Primary health care nurses’ views on patients’ abilities and resources to make choices and take decisions on health care

Recent health reforms in many European countries have emphasised patient choice as a tool for patient participation, and for the improved efficiency of services. Little attention has been paid to experiences of the nurses in these reforms, even though the reforms directly concern all health care personnel and cannot be implemented without their contribution. This study looks at patient choice from the perspective of the nurses working in primary health care clinics in Finland. In Finnish primary care, nurses have a central role in coordinating patient care and advising patients. The data come from 31 interviews conducted in 17 health care clinics. The approach adopted in the analysis is data-driven and brings forth nurses’ experiences in their daily work with patients. A detailed analysis of the nurses’ responses and views was conducted with discourse analysis. While nurses positioned some patients as knowledgeable, able to search for information and make use of different services without nurses’ help, some of the patients were positioned as those needing nurses’ advice and guidance through the complex system of health and social care services. Nurses’ positions varied from co-actors and gate-keepers to advocates and spokespersons. In order to succeed future health care reforms need to take better into account the realities of health clinics and the grassroots-level knowledge that primary care nurses have on patients and clinical practices.     

Navigating double marginalisation: migrant Chinese sexual and gender minority young people’s views on mental health challenges and supports

Sexual and/or gender minority young people who are also members of an ethnic minority can experience unique challenges. Limited research draws directly on the mental health experiences of these ‘double minority’ youth. This study focused on Chinese sexual/gender minority youth in New Zealand. It sought to explore features they found challenging for, or supportive of, their mental health and wellbeing. Semi-structured interviews were conducted with 11 Chinese sexual/gender minority participants aged between 19 and 29 years old and residing in Auckland, New Zealand. An inductive approach to qualitative data analysis was used. Two major domains of findings emerged. Firstly, participants described mental health challenges linked to racism, sexism, cis-heteronormativity and challenges in relation to intersecting identities. Secondly, Chinese culture and community connections, family and peer support and role models seemed to facilitate resiliency. However, the fear of ‘losing face’, unwillingness to disclose distress when unwell and mental health service providers’ lack of cultural and linguistic competency were described as barriers to effective mental health support. In conclusion, Chinese and sexual/gender minority identities were integral parts of participants’ sense of self, and this was associated with their mental health and wellbeing. Further research is required to explore ways to reduce barriers and promote resiliency.     

Patients’ views on dyspepsia and acid suppressant drug therapy in general practice

Objectives: To do an inventory on the opinion of long-term acid suppressant drug (ASD) users on their condition and drug treatment, and from that angle to reflect on possibilities to reduce usage and costs of long-term acid suppressant drug therapy. Methods: In the year 2001, in seven general practices, patients who chronically used ASDs without proper indication were identified. A postal questionnaire based on the literature was sent to these patients (n=498). Results: 318 (64%) returned questionnaires were fit for analysis. Patients experienced dyspepsia as unpleasant and restraining, and were extremely positive about ASDs without differences between H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). ASD use was very compliant. Patients smoked and drank less than the normal population. They did not continue unhealthy habits simply because ASDs enable them to. Most patients were not motivated to stop their ASDs.

Conclusion: Dyspeptic complaints should not be underestimated. Improving lifestyle is not likely to generate much effect on ASD use. Due to a lack of motivation, discontinuing long-term ASD use may not be an efficient way to reduce the use and costs of ASDs. Patient-centred possibilities are prescribing H2RAs instead of PPIs as a first step, as they are perceived by patients to be equally effective, and encouraging patients to self-regulate drug treatment through on-demand regimes.     

Oncologists’ and family physicians’ views on value for money of cancer and congestive heart failure care

Background

Previous studies suggest that cancer-related interventions are valued by policy makers more favorably than interventions for other medical conditions, but the views of practicing physicians have not yet been assessed in Israel. Attitudes and judgments of practicing physicians may assist decision-makers in their deliberations on coverage of new technologies. We conducted a national survey in Israel among oncologists and family physicians to explore their views on access to care, coverage decisions and treatment recommendations for cancer and congestive heart failure (CHF) patients.

