Medical Tourists: Who Goes and What Motivates Them?

This study relates consumers' attitudes toward medical tourism to a number of consumer characteristics, such as age, education, income, and insurance status. Principal components analysis of the attitudes of 289 consumers from various communities of North Carolina resulted in three attitude-related factors: economic, treatment-related, and travel-related. Major findings include: (a) the uninsured and low-income consumers are more sensitive to economic factors than the insured and the middle-income consumers; (b) the 51- to 64-year-olds are less motivated by economic factors than young adults; (c) surprisingly, the better one's health, the more one is motivated by treatment-related factors.     

Preschool Teachers' Use of Time-Out: Is What They Say What They Do?

Using triangulation, this study employed two methods to compare whether the responses of early childhood teachers about their use of timeout as a discipline method in focus group discussion was congruent with their behavior from classroom videotapes. The subjects were 5 teachers, who were among a larger group that had participated in one of 6 focus groups and were later videotaped in their preschool classes. These teachers volunteered to be videotaped after they had engaged in the focus groups. In the focus groups, teachers were asked to discuss how they respond to children's misbehaviors and how they make decisions about their responses. The videotapes were subsequently taken during 2 typical mornings in each class. Detailed analyses of the teachers' use or nonuse of time-out as well as their rationale for using this method, were undertaken for both focus group responses and behaviors observed on the videotapes. Results showed that the verbal responses of the teachers were very congruent with what they carried out while teaching.     

Confidentiality With Adolescents in the Medical Setting: What Do Parents Think?

Purpose

When confidential health care is provided to adolescents they are more likely to seek care, disclose sensitive information, and return for future visits. Guidelines for health professionals recommend seeing young people alone to facilitate confidential care. We sought to document parental views regarding confidentiality with adolescents, aiming to identify topics that parents believe they should be informed about despite an assurance of confidentiality between their child and the doctor. We also aimed to document harms and benefits that parents associate with adolescents seeing doctors alone.

Methods

A sample of 86 parents attending an adolescent medicine clinic with their son/daughter was surveyed using a brief, anonymous questionnaire.

Results

Parents identified several benefits associated with confidential care, yet also believed they should be informed about a wide range of topics, even if their children did not want them to know. Parents' primary concern about confidentiality was a fear of not being informed about important information.

Conclusions

Parental views concerning confidentiality are complex and conflicting and differ from current guidance provided to health professionals. Ensuring that parents accurately understand the limits to confidentiality and support the notion of confidential care for their children is a challenging yet vital task for health professionals.     

How and What Do Pregnant Adolescents Want to Learn about Nutrition?

Few nutrition education materials exist that are designed specifically for pregnant adolescents. Adolescents are considered a high-risk population during pregnancy, and they differ from adult mothers emotionally, socially, and cognitively. We used qualitative methodology in a needs assessment study with pregnant and postpartum adolescents to determine how and what they wanted to learn about nutrition. Ninety-two girls, ages 13 to 19, participated in 1 of 16 focus group sessions held across the state of Tennessee. Discussion focused on (1) what media and (2) what messages they perceived would be effective in reaching other pregnant adolescents and influencing their dietary behaviors. Results of the needs assessment suggest that a videotape format is more appealing than written materials, possibly because a variety of print materials that appeal to all age groups already exist and/or some pregnant adolescents have limited interest in reading. A “talking baby” and teen actresses presenting information were preferred by the adolescents rather than adult characters or authority figures. Participants in the study expressed the need for messages related to eating for the baby's health, eating for the mother's health and physical comfort, and messages emphasizing food rather than nutrients. Nutrition educators can use this information when developing educational materials for pregnant adolescents.     

