\http://www.ncbi.nlm.nih.gov/pubmed/11477055

Fam Pract. 2001 Aug;18(4):449-53.

Unwanted pregnancy and contraceptive knowledge: identifying vulnerable groups from a randomized controlled trial of educational interventions.Little P, Griffin S, Dickson N, Sadler C, Kelly J.

Primary Medical Care Group, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK.

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Fam Pract 2001 Oct;18(5):557.

AbstractOBJECTIVES: The aim of this study was to identify predictors of contraceptive pill knowledge and their relationship to educational interventions.METHODS: A total of 636 women attending for a follow-up appointment for repeat prescription of the combined oral contraceptive pill with a GP or practice nurse were randomized to receive leaflets (simple summary leaflet or FPA leaflet), advice or neither. Sociodemographic details and contraceptive knowledge were determined using a validated contraceptive knowledge questionnaire sent after 3

months by post. The main outcomes were sociodemographic, contraceptive, attitudinal and educational predictors of knowledge.RESULTS: A total of 522 (82%) had complete questionnaires. After controlling for educational intervention and other confounding variables, independent predictors of knowledge were further education (adjusted odds ratio 2.98, 95% confidence interval 1.78-4.99); number of years on the pill (0-5, 6-10, >10 years) 1.0, 0.56 (0.33-0.95) and 0.34 (0.19-0.59), respectively; past emergency contraception (1.87, 1.18-2.97); and importance attached to not falling pregnant (1.83, 1.02-3.29). These predictors are less powerful than the impact ofmost educational interventions (range of odds ratios for interventions: 1.85-6.81), and there was no evidence of a separate effect of educational intervention in any subgroup, except that leaflets have a larger effect in women who have needed emergency contraception in the past (no past use or simple summary and FPA leaflets, 1.74 and 0.90, respectively; with past use, 3.47 and 3.83; interaction term chi-square 6.92, P = 0.03).CONCLUSION: Educational interventions are as important as sociodemographic features in determiningknowledge. With limited time for full educational interventions in practice, priorities for intervention should be women who have used emergency contraception in the past-who will benefit most-and those on the pill for >5 years or with no further education who are at highest risk due to poor knowledge.

PMID: 11477055 [PubMed - indexed for MEDLINE]Free Article

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contraception in women taking the combined contraceptive pill: randomised controlled trial. [BMJ. 1998]

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Little P, Griffin S, Kelly J, Dickson N, Sadler C. BMJ. 1998 Jun 27; 316(7149):1948-52.

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Patient Dialysis Knowledge Is Associated with Permanent Arteriovenous Access Use in Chronic Hemodialysis

1. Kerri L. Cavanaugh * , 2. Rebecca L. Wingard † , 3. Raymond M. Hakim * † , 4. Tom A. Elasy ‡ , 5. T. Alp Ikizler *

+ Author Affiliations

1. *Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; †Fresenius Medical Care – North America, Inc., Brentwood, Tennessee; ‡Diabetes Research and Training Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

1. Correspondence:Dr. Kerri L. Cavanaugh, Vanderbilt University Medical Center, Division of Nephrology, 1161 21st Avenue South, S-3223 MCN, Nashville, TN 37232-2372. Phone: 615-936-7306; Fax: 615-343-7156;E-mail: kerri.cavanaugh@vanderbilt.edu

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AbstractBackground and objectives: Patient knowledge about chronic hemodialysis (CHD) is important for effective self-management behaviors, but little is known about its association with vascular access use.

Design, setting, participants, & measurements: Prospective cohortof adult incident CHD patients from May 2002 until November 2005 and followed for 6 mo after initiation of hemodialysis (HD). Patient knowledge was measured using the Chronic Hemodialysis Knowledge Survey (CHeKS). The primary outcome was dialysis accesstype at: baseline, 3 mo, and 6 mo after HD initiation. Secondary outcomes included anemia, nutritional, and mineral laboratory measures.

Results: In 490 patients, the median (interquartile range) CHeKS score (0 to 100%) was 65%[52% to 78%]. Lower scores were associated with older age, fewer years of education, and nonwhiterace. Patients with CHeKS scores 20 percentage points higher weremore likely to use an arteriovenous fistula or graft compared with a catheter at HD initiation and 6 mo after adjustment for age, sex, race, education, and diabetes mellitus. No statistically significant associations were found between knowledge and laboratory outcome measures, except for a moderate association with serum albumin. Potential limitations include residual confounding and an underpowered study to determine associations with some clinical measures.

Conclusions: Patients with less dialysis knowledge may be less likely to use an arteriovenous access for dialysis at initiation and after starting hemodialysis. Additional studies are needed toexplore the impact of patient dialysis knowledge, and its improvement after educational interventions, on vascular access in hemodialysis.

