Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement

For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes (N = 139 couples) from the perspectives of the patient and spouse. Partners' dyadic expectations and spouses' gender were posited to moderate spouses' diet‐related control and patients' diet adherence. Among male patients, when both partners shared an expectation for spouse involvement greater diet‐related spouse control was associated with better diet adherence of patients. In contrast, when expectations for spouse involvement were not shared, greater spouse control by wives was associated with poorer diet adherence. Dyadic expectations for spouse involvement did not moderate the association between spouse control and diet adherence among female patients. Findings suggest that shared expectations for spouse involvement can facilitate spouses' attempts to improve patients' dietary adherence, especially among male patients and their wives.     

Adherence to the polyp prevention trial dietary intervention is associated with a behavioral pattern of adherence to nondietary trial requirements and general health recommendations

This study investigated the factors associated with success in meeting the dietary goals of the Polyp Prevention Trial (PPT), a 4-y low-fat, high-fiber, high-fruit/vegetable dietary intervention. The PPT provided a rare opportunity to assess factors in long-term adherence to a dietary pattern that required changes to multiple aspects rather than a single aspect of diet. Demographics, health indicators, and dietary intake were assessed at baseline and annually for 4 y of follow-up. Participants (n=833) received dietary and behavioral counseling to support adherence to trial dietary goals. We assessed the association of baseline variables and trial participation with success in meeting dietary goals. Participant adherence to the intervention goals was significantly associated with never smoking, no history of weight gain, and consumption of less fat and more fiber, fruits, and vegetables at trial baseline. Successful participants were also more educated and married, whereas those with the poorest adherence were older. In addition, successful participants demonstrated greater participation throughout the trial, including attendance at counseling sessions, completion of dietary records, and contacts with staff. Of particular interest were the behavioral and demographic characteristics that distinguished the subset of participants who achieved most or all dietary intervention goals across all 4 study years who we termed Super Compliers. These individuals also were more likely to adhere to social norms for healthy lifestyles and demonstrated greater adherence to other aspects of trial participation.     

Predictors of stage of adoption for colorectal cancer screening

BACKGROUND: Although colorectal cancer is the third most common cancer in women, little is known about predictors of adherence to screening. METHODS: A randomly selected sample of 202 predominantly low-income and African-American women were interviewed. Knowledge of, attitudes and beliefs about, and practices related to flexible sigmoidoscopy (FS) screening were assessed. RESULTS: The majority of participants were in the precontemplation stage of adoption (56%). There were significant differences by stage of adoption for FS beliefs, FS barriers, risk of developing colorectal cancer, worry about getting colorectal cancer, and physician recommendation to get a FS. Predictors of adherence to FS guidelines were perceiving fewer barriers to getting a FS and having a physician recommend a FS. CONCLUSION: Seventy-two percent of the women in this study were nonadherent to FS screening guidelines. Psychosocial factors play an important role in screening for colorectal cancer. Ways of reducing barriers and increasing physician recommendations should be explored.     

Why males in Bangladesh do not participate in reproductive health: lessons learned from focus group discussions

The article explores male perception, attitude, and knowledge on reproductive health issues and their opinions on how men's participation in reproductive health could be increased. Data were obtained from six focus groups' sessions organized among the men aged 18-59. The participants indicated that males are not motivated to be involved in reproductive health issues in Bangladesh. The participants feel that men also have unmet reproductive and sexual health needs. Their needs are not addressed and traditionally they are not encouraged to participate in reproductive health services. In Bangladesh poor interaction between husband and wife often makes it difficult to understand reproductive health problems of women. Because of prevailing culture and myth men do not visit health facilities with their wives; they do not feel comfortable to take their wives to the health facility because they do not like to discuss sexual reproductive health issues with the service providers. The analysis suggests that a complex web of social and cultural factors impedes spousal communication regarding reproductive health issues and that discourages them to take their wives to health clinics. In the focus group discussions men said that they do not feel comfortable in discussing sexually transmitted diseases with their wives. Generally women come to the health facility for the treatment of RTIs/STDs. Men do not bring their wives to the health facility because they feel shy to discuss such diseases with service providers. In order to increase male participation in reproductive health, males suggested introduction of male workers like the present female workers and visiting at the household level to counsel and mobilize them to participate in reproductive health. The analysis indicates that male involvement will be an important strategy to reach demographic goals in Bangladesh.     