Methods

We administered a web-based survey to 300 family physicians and 156 oncologists. The questionnaire included 24 statements and physicians were asked to indicate their level of agreement with each statement on a 5-point Likert scale, ranging from “strongly agree” to “strongly disagree”. Where relevant, physicians were asked to express their views on interventions for cancer and CHF respectively.

Results

Response rates were 39% for family physicians and 36% for oncologists. Participants expressed similar views on cancer and CHF care and no significant differences were found between the two medical specialties. More than 85% of physicians believe that inclusion of a treatment in the National List of Health Services (NLHS) strongly affects their patients’ access to care. Approximately 80% suggest that more use of comparative-effectiveness and cost-effectiveness analysis is needed in coverage decisions. The vast majority of respondents (75%) suggest that assessment of value-for-money should be made by an independent (academic) institution or the national committee responsible for recommending coverage decisions, Seventy percent believe that treatments not included in the NLHS should be included in supplementary health insurance programs and only a small minority of respondents (<30%) believe that cancer-related interventions should receive higher priority than non-cancer interventions in coverage decisions.

Conclusions

Our findings suggest that both oncologists and family physicians value cancer and CHF interventions equally. We could not find evidence for a “cancer premium” as implied from previous surveys and analysis of coverage decisions in various countries.

     

HIV prevention: mapping Mozambican people’s views on the acceptability of the widow’s sexual cleansing ritual called pita-kufa

Background

In Mozambique, the widow is traditionally required to undergo a cleansing ritual called pita-kufa, which generally involves several sessions of unprotected sexual intercourse with the brother of her deceased husband. This ritual may play a role in the spread of HIV and reveals, to some degree, the subordinate position to which women are subjected in Mozambican society. Thus, this study’s aim was to map Mozambicans’ views on the acceptability of this ritual, given the gender and public health concerns linked to it.

Methods

A total of 359 Mozambicans participated in the study. The data collection instrument consisted of 18 vignettes describing realistic pita-kufa situations, varying as a function of three factors: a widow’s willingness or not to perform the ritual, the perceived effectiveness of the ritual, and the risk level of HIV infection linked to the practice. For each pita-kufa situation presented in the vignettes, the participants were asked to rate its acceptability on an 11-point scale. In addition, the participants wrote comments giving their general views on the ritual. A cluster analysis using the K-means procedure was applied to the quantitative raw data to capture different perspectives, and the participants’ written comments were subjected to thematic and frequency content analysis.

Results

From the data gathered though the vignettes, three different perspectives were found: total unacceptability (55% of the participants), conditional acceptability (29% of the participants) and unconditional acceptability (16% of the participants). From the data gathered though the participants’ written comments, it emerged that they thought that the practice of this ritual should evolve (61%), stop (27%) and be kept as it is (12%).

Conclusion

According to the main results, it seems that a large majority of study participants think that this ritual is outdated and needs to evolve in order to minimize the risk of HIV transmission and respect women’s rights.

     

Parental concerns about picky eating and undereating,feeding practices,and child’s weight

ObjectiveParents’ concerns about their child’s feeding may lead parents to pressure their child to eat, which may lead to a greater risk for obesity. We aimed to assess if parental concerns for picky eating and undereating are associated with pressure to eat and increased child BMI z-score (BMIz).MethodsWe performed a cross-sectional study of 328 parents of healthy preschoolers assessing parent concerns about picky eating (Child Eating Behavior Questionnaire) and child undereating (“Are you concerned …doesn’t eat enough?”), parent pressure to eat (Child Feeding Questionnaire), and covariates. Dyads’ heights and weights were measured. Structural equation modeling (SEM) was performed to examine the relationships between parental concerns, pressure to eat, and child BMIz. Measurement models were tested and refined, and the structural model was tested. Model fit was determined using multiple goodness-of-fit indices.ResultsDyads were racially and socioeconomically diverse. The SEM model demonstrated good goodness-of-fit. Children who were perceived as not eating enough had significantly higher picky eating scores (β 0.756; p < 0.001). Parents had higher pressure to eat scores if children were more picky (β 0.148; p = 0.02) or were perceived as not eating enough (β 0.654; p < 0.001). Parental pressure to eat was not associated with the child’s BMIz.ConclusionsIn a cohort of diverse preschoolers, parent concerns about eating were associated with increased pressure to eat, but pressure to eat was not associated with BMIz. Identifying these relationships is important to develop effective interventions to improve feeding practices in young children.     