Dialysis access is a critical part of the care of chronic hemodialysis (CHD) patients. Lower mortality has been associated with use of an arteriovenous fistula (AVF) or graft (AVG) compared with use of a catheter (1–3), and mortality risk is lowered if patients change from using a catheter to an AVF or AVG(4). Although fistula use has been increasing, in 2004 only 41% of prevalent CHD patients were using an AVF and another 35% used an AVG for dialysis access (5). Importantly, a large proportion of patients used a catheter for dialysis access. This high prevalence of catheter use is aggravated by the more than 80% of CHD patients who use a dialysis catheter for their first outpatient dialysis treatment (5).

Increasing access-related patient education has been suggested asa fundamental process to improve AVF use (6), and patient education is recommended by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) and the American Nephrology Nurses’ Association to encourage patient empowerment and improve clinical outcomes (7,8). Both CHD patients and providers report that ongoing patient education is atop priority for comprehensive dialysis care (9–11).

Patient education has been associated with improved outcomes in complex chronic diseases such as diabetes mellitus, dyslipidemia,and congestive heart failure (12–15). Improvement in patient knowledge has frequently been described as a primary outcome in randomized clinical trials evaluating kidney disease patient education (16). However, only a few small studies have demonstrated that higher knowledge in dialysis patients is associated with adherence to dialysis prescription and dietary recommendations (17,18), improved phosphorus management (19,20), control of comorbid disease (21), and better self-reported mentalfunction (22). Little is known about the relationship between patient knowledge and vascular access at the time of, and the period following, maintenance hemodialysis initiation.

We measured patient knowledge of hemodialysis care as part of a multidisciplinary disease- management education program for incident CHD patients (23). The primary objective of this study is to describe patient hemodialysis knowledge, characteristics of

patients with lower knowledge, and associations between knowledgeand vascular access use in incident CHD patients.

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Materials and MethodsStudy Design and PopulationThe RightStart (RS) program prospectively enrolled 901 incident adult CHD patients within two weeks after the initiation of outpatient dialysis from 38 participating clinics across the United States. Enrollment occurred from May 2002 until November 2005. Inclusion criteria were all CHD patients who were age 18 yror greater and received hemodialysis therapy at a participating clinic for the study period. Exclusion criteria included seasonalor transient patients and those with poor cognitive function, as judged by the staff of the RS program, with the majority being nursing home residents. From within this cohort, all patients whohad an assessment of dialysis care knowledge at the time of enrollment and documentation about type of access used at dialysis initiation were included in this study.

The Institutional Review Board of Vanderbilt University Medical Center approved this as an exempted study.

Knowledge MeasurementThe Chronic Hemodialysis Knowledge Survey (CHeKS) was developed to evaluate patient knowledge about important issues in CHD care including dialysis adequacy, nutrition, anemia, access care, medications, and safety. Item content was determined by multidisciplinary experts of hemodialysis care including nephrologists, dialysis nurses, social workers, renal dietitians,and CHD patients. The scale included 23 multiple-choice items, with only one correct response (Figure 1) (see Supplemental Appendix for complete survey). The scores were reported as percent correct with a possible range of 0% to 100% with each

item contributing equally. The readability of the survey by the Flesch Reading Ease score was 65.4 and the Flesh-Kincaid Grade Level was 5.8 (Microsoft Office, version 2003; Microsoft, Redmond, Washington). Administration of the survey without time limitations was performed by either the unit case management or trained research staff.

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Figure 1.

CHeKS Question Examples.

Data CollectionParticipant demographic information was collected from the electronic medical record. The primary clinical outcome, access type used, and secondary clinical measures including hematocrit, serum albumin, phosphorus, transferrin saturation, and intact-parathyroid hormone were collected from the medical record at baseline, 3 mo, and 6 mo after dialysis initiation.

Statistical AnalysisDescriptive statistics of patient characteristics and CHeKS scores were performed and presented as either median (interquartile range) or proportion of the total patient population. Knowledge survey responsiveness was assessed in

patients who completed the CHeKS both at baseline and 3 mo after dialysis initiation by comparing the two scores with the Wilcoxonsigned-rank test for paired observations. Internal consistency ofthe survey was determined by the Kuder-Richardson coefficient (KR-20) of reliability = 0.79 (24), a measure of reliability similar to the Cronbach's alpha used for scales with dichotomous responses. Using principal components factor analysis, we identified only one factor, or domain, for the CHeKS survey. The Eigen value was equal to 3.4 and this factor explained greater than 83% of the variance of the survey. Therefore, none of the 23items was omitted from the knowledge test. Construct validity of the CHeKS survey was assessed by evaluation of an a priori model ofcorrelation, hypothesizing that younger age (25,26), more years of education (27), and lower baseline serum phosphorus (20) wouldbe moderately associated with higher knowledge scores.

