Contraception and abortion coverage: what do primary care physicians think?

BackgroundInsurance coverage for family planning services has been a highly controversial element of the US health care reform debate. Whether primary care providers (PCPs) support public and private health insurance coverage for family planning services is unknown.Study DesignPCPs in three states were surveyed regarding their opinions on health plan coverage and tax dollar use for contraception and abortion services.ResultsAlmost all PCPs supported health plan coverage for contraception (96%) and use of tax dollars to cover contraception for low-income women (94%). A smaller majority supported health plan coverage for abortions (61%) and use of tax dollars to cover abortions for low-income women (63%). In adjusted models, support of health plan coverage for abortions was associated with female gender and internal medicine specialty, and support of using tax dollars for abortions for low-income women was associated with older age and internal medicine specialty.ConclusionThe majority of PCPs support health insurance coverage of contraception and abortion, as well as tax dollar subsidization of contraception and abortion services for low-income women.     

Human papillomavirus infections and risks of cervical cancer: what do women know?

Human papillomavirus (HPV) is now known to be a risk factor for the development of cervical cancer. This study examines women's knowledge of cervical screening and dysplasia and HPV. The entire female work force of a medium-sized UK university received a questionnaire concerning knowledge of cervical screening, treatment for abnormalities and HPV. Four hundred women returned completed questionnaires. Knowledge of early cervical cancer detection and screening methods was good. However, risk factors for cervical cancer were not well known. Awareness and knowledge of HPV was very limited. Past experience of an abnormal smear result and colposcopy was significantly associated with good knowledge of cervical screening, but not with knowledge of HPV. It is essential to improve women's understanding of this area in the context of plans to include screening for HPV in the UK's national cervical screening programme.     

Health information, the HIPAA privacy rule, and health care: what do physicians think?

This study examines physicians' attitudes toward key Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule requirements and assesses the effects of their implementation. We found that despite physicians' generally negative views toward the Privacy Rule, they rated organizations implementing more rule requirements better at protecting the privacy of patient records than organizations that have not implemented the requirements. The policy implications of the findings are discussed.     

Adolescents and genetic testing: what do they think about it?

PURPOSE: To examine adolescents' attitudes toward screening for hereditary disorders. METHODS: A survey was distributed among 672 students in grades 10 to 12 attending a public suburban high school. The first part of the survey consisted of information about three diseases: familial breast cancer, Tay-Sachs disease, and hypercholesterolemia. The second part was a questionnaire developed by the authors, which explored students' attitudes toward testing for these diseases. Comparisons between and within groups were performed using X2 analysis. RESULTS: Out of the 672 surveys distributed, 361 were returned (54% response rate). Mean age of participants was 17 +/- 1 years. Most girls (67%) wanted to be tested for familial breast cancer. Girls were significantly more willing than boys to be tested for Tay-Sachs disease (23% vs. 13%, p <.002) and for hypercholesterolemia (54% vs. 39%, p <.001). Girls who had a relative with breast cancer were significantly more willing to be tested than other girls (p <.05). Individuals in the ethnic risk groups for Tay-Sachs disease were significantly more willing to be tested than those not in the ethnic risk groups (p <.001). However, only 33% of those in the ethnic risk groups for Tay-Sachs disease stated that they would either "definitely" or "probably" wish to be tested. Students who had a family history of high cholesterol were significantly more willing to be tested than those without a family history (70% vs. 34%, p <.0001). About 81% of the students with a family history of high cholesterol had never been referred for cholesterol testing. Only about 25% of participants stated that their attitude toward genetic testing was affected by concerns that genetic information might be misused by insurance companies/employers. CONCLUSIONS: The main motivator for genetic testing is having someone in the family affected by the disease in question. Adolescent girls are more willing to be tested for genetic diseases than are boys.     

Evidence-based priority-setting: what do the decision-makers think?

OBJECTIVES: Resource scarcity dictates the need for health organisations to set priorities. Although such activity should be based, at least in part, on evidence, there are limited examples in the literature of decision-makers reflecting on their use of evidence in priority-setting. METHODS: A participatory action-research project was conducted in a single health authority in Alberta. It included in-depth interviews and focus groups with senior decision-makers both before and after development and implementation of a macro-level priority-setting framework (programme budgeting and marginal analysis, PBMA). Data were thematically coded and information on the use of evidence in priority-setting is reported. RESULTS: Barriers to the use of evidence in priority-setting identified by decision-makers included crisis-orientated management, time constraints and a lack of skills. Decision-makers suggested using a mix of 'soft' and 'hard' forms of evidence in priority-setting. Following PBMA implementation, decision-makers wanted better information on capacity to benefit, but preferred to do this pragmatically from multiple sources of information rather than using a single metric. CONCLUSION: In examining the perspectives of decision-makers in using evidence to support priority-setting, valuable information was derived which should provide insight for such processes in other jurisdictions. The main finding of a desire for pragmatic assessment of benefit is informative for those involved in both decision-making and research.     

Emergency contraception in Mexico City: what do health care providers and potential users know and think about it?