Cyclic seasonal variation in plasma lipid and lipoprotein levels: the Lipid Research Clinics Coronary Primary Prevention Trial Placebo Group

Seasonal plasma lipid and lipoprotein cycles were studied in 1446 hypercholesterolemic 35-59 year-old men followed for 7 years as the placebo group of the Lipid Research Clinics (LRC) Coronary Primary Prevention Trial (CPPT). Separate periodic time series were calculated for each study participant; mean parameter estimates were obtained by vector algebra. Highly significant (p less than 0.001) synchronous sinusoidal seasonal cycles, peaking in the first month of winter, were demonstrated for plasma levels of total (TOT-C), low-density lipoprotein (LDL-C), and high-density lipoprotein (HDL-C) cholesterol. Their mean seasonal changes (nadir to zenith) were 7.4, 6.4, and 0.8 mg/dl, respectively. An irregular but statistically significant seasonal pattern was also observed for plasma triglyceride (TG) levels, with peak levels in the autumn. The variation of these seasonal effects among subgroups and geographic locales and their correlation with seasonal weight and dietary patterns yielded few clues as to their underlying etiologic mechanisms.     

Physical activity and coronary heart disease among asymptomatic hypercholesterolemic men (the Lipid Research Clinics Coronary Primary Prevention Trial).

We examined the relation between reported regular strenuous exercise or hard physical labor and the incidence of coronary heart disease (CHD) death and nonfatal myocardial infarction among 1,533 hypercholesterolemic men aged 35-59 years who were in the placebo group of the Lipid Research Clinics Coronary Primary Prevention Trial. The mean follow-up of the cohort was 7.4 years. The men were free of clinical heart disease at entry; men with an abnormal resting electrocardiogram or graded exercise test also were excluded. Regular physical activity was not associated with the incidence of CHD (RR = .94, 95% CI = .68, 1.38) in this study population. Adjustment by the proportional hazards model for age, low-density lipoprotein cholesterol, smoking, family history of CHD, and occupation did not alter this finding. This observation suggests that reported regular physical activity may not be related to the risk of coronary heart disease among asymptomatic, hypercholesterolemic, middle-aged men.     

The therapeutic value of fees: What do practitioners believe?

Theorists have proposed that out-of-ocket fee payment helps clients benefit from psychotherapy. 159 staff members of a public mental health agency completed a fee attitude survey. Aggregate results indicated neutral beliefs. Significant differences appeared by gender, population served, and organizational role. Women were less likely than men to endorse TVF beliefs. Addiction services staff held strongest TVF beliefs, child and adult mental health staffs were neutral, and victim services staff rejected TVF beliefs. Clinical service providers were less likely to endorse TVF concepts than were clinicians in management roles, and non-clinical support staff held the strongest TVF beliefs. By understanding the relationships between fee attitudes, organizational role, and populations served, mental health administrators may be better able to manage changes in fee procedures.     

The Effect of Changes in Health Beliefs Among African-American and Rural White Church Congregants Enrolled in an Obesity Intervention: A Qualitative Evaluation

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants’ health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel “empowered” after 12 weeks compared to initially feeling “out of control” with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.     

Unsafe abortion in Tanzania and the need for involving men in postabortion contraceptive counseling

Targeting male partners involved in unsafe abortions for contraceptive counseling could be an important strategy for decreasing the incidence of unwanted pregnancies, yet few postabortion-care programs have attempted to involve these men. To assess the need for and determine the content of postabortion contraceptive counseling for men, this study examined the contraceptive knowledge, attitudes, and practices of male partners of women who have had an unsafe abortion. A survey was administered to 213 men accompanying female partners receiving hospital care after having undergone an unsafe abortion in Dar es Salaam, Tanzania, and 20 of these men participated in in-depth interviews. Sixteen percent of the men surveyed accompanied an extramarital partner, and of those, only 44 percent reported having practiced contraception in the last six months, compared with 81 percent of the men accompanying their wives and 83 percent accompanying their girlfriends. In general, the men wished to support their partners in practicing contraception, and the majority were willing to participate in contraceptive counseling. These findings suggest that male partners should be included in postabortion contraceptive counseling, which should be sensitive to the nature of the partners' relationship, the risk of HIV transmission, and the importance of promoting gender     

Knowledge, attitudes and beliefs about HIV infection and AIDS among healthy factory workers and their wives, Kinshasa, Zaire

