Physical and psychological health of first and second generation Turkish immigrants in Germany

Recent studies in Germany suggest that first generation Turkish immigrants have lower mortality rates compared to native Germans. Conversely, studies examining morbidity, though not national in scope, have demonstrated that first generation Turks may have poorer health than native Germans. Additionally, little is known about the health of the emerging second generation Turkish population in Germany. To evaluate the discrepancy between mortality and morbidity trends and contribute to a better understanding of second generation Turkish immigrant health, this paper uses a nationally‐representative dataset, including the 2005 German Gender and Generations Study (GGS) (n = 10,017) and the 2006 GGS Turkish supplement (n = 4,045), to assess three health outcomes: chronic illness, self‐assessed health, and feelings of emptiness. The paper investigates whether sex, age, socioeconomic status, emotional support, or duration of residence in Germany predict these dimensions of health. Results establish clear health status differences between Turks and native Germans. Surprisingly, both first and second generation Turks tend to have lower chronic illness rates and rate their health as better than Germans at younger ages, but the advantage diminishes among higher age strata for the first generation. Feelings of emptiness results generally indicate an increased susceptibility to psychological problems for both generations of Turks. Controlling for socioeconomic status and age reduces these health differences modestly, pointing to their likely role as mediators. The relatively higher risks for all three health outcomes among Turkish females of both generations compared to their German counterparts suggest that female Turkish immigrants and their female offspring may be particularly vulnerable. Am. J. Hum. Biol. 2010. © 2010 Wiley‐Liss, Inc.     

Increase in safe sex among the young and non-monogamous: knowledge,attitudes and behavior regarding safe sex and condom use in The Netherlands from 1987 to 1993

In 1987, the Dutch STD Foundation started several safe sex campaigns targeting the general population. These campaigns have been accompanied by surveys which were conducted every 6 months. Questions were asked about knowledge, attitudes and behavior. The number of people who regard condom use as being a safe sex practice increased over the years, as did the number of people who know that condoms protect against STDs and AIDS. Surprisingly, no accompanying changes in attitudes occurred. Nevertheless, the number of people saying they have done something to prevent HIV infection increased significantly among the young and non-monogamous. Also, specifically in these groups, both actual and intentional condom use increased remarkably. Although it is encouraging that those towards whom the campaigns were particularly directed, show the largest changes, there are also signs that these behavioral changes are levelling off.     

Perceived distributions of opinions in young generation and their parents' generation regarding sex roles

This study examined how people perceive the distributions of opinions about sex roles, in particular, how they saw generational differences in the opinions. Undergraduates and their parents were asked to estimate the opinion distributions in young generation as well as in their parents' generation. They were also asked to indicate their own opinions and the degree of their involvement with the issue. Main results were as follows: First, generation gaps were perceived; the respondents estimated that there would be stronger support for relatively liberal opinions in young generation than in their parents' generation, while the generation gaps were perceived in the reverse direction regarding relatively traditional opinions. Second, although this tendency was found for both sexes, it was more pronounced for female respondents. Third, fathers with higher personal involvement with the issue estimated stronger support for liberal opinions, while mothers with higher personal involvement estimated weaker support. This tendency in mothers was more salient in those who themselves supported relatively liberal opinions.     

The association between implicit attitudes toward physical activity and physical activity behaviour: a systematic review and correlational meta-analysis

ABSTRACT

As a result of recent calls to attend to the implicit processes that regulate health behaviours, the study of implicit attitudes and physical activity behaviour has grown rapidly in the past decade. The aim of this study was to summarise existing evidence on the extent to which implicit attitudes toward physical activity are associated with physical activity behaviour. A systematic literature review was performed to retrieve studies reporting both a measure of implicit attitudes and physical activity. For the meta-analysis, effect size (Pearson’s r) were extracted from eligible studies or retrieved from authors. A total of 26 independent studies, and 55 effect sizes, were eligible. There was a small, significant, and positive correlation between implicit attitudes and physical activity, a finding replicated across multiple meta-analytical strategies with sensitivity analyses applied. This association was not significantly moderated by study design or objective, participants’ age or other characteristics, or measures of implicit attitudes or physical activity. This meta-analysis provides evidence that implicit attitudes toward physical activity are positively associated with physical activity in adults to a small degree.     

