Medical care-seeking and health-risk behavior in patients with head and neck cancer: the role of health value, control beliefs and psychological distress

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.     

Self-care among older adults

Defining self-care as treatment for a perceived symptom, this paper posits that explanations for such illness behavior will differ depending on whether symptoms experienced are perceived as not serious and most amenable to self-treatment or more serious and less likely to respond to self-care. Borrowing from the Health Belief Model, two major concepts, a health set (consisting of five measures of perceived physical and mental health) and an attitude set (comprising four indicators of belief in physician efficacy) are included to explain rates of self-care across all reported symptoms. Self-care rate, calculated as the percentage of experienced symptoms self-treated without professional advice, was slightly higher for persons whose symptoms were seen as less serious. Measures of self-assessed health were related to self-care for those less severe symptoms, while lower faith in doctors as well as health were more closely related to the ailments perceived as more serious. Implications of the results for further studies are discussed.     

Allied health perceptions of effective clinical instruction

Clinical instruction is a critical component of allied health education. The purposes of this study were to identify those behaviors of clinical instructors perceived as both most effective and most hindering in facilitating learning, to identify and compare the behaviors of clinical instructors as perceived by two different allied health groups, and to categorize into meaningful domains the behaviors identified. A published 58-item questionnaire was completed by 311 clinical students and instructors from eight physical therapy and ten physician assistant programs. Results were analyzed by multivariate analysis of variance. Instructor behaviors rated as most helpful in learning included answering questions clearly, taking time for discussion and questions, and providing opportunities for practicing skills. Behaviors most hindering to learning were asking questions in an intimidating manner and correcting student errors in front of patients. Ratings were significantly different (P less than or equal to .001) between the physical therapy and physician assistant groups on 13 items, and posed important considerations for allied health educators.     

Effects of ePREP and OurRelationship on Low-Income Couples’ Mental Health and Health Behaviors: a Randomized Controlled Trial

Relationship distress is a pervasive problem in the USA that disproportionally impacts couples with low-income levels. The goal of the present study was to evaluate the effectiveness of two online relationship interventions, OurRelationship and ePREP, both of which were supported by a paraprofessional coach, in improving mental health and physical health behaviors with low-income couples. Couples (N?=?742) were randomized to either intervention or a 6-month waitlist control group and assessed pre-, mid-, and post-intervention as well at 4 and 6 months after randomization. Results from multilevel models indicated that during treatment, compared to couples in the waitlist group, couples in the intervention groups reported significantly greater improvements in mental health that were small to moderate in magnitude (psychological distress, anger, problematic alcohol use, and perceived stress) as well as improvements in physical health/health behaviors (perceived health, insomnia, and exercise) that were small in magnitude. Furthermore, the differences between intervention and waitlist groups were maintained over follow-up. Treatment gains in both mental health and physical health behaviors were generally stronger for those who began treatment with greater difficulties in those areas. Implications of these findings with regard to intervention and policy are discussed.

     

Comparison between Kanagawa Prefecture and Ohio state of factors related to health behavior among older adults

Factors related to health behavior of older adults in Japan and the United States were compared. A total of 900 persons from three age groups (45 to 59, 60 to 74 and 75 and over) were interviewed in three communities (major metropolitan, midsized city, and small town), in both Kanagawa Prefecture and Ohio State. To determine the reliability of the results, in addition to analysis for all subjects, each of communities were analyzed separately. Health behaviors were divided into 2 separate levels: 1) preventive health behaviors and 2) coping behaviors for symptoms which may be signs of a serious illness. The latter behaviors were classified into three types: 1) seeing a physician, 2) changing lifestyle and 3) taking OTC drugs. The following results were obtained: 1) In both Kanagawa Prefecture and Ohio State, good preventive health behaviors were unrelated to coping behaviors associated with potentially serious illness. Interviewees who used OTC drugs when experiencing a potentially serious illness had a low tendency toward seeing a physician. In Kanagawa Prefecture, individuals who saw a physician showed a strong tendency toward changing their lifestyle, for symptoms which were potential signs of a serious illness. 2) There were some differences in factors related to preventive health behaviors between Kanagawa Prefecture and Ohio State. In Kanagawa Prefecture, there were sex differences, with males exhibiting preventive health behaviors. In Ohio State, good preventive health behaviors were few among interviewees who were black. 3) There was little difference between Kanagawa and Ohio State as far as the tendency toward seeing a physician when experiencing potentially serious illness. In both places, interviewees with good self-rated health status and having strong self-treatment attitudes showed a lower tendency to see a physician when experiencing symptoms which were potential signs of a serious illness.     