Effect of long-term treatment with galantamine on weight of patients with Alzheimer’s dementia

Objectives

There is discussion about the effect of cholinesterase inhibitors (CERs) on weight of patients with Alzheimer’s disease (AD). Given the adverse outcomes of weight loss in AD patients, it is important to establish the effect of CERs on weight. This study aimed tot assess the long-term effect of galantamine on weight of AD patients.

Design, setting and participants

This longitudinal study was performed at a large memory clinic in the North of the Netherlands. During the period 2002 to 2010, 303 communitydwelling AD patients, aged 65 years or older who started using a cholinesterase inhibitor (CER), were included.

Measurements

Socio-demographic characteristics and data on comorbidity, number of medications, type and dosage of CER, use of care, cognitive function, behaviour and nutritional status (weight, Body Mass Index (BMI)) were recorded at the time the diagnosis AD was made and at subsequent outpatient clinic visits. The Generalized Estimating Equations (GEE) model was used to determine the effect of galantamine of 16 mg and 24 mg on weight. The effect of galantamine in a dose of 16 and 24 mg was investigated because the other groups (rivastigmine, galantamine 8 mg) were too small to determine the effect on weight by GEE analysis. Donepezil is not available in the Netherlands.

Results

The median follow-up time between the moment patients started using a CER (T0) and the 1st visit was 6 months (n=300); between T0 and the 2nd visit 13 months (n=212); between T0 and the 3rd visit 25 months (n=117) and between T0 and the 4th visit 37 months (n=58). Galantamine 16 mg and 24 mg, corrected for age, gender, social status, informal care, professional care, comorbidity, number of medications, cognition, behaviour and appetite, had no effect on weight (p > 0.05). Male patients had a higher average weight compared to female patients (p=0.000, B=8.333). Patients without an informal caregiver (p=0.01, B=?3.697) or partner (p=0.042, B=?3.197) had a lower average weight compared to patients with an informal caregiver or partner.

Conclusion

Weight loss in AD patients should not be attributed to long-term treatment with galantamine. This is in accordance with the French guideline. If AD patients are losing weight, other causes, including insufficient care, should be investigated.     

Effect of a low molecular weight, high-purity β-glucan on in vitro digestion and glycemic response

β-Glucans are believed to lower postprandial glycemia due to their ability to increase viscosity and slow down gastric emptying. The effect of high-purity barley β-glucan (Glucagel) was tested on in vitro starch digestibility and glycemic response of chapattis. In a randomized controlled crossover trial, 10 healthy human subjects consumed chapattis containing 0, 4 and 8% β-glucan on different occasions. Capillary blood samples were collected before and at 0, 15, 30, 45, 60, 90 and 120 min after consuming the chapattis. There was no significant difference either in the amount of glucose released after in vitro digestion or in the glycemic response to chapattis with 0, 4 and 8% β-glucan (P>0.05). It may be concluded that low molecular weight barley β-glucan, although of 75% purity, was not effective in lowering glycemic response possibly due to its inability to influence starch digestion and particle breakdown during in vitro digestion.     

Men’s perspectives on women’s empowerment and intimate partner violence in rural Bangladesh

Intimate partner violence (IPV) may increase as women in patriarchal societies become empowered, implicitly or explicitly challenging prevailing gender norms. Prior evidence suggests an inverse U-shaped relationship between women’s empowerment and IPV, in which violence against women first increases and then decreases as more egalitarian gender norms gradually gain acceptance. By means of focus-group discussions and in-depth interviews with men in 10 Bangladeshi villages, this study explored men’s evolving views of women, gender norms and the legitimacy of men’s perpetration of IPV in the context of a gender transition. It examines men’s often-contradictory narratives about women’s empowerment and concomitant changes in norms of masculinity, and identifies aspects of women’s empowerment that are most likely to provoke a male backlash. Findings suggest that men’s growing acceptance of egalitarian gender norms and their self-reported decreased engagement in IPV are driven largely by pragmatic self-interest: their desire to improve their economic status and fear of negative consequences of IPV.     