Informing school sex education using the stages of change construct: sexual behaviour and attitudes towards sexual activity and condom use of children aged 13-16 in England

A survey of 3820 school children in England aged 13-16 years examined sexual activity using the Transtheoretical Model (TTM) Stages of Change. A quarter (26%) of teens were sexually experienced, 44.8 per cent did not use contraception and 48.9 per cent did not use condoms, every time. Past history of condom and contraceptive use, and partner willingness to use condoms were the best predictors of being in Action or Maintenance stage for condom use. Of virgins, 19.82 per cent were in Contemplation or Preparation stages for intercourse, and 85.4 per cent would use condoms every time. Sex education should be tailored to Stage, and signposting to sexual health and contraception services.     

AIDS and Danish adolescents--knowledge, attitudes, and behaviour relevant to the prevention of HIV-infection

To evaluate the effect of previous AIDS education on AIDS knowledge and sex behaviour among Danish adolescents, a survey was carried out in April-May 1988 amongst 15-16 year-old school children of 9th grade elementary school. Through a cluster-sampling procedure, 45 school classes in nine geographical areas around the country were selected representing various degrees of urbanisation. A questionnaire was handed out and collected by the local school physician during a class session. The 728 pupils responding corresponded to a response rate of 89% of the pupils enlisted and 99% of the pupils present. The results demonstrate that AIDS education has been widely introduced in Danish schools and is well accepted. However, school health services have only rarely been involved. The educational activities seem to have a positive effect on knowledge about HIV-transmission and AIDS, attitudes towards the use of condoms and actual sexual behaviour, although risk-behaviour is still prevalent. The respondents express positive attitudes towards more AIDS education--especially among those with very little or no previous educational experiences.     

Histamine H1 receptor occupancy and pharmacodynamics of second generation H1-antihistamines

Summary. The predictive efficacy of drugs in humans is frequently estimated from both a high affinity for their receptor as measured in vitro and a long plasmatic half-life. This is grossly misleading since one key parameter is missing: drug concentration at the receptor site in vivo. As a case study we compared the efficacies of three H₁ antihistamines in inhibiting histamine-induced wheal and flare in humans at two different time points with the above mentioned parameters. It is concluded that estimating in vivo receptor occupancy, which takes into account both the affinity of the drug for the receptor and its free plasma concentration, is a far better predictor for human pharmacodynamics and hence antihistamine potency, than considering in vitro affinity and plasmatic half-life only. Received 2 May 2005; returned for revision 7 June 2005; accepted by M. J. Parnham 13 June 2005     

A comparison between one first generation and three second generation anti-HCV ELISAs: an investigation in high- and low-risk subjects in correlation with recombinant immunoblot assay and polymerase chain reaction

One first generation assay (manufactured by Ortho, test I) and 3 second generation anti-HCV ELISAs (manufactured by Ortho, Abbott, and UBI, tests II-IV) were compared. Sera from 4 different sources were used: (1) intravenous drug-users (IVDUs, n = 50), (2) blood donors (n = 1055), (3) all clinical samples from one day of routine anti-HCV testing (n = 89), (4) hemodialysis patients previously found negative by test I but clinically suspected to have a HCV infection (n = 11). Confirmatory anti-HCV tests were carried out with a second generation recombinant immunoblot assay (RIBA II). In sera positive exclusively by test IV, one antibody consumption test (UBI HCV Neutralization EIA) and one further immunoblot assay (INNO-LIA HCV Ab) were used. PCR for HCV RNA was carried out on all hemodialysis patient sera and in the RIBA II positive blood donor sera. The second generation ELISAs discriminated 11 more positive samples than the first generation test (2 IVDUs, 5 blood donors, 4 clinical samples). The 9 sera from blood donors and clinical samples were all RIBA II positive or indeterminate. The second generation tests thus showed increased sensitivity. The second generation tests also showed increased specificity in that 4 samples that were positive by test I but negative by the second generation tests, were also negative by RIBA II. With few exceptions, all RIBA II-positive and most of the indeterminate samples were positive by the second generation ELISAs. With few exceptions, all the RIBA II-negative samples were negative by the second generation ELISAs. Eleven blood donor sera were positive by test IV exclusively where RIBA II and other supplementary assays were negative. The recently introduced second generation anti-HCV ELISAs were found to have a higher sensitivity than the first generation test. The tests also showed a good concordance with the exception of test IV in the group of blood donor sera.     