Treatment of self-reported depression among Hispanics and African Americans

This study applied the Behavioral Model for Vulnerable Populations framework to examine the correlates of depression and the receipt of medical treatment among low-income Hispanics and African Americans residing in public housing. We compared three groups: those who reported (1) self-diagnosed but without physician-diagnosed depression, (2) depression diagnosed by a physician but who did not receive pharmaceutical treatment, and (3) depression diagnosed by a physician and antidepressant pharmacotherapy consumed by patient. Random samples of 287 adults from three public housing communities were surveyed. Over 48% of this sample reported that they were suffering from depression. One out of three people who reported being depressed also said that a physician had never diagnosed his or her condition. Only 40% of those who said that a physician had diagnosed depression also reported taking antidepressant medication. Untreated depression among underserved racial and ethnic minorities is alarming and points to an urgent need for intervention.     

Barriers to supplemental calcium use among women in suburban family practice: a report from the Cleveland Clinic Ambulatory Research Network (CleAR-eN)

BACKGROUND: The majority of adult women in the United States fail to meet daily calcium intake recommendations. This study was undertaken to (1) identify predictors of calcium supplement use versus non-use, (2) understand barriers to calcium supplementation, and (3) determine the potential impact of physician recommendation on calcium supplement use. METHODS: Surveys were self-administered by 185 women, ages 20 to 64, presenting consecutively for care at 6 suburban community-based family medicine practices within the Cleveland Clinic Ambulatory Research Network (CleAR-eN). We compared demographic characteristics, health beliefs, and health behaviors of those women who reported never using calcium supplements with those who presently took calcium supplements. Women who never took calcium were also queried about reasons for non-use and whether physician recommendation would influence their adoption of calcium supplementation. RESULTS: Multivitamin use, self-perceived risk of osteoporosis, and age were independent predictors of calcium supplement use. Leading barriers for never-users were lack of knowledge about the need/importance of increasing calcium intake, lack of motivation to start supplements, and the belief that their dietary calcium intake alone was sufficient. Ninety-six percent of never-users reported that they would consider taking a calcium supplement if recommended by their physician. CONCLUSIONS: Many patient-identified barriers to calcium supplementation seem amenable to focused and brief office-based interventions that could increase the number of women meeting calcium intake guidelines.     

加强卫生立法 促进卫生改革与发展

阐述了我国卫生立法的宗旨和指导思想,从农村初级卫生保健、防止通过血液途径传播疾病、药品管理、医患双方权利义务等方面论述了架构卫生立法体系的思路。     

Determinants of health counseling practices in hospitals: the patient's perspective

We conducted a survey of 518 patients who had been admitted to three hospitals for selected medical, surgical, and obstetrical conditions. All patients came from the same city. One of the hospitals had put forward health promotion and disease prevention as a formal goal. Almost 40% of the respondents reported that they received health counseling during their hospital stay. Logistic regression analyses revealed that medical care processes and organizational factors were more important than patient characteristics in determining health counseling. The only patient characteristic that was positively related to health counseling was "perceived poor health status." Favorable conditions for the development of health counseling included having an attending physician different from the one who treated the patient before entering the hospital, an adequate number of physician visits, and a longer length of stay. Being admitted to a medical ward rather than a surgical or an obstetrical ward also was associated with more frequent health counseling. No significant differences were found among hospitals. Finally, having a general practitioner rather than a specialist as attending physician did not make a difference. These findings support the view that although hospitals have an important and legitimate role to play in health promotion, organizational and institutional obstacles to implementing such practices must not be ignored.