Men Who Purchase Sex,Who Are They? An Interurban Comparison

Most research concerning clients of commercial sex workers (CSWs) relies upon CSW reports of client characteristics and behavior. We describe correlates of ever purchasing sex among 3,829 men from three cities: São Paulo, Brazil; Cuernavaca, Mexico; and Tampa, USA. A computer-assisted self-interview collected data on demographics and sexual behavior. There were significant site differences—26.5 % paid for sex in São Paulo, 10.4 % in Cuernavaca, and 4.9 % in Tampa. In all cities, men who had sex with men and women (versus sex with women only) were more likely to have ever paid for sex. In São Paulo and Cuernavaca, CSW clients were older, had higher educational attainment, and were less likely to be married. In Tampa, older age was associated with being a CSW client but not education and marital status. In São Paulo and Cuernavaca, CSW clients had more partners than men who had never paid for sex. In São Paulo, CSW clients initiated vaginal sex at an earlier age, while in Cuernavaca they were more likely to self-report a sexually transmitted infection. CSW clients varied with respect to demographics across the three cities while the association between paying for sex and risky sexual behavior seems to be somewhat conserved. These findings suggest that interventions among CSW clients should focus on condom use with commercial and non-commercial partners as these men may be at increased risk for transmitting and acquiring sexually transmitted infections to and from their sex partners. Better understanding of client characteristics is needed for targeting interventions and creating culturally appropriate content.     

How Do Older Portuguese and Mexican Adults Experience Their Sexual Well-Being? A Cross-Cultural Qualitative Study

Archives of Sexual Behavior - Sexual well-being (SWB) refers to the subjective emotional and cognitive evaluation of the quality of the individual's sexuality. SWB plays a relevant role in...     

Letter to the Editor: Response to “What Women Want From Abortion Counseling in the United States: A Qualitative Study of Abortion Patients in 2008”

Abstract

Diabetes is aggravated by a sedentary lifestyle, obesity and smoking. Based on a theoretical model relating attitudes and behavior, this study examined the association between physicians' self efficacy in counseling diabetic patients on life style behaviors and their counseling practices. Data were gathered from a representative sample of 743 primary care physicians in Israel's two largest health plans. The main findings were that only a small percentage of physicians felt capable of influencing their patients' life-style behaviors. Self-efficacy had an independent effect on the likelihood of counseling diabetic patients on life style behaviors, controlling for other background variables. We conclude that there is a need for enhancing physicians' life-style counseling skills, and that social workers could expand their role by training physicians to counsel effectively. This could both improve the care of diabetic patients, and strengthen the status of the social work profession in the healthcare system.     

Do-Not-Resuscitate and Do-Not-Hospitalize Orders in Nursing Homes: Who Gets Them and Do They Make a Difference?

ObjectivesTo describe the rate of do-not-resuscitate (DNR) and do-not-hospitalize (DNH) orders among residents newly admitted into long-term care homes. We also assessed the association between DNR and DNH orders with hospital admissions, deaths in hospital, and survival.DesignA retrospective cohort study.Setting and participantsAdmissions in all 640 publicly funded long-term care homes in Ontario, Canada, between January 1, 2010 and March 1, 2012 (n = 49,390).MeasuresWe examined if a DNR and/or DNH was recorded on resident's admission assessment. All residents were followed until death, discharge, or end of study to ascertain rates of several outcomes, including death and hospitalization, controlling for resident characteristics.ResultsUpon admission, 60.7% of residents were recorded to have a DNR and 14.8% a DNH order. Those who were older, female, widowed, lived in rural facilities, lived in higher income neighborhoods prior to entry, had higher health instability or cognitive impairment, and spoke English or French were more likely to receive a DNR or DNH. Survival time was only slightly shorter for those with a DNR and DNH with a mean of 145 and 133 days, respectively, vs 160 and 153 days for those without a DNR and DNH. After controlling for age, sex, rurality, neighborhood income, marital status, health instability, cognitive performance score, and multimorbidity, DNR and DNH were associated with an odds ratio of 0.57 [95% confidence interval (CI) 0.53-0.62] and 0.41 (95% CI 0.37-0.46) for dying in hospital, respectively. Those with a DNR and DNH, after adjustment, had an incidence rate ratio of 0.87 (95% CI 0.83-0.90) and 0.70 (95% CI 0.67-0.73), respectively, days spent in hospital.Conclusions and implicationsThis study outlines identifiable factors influencing whether residents have a DNR and/or DNH order upon admission. Both orders led to lower rates, but not absolute avoidance, of hospitalizations near and at death.     

Nutrition Facts Panels: Who Uses Them,What Do They Use,and How Does Use Relate to Dietary Intake?

Background

Nutrition labels are a low-cost tool with the potential to encourage healthy eating habits.