Attitudes of health care providers and students towards tattooed people

Attitudes of health care providers and medical and nursing students (n = 513) towards tattooed adults and adolescents were examined. No respondent group had mean scores reflecting a positive attitude towards tattooed persons. Overall, physicians (MDs) and registered nurses (RNs) rated tattooed people less positively than did students. Womens' attitudes were consistently less favourable than those of men, especially towards tattooed professional women. Attitudes towards tattooed adolescents were generally less positive than attitudes towards the adult groups. Research has found that negative attitudes impact patient care. This study suggests that tattooed persons, especially adolescents, may be at risk of being negatively perceived when they seek health care. Increased efforts are needed to assure that those with tattoos receive non-judgemental and sensitive care.     

Educating primary care providers about HIV disease: multidisciplinary interactive mechanisms

We have recently demonstrated that macrophage conditioned medium (MP medium) and beta VLDL enhance cholesterol esterification in cultured aortic smooth muscle cells by LDL receptor mediated and other pathways (Stein, O. et al. (1993) Arteroscl. Thromb. 13, 1350-1358). In view of the presence of extracellular non-lipoprotein cholesteryl ester (in the form of lipid droplets) in the atheroma, the effect of MP medium on the cellular uptake of liposomal cholesteryl linoleyl ether (CLE) or cholesteryl ester (CE) was studied. After 4 h incubation in MP medium, the uptake of liposomal [3H]CLE was up to 10-fold higher than in the presence of control medium of the same composition but not conditioned with macrophages (DV medium). Similar results were seen also with HSF derived from LDL receptor negative donors. The MP medium-stimulated uptake of liposomal [3H]CE resulted also in hydrolysis of 70-90% of the labeled compound, indicating that the [3H]CE was intracellular. While the MP medium effect on liposomal [3H]CLE uptake was evident after 4 h, its effect on [3H]cholesterol esterification by SMC in the presence of beta VLDL could be demonstrated only after 24 h. Addition of apoE to MP medium resulted in a small (30-40%) increase in the uptake of liposomal [3H]CLE; however, it was augmented more than 4-fold when apoE was added to DV medium. The MP medium effect on the uptake of liposomal [3H]CLE was interfered with by heparin, anti-LPL antibody or heparinase, while these treatments did not affect [3H]cholesterol esterification in the presence of beta VLDL. These results suggest that the interaction between SMC and two potential sources of lipids in atheroma, i.e., lipoproteins and non-lipoprotein lipid droplets, could be governed by different components of the MP medium. In the case of the lipid droplets, as modeled here in the form of liposomes, macrophage-derived lipoprotein lipase could play a major role in cholesteryl ester transfer into SMC.     

Personal barriers to diabetes care: lessons from a multi-ethnic community in New Zealand

The aim of this study was to identify and quantify barriers to diabetes care perceived by diabetic subjects from a multiethnic, urban community (mainly New Zealand Europeans, Maori, and Pacific Islanders). A qualitative survey including 57 diabetic subjects and health care providers from a diverse range of backgrounds was followed by a cross-sectional household survey. Barriers to care were quantified among 1862 (2.1%) diabetic residents of a total surveyed population of 90477. Thirty barriers to care categories were generated incorporating patient beliefs, internal and external physical barriers, educational, psycho-social and psychological barriers. In spite of major difference in culture, acculturation, and socio-economic status, the top 10 barriers were similar between the ethnic groups. The most important barriers were perceiving that the benefits of self-care were outweighed by the disadvantages (20% Europeans, 20% Maori, 29% Pacific Islanders, 16% others, p<0.001), lack of community-based services (13% Europeans, 27% Maori, 25% Pacific Islanders, 11% others, p<0.001) and the limited range of services available (15% Europeans, 22% Maori, 20% Pacific Islanders, 14% others, p<0.05). It is postulated that definition of these barriers, with subsequent, systematic action to reduce their impact, in both patients and populations could result in an improvement in diabetes outcomes.     

Clostridium difficile and older adults: what primary care providers should know

Clostridium difficile poses particular risk for older adults, who are subject to more serious symptoms than younger patients. Antibiotic exposure and other risk factors are associated with the pathogenesis of C. difficile-associated disease. Treatment goals include prescribing anti-C. difficile activity agents (when indicated), attending to volume status and prescribing oral rehydration therapy as needed, avoiding the use of antiperistaltic drugs, discontinuing any offending antibiotics, avoiding the indiscriminate use of broad-spectrum antibiotics, providing supportive therapy, following infection control protocols, and eliminating environmental contaminants.     