Baseline CHeKS scores were evaluated for associations with clinical measures both as raw values and also categorized as either meeting or not meeting common goals described in the K/DOQI guidelines for hemodialysis quality measures (28). Associations were evaluated with Spearman's χ2 or Wilcoxon-rank sum test, as appropriate. Additionally, associations between use of an AVF or AVG and CHeKS score were determined by using the Cuzick nonparametric test for trend across CHeKS score quintiles (29). Logistic regression analysis was performed to determine theassociation between CHeKS score and vascular access use at baseline, 3 mo, and 6 mo after enrollment, with a priori adjustmentfor potential confounding variables including age, sex, race, education, and the diagnosis of diabetes mellitus. Subjects with missing data were not included in the analyses. Logistic regression models did not demonstrate evidence of collinearity between covariates and were satisfactory by the Hosmer-Lemeshow goodness-of-fit test (30). Evaluation for effect moderation by education level in the adjusted analyses was determined by assessment of p-values for interaction. All tests were two-tailedand a p-value of less than 0.05 was considered statistically significant. All statistical analyses were performed with Stata 8.0 (StataCorp, College Station, Texas).

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ResultsStudy PopulationA total of 490 incident CHD patients completed the baseline CHeKSand had baseline measures available. Patient characteristics are presented in Table 1. The median age was 64 yr, 46% were female, and 33% were African American. The majority of the patients had completed high school (75%) and more than 50% had a diagnosis of diabetes mellitus. The characteristics of the patients in this study did not have any statistically significant differences compared with the 411 patients who were excluded from the original cohort because they lacked baseline information about either knowledge score or access type.

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Table 1.

Patient characteristicsa

Baseline clinical characteristics were also measured and are shown in Table 1. The median (interquartile range [IQR]) were hematocrit of 31.5% (28.5% to 34.5%), serum albumin of 3.5 (3.2 to 3.9) g/dl, and serum phosphorus of 4.7 (3.9 to 5.9) mg/dl. At initiation of dialysis, only 26% of patients were using an AVF orAVG for dialysis access. The proportion of patients using an AVF or AVG increased over the study period to 41% and 58% at 3 mo and6 mo, respectively.

Knowledge Test PerformanceThe median score on the CHeKS administered to patients at baseline was 65% (IQR: 52% to 78%). Areas of poor knowledge, where less than 50% of the patients correctly answered the surveyquestion, included safety of over-the-counter medications for

dialysis patients, the role of exercise, and also methods to improve dialysis adequacy. There were 251 patients who also completed the survey 3 mo after dialysis initiation and they scored a median (IQR) of 83% (70% to 91%) correct with a median improvement of 13% (4% to 26%) compared with baseline performance(P < 0.001).

Patient characteristics and their associations with hemodialysis care knowledge are shown in Table 2. The CHeKS score was highly correlated with age, race, and education. Older patients had a lower average score (rho = −0.295; P < 0.001) as did patients with less than a high school education (54% versus 66%; P < 0.001). Patients of white race scored higher than patients of nonwhite race (65% versus 59%; P < 0.001). There was no association found between knowledge survey score and sex, maritalstatus, or diabetes mellitus diagnosis.

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Table 2.

Association between baseline Chronic Hemodialysis Knowledge Survey score and patient characteristicsa

There were no statistically significant correlations found between baseline laboratory measures, including serum phosphorus,and performance on the CHeKS (Table 2), except for a modest association with serum albumin (r = 0.093; P = 0.04). Patients with higher CHeKS scores were more likely to have higher baselineserum albumin levels. Results were similar if the clinical measures were included as raw values or categorized based on NKF-KDOQI recommended goals.

Knowledge Test Scores and Vascular AccessLower knowledge scores were found in patients who used a dialysiscatheter at initiation compared with those who used an AVF or AVG

(P = 0.05) (Table 2). For patients who scored in the lowest quintile of CHeKS scores (scoring <50%), 20% used an AVF or AVG at baseline; and for patients in the two highest CHeKS score quintiles, 29% to 35% used an AVF or AVG (p-trend = 0.08). Patients who scored the equivalent of one SD higher (or 20 percentage points) higher on the CHeKS were 25% more likely to use an AVF or AVG at initiation of dialysis (Odds Ratio [OR] [95%CI]: 1.25 [1.00, 1.57]; P = 0.05) compared with use of a catheterfor dialysis access. This was statistically significant even after adjustment for potential confounding factors, including age, sex, race, education, and diabetes status (Table 3). At 6 moafter dialysis initiation, use of an AVF or AVG had increased overall, and patients in the two highest CHeKS score quintiles continued to have a greater proportion of patients using an AVF or AVG compared with patients in the lowest quintile (63 to 66% versus 45%, respectively; p-trend = 0.008). In multivariable analyses at 3 mo and 6 mo after dialysis initiation, patients whoscored 20 percentage points higher on the CHeKS at baseline were more likely to be using an AVF or AVG for dialysis access (OR [95% CI] = 1.49[1.16, 1.93]; P = 0.002 and 1.33[1.03, 1.72]; P = 0.03, respectively) (Table 3).