As a first step in designing an AIDS prevention program at a large factory in Kinshasa, Zaire, we collected information on attitudes towards human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) from factory foremen and their wives. Trained moderators conducted twelve focus group discussions (from November through December 1987) that addressed knowledge, attitudes and beliefs about HIV infection and AIDS. In general, participants were familiar with HIV infection and AIDS and considered these conditions leading health problems in Kinshasa. Although participants had a fairly accurate understanding of the causes of HIV infection, modes of transmission and preventive measures, many myths and misconceptions existed. Many participants did not believe that condom use would consistently prevent infection through sexual intercourse. Participants strongly favored the counseling of seropositive persons but showed less consensus about whether the spouse of a seropositive person should be notified of the partner's test result. Participants predicted that couples in which one member is seropositive and the other is not would experience marital discord and friction with family, neighbors and co-workers. These findings were applied to the development of a counseling and educational program for seropositive factory employees and their spouses.     

广西乡镇卫生院医务人员精神卫生知识知晓状况及影响因素调查

目的 了解广西乡镇卫生院医务人员精神卫生知识知晓情况及其影响因素。方法 于2018年6月,采取分层整群随机抽样方法抽取广西45所乡镇卫生院888名医务人员,开展精神卫生知识知晓状况调查,调查工具采用原卫生部办公厅下发的《心理健康知识和精神障碍预防知识问卷》。结果 广西乡镇卫生院医务人员精神卫生知识总体知晓率为75.8%,其中反映精神障碍病因与预防知识的知晓率为66.1%,精神卫生节日-“世界自杀预防日”知晓率为27.4%。不同年龄、学历、职称、职业类型、精防工作和培训等因素之间知晓率差异有统计学意义（〖XC小五号.EPS;P〗值分别为12.049、185.897、41.145、37.297、108.006和88.153,P均<0.05）。精防人员知晓率（83.9%）高于非精防人员（74.4%）;参加精神卫生培训者知晓率（81.3%）高于非参加者（74.2%）。多元逐步回归分析显示,学历、职称、参加精防工作和培训与精神卫生知识得分呈正相关（P<0.05）;参加精防工作和培训是影响知识得分的主要因素。结论 广西乡镇卫生院医务人员精神卫生知识的知晓率仍需进一步提高。影响精神卫生知识知晓水平的主要因素包括参加精防工作、参加精神卫生培训、学历和职称。     

Effects of passive smoking in the Multiple Risk Factor Intervention Trial

The Multiple Risk Factor Intervention Trial (MRFIT), conducted in 1973-1982, provided a unique opportunity to study the effect of passive smoking on men whose wives smoke. MRFIT participants who reported at entry that they had never smoked tobacco products were classified according to the smoking status of their wives. Men with wives who smoked had similar mean levels of serum thiocyanate (54.3 vs. 53.9 mumol/liter, p = 0.83) but higher mean levels of expired carbon monoxide (7.7 vs. 7.1 ppm, p = 0.001). Lower levels of pulmonary function (by maximum forced expiratory volume in one second) were also observed in these men (3,493.1 vs. 3,591.9 ml, p = 0.04). The relative risks, for men whose wives smoked compared with men whose wives did not smoke, for the endpoints coronary heart disease death, fatal or nonfatal coronary heart disease event, and death from any cause were 2.11 (p = 0.19, 95% confidence interval (CI) 0.69-6.46), 1.48 (p = 0.13, 95% CI 0.89-2.47), and 1.96 (p = 0.08, 95% CI 0.93-4.11), respectively. When smokers who quit prior to entry were included in the analyses, the relative risks, for men whose wives smoked compared with men whose wives did not smoke, for the above endpoints were 1.45 (p = 0.25, 95% CI 0.77-2.73), 1.19 (p = 0.29, 95% CI 0.85-1.65), and 1.72 (p = 0.01, 95% CI 1.12-2.64), respectively. These relative risk estimates did not change appreciably after adjusting for other baseline risk factors. The results suggest that passive exposure to cigarette smoke may have a deleterious impact on the health of nonsmokers and that nonsmokers may be at an increased risk of death through passive exposure to cigarette smoke.     

The validity of estimating heart disease reduction from a Framingham logistic equation.

