What Do Resident Physicians Know about Nutrition? An Evaluation of Attitudes,Self-Perceived Proficiency and Knowledge

Objective: Despite the increased emphasis on obesity and diet-related diseases, nutrition education remains lacking in many internal medicine training programs. We evaluated the attitudes, self-perceived proficiency, and knowledge related to clinical nutrition among a cohort of internal medicine interns.

Methods: Nutrition attitudes and self-perceived proficiency were measured using previously validated questionnaires. Knowledge was assessed with a multiple-choice quiz. Subjects were asked whether they had prior nutrition training.

Results: Of the 114 participants, 61 (54%) completed the survey. Although 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. There was no correlation among attitudes, self-perceived proficiency, or knowledge. Interns previously exposed to nutrition education reported more negative attitudes toward physician self-efficacy (p = 0.03).

Conclusions: Internal medicine interns’ perceive nutrition counseling as a priority, but lack the confidence and knowledge to effectively provide adequate nutrition education.     

We care don't we? Social workers, the profession and HIV/AIDS

The HIV/AIDS epidemic has impacted all levels of society from the individual to the macro-economic. The continuing spread of infection around the world means that traditional methods of care and support are put under extreme pressure and many families lose their capacity to cope. Social workers are involved in providing care, counseling and support to those affected, and in developing programmes and other interventions to prevent the spread of the disease. Prevention and behaviour change are vital, but access to treatment is an ethical imperative, particularly in developing countries where the epidemic is most prevalent. Social work is a profession uniquely situated to demonstrate leadership in multi-sectoral collaboration in responding to this pandemic. Consequently this paper briefly reviews the scale and current nature of the epidemic and then considers how social workers can help build more compassionate policies at an international level. Social workers can help to create awareness of the negative effects of poverty, tackle gender inequity, help build more effective coalitions and partnerships, and work with other concerned groups and organisations to end stigma and discrimination. Using case examples the paper considers how social workers can help develop caring strategies that improve the lives of those living with HIV and AIDS.     

What Do Healthy Women Know about the Consequences of Delayed Childbearing?

Female fertility declines dramatically with age, and childbearing at older maternal ages has significant medical consequences for mother and infant that are well-known to health professionals. Despite this, the average maternal age in the United States continues to rise. Many factors likely contribute to this secular trend; to date, no research has examined whether American women are aware of the complications of deferring conception and how this correlates with health literacy. The purpose of this study was to evaluate women's knowledge of the implications of delaying pregnancy. A structured, in-person interview was administered to 300 women between 20 and 50 years of age attending 1 of 2 gynecologic clinics at a single institution. Demographic information, medical history, and gynecologic history were obtained; and participants answered questions about the implications of aging for fertility and pregnancy outcome. Health literacy and numeracy were assessed. Participants demonstrated knowledge deficits about the implications of aging on fertility and pregnancy, and many were unfamiliar with success rates of infertility treatments. Several demographic factors correlated with knowledge; health literacy and numeracy were both important predictive variables. To the authors' knowledge, this is the first study of women's knowledge about fertility, aging, and their health literacy. Awareness of the importance of health literacy and numeracy should inform future educational efforts about fertility.     

Do Community Social Capital and Built Environment Associate With Homebound in Older Adults? The JAGES Niigata Study

BackgroundHomebound status is one of the most important risk factors associated with functional decline and long-term care in older adults. Studies show that neighborhood built environment and community social capital may be related to homebound status. This study aimed to clarify the association between homebound status for community-dwelling older adults and community environment—including social capital and neighborhood built environment—in rural and urban areas.MethodsWe surveyed people aged 65 years and older residing in three municipalities of Niigata Prefecture, Japan, who were not certified as requiring long-term care. The dependent variable was homebound status; explanatory variables were community-level social capital and neighborhood built environment. Covariates were age, sex, household, marital status, socioeconomic status, instrumental activities of daily living, the Geriatric Depression Scale-15, self-rated health, number of diseases under care, and individual social capital. The association between community social capital or neighborhood built environment and homebound status, stratified by rural/urban areas, was investigated using multilevel logistic regression analysis.ResultsAmong older adults (n = 18,099), the homebound status prevalence rate was 6.9% in rural areas and 4.2% in urban areas. The multilevel analysis showed that, in rural areas, fewer older adults were homebound in communities with higher civic participation and with suitable parks or pavements for walking and exercising. However, no significant association was found between community social capital or neighborhood built environment and homebound status for urban older adults.ConclusionCommunity social capital and neighborhood built environment were significantly associated with homebound status in older adults in rural areas.Key words: community social capital, neighborhood built environment, epidemiology, homebound, urban rural differences     

How Do Women at Risk of HIV/AIDS in Iran Perceive Gender Norms and Gendered Power Relations in the Context of Safe Sex Negotiations?

