The average cost of a Thrifty Food Plan and 2005 Dietary Guidelines market basket for fruits and vegetables. STATISTICAL ANALYSES PERFORMED: Student t tests were used to compare the mean cost of market baskets. RESULTS: The 2005 Dietary Guidelines market basket cost 4% less than the Thrifty Food Plan (P<0.001), and was significantly less expensive in low-income areas at 65 dollars (P<0.05), and in bulk supermarkets at 59 dollars (P<0.05). The 2005 Dietary Guidelines market basket would require a low-income family to devote 43% to 70% of their food budget to fruits and vegetables. CONCLUSIONS: Public policies should examine ways to make fruits and vegetables more affordable to low-income families.     

Chronic Constipation: Is a Nutritional Approach Reasonable?

Chronic constipation (CC) is one of the most common gastroenterological diagnoses in clinical practice. Treatment includes several steps, depending on the severity of symptoms. Lifestyle modifications and increased intake of fiber and water are suggested by most health professionals. Unfortunately, the recommendations in this regard are the most varied, often conflicting with each other and not always based on solid scientific arguments. This paper aims to clarify this topic by providing practical indications for the management of these patients in every day clinical practice. The literature available on this topic is scarce, and dietary studies have important methodological biases. However, fiber, mainly by binding water and acting as bulking agents and/or as prebiotics for the intestinal microbiota, and mineral water, especially if rich in magnesium and/or bicarbonate, are useful tools. An adequate, well-designed diet should be a cornerstone of any effective treatment for chronic constipation. High-quality studies on larger samples are mandatory to give scientific validity to the role of the food in CC therapy and to enable professionals to choose the best approach for their patients, combining nutritional and pharmacological agents.     

‘Good health’ as a barrier and facilitator to ART initiation: a qualitative study in the era of test-and-treat in Mozambique

HIV test-and-treat programmes are being implemented throughout sub-Saharan Africa, enrolling HIV-positive clients into antiretroviral treatment (ART) immediately after diagnosis, regardless of clinical stage or CD4 count. This study conducted in Mozambique examined what influenced clients who tested HIV-positive in the context of test-and-treat to make ART initiation decisions. Eighty in-depth interviews with HIV-positive clients and nine focus group discussions with health care workers were completed across 10 health facilities. ‘Good health’ acted simultaneously as a barrier and facilitator; clients in good health often found a positive HIV diagnosis hard to cope with since HIV was traditionally associated with ill health. Concerns about ART side effects, fear of inadvertent HIV status disclosure and discrimination, limited privacy at health facilities and long waiting times were also barriers to initiation. In contrast, being in good health also acted as a motivator to start treatment so as to remain healthy, maintain responsibilities such as work and caring for dependents and avoid unwanted disclosure. Study findings offer an in-depth understanding of the complex dynamics between individual perceptions of ‘being healthy’ and its influence on ART initiation within the context of test-and-treat programme implementation.     

Food Data Quality in Nutritional Surveys: which Issues are to be Tackled?

Food data (food intake or food consumption) quality is a central issue to be tackled in order to ensure a correct interpretation of the results from population studies in the nutritional field. In fact, several sources of errors can be identified in this type of study because of inherent characteristics and specific possible procedural inaccuracies. Particularly for the quantitative aspect, inherent imprecision and procedural errors (non-probabilistic) should be clearly identified in order to adopt preventive measures. Therefore, necessary quantitative data, their numerical expression and the calculation used to obtain net intake must be defined together with the detail of food section and the related food coding system in open-ended forms and the classification criteria in the closed-ended ones. Furthermore, the precision of food components intake depends upon both the food data quality and either the food composition data or the algorithms to assess the equivalent for other substances contained in the food products. Comprehensively, the data quality can be evaluated by considering the quantitative aspect (coherence of consumed quantities, percentage of under/over-reporting subjects, percentage of missing data for nutrients) and the detail of food items (percentage of “unspecified” items). Subsidiary tools for people collecting data will be useful.     

The costs and benefits to participants in community partnerships: a paradox?

This article examines the degree of stakeholder participation in health and social partnership schemes in relation to their perceptions of benefits, costs, satisfaction, commitment, and ownership. The findings suggest that (a) involvement, commitment, and sense of ownership were invariably associated with high benefits and mostly with low costs; (b) benefits, commitment, and ownership might be more sensitive monitors of involvement than costs and satisfaction; (c) an increase in involvement was initially associated with decreased costs and increased satisfaction up to a point beyond which costs increased and satisfaction decreased despite increasing benefits; and (d) favorable cost-benefit ratios were perceived when the benefits were at least 1.6 times the costs. Partnership initiatives need to explore the involvement "cut-off" point at which the costs (and satisfaction) might change direction. For favorable cost-benefit ratios, benefits need to be at least 60% more than costs (Ansari's paradox).     