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Table 3.

Adjusted Logistic Regression Analyses: Association between baseline CHeKS score and use of an arteriovenous fistula or graftat baseline and three- and six-months after dialysis initiation

Adjusted analyses also demonstrated evidence that the associationbetween higher CHeKS score and use of a catheter for dialysis access was significantly different comparing patients with less than a high school education and those with at least a high school education or more (p-interaction = 0.03). In patients withless than a high school education who scored higher on the CHeKS,no association was found with use of an AVF or AVG as initial

dialysis access (OR [95% CI]: 0.85[0.51, 1.41]; P = 0.53), but among patients with higher levels of education, those who scored 20 percentage points higher on the CHeKS were 60% more likely to use an AVF or AVG at baseline (OR [95% CI]: 1.60[1.15, 2.24]; P =0.006). This finding persisted with similar results at the 3-mo interval after dialysis initiation; however, there was no statistical evidence of effect modification at the 6-mo interval.

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DiscussionIn this study, patient hemodialysis knowledge was fair, with specific areas of poor knowledge. Lower knowledge scores were associated with older age, nonwhite race, and fewer years of education. Although there were few associations found between CHeKS score and clinical measures, there was a moderate and persistent association between higher scores and use of an AVF orAVG for dialysis access, especially in patients who reported a higher level of education.

Education programs for chronic kidney disease patients have been shown to delay the time to dialysis and even improve survival (31,32). However, 36% of patients with chronic kidney disease stages 3 to 5, seen by a nephrologist, report having no knowledgeabout hemodialysis (33). Our study supports that patients who go on to receive hemodialysis may indeed have moderate to low levelsof dialysis knowledge.

Our study also suggests that patients with greater knowledge about dialysis at initiation are more likely to use an AVF or AVG. Predialysis programs may increase permanent access use at dialysis initiation by many mechanisms (34). In our study, patients with higher dialysis knowledge were also more likely to be using an arteriovenous permanent access 3 and 6 mo after initiation, suggesting that greater knowledge at the start of dialysis may have persistent impact on dialysis care. We are unable to comment on the independent association of dialysis knowledge and access use because we do not have a measure of

predialysis care. However, assuming that once patients initiate dialysis they are exposed to similar education and referrals for access placement, we might hypothesize that if predialysis care was the dominant factor, then the association between knowledge and permanent access at 6 mo after dialysis initiation would not persist. Another explanation may be that patients who have more dialysis knowledge may also have the overall skills to interact with the health care system more effectively.

Interestingly, in patients with less than a high school educationthere was no significant association between dialysis knowledge and use of a permanent dialysis access. For this subgroup of patients, there may be additional barriers to successful permanent access placement such that knowledge itself has less ofan impact. Another reason for the difference seen by educational level may be that years of educational attainment may not reflectthe skill set of the patient. Even patients who report a high school education may still have significant deficits with the interpretation and application of health care information, such as low health literacy skills (35). Therefore, dialysis knowledge(CHeKS score) is a measure that more specifically characterizes the patients’ skills and their association with the access type used. This exploratory subgroup analysis needs replication and verification in a larger chronic dialysis population.

In this study, the only statistically significant association between patient dialysis knowledge and laboratory measures was for serum albumin. Lower serum albumin has been shown to be associated with a higher risk of mortality and a lower reported general health status in dialysis patients (36,37). Patients withmore severe kidney, or comorbid, disease may have lower knowledgescores and also have lower serum albumin due to a more impaired nutritional profile (38). Additional studies exploring other markers of severity of illness, such as inflammatory markers and more detailed nutritional assessments, may give additional insight into this preliminary finding. Despite our reasonable sample size, this study was underpowered to detect significant associations with dialysis knowledge and other clinical measures.

The CHeKS was a reliable survey to evaluate dialysis knowledge ofCHD patients, was easy to administer, and differentiated patientswith poor hemodialysis knowledge. Other kidney knowledge surveys (22,39,40) have evaluated a broad range of kidney information in both chronic kidney disease and dialysis patients. Similar to other studies, lower knowledge was associated with older age and less education (25–27). Nonwhite race (78% African American) was associated with lower knowledge, and it is important to note thatin another recent study African American race was associated withlower perceived knowledge of dialysis therapies (33). The mechanisms underlying this disparity remain unknown, and further investigation is needed.