Sexual transmission of HIV/AIDS among women is growing in the Middle East region. Despite the fact that there are numerous gender-related sociocultural factors influencing HIV/AIDS protective behaviors, little gender-specificity is carried out in HIV prevention in Iran. In order to close this gap, we aimed to provide preliminary work that explored the perceptions that women at risk of HIV had about gender norms and gendered power and their ability to protect themselves against HIV/AIDS. Twenty-five semi-structured in-depth interviews were conducted with women at risk of HIV/AIDS, aged 21–49 years, at Voluntary Counseling and Testing Centers or Drop in Centers in Tehran, Iran. Results showed that perceived gender norms were essential barriers of protective behavior through sexual socialization, male control over condom use and sexual decision-making, male pleasure predominating in sexual encounters and sexual double standards, and economic dependencies. In the conclusions, we consider how HIV/AIDS preventive programs can be structured to be gender-sensitive and empowering in Iran.     

Do Social Support,Self-efficacy and Resilience Influence the Experience of Stress in Ghanaian Orphans? An Exploratory Study

Much of the literature suggests that the availability of certain protective factors can help to buffer the adverse effects of negative life events such as parental loss and the negative experiences surrounding placement in orphanages. Following on from this perspective, the present study explores the influence of perceived social support, self-efficacy and resilience on the stress experience (as measured by the symptoms of depression and anxiety) of 200 children in Accra, Ghana. The sample comprised 100 orphans placed in orphanages and 100 non-orphans – all aged between seven and 17 years. The children completed the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Multidimensional Scale of Perceived Social Support, the General Self-efficacy Scale and the 14-item Resilience Scale. The results revealed that orphans had significantly stronger perceptions of social support from friends than non-orphans, whereas non-orphans had significantly stronger perceptions of support from families than orphans. However, both the orphans and non-orphans reported high levels of self-efficacy and resilience. Regression analyses also revealed that self-efficacy emerged as a significant positive predictor of resilience for the orphaned children, whereas self-efficacy and perceived social support emerged as significant positive predictors of resilience for the non-orphans. Implications of the findings are discussed.     

Why Not the University of New Orleans? Social Disorganization and Sexual Violence Among Internally Displaced Women of Hurricane Katrina

Researchers have reported that natural disasters lead to an increase in sexual violence against women and this is echoed by the current situation in Haiti. This is a social pattern throughout the world during periods of war, as well as natural disasters such as tsunamis, famine, and hurricanes. This article examines the prevalence of sexual violence experienced by women students at the University of New Orleans (UNO) before and after Hurricane Katrina using the CORE Alcohol and Drug Survey. Two hundred and thirty seven women participated in the pre-Katrina study and 215 women participated in the post-Katrina study. We hypothesized that, due to the trauma of this disaster, there would be a higher prevalence of sexual aggression against women after Katrina than there was before Katrina. Our analyses yielded no significant differences in any of the measures of sexual violence toward women (nine CORE survey items) pre to post Katrina, so our hypothesis was not supported. We suggest that social organization and cultural attenuation—often indicators of sexual assault in FEMA Greenfield communities—were mitigated by social cohesion found on the UNO campus post-Katrina.     

What Do Healthcare Providers Know About Nutrition Support? A Survey of the Knowledge,Attitudes, and Practice of Pharmacists and Doctors Toward Nutrition Support in Malaysia

Background and Aims: Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers' inadequate knowledge. The aim of this study was to evaluate the self‐reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. Methods: A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. Result: Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients' nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the “average” score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. Conclusion: Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established.     

Social Change and the Health of Sexual Minority Individuals: Do the Effects of Minority Stress and Community Connectedness Vary by Age Cohort?

Archives of Sexual Behavior - This study examined the extent to which social stress stemming from a stigmatized social status (i.e., minority stress) was associated with three domains of health in...     

Who are the Women Who Work in Their Last Month of Pregnancy? Social and Occupational Characteristics and Birth Outcomes of Women Working Until the Last Month of Pregnancy in France

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks’ gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks’ gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks’ gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women.     