Promoting tobacco cessation in the military: an example for primary care providers

The tobacco cessation program from one isolated duty station is presented. The cessation program used active duty Marines who wished to cease tobacco use. After completion of four classes, abstinence rates of 47% were obtained based on weekly follow-up self-reports for periods ranging from 7 to 32 weeks. Most relapses were noted in the first 2 weeks after quitting. The command expense was estimated at $165 per participant. Military health care professionals should actively participate in tobacco cessation regardless of access to specialized preventive medicine services. The cost benefit and optimal utilization of nicotine replacement therapy and newer tobacco cessation aids in active duty populations should be studied further.     

In their own words: nursing assistants'' perceptions of barriers to implementation of prompted voiding in long-term care

An alteration of the enteroinsular axis (EIA) may be an important etiologic factor in postsurgical changes in gastrointestinal (GI) function. In this review, we present recent works, both from our laboratory and others, on how changes in the EIA function may be involved in postsurgical GI complications, especially late dumping syndrome (LDS). We found no or minimal direct role for vagal signals in the control of gastric inhibitory polypeptide (GIP) and enteroglucagon secretion, which regulate EIA function. In gastrectomized patients, it is suggested that the hypersecretion of glicentin and glucagon-like peptide-1 (GLP-1) induced by a rapid arrival of nutrients to the distal gut suppresses glucagon secretion and may be a cause of LDS. In patients who underwent proctocolectomy, we observed no significant postoperative changes in EIA function, although there are some conflicting reports. It seems unlikely that ordinary pancreaticobiliary diversion would cause a significant change in EIA function after an oral glucose load. Our experimental model of ileojejunal transposition produced marked hypersecretion of incretin secreted from the distal gut, which may alter EIA function. Further elucidation of the regulatory mechanism of EIA may provide a new strategy for the medical and surgical treatment of LDS.     

Diabetes care for Medicare beneficiaries. Attitudes and behaviors of primary care physicians

OBJECTIVE: To obtain information related to primary care physician (PCP) attitudes, knowledge, and practice patterns, as well as perceptions about barriers to care and the use of materials to assist in the delivery of diabetes care for elderly patients in the office setting. RESEARCH DESIGN AND METHODS: A survey was mailed to a random sample (n = 900) of PCPs (internal medicine, family practice, and general practice physicians and endocrinologists) from the states of Alabama, Iowa, and Maryland who met selection criteria and provided diabetes care to > or = 25 Medicare beneficiaries during calendar year 1993. RESULTS: Respondents provided self-reported information regarding diabetes care for elderly patients. PCP respondents (n = 370) considered blood glucose control to be the most important treatment goal. Most respondents (92%) considered acceptable GHb values to be those < 8%. Blood pressure measurement and foot inspections for the detection of ulcers and infection were the most commonly reported routine procedures performed as part of an office visit. Laboratory tests reported to be frequently ordered included GHb, serum creatinine, and proteinuria tests. Patient nonadherence to the treatment regimen was reported to be the most common barrier to care. The majority of respondents reported using two treatment aids in caring for patients with diabetes. CONCLUSIONS: The results of this study provide some evidence that PCP self-reported attitudes, knowledge, and practice patterns in delivering diabetes care for elderly patients in the office setting more closely reflect current recommended practice than reported in previous physician surveys. Opportunities for improvement still exist.     

Attitudes toward psychology relative to other disciplines.

In a rapidly changing health care marketplace, professional psychologists are increasingly concerned about the public's attitude toward psychology. In two samples, one of the general population and one of college faculty, both psychology and sociology were rated as having made less important contributions to society and as having less expertise than biology, chemistry, medicine, and physics. The implications of these findings are considered in relation to the recent American Psychological Association (APA) public education campaign and the field's century-long concern about the public perception of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural barriers to health care reform

The rate of proliferation of health care reform proposals makes it impossible to consider them all adequately; whatever plan is finally legislated, there will be many who are not satisfied with it, and clamor for change is likely to be a prominent feature of health care politics for a long time. This article takes a brief look at the health care reform process in the United States, including some of the impediments to development of a plan that would address both contemporary and future issues. Some traditional ethical viewpoints and cultural values, having to do with concepts of justice, are seen as inimical to long-range program development. The need for alteration of traditional views is regarded as urgent, to facilitate cultural movement in directions that will not only permit development of workable health care programs, but will extend broadly to address other compelling societal issues. The impetus for advantageous cultural movement originates among perceptive individuals who are regarded by society as legitimately influential. Many physicians still are accorded this sort of recognition, and the considered input of medical professionals is essential.     

Attitudes toward death: A psychological perspective.

Discusses research on death. The influencing aspect of consciousness of death is active over the entire age continuum and is not restricted to the sick, aged, suicidal, or combat soldier. The meaning of death is multidimensional and varies not only between individuals but within the same person. Dying and death possess psychological and social features and are not merely biological events. Socially repressive orientation toward death promotes neurotic concerns about it. More intimate familiarity with death is required in developmental upbringing and culture. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting psychology in diabetes primary care.