Community-living older people’s interpretation of the Norwegian version of older people’s quality of life (OPQOL) questionnaire

The aim of this study is to investigate how community-living older people interpret the Norwegian version of Older People's Quality of Life (OPQOL) questionnaire. The original OPQOL questionnaire was translated based on guidelines for cross-cultural translation. The Three-Step Test-Interview instrument was adopted to investigate how community-living older people interpreted the questionnaire. Data were collected from 14 participants (72–89 years). The questionnaire was filled in under observation. Semi-structured interviews were then conducted to clarify the observational data and elicit the participants’ experiences and opinions. Lastly, data were analysed using a hermeneutic interpretation approach. Our findings indicate that most of the participants managed to complete the OPQOL questionnaire without problems. The data analysis resulted in four primary themes: relevance & applicability, formulation, consistency & accuracy and subjectivity. The questionnaire covered all aspects related to the participants’ quality of life. However, statements related to religion were found to be irrelevant to their quality of life. Most of the participants thought that religion, philosophy and culture should be separate rather than included in the same statement. The participants missed the option of ‘not applicable’ when the statements were irrelevant to them. The statements are formulated in both positive and negative ways, which was sometimes confusing to them. The participants perceived phases such as “around me” “local,” and “things” as ambiguous, and thus they raised concerns about whether the OPQOL questionnaire could capture consistent data regarding their quality of life. The results of this study pinpoint the issues that community-living older people faced when interpreting and answering the Norwegian version of OPQOL questionnaire. These issues were mostly caused by sociocultural differences. Our work provides an overview of the changes that must be made in the questionnaire in order to address these sociocultural differences while using the OPQOL questionnaire in the Norwegian context.     

Understanding and defining bullying – adolescents’ own views

Background

The negative consequences of peer-victimization on children and adolescents are major public health concerns which have been subjected to extensive research. Given all efforts made to analyze and estimate the social and health consequences of peer-victimization, the adolescents’ own experiences and understandings have had surprisingly little impact on the definition of bullying. Therefore, the aim of the current study is to explore adolescents’ definitions of bullying.

Methods

A questionnaire study (n = 128) and four focus group interviews (n = 21) were conducted among students aged 13 and 15. First, gender and age differences were analyzed with respect to what behaviors are considered bullying (questionnaire data). Second, analysis of what bullying is (focus group interviews) was conducted using qualitative content analysis.

Results

The adolescents own understanding and definition of bullying didn’t just include the traditional criteria of repetition and power imbalance, but also a criterion based on the health consequences of bullying. The results showed that a single but hurtful or harmful incident also could be considered bullying irrespective of whether the traditional criteria were fulfilled or not. Further, girls and older students had a more inclusive view of bullying and reported more types of behaviors as bullying compared to boys and younger students.

Conclusions

The results of the current study adds to the existing literature by showing that adolescents consider the victim’s experience of hurt and harm as a criterion for defining bullying and not only as consequences of bullying. This may be of special relevance for the identification and classification of bullying incidents on the internet where devastating consequences have been reported from single incidents and the use of the traditional criteria of intent, repetition and power imbalance may not be as relevant as for traditional bullying. It implies that the traditional criteria included in most definitions of bullying may not fully reflect adolescents’ understanding and definition of bullying. Assessments of bullying behaviors that ask adolescents to strictly adhere to the traditional definition of bullying might not identify all adolescents experiencing peer victimization and therefore not provide estimates of prevalence rates reflecting adolescents’ own understanding of bullying.     