There are several limitations of this study. First, there is the possibility of residual confounding. Knowledge may be associated with other variables, including income, social support, and health literacy, which may also be related to clinical outcomes. Second, this study included patients who were eligible for participation in a renal disease management educational intervention. Therefore, the findings may not be generalizable toall dialysis patients. Third, although there were no differences in characteristics between patients beginning dialysis who completed the CHeKS and those who did not, there is the possibility of selection bias because not every patient in this program completed the survey. Additionally, a limitation of CHeKSis that it was not evaluated for test-retest reliability. However, the survey did demonstrate responsiveness in those who completed it at both baseline and 3 mo. Use of the CHeKS in larger, prospective cohort, or educational intervention trials will provide further evaluation for its role in describing hemodialysis patient knowledge, as well as its predictive validity of CHD clinical outcomes. Finally, all patients in this project were exposed to an educational intervention, and therefore there is not an adequate control group to explore over time the effect of improvement of knowledge scores on the outcomes.

Conclusions

Evaluation of patient dialysis knowledge is a rapid and easy method to identify patients who may be at higher risk of not using an arteriovenous access both at dialysis initiation and after starting dialysis, and therefore may be candidates for targeted educational interventions. Further evaluation of the impact of patient dialysis knowledge and the improvement in knowledge level in larger studies is needed to better understand its relationship with clinical measures and to provide guidance for improved CHD patient education.

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DisclosuresNone.

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AcknowledgmentsWe thank James Thomas and Marie Hobbs, Fresenius Medical Care, for their data management assistance. This work was presented in part as an abstract and poster presentation at the National Kidney Foundation Clinical Meeting April 10 through 14, 2007, (Orlando, Florida) AJKD 2007; 49 (4):A33. The RightStart program was supported by a grant from Amgen, Inc. However, Amgen, Inc. did not provide support for the analyses presented, nor did the company review this manuscript. Dr. Cavanaugh is supported by a National Kidney Foundation Young Investigator Grant and grant K23DK080952-01, Dr. Ikizler by grant K24 DK62849, and Dr. Elasy by grants K24 DK77875 and P60 DK 020593 from the National Institute of Diabetes and Digestive and Kidney Diseases.

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Footnotes

Published online ahead of print. Publication date available at www.cjasn.org.

Supplemental information for this article is available online at http://www.cjasn.org.

Received September 9, 2008. Accepted February 18, 2009.

Copyright © 2009 by the American Society of Nephrology

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http://www.leprahealthinaction.org/lr/Mar06/Lep062-068.pdf

1.Knowledge of and attitudes to leprosy among2.patients and community members: a comparative3.study in Uttar Pradesh, India4. PRAMILA BARKATAKI*, SHEO KUMAR* &5. P. S. S. RAO**6. *The Leprosy Mission Hospital, Faizabad, Motinagar (Post),7. Faizabad (District), Uttar Pradesh 224 201, India8. **The Leprosy Mission Trust India, Research Resource Centre,9. Shahdara, Nand Nagri, Delhi 110 093, India10. Accepted for publication 7 September 200511. Summary The roles of literacy and gender in enhancing help seeking behaviour

in12. leprosy need further research in order tomaximize the effectiveness of health

education13. programmes. A study on leprosy knowledge and attitudes was carried out in14. Uttar Pradesh, one of the hyper endemic states for leprosy in north India, on

a random15. sample of 130 leprosy patients, 120 non-leprosy patients, and 150

communitymembers.16. A questionnaire was prepared, tested and administered inHindi, the local

language, by a

17. qualified interviewer. Statistical analyses were done in each group by gender and

18. literacy, and compared. Almost everyone in the three groups knewof leprosy, but only a

19. larger proportion of leprosy patients (60%) mentioned anaesthetic patch, as compared to

20. about 20%or less in the other groups.Avast majority in all groupsmentioned badblood,

21. or divine curse as the cause. Evenamong leprosy patients, less than 10%of illiterates and

22. only about 40% of literates cited infection as the cause of leprosy. Literateshad a better,

23. though still quite a poor knowledge on the symptoms aswell as the causation ofleprosy.

24. However, almost all stated that leprosy was curable, though they couldn’t mention

25. MDT specifically. They felt that not all patients need have deformity. About 20–30%of

26. the leprosy affected, but nearly 50–60% in the other groups stated that there was

27. discrimination. Nearly 70% felt that leprosy affected social participation, over 90%

28. attributing this to adverse social stigma. Multivariate analyses, adjusted forsex,

29. confirmed the significant association of literacy with both knowledge and attitudes. In the

30. light of massive health education and IEC campaigns, the findings from this study are