We compared two ways in which a logistic equation could be used to estimate the number of heart disease events prevented after lowering blood cholesterol levels. Men were selected from an Australian population survey who met the entry criteria of the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT). The numbers of heart disease events expected over 7.4 years were calculated from the logistic equation after reducing the men's blood cholesterol by the amounts achieved in the LRC-CPPT placebo and treatment groups (our simulated placebo and treatment groups). The number of events prevented was calculated as the absolute difference between the simulated groups (9.48 per 1000 men per 7.4 years) and the percentage difference of the simulated groups multiplied by the observed incidence rate in the LRC-CPPT placebo group (13.66 per 1000 men per 7.4 years). The second estimate was closer to that observed in the LRC-CPPT (17.10 per 1000 men per 7.4 years), and we recommend this approach in cost-effectiveness studies.     

Perception of genital prolapse: a hospital-based study in Alexandria (Part II)

Genital prolapse is a common health problem, understanding women's perceptions and beliefs may illuminate our understanding of their health seeking behavior which form a first step in any effort to improve their health. The present study was designed to investigate the perception of genital prolapse among women attending the outpatient clinic in El-Shatby Maternity University Hospital in Alexandria. Data was collected from a sample of 291 women who had any form of genital prolapse. Women's knowledge about risk factors for genital prolapse, women's beliefs related to genital prolapse as well as their beliefs about assistance at delivery (beliefs were assessed through the Health Belief Model) were measured for women who knew that they were suffering of genital prolapse (n = 40). The results revealed that more than two thirds of cases (70.4%) had poor (36.4%) or fair knowledge (34%) and only 29.6% had satisfactory knowledge. The majority of women having positive perception to diagnosis and symptoms for genital prolapse had high perception of "susceptibility" to and "severity" of complications of genital prolapse (97.5% and 85% respectively). More than two thirds (67.5%) had high scores of "perceived benefits" of treatment and medical advice, while nearly one third (32.5%) scored moderate. The majority of women (82.5%) had either moderate scores (55%) or high scores (27.5%) of perceived barriers to compliance to medical instructions or recommended surgery. About two thirds of cases (65.6%) sought medical care later than one year of perception of symptoms. Women's knowledge and degree of genital prolapse were directly related to women's report of symptoms characteristic of prolapse, while the level of education was inversely related. Health education for women on different aspects of reproduction using appropriate materials is highly recommended.     

Video intervention/prevention assessment: a patient-centered methodology for understanding the adolescent illness experience.

OBJECTIVE: To better understand the issues and needs of adolescents with chronic health conditions, the Video Intervention/Prevention Assessment (VIA) integrates video technology with qualitative research methods to obtain a patient-centered perspective on illness and health care. METHODS: Young people with chronic disease are interviewed for condition-specific verbal reports (CSVRs) of their medical and psychosocial histories. Standardized health-related quality of life (HRQL) instruments are administered. Trained to use video camcorders, participants record visual narratives of their illness experiences. They document their daily lives, interview families and friends, and record personal monologues regarding their observations, behaviors, understandings, and beliefs about their disease. On completion of the visual narratives, HRQL is again evaluated. Verbal, scaled, and visual data are analyzed from three perspectives: medical, psychosocial, and anthropological. Data from the CSVRs, HRQLs, and visual narratives are triangulated to validate and enrich findings. RESULTS: Investigating the illness experience from the adolescent patient's perspective, the VIA method was pilot-tested with children and adolescents with asthma. As a research tool, VIA found environmental risk factors, medication adherence problems, and outcome-affecting illness beliefs and psychological states that were not identified by standard clinical tools. As an intervention, VIA showed that it may be an effective tool for health-related environmental surveys. Participants' condition-specific quality of life showed measurable improvement after the self-examination process of VIA. As communication, VIA made apparently counterproductive patient behaviors understandable by showing them in context with the adolescent's experience of illness and health care. VIA can enhance medical history-taking and management strategies, improve adolescents' self-management skills, and educate clinicians, families, and students of the health care professions about the realities of the adolescent living with a chronic health condition.     

The involvement of occupational health services prior to ill-health retirement in NHS staff in Scotland and predictors of re-employment

OBJECTIVE: To assess the process, causes and outcomes of retirement because of ill-health in NHS staff in Scotland. Particular areas to be investigated include the involvement of occupational health services, access to rehabilitation and redeployment, current health, whether working again and to identify predictors of re-employment. METHOD: An ill-health retirement (IHR) questionnaire was mailed to 863 NHS staff awarded IHR benefits by the Scottish Public Pensions Agency between April 1998 and March 2000. RESULTS: In all, 49% of the 863 postal questionnaires were returned. The most common reasons for retiring were diseases of the musculoskeletal system (38%) and mental disorders (21%). Seventy-one percent of the participants reported their ill-health was partly or completely work related and 29% not work related. Ninety-two percent of NHS staff had attended an occupational health department prior to IHR. Twenty-three percent of participants had no contact with their line manager during their illness prior to retiral. Eighteen percent of individuals were offered the opportunity of working part-time and 15% offered alternative work. Seventeen percent of participants have obtained other work. Predictors of re-employment after IHR were: medical condition, managerial responsibility, improvement of health, wanting to work again, occupation and age at retirement. CONCLUSION: This is the first comprehensive study investigating NHS staff experiences of IHR in Scotland. This study illustrates the need for improved support and rehabilitation for ill-health care workers and that there is the potential to reduce levels of ill-health retirement.     