‘Always between two cultures’: young British Bangladeshis and their mothers' views on sex and relationships

This paper presents data on the sexual health perspectives of young British Bangladeshis and their mothers. It discusses the implications of these data for the development of appropriate sexual health education. Between April and September 2006, 36 young people and 25 mothers of Bangladeshi young people were interviewed through seven focus group discussions. Groups were gender and age specific (16–18 years, 19–20 years and mothers). Recruitment took place in community‐based organisations in an inner city London borough. Mothers expressed concern about pre‐marital sex but felt unable to control out‐of‐home activity. Feelings of isolation, lack of control and communication difficulties were key issues for them. Young people had varied perspectives on pre‐marital sex. Some experienced emotional conflict between what was expected of them in terms of their faith and their engagement in intimate relationships. Both the young people and mothers highlighted the need for sex and relationship education to take account of cultural perspectives and the involvement of parents and the wider community. However, parents and community representatives require information and communication support to enable this involvement. Sex and relationships education content needs to be inclusive, have both secular and faith perspectives and engage where relevant with local communities.     

Financial incentives and patient selection: Hospital physicians’ views on cream skimming and economic management focus in Norway

This paper uses survey data to analyse physician views on the risk of cream skimming under a system with activity based financing (ABF) for hospital services. We used data from two nation-wide physician surveys. A survey undertaken in 2006 captures views following a large NPM-inspired structural reform in 2002. In contrast, a survey undertaken in 2016 captures views after a period of a higher degree of institutional and financial stability. We find that the majority of physicians believed that the 2002 reform both provided incentives for and led to more cream skimming. In 2016, however there is less consensus among physicians about the extent of cream skimming. Looking at different types of physicians we find some indications that physicians in leading positions are less likely to view cream skimming as a problem. However, there is concern that hospital management in general puts too much emphasis on economic issues.     

Future Directions in Research on Institutional and Interpersonal Discrimination and Children’s Health

Research evidence indicates that 2 forms of racial discrimination—perceived interpersonal discrimination and racial/ethnic residential segregation (a form of institutional discrimination)—may influence children’s health and disparities.Although research on these 2 forms of discrimination and health has primarily focused on adults, smaller bodies of work have documented that perceived interpersonal discrimination and segregation have a negative effect on infants’ health, and that perceived interpersonal discrimination may negatively affect children’s mental health.Three directions for research are (1) incorporating a life-course perspective into studies of discrimination and children’s health, (2) linking residential segregation with geography-of-opportunity conceptual frameworks and measures, and (3) considering residential segregation along with segregation in other contexts that influence children’s health (e.g., schools).Racial/ethnic disparities in the health and development of US children are large and persistent over time.1,2 Because of demographic trends, such disparities affect a growing number of children. In 2011, 47% of children were racial/ethnic minorities, up from 26% in 1980 (authors’ calculations, US Census Bureau estimates3,4). These trends suggest that the health of minority children will have an increasing impact on population health over time.The changing racial/ethnic composition of the US children’s population is occurring in the context of high levels of residential and school segregation, affecting a large proportion of Black and Latino children. In 2010, 81.6% of Black children residing in large metropolitan areas lived in areas with high Black–White residential segregation, and 77.8% lived in areas with high levels of school segregation; the respective percentages for Latino children were 32.6% and 54.2% (7

TABLE 1—

Share of Racial/Ethnic Minority Children and Public Primary School Students in Metropolitan Areas With Segregation (Dissimilarity Indices) in Specified Ranges: 100 Largest US Metropolitan Areas, 2010

'Important… but of low status': male education leaders' views on gender in medicine

Medical Education 2011; 45 : 613–624 Objectives The implementation of and communication about matters associated with gender in medical education have been predominantly perceived as women’s issues. This study aimed to explore attitudes towards and experiences of gender‐related issues among key male members of faculties of medicine. Methods We conducted semi‐structured interviews with 20 male education leaders from the six medical schools in Sweden. The interviews were analysed qualitatively using a modified grounded theory approach. Results The core category –‘important… but of low status’– reflects ambivalent attitudes towards gender‐related issues in medicine among male education leaders. All informants were able to articulate why gender matters. As doctors, they saw gender as a determinant of health and, as bystanders, they had witnessed inequalities and the wasting of women’s competence. However, they had doubts about gender‐related issues and found them to be overemphasised. Gender education was seen as a threat to medical school curricula as a consequence of the time and space it requires. Gender‐related issues were considered to be unscientifically presented, to mostly concern women’s issues and to tend to involve ‘male bashing’ (i.e. gender issues were often labelled as ideological and political). Interviewees asked for facts and knowledge, but questioned specific lessons and gender theory. Experiences of structural constraints, such as prejudice, hierarchies and homosociality, were presented, making gender education difficult and downgrading it. Conclusions The results indicate that male faculty leaders embrace the importance of gender‐related issues, but do not necessarily recognise or defend their impact on an area of significant knowledge and competence in medicine. To change this and to engage more men in gender education, faculty measures are needed to counteract prejudice and to upgrade the time allocation, merits and status of gender implementation work. Based on our findings, we present and discuss possible ways to interest more men and to improve gender education in medicine.     

