Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

<p>Abstract</p> <p>Background</p> <p>Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour.</p> <p>Methods</p> <p>A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview.</p> <p>Results</p> <p>The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's <it>overall </it>health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia.</p> <p>Conclusions</p> <p>The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.</p

Patients' perspectives on self-testing of oral anticoagulation therapy: Content analysis of patients' internet blogs

<p>Abstract</p> <p>Background</p> <p>Patients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices.</p> <p>Methods</p> <p>Internet blog text mining was used to collect 246 blog postings by 108 patients, mainly from the USA and the UK. The content of these qualitative data were analysed using XSight and NVivo software packages.</p> <p>Results</p> <p>The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind. Equipment issues included high costs, reliability, quality, and learning how to use the device. PT/INR issues focused on the frequency of testing, INR fluctuations and individual target (therapeutic) INR level. Other themes noted were INR testing at laboratories, the interactions with healthcare professionals in managing and testing OAT and insurance companies' involvement in acquiring the self-testing equipment. Social issues included the pain and stress of taking and testing for OAT.</p> <p>Conclusions</p> <p>Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT. The themes identified in this paper highlight the substantial complexities involved in self-testing programmes in the healthcare system. Thus, the issues elicited in this study are very valuable for all stakeholders involved in developing effective self-testing strategies in healthcare that are gaining considerable current momentum particularly for patients with chronic illness.</p

Using photo-elicitation to understand reasons for repeated self-harm: a qualitative study

Background: Reasons for self-harm are not well understood. One of the reasons for this is that first-hand accounts are usually elicited using traditional interview and questionnaire methods. This study aims to explore the acceptability of using an approach (photo-elicitation) that does not rely on solely verbal or written techniques, and to make a preliminary assessment of whether people can usefully employ images to support a discussion about the reasons why they self-harm. Method: Interviews with eight participants using photo elicitation, a method in which photographs produced by the participant are used as a stimulus and guide within the interview. Results: Participants responded positively to using images to support a discussion about their self-harm and readily incorporated images in the interview. Four main themes were identified representing negative and positive or adaptive purposes of self-harm: self-harm as a response to distress, self-harm to achieve mastery, self-harm as protective and self-harm as a language or form of communication. Conclusions: Employing this novel approach was useful in broadening our understanding of self-harm

Community diversity and invasion resistance: An experimental test in a grassland ecosystem and a review of comparable studies

The relationship between community diversity and invasion resistance in a grassland was examined using experimental plant assemblages that varied in species richness and composition. The assemblages were weeded for three seasons to remove unsown species and we used the number of weeded seedlings, their total biomass and the number of species removed as indicators of community resistance and susceptibility to invasion. In general, we found a positive relationship between invasion resistance and increasing community diversity. Similar patterns of establishment were observed at the end of the fourth field season after several months without weeding. Increased invasion resistance with higher diversity appears to come through reduced levels of several above- and belowground resources, although these did not fully explain the effects of species richness in the study's analyses. Experimental increases and reductions of litter biomass within the study's experimental plant assemblages did not modify these patterns significantly. A review of comparable studies of invasion across directly manipulated diversity gradients revealed similar patterns. Positive effects of species diversity on invasion resistance were found in experimental manipulations of plant diversity conducted in the field and in the glasshouse, from studies with aquatic microcosms and in a marine system. Although some exceptions to this pattern were found in both terrestrial plant systems and aquatic microcosms, it was concluded that in biodiversity manipulation experiments more diverse communities are generally more resistant to invasion

Species evenness and productivity in experimental plant communities

In nature, plant biomass is not evenly distributed across species, and naturally uncommon species may differ from common species in the probability of loss from the community. Understanding relationships between evenness and productivity is therefore critical to understanding changes in ecosystem functioning as species are lost from communities. We examined data from a large multi-site grassland experiment (BIODEPTH) for relationships between evenness of species composition (proportional abundance of biomass) and total biomass of communities. For plots which started with the same and even species composition, but which diverged in evenness over time, those with lower evenness had a significantly greater biomass. The relationship between evenness and biomass across all plots was also negative. However, for communities where the most common species represented one of the three largest species in monoculture at that site (inclusion of a large dominant species), the relationship was neutral. Path analyses indicated that three paths contributed to this negative relationship. First, higher species richness decreased evenness, but increased biomass (primarily through an increase in maximum plant size). Contrary to predictions