31. disappointing. Adult literacy programmes combined with more innovative focused32. approaches to suit various target audiences can impact knowledge and attitudes

better.33. Introduction34. Much of the stigma associated with leprosy stems from inadequate

or incorrect knowledge35. about the disease and its current treatment.1,2 Even after nearly 2

decades of excellent36. Correspondence to: P. Barkataki (e-mail: tlmfaizabad@tlm-india.org)

http://www.springerlink.com/content/r56843702754r66p/

osteoarthritis and the impact on quality oflife health indicators

Abstract The purpose of this study was to compare quality of life health identifiers in patients with and without osteoarthritis (OA) while controlling for the potentially confounding variables of gender, age, race, education, and income. Data were obtained for comparison from the Behavioral Risk Factor Surveillance System (BRFSS) database. Patients with and without OA were analyzed for differences in exercise and activity level, report of physical and mental health, and joint-related symptoms. Over 37,000 individuals were included in the analysis, 6,172of the participants reported a diagnosis of OA. Participants with a report of OA were more likely to identify problems in all categories except report of mental health. When the potentially confounding variables were controlled, individuals with OA were more likely to report mental health problems. These findings suggest that individualswith OA are more likely to report lower levels of quality of life evenwhile controlling confounding variables.

http://campusesp.uchile.cl:8080/dspace/bitstream/123456789/246/10/Smoking_prevalence_determinants_%20knowledge.pdf

Smoking prevalence, determinants, knowledge, attitudes andhabits among Buddhist monks in Lao PDRSychareun Vanphanom*1, Alongkon Phengsavanh1, Visanou Hansana1,Sing Menorath1 and Tanja Tomson2Address: 1Postgraduate Studies & Research Department, University of Health Sciences, Lao PDR, PO Box 7444, Vientiane, Lao PDR and 2Dept. ofPublic Health Sciences, Division of Social Medicine, Karolinska Institutet, SE-171 77 Stockholm, SwedenEmail: Sychareun Vanphanom* - vsychareun@gmail.com; Alongkon Phengsavanh - ogalk@yahoo.com;Visanou Hansana - visanou65@hotmail.com; Sing Menorath - Menorath-smenorath@yahoo.com; Tanja Tomson - tanja.tomson@ki.se* Corresponding authorAbstractBackground: This cross-sectional study, the first of its kind, uses baseline data on smoking

prevalence among Buddhist monks in Northern and Central provinces of Lao PDR.Findings: Between March and September 2006, 390 monks were interviewed, usingquestionnaires, to assess smoking prevalence including determinants, knowledge andattitudes.Data entry was performed with Epi-Info (version 6.04) and data analysis with SPSS version 11.Descriptive analysis was employed for all independent and dependent variables. Chi-square orFisher's exact test were used for categorical variables to compare smoking status,knowledge,attitudes and province. Logistic regression was applied to identify determinants of smoking. Dailycurrent smoking was 11.8%. Controlling for confounding variables, age at start of monkhood andthe length of religious education were significant determinants of smoking. The majority of themonks 67.9% were in favor of the idea that offerings of cigarettes should be prohibited and thatthey should refuse the cigarettes offered to them (30.3%) but, in fact, 34.8% of the monks who werecurrent smokers accepted cigarettes from the public.Conclusion: Some monks were smokers, whilst they, in fact, should be used as non-smoking rolemodels. There was no anti-smoking policy in temples. This needs to be addressed when setting upsmoke-free policies at temples.BackgroundEvery six seconds, someone dies of a smoking-related disease[1]. By 2030, more than 80% of tobacco-relateddeaths will be in low- and middle-income countries [2].The tobacco epidemic is one of the greatest public healthchallenges not least in the Western Pacific and South EastAsia.The Lao People's Democratic Republic (Lao PDR) is oneof the poorest countries in the world with a GrossNational Income (GNI) per capita of $ 935 or less, lifeexpectancy at birth of 63 years and under-five mortalityrate of 75 [3,4]. Tobacco is listed as the third most importantagricultural crop in Lao PDR and this is, obviously, inconflict with any tobacco control policy [5]. Daily smok-Published: 8 June 2009BMC Research Notes 2009, 2:100 doi:10.1186/1756-0500-2-100Received: 11 December 2008Accepted: 8 June 2009This article is available from: http://www.biomedcentral.com/1756-0500/2/100© 2009 Vanphanom et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

http://journals.cambridge.org/action/displayAbstract;jsessionid=54EC76A8C6E3A1C9C8A6A991898866A5.tomcat1?fromPage=online&aid=7886624

Nutrition knowledge, attitudes, behaviours and the influencing factors among non-parent caregivers of rural left-behind children under 7 years old in China

Cai Tana1, Jiayou Luoa1 c1, Rong Zonga2 c1, ChuhuiFua1, Lingli Zhanga1, Jinsong Moua1 and Danhui Duana1

a1 Department of Women and Children Health, School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, People’s Republic of China

a2 Xiangya Hospital, Central South University, Changsha 410078, People’s Republic of China

Abstract

Objective To explore and compare nutrition knowledge, attitudes and behaviours (KAB) between non-parent and parent caregivers of children under 7 years old in Chinese rural areas, and to identify the factors influencing their nutrition KAB.