Reflections on Serving Remote Mountain Communities: Mobile Hospitals and Women’s and Children’s Health Care in Northern Haiti

In 2003 Alyans Sante Borgne’s (ASB) conducted the first week-long mobile hospital in Molas, a poor mountain community a 10-h walk from the main hospital in the town of Borgne in North Haiti. ASB is a partnership between Haiti Outreach—Pwoje Espwa (H.O.P.E.), a US-based NGO, and Haiti’s Ministry of Health. The paper reflects on this first experience and the evolution of an indigenous model of health care delivery, Sante Nan Lakou (SNL)/Health at the Extended Family Level, a model that prioritizes the needs of patients over those of the institution. It highlights the challenges of providing quality care to a much neglected segment of our population and documents the impact of this event for the community and for ASB. Lessons learned during that week shaped ASB’s response to the root causes of women and children’s poor health in the commune of Borgne. The response is articulated in a holistic grassroots program called Sante/Health, Edikasyon/Education, Ekonomi/Economy for Fanm/Women (SEE Fanm). SEE Fanm is a constellation of programs and initiatives that together brings quality care to women and seeks to empower them to take charge of their health and wellbeing and, by extension, that of their families and communities.     

The U.S. Food and Drug Administration Risk Assessment on Lead in Women’s and Children’s Vitamins Is Based on Outdated Assumptions

Background

Following a recent report of lead in certain commercial vitamin products, the U.S. Food and Drug Administration (FDA) conducted a nationwide survey to determine the Pb content in 324 multivitamin/mineral products labeled for use by women and children. The FDA compared estimated Pb exposures from each product with safe/tolerable exposure levels, termed provisional total tolerable intake (PTTI) levels, previously developed for at-risk population groups in 1992.

Objective

We investigated the FDA’s conclusions that Pb concentrations in all vitamin products examined do not pose a hazard to health because they are below the PTTI levels for all groups considered.

Discussion

For their initial estimations of PTTI levels, the FDA used a blood lead level (BLL) of 10 μg/dL as the threshold for adverse effects in children and in pregnant or lactating women. Studies have repeatedly linked chronic exposure to BLLs < 10 μg/dL with impairments in cognitive function and behavior in young children despite the absence of overt signs of toxicity. The FDA analysis also omitted any consideration of nonfood sources of Pb exposure, which is inconsistent with our current understanding of how most children develop elevated BLLs.

Conclusion

We feel that based on these oversights, the FDA’s conclusions are unduly reassuring and that reconsideration of their current recommendations appears warranted.     

The influence of children’s diet on their cognition and behavior

The rapid growth of the brain and its high metabolic rate suggests that it is reasonable to consider whether their diet may influence the cognitive development of children. To date although there are few nutritional recommendations that can be made with confidence, there is a growing body of evidence that diet can influence the development and functioning of the brain. Several lines of evidence support the view that the diet of the mother during pregnancy, and the diet of the infant in the perinatal period, have long-term consequences. The provision of fatty acids has been the most studied aspect of nutrition, although the evidence is lacking that supplementation has long-term benefits. There is increasing evidence that the missing of breakfast has negative consequences late in the morning and a working hypothesis is that meals of a low rather than high glycemic load are beneficial. The aim is to introduce a range of topics to those for whom this area is of potential interest. Where appropriate the main themes and conclusions are summarized and attention is drawn to review articles that allow those interested to go further.     

Lead Content and Exposure from Children’s and Adult’s Jewelry Products

No abstract available.