Understanding Minority Patients’ Beliefs About Hypertension to Reduce Gaps in Communication Between Patients and Clinicians

The authors’ objective was to gain a better understanding of minority patients’ beliefs about hypertension and to use this understanding to develop a model to explain gaps in communication between patients and clinicians. Eighty-eight hypertensive black and Latino adults from 4 inner-city primary care clinics participated in focus groups to elucidate views on hypertension. Participants believed that hypertension was a serious illness in need of treatment. Participants’ diverged from the medical model in their beliefs about the time-course of hypertension (believed hypertension was intermittent); causes of hypertension (believed stress, racism, pollution, and poverty were the important causes); symptoms of hypertension (believed hypertension was primarily present when symptomatic); and treatments for hypertension (preferred alternative treatments that reduced stress over prescription medications). Participants distrusted clinicians who prioritized medications that did not directly address their understanding of the causes or symptoms of hypertension. Patients’ models of understanding chronic asymptomatic illnesses such as hypertension challenge the legitimacy of lifelong, pill-centered treatment. Listening to patients’ beliefs about hypertension may increase trust, improve communication, and encourage better self-management of hypertension

AROUSING FEAR IN DENTAL HEALTH EDUCATION * , †

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65851/1/j.1752-7325.1965.tb00484.x.pd

Time-of-Day Differences in Treatment-Related Habit Strength and Adherence

Background. Many of our daily behaviors are habitual, occurring automatically in response to learned contextual cues, and with minimal need for cognitive and self-regulatory resources. Behavioral habit strength predicts adherence to actions, including to medications. The time of day (morning vs. evening) may influence adherence and habit strength to the degree that stability of contexts/routines varies throughout the day. Purpose. The current study evaluates whether patients are more adherent to morning versus evening doses of medication and if morning doses show evidence of greater habit strength than evening doses. Methods. Objective adherence data (exact timing of pill dosing) were collected in an observational study by electronic monitoring pill bottles in a sample of patients on twice-daily pills for Type 2 diabetes (N = 51) over the course of 1 month. Results. Data supported the hypothesis that patients would miss fewer morning than evening pills. However, counter to the hypothesis, variability in dose timing (an indicator of habit strength) was not significantly different for morning versus evening pills. Conclusions. Findings suggest that medication adherence may be greater in the morning than in the evening. However, more research is needed to evaluate the role of habitual action in this greater adherence. Furthermore, future research should evaluate the validity of behavioral timing consistency as an indicator of habit strength

Gestión de enfermedades crónicas en la vida cotidiana: Modelo de sentido común

The Commonsense Model of Self-Regulation (CSM) has a history of over 50 years as a theoretical framework that explicates the processes by which individuals form cognitive, affective, and behavioral representations of health threats. This article summarizes the major components of individuals\u27 "commonsense models", the underlying assumptions of the CSM as a theory of dynamic behavior change, and the major empirical evidence that have developed these aspects of the CSM since its inception. We also discuss ongoing changes to the theory itself as well as its use in medical practice for optimizing patients\u27 self-management of chronic health threats. The final section focuses on future directions for the theory and its application.El modelo de sentido común de autorregulación (MSC) tiene una historia de más de 50 años como marco teórico que explica los procesos por los cuales los individuales forman representaciones cognitivas, afectivas y conductuales de la amenaza para la salud. Este artículo resume las mayores componentes de los modelos de sentido común de individuales, las suposiciones fundamentales de MSC como la teoría del cambio conductual dinámico y las mayores pruebas empíricas que han desarrollado estos aspectos de MSC desde los comienzos. Además, discutimos los cambios en curso de la misma teoría, tanto como su uso en la práctica médica para ayudar a los pacientes a optimizar la autogestión de amenazas de salud crónicas. La última sección se enfoca en las direcciones futuras de la teoría y su aplicación

The Common Sense of Counseling Psychology: Introducing

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving client’s self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we propose it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. In particular, the model has important practical implicationsfor addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment

The impact of culture and sociological and psychological issues on Muslim patients with breast cancer in Pakistan