Family experiences and attitudes about receiving the diagnosis of sex chromosome aneuploidy in a child

The most common sex chromosome aneuploidies (SCA) (47, XXY; 47, XYY; 47, XXX) frequently result in a milder phenotype than autosomal aneuploidies. Nevertheless, these conditions are highly variable and more symptomatic phenotypes may require significant clinical involvement, including specialty care. While historically most individuals with mild phenotypes remained undiagnosed during their lifetime, the increasing use of genetic testing in clinical care has increased the prenatal and postnatal diagnosis of SCAs. These genetic tests are frequently ordered by nongenetic providers who are also responsible for delivering the diagnosis. We surveyed parents of children (n = 308) to evaluate their experience of receiving a diagnosis and their support needs. The majority (73.3%) received the diagnosis from a nongenetic medical provider. Following a prenatal diagnosis parents reported experiencing depression, anxiety, and less optimism than those receiving a postnatal diagnosis. Few parents reported receiving materials explaining their child's condition that they found to be up‐to‐date, accurate, and unbiased. The frequently negative reported experiences of parents at time of diagnosis suggests more educational opportunities should be provided for nongenetic providers in order to become more informed about these conditions and communicate the diagnosis in a way parents experience as supportive.     

The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda

Background

Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples.

Methods

A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2.

Results

Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51, and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity, securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child, lack of negotiating power for safer sex, failure of health systems to offer safe methods of reproduction

Conclusions

HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues, risky behaviour and reproductive health services for HIV sero-discordant couples.     

Assessment of medical students' communicative behaviour and attitudes: estimating the reliability of the use of the Amsterdam attitudes and communication scale through generalisability coefficients

It is widely accepted that adequate attitudes and communicative skills are among the essential objectives in medical education. The Amsterdam attitude and communication scale (AACS) was developed to assess communicative skills and professional attitudes of medical students. More specifically, it was designed to evaluate the clinical behaviour of clerks to establish their suitability for the medical profession. The AACS covers nine dimensions. Moreover, an overall judgement of the student's performance is included. The present paper reports first results on the reliability of the use of the AACS.Data were collected in the course of an AACS training programme for future judges: senior medical and nursing staff members (N=98). Participants judged three videotapes of clerks interviewing patients at the bedside. For the assessment of videotapes, the first four dimensions of the AACS and the overall judgement are relevant. By applying Generalisability Theory to the training data we can forecast the reliability of the AACS in practice and gain insight in the number of raters that is needed to achieve sufficient reliability in clinical practice.If clerk behaviour is rated by six judges, summative assessment is sufficiently precise, i.e. <0.25. When using the full AACS, covering 10 items, the same number of judges is needed. Scores on individual AACS items are not sufficiently reliable. In conclusion, the results indicate that students' behaviour can be evaluated in a reliable manner using the AACS as long as enough judges and items are involved.     

Clinical guidelines in primary care: a survey of general practitioners'' attitudes and behaviour.

BACKGROUND: In the United Kingdom little is known about general practitioners' attitudes to and behaviour concerning clinical guidelines. AIM: A study was performed to investigate these two under-researched areas. METHOD: In 1994 a postal questionnaire on clinical guidelines was sent to all 326 general practitioner principals on the list of Lincolnshire Family Health Services Authority. The questionnaire consisted of 20 attitude statements and an open question on clinical guidelines, as well as surveying characteristics and behaviour of respondents. RESULTS: Of the 326 general practitioners sent questionnaires, 213 (65%) replied. Most respondents (78%) reported having been involved in writing inhouse guidelines. An even greater proportion (92%) reported having participated in clinical audit. Respondents were generally in favour of clinical guidelines, with mean response scores indicating a positive attitude to guidelines in 15 of the 20 statements, a negative attitude in four and equivocation in one. The majority of respondents felt that guidelines were effective in improving patient care (69%). Members (or fellows) of the Royal College of General Practitioners had a more positive attitude than non-members towards guidelines. They were also significantly more likely than non-members to have written inhouse guidelines, as were those who had participated in audit compared with those who had not participated in audit. A substantial minority (over a quarter) of general practitioners were concerned that guidelines may be used for setting performance-related pay, or that they may lead to 'cookbook' medicine, reduce clinical freedom or stifle innovation. There was also concern that guidelines should be scientifically valid. CONCLUSION: This study suggests that many general practitioners in the Lincolnshire Family Health Services Authority area have produced written inhouse guidelines. This is largely sustained by positive attitudes about the effectiveness and benefits of clinical guidelines. The positive attitude of RCGP members supports it in its continuing role in developing, implementing and evaluating guidelines in primary care. The question of whether incorporation of guidelines into clinical audit is an effective means to disseminate systematic research-based guidelines warrants further study.