Emergency contraception promises to reduce Mexico's high unwanted pregnancy and unsafe abortion rates. Because oral contraceptives are sold over-the-counter, several emergency contraceptive regimens are already potentially available to those women who know about the method. Soon, specially packaged emergency contraceptives may also arrive in Mexico. To initiate campaigns promoting emergency contraception, we interviewed health care providers and clients at health clinics in Mexico City, ascertaining knowledge, attitudes, and practices concerning the method. We found limited knowledge, but nevertheless cautious support for emergency contraception in Mexico. Health care providers and clients greatly overestimated the negative health effects of emergency contraception, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believed emergency contraception should be more widely available, including in schools and vending machines with information prevalent in the mass media and elsewhere.     

The recruitment and training crisis in community paediatrics: what do registrars think?

OBJECTIVE: There is currently a crisis in the recruitment of trainees into community paediatrics. Focus groups were conducted to explore the views of paediatric specialist registrars about this crisis. DESIGN: A total of 18 registrars participated in two focus groups. Data were analysed qualitatively by content analysis. RESULTS: The overriding theme was the poor status and image of community compared with acute paediatrics. This existed at five levels, which could be arranged from a 'macro' structural level down to a 'micro' individual level. These were: the hospital/community divide, issues related to training, practical experience, the influence of role models, and personal factors. CONCLUSIONS: We identified several specific implications for community paediatric training. However, the deep divide between acute and community paediatrics, as perceived by registrars, is unlikely to change unless training programmes are designed to produce paediatricians suited to the needs of future child health services rather than existing models of acute and community paediatricians.     

A novel ENT iBook: what do junior doctors think?

Exposure to the specialty of Otolaryngology is limited. It may be consolidated by the use of an iBook as a self-study tool. The purpose of this study was to ascertain the perceptions of junior doctors on the clinical relevance of this novel educational resource. Three focus groups were formed each consisting of five junior doctors (eight female: seven male, median age 27 years). The iBook was found to be clinically relevant to the work of junior doctors, have a clear layout, with adequate interactivity and a good range of integrated multimedia elements.     

Concordance with heart failure medications: what do patients think?

The need for effective diagnostic and treatment strategies inheart failure is immense: the condition occurs in at least 2.3%of the adult population over 45,¹ rising to 4% in over 75 yearolds.¹ Symptomatic heart failure has a major impact on patientsand healthcare systems: its prognosis for patients after hospitaldiagnosis is worse than breast or prostate cancer,²     

Executive summary--nutritional care of HIV-infected adolescents and adults, including pregnant and lactating women: what do we know, what can we do, and where do we go from here?

The HIV pandemic continues to place an unbearable burden on the international community, with disease prevalence remaining highest in resource-limited settings in Africa, Asia, and the Americas. HIV is most often imposed on conditions of food insecurity and consequent malnutrition, poor sanitation, and chronic exposure to a myriad of infectious (eg, malaria, tuberculosis, and diarrheal) and noncommunicable (eg, obesity, diabetes, cancer, and cardiovascular) diseases. Women and children continue to bear the greatest burden. Two essential tenets underpin our approach to HIV: 1) antiretroviral drugs (ARVs) are essential to prolong lives and to halt the spread of HIV and AIDS and 2) food and sound nutrition are essential to human health. The challenge is to apply sound principles of clinical care and nutrition science to the safe and efficacious implementation of ARVs and for long-term care for people living with HIV and AIDS. The WHO has played a leading role in developing guidelines to support this goal with the generation of general recommendations regarding nutritional needs of people living with HIV and AIDS and specific guidelines for the nutritional care of HIV-infected infants and children (<14 y of age). These proceedings represent a summary of the work accomplished at a workshop sponsored by the NIH to review the existing evidence to support changes in the recommendations regarding nutrient requirements for people living with HIV and AIDS; to support development of new WHO guidelines for adolescents and adults, including for pregnant and lactating women; and to identify a research agenda to address outstanding knowledge gaps.     

Health care participation of perinatal women with HIV: what helps and what gets in the way?

Dealing with the reality of the human immunodeficiency virus (HIV) is a life-changing challenge to perinatal women as they try to care for themselves and their children in environments that often include stigma, uncertainty, and limited access to information and health care. Our purpose for this interpretive hermeneutic study was to identify factors that women with HIV saw as helping or impeding their participation in their health care. We analyzed the qualitative data from open-ended interviews conducted with 18 women. We identified the facilitating themes of "Staying Healthy for Kids," "God Has His Reasons," and "My Family's There for Me." Barriers were "It Hurts to Know," "Health Care System Struggles," and "Kids and Buses and Taxies." We found that the women identified "Health Care Providers' Behaviors" as both an enhancing and an impeding factor to their health care participation. These findings can guide providers to offer more "user-friendly" support systems for women with HIV and their children.     

Sick child care options: what do working mothers prefer?

More than half of all mothers with children under age 6 are in the labor force. Working mothers must take off anywhere from 5.6 days to 28.8 days per employee per year to care for their sick children. In a survey of 134 working mothers with children in day care centers, 70% expressed an interest in sick child care options outside the home, especially a sick room at the child's regular day care center or an infirmary at the parent's workplace. Mothers who chose "out-of home care" were more likely to: be minority (p less than 0.01); be single parents (p = 0.06); earn less than $10,000 annually (p = 0.03); want their children with temperatures of 100-100.9 F to remain in school until the end of the day (p less than 0.01). Communities and day care centers serving especially lower income, minority or single-parent working mothers should consider investigating these out-of-home sick child care options; the savings to employers could be $2 to $12 billion per year, not to speak of the personal savings to the mothers themselves.