This is a non-final version of an article published in final form in Cancer Nursing, 32(4), 2009. The final published article is available from the link below.Breast cancer is the most common form of cancer in Muslim women in Pakistan. The impact of the initial diagnosis, culture, religion, and psychosocial and psychological aspects of the disease is not well established. This qualitative study examined the experience and coping strategies used by patients with breast cancer in relation to its impact on their physical, mental health, religious, and family issues. Thirty patients with breast cancer were interviewed. Data were analyzed using thematic analysis. The patient's experience of breast cancer focused on the range of emotions felt throughout the illness trajectory, the importance of religion and family support on coping strategies used to manage the adverse effects of chemotherapy, and also the financial concerns. This is the first study to examine Pakistani Muslim women's views on the lived experience of breast cancer. This article provides clarification of the voiced experiences of women with breast cancer. The data not only highlight the role of religion and family support as essential coping strategies but also emphasize the issues of isolation, aggression, and anger as common responses to chemotherapy. Unique features of this study are women's need to seek spiritual support for their illness and the overriding innate characteristic of maternal responsibility. These cultural features require further analysis and research

Inside-Out Corporate Governance

Until late in the twentieth century, internal corporate governance—that is, decision making by the principal constituencies of the firm—was clearly distinct from outside oversight by regulators, auditors and credit rating agencies, and markets. With the 1980s takeover wave and hedge funds’ and equity funds’ more recent involvement in corporate governance, the distinction between inside and outside governance has eroded. The tools of inside governance are now routinely employed by governance outsiders, intertwining the two traditional modes of governance. We argue in this Article that the shift has created a new governance paradigm, which we call inside-out corporate governance. Using the inside-out model as our lens, and drawing on comparisons to Italian and E.U. governance, we explore three areas of corporate governance that have been pervasively restructured by the Dodd-Frank Act and subsequent regulation: proxy access, credit rating agencies, and derivatives. We begin, in Part I, with proxy access, arguing that the new scheme for minority shareholder access excludes the very outsiders it ostensibly integrates into corporate governance. In Part II, which focuses on auditing and credit rating agencies, we argue that the inside-out relationship—in which the corporation itself chooses its gatekeeper—is deeply problematic but cannot be “cured.” The most realistic strategy is to create more flexibility in the audit relationship, and diminish the importance of credit ratings. Part III analyzes the new derivatives regulation. Here, we argue that Congress’s effort to sharply separate the inside and outside uses of derivatives is incoherent from a corporate governance perspective. We conclude by briefly speculating about the future implications of inside-out governance

Inside-Out Corporate Governance

Until late in the twentieth century, internal corporate governance—that is, decision making by the principal constituencies of the firm—was clearly distinct from outside oversight by regulators, auditors and credit rating agencies, and markets. With the 1980s takeover wave and hedge funds’ and equity funds’ more recent involvement in corporate governance, the distinction between inside and outside governance has eroded. The tools of inside governance are now routinely employed by governance outsiders, intertwining the two traditional modes of governance. We argue in this Article that the shift has created a new governance paradigm, which we call inside-out corporate governance. Using the inside-out model as our lens, and drawing on comparisons to Italian and E.U. governance, we explore three areas of corporate governance that have been pervasively restructured by the Dodd-Frank Act and subsequent regulation: proxy access, credit rating agencies, and derivatives. We begin, in Part I, with proxy access, arguing that the new scheme for minority shareholder access excludes the very outsiders it ostensibly integrates into corporate governance. In Part II, which focuses on auditing and credit rating agencies, we argue that the inside-out relationship—in which the corporation itself chooses its gatekeeper—is deeply problematic but cannot be “cured.” The most realistic strategy is to create more flexibility in the audit relationship, and diminish the importance of credit ratings. Part III analyzes the new derivatives regulation. Here, we argue that Congress’s effort to sharply separate the inside and outside uses of derivatives is incoherent from a corporate governance perspective. We conclude by briefly speculating about the future implications of inside-out governance