Population screening and referral for hypercholesterolemia

To determine the potential effect of screening on referral patterns, an adult population sample (4,404 men, 5,164 women, 20-69 years of age) was systematically recruited and screened for hypercholesterolemia and then analyzed by different cholesterol referral recommendations. Using levels suggested by the Lipid Research Clinics Coronary Primary Prevention Trial (greater than or equal to 265 mg/dL), 7.3% of men and 5.8% of women would be referred for follow-up. With the suggested recommendations of the National Cholesterol Education Program (NCEP), (greater than or equal to 200 mg/dL), 49.2% of men and 40.2% of women would be referred. The use of age-related definitions of the NIH Consensus Conference on Lipid Lowering results in 28.0% referrals in men and 21.8% in women. From this population, hypercholesterolemia subjects (greater than or equal to 265 mg/dL at screening; n = 624) were invited for a second cholesterol determination (58% returned), which found 36% below the 265 mg/dL level. Population screening for cholesterol is likely to produce large numbers of patients for follow-up, with the actual numbers strongly dependent on cutoff levels and age-sex distributions. Referral and follow-up of these patients may place a significant load on an unprepared health care community.     

Dietary changes among husbands of participants in a low-fat dietary intervention.

A dietary intervention delivered to one family member with a beneficial impact on other members could provide a cost-effective approach to public health dietary intervention programs. The Women's Health Trial (WHT) was a study in which women were randomized to be trained in adopting a low-fat diet or to continue their normal diet. The intervention women consumed 21% of total calories from fat versus 38% for control women at six months postrandomization. Husbands of women in the Seattle Clinical Center of the WHT were surveyed between 1985 and 1988 to determine whether and to what extent the husbands' diets changed at six months. Ninety-one intervention men and 162 control men, 79% of those eligible, participated. Intervention men reported an average weight loss of 2.4 pounds, compared to an average 0.7-lb loss among controls (P = .03). Based on self-reported change of specific foods, we found that intervention men more often reduced butter, margarine, eggs, and red meat over the six months than did control men (P less than .001). Based on nutrient consumption estimated by a food frequency questionnaire, intervention husbands consumed 34% of total calories from fat versus 36% for controls (P = 0.04). The number of meals shared with wives per week modified the effect of the intervention: among the intervention group, for every three meals shared, an accompanying one percentage point reduction in percentage of calories from fat occurred in the husband's diet. Thus, we suggest that dietary intervention programs attended by one spouse appear to exert a small beneficial effect on the other spouse.     

Smoking, physical activity, and other predictors of endurance and heart rate response to exercise in asymptomatic hypercholesterolemic men. The Lipid Research Clinics Coronary Primary Prevention Trial

The association of known coronary risk factors with progressive submaximal treadmill exercise tolerance test performance was studied in 6,238 asymptomatic white 34-60-year-old hypercholesterolemic men screened between 1973 and 1976 for the Lipid Research Clinics Coronary Primary Prevention Trial. Cigarette smoking and habitual physical inactivity were each associated with a doubling of the rate of symptom-related discontinuation of the exercise test; the tests of sedentary smokers were discontinued at four times the rate observed for active nonsmokers. Smaller increases in heart rate were observed during exercise testing in physically active men and in smokers than in their sedentary and nonsmoking counterparts. Thus, smoking, like habitual physical activity, reduced the heart rate required to sustain a given external workload. However, the heart rates of smokers tended to remain elevated after exercise, while those of physically active men returned more rapidly toward resting levels. Age, Quetelet index, and low plasma levels of high density lipoprotein cholesterol were also strong predictors of decreased endurance, while resting heart rate and blood pressure levels were significant predictors of heart rate response. Comparison of these results with those previously reported for ischemic electrocardiographic changes in this cohort suggests that coronary risk factors may selectively influence specific aspects of exercise tolerance test performance.