What Do We Know About Knowledge Translation in the Care of Older Adults? A Scoping Review

ObjectivesThe recent emphasis on knowledge translation (KT) in health care is based on the premise that quality of care improves when research findings are translated into practice. This study aimed to identify the extent, nature, and settings of KT research pertaining to the care of older adults.Design and MethodsWe searched Medline, CINAHL, The Cochrane Library, and EMBASE for systematic reviews related to KT using the terms knowledge translation, research use, evidence-based practice, clinical practice guidelines, or diffusion of innovations. Then we searched the systematic reviews to identify included articles related to older adults. We used quantitative content analysis to summarize the information.ResultsTwo of the 53 systematic reviews about KT focused on the care of older adults. One examined the impact of quality systems on care processes and outcomes for long term care residents. The other studied the effectiveness of active-mode learning programs on physician behavior. Sixty-one of the 1709 primary research articles (3.6%) pertained to the care of older adults. Thirty of these were conducted in long term care facilities, 26 in outpatient clinics, 2 in hospitals, and 3 in multiple settings. Most studies focused on KT interventions targeting professionals (eg, prescribing medications). Organizational interventions (eg, modifying roles) were few; financial and regulatory interventions were rare.ConclusionWe identified a gap in KT research pertaining to the care of older adults. KT intervention research focusing on organizational, financial, and regulatory areas is warranted. The connection between geriatrics and KT is fertile ground for future research.     

Do stigma,blame and stereotyping contribute to unsafe sexual behaviour? A test of claims about the spread of HIV/AIDS arising from social representation theory and the AIDS risk reduction model

In the context of social representation theory and the AIDS risk reduction model, it has been claimed that stigmatizing, blaming and stereotyping attitudes make people feel less at risk of contracting HIV/AIDS, and that this, in turn, results in them taking fewer precautions in their sexual behaviour. Previous research has failed to provide convincing evidence to support these claims. The present study provided a test of the claims that addressed some of the methodological issues identified in the earlier research. A sample of 460 young people from Ghana, ranging in age from 15 to 28 years (mean = 18), completed a questionnaire that measured the relevant constructs. The results supported the claims in relation to stigmatizing and intended sexual risk behaviour, but not stigmatizing and actual sexual risk behaviour. Although the latter two were correlated, this was not mediated by reduced perceptions of vulnerability. Claims in relation to blaming and stereotyping were not supported. Contrary to expectation, specific blaming and stereotyping attitudes that constructed HIV/AIDS as a sexual disease were associated with safer intended sexual behaviour, and this relationship was mediated by feeling at greater risk.     

Social surveys in HIV/AIDS: telling or writing? A comparison of interview and postal methods

We compare a probability sample postal questionnaire survey and a quota controlled interview survey, and review the literature on these subjects. In contrast to other studies, where quota samples were not representative because of biased selection of respondents by interviewers, our quota sample was representative. Response rates were similar in our postal and interview surveys (74 and 77%, respectively), although many previous similar postal surveys had poor response rates. As in other comparison studies, costs were higher in our interview survey, substantive responses and the quality of responses to closed-ended questions were similar, and responses to open-ended questions were better in the interview survey. 'Socially unacceptable' responses on sexual behaviour were less likely in interviews. Quota controlled surveys are appropriate in surveys on HIV/AIDS under certain circumstances, e.g. where the population parameters are well known, and where interviewers can gain access to the entire population. Postal questionnaires are better for obtaining information on sexual behaviour, if adequate steps are taken to improve response rates, and when in-depth answers are not needed. For most surveys in the HIV/AIDS field we recommend the postal method.     

Do Physicians Discuss HIV and AIDS with Patients? A Survey of Physician Practices

HIV and AIDS continue to be major concerns to the health care community and the world around them. Preventive efforts and education have been the focus of the fight against AIDS thus far. By the year 2000, 75% of physicians are expected to conduct risk-reduction counseling for patients regularly. Previous studies show that a smaller percentage routinely follow this recommendation. The purpose of our study was to assess with what percentage of patients physicians discuss several HIV/AIDS-related topics, what percentage of their patients are considered at risk for infection, and how comfortable the physicians are with their knowledge level and discussing the subject matter. We sent surveys to the last five graduating classes from St. Louis University School of Medicine and to 169 physician preceptors in the community. The survey asked about patients considered at risk, physician comfort level with HIV/AIDS, the percentage of patients they discuss various HIV/AIDS topics with, and his or her preparedness for these discussions. Total responses were 464 (53.7%) representing all areas of medicine. Most of the physicians (72.9%) consider 0–25% of their patients at risk for HIV/AIDS. Eighty-one percent claim they are moderately or very comfortable discussing the material with patients and more than 90% feel they have at least adequate knowledge. Most of the respondents discuss the HIV/AIDS topics with 0–25% of patients. Recent medical school graduates and primary care physicians are more comfortable with HIV/AIDS and discuss the surveyed topics with a higher percentage of patients.     