Does home oxygen therapy (HOT) in addition to standard care reduce disease severity and improve symptoms in people with chronic heart failure? A randomised trial of home oxygen therapy for patients with chronic heart failure

Background: Home oxygen therapy (HOT) is commonly used for patients with severe chronic heart failure(CHF) who have intractable breathlessness. There is no trial evidence to support its use.Objectives: To detect whether or not there was a quality-of-life benefit from HOT given as long-termoxygen therapy (LTOT) for at least 15 hours per day in the home, including overnight hours, comparedwith best medical therapy (BMT) in patients with severely symptomatic CHF.Design: A pragmatic, two-arm, randomised controlled trial recruiting patients with severe CHF. It includeda linked qualitative substudy to assess the views of patients using home oxygen, and a free-standingsubstudy to assess the haemodynamic effects of acute oxygen administration.Setting: Heart failure outpatient clinics in hospital or the community, in a range of urban andrural settings.Participants: Patients had to have heart failure from any aetiology, New York Heart Association (NYHA)class III/IV symptoms, at least moderate left ventricular systolic dysfunction, and be receiving maximallytolerated medical management. Patients were excluded if they had had a cardiac resynchronisation therapydevice implanted within the past 3 months, chronic obstructive pulmonary disease fulfilling the criteria forLTOT or malignant disease that would impair survival or were using a device or medication that wouldimpede their ability to use LTOT.Interventions: Patients received BMT and were randomised (unblinded) to open-label LTOT, prescribed for15 hours per day including overnight hours, or no oxygen therapy.Main outcome measures: The primary end point was quality of life as measured by the Minnesota Livingwith Heart Failure (MLwHF) questionnaire score at 6 months. Secondary outcomes included assessing theeffect of LTOT on patient symptoms and disease severity, and assessing its acceptability to patientsand carers.Results: Between April 2012 and February 2014, 114 patients were randomised to receive either LTOT orBMT. The mean age was 72.3 years [standard deviation (SD) 11.3 years] and 70% were male. Ischaemicheart disease was the cause of heart failure in 84%; 95% were in NYHA class III; the mean left ventricularejection fraction was 27.8%; and the median N-terminal pro-B-type natriuretic hormone was 2203 ng/l.The primary analysis used a covariance pattern mixed model which included patients only if they provided datafor all baseline covariates adjusted for in the model and outcome data for at least one post-randomisationtime point (n = 102: intervention, n = 51; control, n = 51). There was no difference in the MLwHF questionnairescore at 6 months between the two arms [at baseline the mean score was 54.0 (SD 18.4) for LTOT and54.0 (SD 17.9) for BMT; at 6 months the mean score was 48.1 (SD 18.5) for LTOT and 49.0 (SD 20.2) forBMT; adjusted mean difference –0.10, 95% confidence interval (CI) –6.88 to 6.69; p = 0.98]. At 3 months,the adjusted mean MLwHF questionnaire score was lower in the LTOT group (–5.47, 95% CI –10.54 to–0.41; p = 0.03) and breathlessness scores improved, although the effect did not persist to 6 months.There was no effect of LTOT on any secondary measure. There was a greater number of deaths in the BMTarm (n = 12 vs. n = 6). Adherence was poor, with only 11% of patients reporting using the oxygenas prescribed.Conclusions: Although the study was significantly underpowered, HOT prescribed for 15 hours per dayand subsequently used for a mean of 5.4 hours per day has no impact on quality of life as measured bythe MLwHF questionnaire score at 6 months. Suggestions for future research include (1) a trial of patientswith severe heart failure randomised to have emergency oxygen supply in the house, supplied by cylindersrather than an oxygen concentrator, powered to detect a reduction in admissions to hospital, and (2) astudy of bed-bound patients with heart failure who are in the last few weeks of life, powered to detectchanges in symptom severity.Trial registration: Current Controlled Trials ISRCTN60260702.Funding: This project was funded by the NIHR Health Technology Assessment programme and will bepublished in full in Health Technology Assessment; Vol. 19, No. 75. See the NIHR Journals Library websitefor further project information