General stabilizing effects of plant diversity on grassland productivity through population asynchrony and overyielding

Insurance effects of biodiversity can stabilize the functioning of multispecies ecosystems against environmental variability when differential species’ responses lead to asynchronous population dynamics. When responses are not perfectly positively correlated, declines in some populations are compensated by increases in others, smoothing variability in ecosystem productivity. This variance reduction effect of biodiversity is analogous to the riskspreading benefits of diverse investment portfolios in financial markets. We use data from the BIODEPTH network of grassland biodiversity experiments to perform a general test for stabilizing effects of plant diversity on the temporal variability of individual species, functional groups, and aggregate communities. We tested three potential mechanisms: reduction of temporal variability through population asynchrony; enhancement of long-term average performance through positive selection effects; and increases in the temporal mean due to overyielding. Our results support a stabilizing effect of diversity on the temporal variability of grassland aboveground annual net primary production through two mechanisms. Two-species communities with greater population asynchrony were more stable in their average production over time due to compensatory fluctuations. Overyielding also stabilized productivity by increasing levels of average biomass production relative to temporal variability. However, there was no evidence for a performance-enhancing effect on the temporal mean through positive selection effects. In combination with previous work, our results suggest that stabilizing effects of diversity on community productivity through population asynchrony and overyielding appear to be general in grassland ecosystems

Biodiversity and ecosystem functioning: reconciling the results of experimental and observational studies

Biodiversity and ecosystem functioning research has been some of the most controversial of the last decade but rapid progress has been made by deriving hypotheses from the differing view points and challenging them with appropriate experimental and analytical tests (Loreau et al. 2001). Here we address some recent criticisms of the BIODEPTH project (Thompson et al. 2005) and show that: 1. While legume species play an important role in the BIODEPTH results, patterns are not generally consistent with the multispecies sampling effect for legumes proposed by Huston & McBride (2002) as suggested in Thompson et al. (2005). 2. The BIODEPTH results are also not consistent with transient biodiversity effects. Levels of species diversity were generally maintained over the 3 years of the project (i.e. little competitive exclusion) and diversity-productivity relationships in BIODEPTH generally strengthened during the experiments

Ecosystem effects of biodiversity manipulations in European grasslands

We present a multisite analysis of the relationship between plant diversity and ecosystem functioning within the European BIODEPTH network of plant-diversity manipulation experiments. We report results of the analysis of 11 variables addressing several aspects of key ecosystem processes like biomass production, resource use (space, light, and nitrogen), and decomposition, measured across three years in plots of varying plant species richness at eight different European grassland field sites. Differences among sites explained substantial and significant amounts of the variation of most of the ecosystem processes examined. However, against this background of geographic variation, all the aspects of plant diversity and composition we examined (i.e., both numbers and types of species and functional groups) produced significant, mostly positive impacts on ecosystem processes. Analyses using the additive partitioning method revealed that complementarity effects (greater net yields than predicted from monocultures due to resource partitioning, positive interactions, etc.) were stronger and more consistent than selection effects (the covariance between monoculture yield and change in yield in mixtures) caused by dominance of species with particular traits. In general, communities with a higher diversity of species and functional groups were more productive and utilized resources more completely by intercepting more light, taking up more nitrogen, and occupying more of the available space. Diversity had significant effects through both increased vegetation cover and greater nitrogen retention by plants when this resource was more abundant through N2 fixation by legumes. However, additional positive diversity effects remained even after controlling for differences in vegetation cover and for the presence of legumes in communities. Diversity effects were stronger on above- than belowground processes. In particular, clear diversity effects on decomposition were only observed at one of the eight sites. The ecosystem effects of plant diversity also varied between sites and years. In general, diversity effects were lowest in the first year and stronger later in the experiment, indicating that they were not transitional due to community establishment. These analyses of our complete ecosystem process data set largely reinforce our previous results, and those from comparable biodiversity experiments, and extend the generality of diversity–ecosystem functioning relationships to multiple sites, years, and processes