Design Face-to-face interviews were carried out with 1691 non-parent caregivers and 1670 parent caregivers in the selected study areas; multivariate logistic regression models were used toidentify the factors influencing nutrition KAB in caregivers.

Results The awareness rate of nutrition knowledge, the rate of positive attitudes and the rate of optimal behaviours in non-parent caregivers (52·2 %, 56·9 % and 37·7 %, respectively) were significantly lower than in the parent group (63·8 %, 62·1 % and

42·8 %, respectively). Multivariate logistic regression modellingshowed that caregivers’ family income and care will, and children’s age and gender, were associated with caregivers’ nutrition KAB after controlling the possible confounding variables (caregivers’ age, gender, education and occupation).

Conclusions Non-parent caregivers had relatively poor nutrition KAB. Extra efforts and targeted education programmes aimed to improve rural non-parent caregivers’ nutrition KAB are wanted andneed to be emphasized.

(Received January 13 2009)

(Accepted December 29 2009)

(Online publication March 03 2010)

http://her.oxfordjournals.org/content/early/2011/03/29/her.cyr017.abstract

Smoking patterns, attitudes and motives: unique characteristics among 2-year versus 4-year college students

1. C. J. Berg 1 ,*, 2. L. C. An 2 , 3. J. L. Thomas 3 ,4, 4. K. A. Lust 5 , 5. J. R. Sanem 5 , 6. D. W. Swan 1 and 7. J. S. Ahluwalia 3 ,4

+ Author Affiliations

1. 1Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322, USA

2. 2Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA

3. 3Department of Medicine 4. 4Masonic Cancer Center, University of Minnesota Medical School, Minneapolis,

MN 55414, USA 5. 5Boynton Health Services, University of Minnesota, Minneapolis, MN 55414, USA

1. *↵Correspondence to: C. J. Berg. E-mail: cjberg@emory.edu

Received March 16, 2010. Accepted February 20, 2011.

AbstractGiven the previously documented higher rates of smoking among 2-year college students in comparison with 4-year university students, this study compares smoking patterns, attitudes and motives among 2-year and 4-year college students. Two thousand two hundred and sixty-five undergraduate students aged 18–25 years at a 2-year college and a 4-year university completed an online survey in 2008. Current (past 30-day) smoking was reportedby 43.5% of 2-year and 31.9% of 4-year college students, and daily smoking was reported by 19.9% of 2-year and 8.3% of 4-year college students. Attending a 2-year college was associated with higher rates of current smoking [odds ratio (OR) = 1.72] and daily smoking (OR = 2.84), and with less negative attitudes regarding smoking, controlling for age, gender, ethnicity and parental education. Also, compared with 4-year college student smokers, 2-year college smokers had lower motivation to smoke forsocial reasons, but more motivation to smoke for affect regulation, after controlling for age, gender, ethnicity and parental education. Two- and 4-year college students report different smoking patterns, attitudes and motives. These distinctions might inform tobacco control messages and interventions targeting these groups of young adults.

http://www.psychiatry.org.il/upload/infocenter/info_images/2706200784535AM@Pages%20from%20IJP-44-1-12.pdf

Gender Effect onAttitudes Towards theMentally Ill:ASurvey of TurkishUniversity StudentsBayram Mert Savrun, MD, 1 Kemal Arikan, MD,1 Omer Uysal, MS,2 Gunay Cetin,MD,3Burc Cagri Poyraz, MD,1 Cana Aksoy, MD,1 and Mahmut Reha Bayar, MD11 Department of Psychiatry, CerrahpasaMedical Faculty, University of Istanbul, Turkey2 Department of Biostatistics, CerrahpasaMedical Faculty, University of Istanbul, Turkey3 Freelance psychiatrist, Istanbul, Turkey .

Abstract: This study investigates gender-associated characteristics of attitudes towards the mentally ill in a large sampleof Turkish university students. Factors associated with gender variation were also analyzed.Materials and methods:Student’s t-test and linear regression analyses of the results of a vignette-based opinion survey conducted on a sampleof final-year Turkish university students (n=700) were performed. The survey consisted of the following: the “DangerousnessScale,” “Characteristics Scale,” “Skill Assessment Scale,” “Social Distance Scale,” “Affective Reaction Scale” anda socio-demographic questionnaire. Results: The results showed a statistically significant difference between femaleand male respondents with regard to their answers to the questions on the “Dangerousness Scale,” “CharacteristicsScale” and the “Skill Assessment Scale.” In all of these three scales, female respondents showed a less stigmatizing attitudethan themale respondents. This gender effect continued after controlling for the subjects’ age and family income.In female respondents, parents’ level of education and a more positive attitude about treatment of mental illness predictedless stigmatizing attitudes towards mental illness. Conclusions: The findings suggest that gender difference inthis sample has an impact on the stigmatization phenomenon in an independent fashion. A more positive view of femaleuniversity students towards the mentally ill might be due to their comparatively optimistic attitudes about thetreatability of mental illnesses. The observed gender difference seems to be accentuated by the fact that female students’parents’ level of education was higher than that of their male counterparts.IntroductionStigma has been identified by professionals as a key