Cross‐promotional alcohol discounting in Australia's grocery sector: a barrier to initiatives to curb excessive alcohol consumption?

Objective: Excessive alcohol consumption is an increasing issue internationally. Pricing strategies, including discount restrictions, have been identified as one of the most effective policy means by which to reduce heavy alcohol consumption. In Australia, cross‐promotional alcohol discounts are increasingly used by supermarket chains as a marketing tool. The purpose of the present study is to provide preliminary data on the nature and extent of cross‐promotional alcohol discounting in the Australian grocery sector. Methods: A purposive sample of 34 supermarkets in Australia's three largest cities was selected and minor grocery purchases made to uncover the prevalence and level of cross‐promotional alcohol discounting. Results: Cross‐promotional ‘bundled’ discounts were very common with 33 of the 34 supermarkets offering a ‘two for one’ discount on bottles of wine. Even with minor purchases (mean purchase $1.35), the mean value of discounts received was substantial ($16.23). Conclusions: These results appear to be consistent with claims that major supermarket chains are using alcohol discounts as loss leaders to entice new consumers. Implications: These strategies are antithetical to public health strategies aimed at reducing excessive alcohol consumption. Further examination of the impact of major retailers on public health initiatives is warranted, particularly in light of increasing retailer concentration.     

Nutritional data: what is available in Brazil?

Available nutritional information in Brazil, generated by non-periodic population surveys, has scarcely contributed to the development of policies aimed at improving the nutritional status of the Brazilian population, although it has helped establish the magnitude and distribution of this problem. We suggest that data available in the various health information systems be used to feed, monitor, and evaluate nutritional policies, for updating and local follow-up purposes. Deficiencies in the quality of data available in these health information systems can be minimized through validation studies, thus improving the information generated by the system as a whole and consequently the quality of health care.     

Aging and immigration: Who are the elderly?

Much U.S. research in aging and the social sciences of health compares beliefs, conditions, or behaviors of racial groups. In immigration studies, social identity is most often delineated by virtue of foreign origin with respect to a host country. Thus, nationality is often the marker of difference. The present article joins two generally separate streams of research, gerontologic and immigration research in the United States. The paper considers data from several studies of seniors in Cleveland, Ohio in the 1990s; the Black and White Caregivers and the Use of Services of Black and White Elderly. These are considered not in terms of their original research goals, but rather in terms of a reflective examination of assumptions regarding the identity of the elders and caregivers that framed the two studies. The results show that racial terms conceal, not reveal, the actual ethnic and therefore, cultural, affiliations of the seniors. We suggest that because racial classification is an impediment to, rather than a facilitator of, cultural comparisons, such terms should not be used to compare, predict or explain beliefs or behaviors. The revelation of distinct, highly varied ethnic groups within asserted homogeneous racial groups has implications for immigration studies. These are discussed in the final section as relates to psychiatric and social issues.     

insulin-like growth factor-i enhances gut growth and improves mucosal barrier function in sepric rats

Sepsis causes gut mucosal metabolic derangem-ints and has been implicated in altered barrier func-tion.Insulin-like growth factor-I(IGF-I)has beenshown to accelerate somatic growth,as well as to in-duce growth of the gut.To investigate the effect ofIGF-I on gut mucosal metabolism and barrier functionin sepsis,32 male wistar rats underwent cecal ligationwere randomized to 2 groups:IGF-I(n=17)re-ceived parenteral nutrition(PN)plus IGF-I 4mg.kg.~(-1)d~(-1)and control group(n=15)received PNonly,or 3 days.On day 4,body weight(BW)gain,     

Nutritional genomics in practice: where do we begin?

Nutritional genomics, which studies the genome-wide influences of nutrition, has far-reaching potential in the prevention of diet-related disease. It is highly likely that during the next decade the nutritional supplement and functional food industries will continue robust growth in response to advances in nutritional genomics research and its applications. Parallel to this growth will be impressive progress in understanding the specific influence of certain food components on metabolic pathways and on long-term risk for disease. As genetic information about individuals becomes available, such data are likely to redefine the current concept of preventive medicine. Dietetics professionals have the potential to harness this information and influence health promotion and disease prevention on a global scale. For these reasons, the dietetics profession has an exciting opportunity that, if seized and properly executed, could enhance the scientific foundation of clinical practice, improve therapeutic outcomes, and significantly expand career and economic opportunities for practitioners. The future of dietetics is unquestionably intertwined with nutritional genomics.