The natural resource curse and the spread of HIV/AIDS, 1990–2008

Experts suggest that effective public action can prevent the spread of HIV/AIDS. Countries dependent on natural resource wealth, such as oil, are likely to suffer from governance failures and thereby suffer lower quality public health. Since the cost of fighting disease redistributes income away from rulers, resource wealth is likely to lead to neglect of public action aimed at stemming a deadly disease. We test this proposition in 137 countries from 1990 until 2008 using oil wealth as a proxy for endogenous policy choices on the prevalence of HIV/AIDS, a proxy outcome for ineffective policy and neglect of public action. We find that the ‘resource curse’ seems to affect the spread of HIV/AIDS, even though oil-rich countries ceteris paribus should have more financial resources for effective public action. The results are robust to a host of controls, alternative indicators, and fixed effects estimation.     

What Do People Know about Food,Nutrition and Health?—General Nutrition Knowledge in the Austrian Population

Background: Only limited information is available on the nutrition knowledge of the general Austrian population and how this relates to the nutrition knowledge of health professionals (medical doctors, pharmacists, nutritionist, dieticians) and school teachers. Methods: Adolescents and adults at the age of 14–75 years (n = 1000), medical doctors (n = 307), pharmacists (n = 295), nutritionists (n = 124), dieticians (n = 160) and school teachers (n = 873) completed an online survey using a German version of the General Nutrition Knowledge Questionnaire-Revised (GNKQ-R) including self-reported data on sex, age, BMI, and health status. Adolescent and adult participants were recruited by a research agency to be representative for the Austrian population for age, sex, and education. A convenience sample was used for health professionals (medical doctors, pharmacists, nutritionist, dieticians) and school teachers. All participants completed a computer-assisted web-based interviewing (CAWI) survey. Results: Total scores for nutrition knowledge of the general population (61.4%) were significantly lower than scores from all other groups (medical doctors 81.3%, pharmacists 83.0%, dieticians 87.5%, nutritionists 85.6%, school teachers 74.5%). The main drivers for better nutritional knowledge were female sex, higher age, and higher level of education, while BMI classification and self-reported health status had no impact. In regard to single questions, the most striking result was the misclassification of sugar as the nutrient with the most calories by 41.4% of the general population while only 29.0% correctly identified fat to be the nutrient with the most calories. Conclusions: The nutritional knowledge of the general population should be significantly improved in order to lay a basis for better dietary behavior. In view of the relatively low scores of teachers, their nutrition education should be improved in order to enable transfer of sound education in schools.     

Breastfeeding Patterns in the Rural Community of Hilo,Hawai‘i: An Exploration of Existing Data Sets

Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai‘i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai‘i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in Hilo was obtained from the Hawai‘i WIC program and includes initiation, duration, exclusivity of breastfeeding, and reasons for not breastfeeding. These data were compared to data from published reports available at the county, state, and national level. The State of Hawai‘i and Hilo exceed national targets for breastfeeding initiation; however, rates soon drop following delivery, and mixed feedings of infants is common. The highest percentage of mothers weaned their infants within the first four weeks postpartum. The reasons the majority of the mothers gave for weaning were tied to breastfeeding situations that are amenable to skilled lactation support (eg, milk supply issues and latch or sucking problems). While available data sets offer valuable information on the breastfeeding patterns in this rural community, there are limitations to their usefulness, primarily due to the inconsistent operational definitions of infant feeding variables used in the surveys, and the lack of availability of community level data.     

An unbridgeable gap? Comparing the HIV/AIDS epidemics in Australia and sub–Saharan Africa

OBJECTIVE: To compare the HIV/AIDS epidemics in Australia and sub-Saharan Africa, to outline reasons for differences, and to consider implications for the Asia and Pacific region. METHODS: Comparison of key indicators of the epidemic in Australia, and Africa viewed largely through the experience of the Hlabisa health district, South Africa. RESULTS: To the end of 1997, for all Australia, the estimated cumulative number of HIV infections was approximately 19,000, whereas in Hlabisa 31,000 infections are estimated to have occurred. Compared with the low and declining incidence of HIV in Australia (< 1%), estimated incidence in Hlabisa rose to 10% in 1997. In all, 94% of Australian infections have been amongst men; in Hlabisa equal numbers of males and females are infected. Consequently, whereas 3000 children were perinatally exposed to HIV in Hlabisa in 1998 alone, 160 Australian children have been exposed this way. In Australia, HIV-related disease is characterised by opportunistic infection whereas in Hlabisa tuberculosis and wasting dominate. Surveys among gay men in Sydney and Melbourne indicate > 80% of HIV infected people receive antiretroviral therapy whereas in Hlabisa these drugs are not available. IMPLICATIONS: It seems possible that Asia and the Pacific will experience a similar HIV/AIDS epidemic to that in Africa. Levels of HIV are already high in parts of Asia, and social conditions in parts of the region might be considered ripe for the spread of HIV. As Australia strengthens economic and political ties within the region, so should more be done to help Pacific and Asian neighbours to prevent and respond to the HIV epidemic.