Better diabetes management can be achieved by adding an explicit psychological component to diabetes treatment. Three cases are presented that illustrate how integrated assessment and psychotherapy can improve glucose control through three mechanisms: increasing patient acceptance of a disease state, enabling behavior change for self-care, and removing psychological barriers to disease control. Guidelines are suggested for standardized integration of psychology into diabetes care. The explicit treatment of psychological barriers to diabetes self-management would enhance standard medical practice, which normally relies on education to overcome treatment adherence problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teenagers' perceptions of barriers to prenatal care

A structured interview conducted during the postpartum hospitalization of 184 patients aged 17 years or younger was used to study teenagers' perceptions of barriers to prenatal care. The interview consisted of more than 100 questions on demographic characteristics, family and social support, desire for the pregnancy, perceptions of the importance of prenatal care, practical obstacles to access to health care (such as lack of transportation, day care, etc), financial problems related to care, problems finding time to obtain health care, knowledge of available prenatal care resources, and perceptions of ease or difficulty in the use of existing clinics. Multiple regression analysis using the Kessner index as the criterion variable showed that major factors related to the adequacy of prenatal care received by these teenagers were perceptions of cost barriers, the gestational age at which the teenager discovered she was pregnant, school enrollment status (those in school received poorer care than those who had dropped out), and the degree of social support experienced by the teenager. These findings suggest that specific changes in the health care system are needed to make prenatal care more accessible for pregnant teenagers. These changes would include enhancing community awareness that Medicaid pays for prenatal care, establishing links between prenatal clinics and school health systems, and scheduling prenatal clinics at times more convenient for teenagers.     

Attitudes of psychiatrists toward elderly patients

A group of 179 psychiatrists responded to a questionnaire requesting their opinions concerning four clinical vignettes. Analysis of their responses indicated that these psychiatrists, at a highly statistically significant level, regarded older patients as less ideal for their practices than younger patients with identical symptoms. The respondents viewed the older patients as having a poorer prognosis, and their treatment plans for them were less likely to emphasize psychotherapy. In general, there was a negative correlation between the age of the respondent psychiatrists and their estimate of the "idealness" of and favorable prognosis for older patients.     

A multidisciplinary meta-analysis of human barriers to technology implementation.

Although "people-issues" are often blamed for technology implementation failures (Klein, 2001), research on the human behaviors and attitudes that challenge workplace innovation is scattered across multiple disciplines and lacks integrated theory. The Person-Implementation Framework proposed here describes person-related problem sources, symptoms, and solutions associated with information technology (IT) implementation failure, and is used to analyze scholarly literature (N = 81) from four academic disciplines spanning two decades (1984-2004). Findings reveal dominant and underrepresented person-related implementation factors over time. Linkage analyses are used to identify symptoms and solutions associated with two of the frequently researched implementation problem sources: participation and management. Finally, despite psychology's centrality to understanding person-related IT implementation barriers, less than 10% of the research on this topic appears in the psychology literature. Suggestions are provided for how academic researchers and consulting psychologists can contribute to this important and timely issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward posthumous organ donation and commitment to donate.

Constructed and administered verbal attitude scales to 110 adults (aged 17–66 yrs), which resulted in reliable measurement of 2 independent dimensions, prodonation and antidonation. Cluster analysis revealed that the positive dimension involves belief in the humanitarian benefits of organ donation and feelings of pride experienced by the donor. The negative dimension reflects fears of body mutilation and of receiving inadequate medical treatment when one's life is at risk. Positive and negative scores in combination predicted willingness to sign a donor card. An analysis of variance (ANOVA) revealed significant main effects for both positive and negative attitude. Ss with strong positive attitudes and weak negative attitudes were especially willing to sign donor cards. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nurse''s guideline: a guide in complicated care

The authors present the fundamentals of making outpatient computer case histories for prophylactic check-ups of chronic outpatients with ocular diseases. They validate the necessity of creating mononosological versions of computer histories which should not only describe the underlying diseases in detail, but reflect any concomitant ocular disease as well. The basic criteria formulated by the authors helped create a computer history of a modulus type, which may be easily mastered by physicians within just 2-3 hours and be adapted to research of this or that patient population. The authors emphasize the importance of creating and wide use of software in everyday practical medicine.     

Attitudes of psychiatry residents toward psychology.

Discusses how the development of health psychology will facilitate the trend for psychologists' continued involvement in medical settings, principally in departments of psychiatry. With the shortage of psychiatrists, it is anticipated that today's residents will assume major administrative roles in departments of psychiatry relatively early in their careers. The attitudes of 201 psychiatric residents with regard to organizational issues involving psychologists and the role of psychology in assessment, treatment, research, and training were assessed via a questionnaire. The majority of Ss felt that psychologists should not hold senior administrative roles in departments of psychiatry, and 47% felt that the medical model should be basic to both research and practice. There was substantial support for maintaining divisions of psychology within (rather than separate from) departments of psychiatry. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)