issue in mental illness (1, 2). Stigmatizing attitudesmay inhibit help seeking among individuals with amental disorder (3, 4), provide barriers to their successfulreintegration into society (5), and increasetheir psychological distress (6).Previous research findings on gender and stigmahave been mixed. In an early review by Farina, theauthor summarized results of community surveysconducted before the 1980s in the United States,with a conclusion that males and females tended notto differ in their overall attitudes towards individualswith mental illness (7). Literature on community attitudestowards the mentally ill demonstrated a suddensurge in the following years. Only recentlystigma has been depicted as different dimensions ofattitudes, not always consistently correlated witheach other. Among these stigma-dependent measuresemployed with success in previous research arethe questionnaires that separately address the subject’ssocial avoidance of contact with the patient; thesubject’s beliefs about whether persons with mentalillness are likely to be dangerous to others; the subject’sreported affective reaction to being acquaintedwith the patient; the subject’s view of the patient’s degreeof blame and responsibility for his/her diseaseand a measure of the subject’s opinion on the patient’ssocial skills (8). Specific study of these dimensionsmight lead to a better understanding of thenature of stigma, allowing for development of effectivecommunity de-stigmatization programs.In this study, we investigated the influence ofgender on characteristics of stigmatizing attitudes byuse of stigma-dependent measures in a large surveyof Turkish undergraduate university students. Wesought to test the hypothesis of whether gender

should be considered in the analysis of study results

http://linkinghub.elsevier.com/retrieve/pii/S1607551X0970395X

Select a website below to get this article.Effect of Systematic Menstrual Health Education on Dysmenorrheic Female Adolescents' Knowledge, Attitudes, and Self-Care BehaviorThe Kaohsiung Journal of Medical Sciences, Volume 23, Issue 4, Pages 183-190M. Chiou, H. Wang, Y. Yang

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AbstractThe purpose of this study was to evaluate the effects of systematic health education on female adolescents' knowledgeof dysmenorrhea, menstrual attitudes, and dysmenorrhea-related self-care behaviors. Through the research process, a

dysmenorrheal self-care pamphlet for female adolescents was developed. The study used a quasi-experimental intervention with a nonequivalent-control group design. Three vocational nursing schools were requested to participate in this study:one was assigned to the experimental group and two were assigned to the control group. Female students who had experienced dysmenorrheic cramps two or more times during the last 6 months since the interview were recruited for thestudy. There were 218 subjects randomly assigned to an experimental group, and 237 subjects to a control group. Intervention consisted of a three-session health education program in which the experimental group was split up into six smaller groups. Data were collected before, 2 weeks after, and 4 months after the intervention. Results revealeda significant increase in the experimental group members' dysmenorrhea-related knowledge and self-care behavior, but not in their attitudes. The findings of this study can serveas a guide to healthcare providers who want to design an effective systematic menstrual health education program for female adolescents.

http://www.freepatentsonline.com/article/Journal-Managerial-Issues/120612563.html Changing attitudes toward people with disabilities: experimenting with an educational intervention. Ads by GoogleMobility Scooters S'poreMobility Solutions For The Elders Call CARE Hotline 6777 8467Bion-Advance.com/Disability+ScooterAbstract:People with disabilities represent a significant minority population in the United States; however, they are relatively underrepresented in the American workforce, in spite of the passage of the Americans with Disabilities Act in 1990. Many experts agree that the continuing unemployment of people with disabilities is due in large part to the fact that potential employers and co-workers still maintain negative attitudes towardthem as a group. These negative attitudes appear to be rooted in a lack of knowledge about people with disabilities, as well as

the perpetuation of erroneous stereotypes about them. Some scholars and advocates (e.g., Lee and Rodda, 1994; Unger, 2002) assert that training designed to challenge existing beliefs is the key to changing these negative attitudes. Our research soughtto test that assertion by determining the effects of a brief educational intervention on individuals' knowledge about and attitudes toward people with disabilities in the workplace. Usinga Solomon four-group quasi-experimental design, undergraduate students were placed into one of four conditions and completed a survey that included a knowledge assessment and the Attitude Toward Disabled Persons Scale (Yuker and Block, 1986). Results indicate that the educational intervention had a significant impact on both participants' knowledge levels and their attitudes, even after controlling for gender and prior experiencewith people with disabilities. Implications of the findings are discussed.