Digging deeper: quality of patient-provider communication across Hispanic subgroups

<p>Abstract</p> <p>Background</p> <p>Recent research suggests that ethnic subgroup designation plays an important role in health-related disparities among Hispanics. Our objective was to examine the influence of Hispanics' self-reported ethnic subgroup designation on perceptions of their health care providers' communication behaviors.</p> <p>Methods</p> <p>Cross-sectional analysis of the 2005 Medical Expenditure Panel Survey (MEPS). Participants included non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged ≥18 years, reporting visiting a health care provider within the past 12 months. Six (n = 6) items were used to capture respondents' perceptions of their health care providers' communication behaviors.</p> <p>Results</p> <p>After controlling for socio-demographic covariates, compared to Other Hispanics (reference group), very few differences in perceptions of health care providers communication emerged across ethnic subgroups. Puerto Ricans were more likely to report that their health care provider "always" showed respect for what they had to say (OR = 2.16, 95% CI 1.16-4.03). Both Puerto Ricans (OR = 2.28, 95% CI 1.06-4.92) and Mexicans (OR = 1.88, 95% CI 1.02-3.46) were more likely to indicate that their health care provider "always" spent enough time with them as compared to Other Hispanics.</p> <p>Conclusions</p> <p>We observed very few differences among Hispanics respondents in their perceived quality of interactions with health care providers as a function of their ethnic subgroup designation. While our findings somewhat contradict previous research, they do suggest that other underlying factors may influence the quality of perceived interactions with health care providers.</p

Health literacy: setting an international collaborative research agenda

<p>Abstract</p> <p>Background</p> <p>Health literacy is an increasingly important topic in both the policy and research agendas of many countries. During the recent 36^thAnnual Meeting of the North American Primary Care Research Group, the authors led an audio-taped 3-hour forum, "<it>Studying Health Literacy: Developing an International Collaboration</it>," where the current state of health literacy (HL) in the United States (US) and United Kingdom (UK) was presented and attendees were encouraged to debate a future research agenda.</p> <p>Discussion of Forum Themes</p> <p>The debate centred around three distinct themes, including: (1) refining HL definitions and conceptual models, (2) HL measurement and assessment tools, and (3) developing a collaborative international research agenda. The attendees agreed that future research should be theoretically grounded and conceptual models employed in studies should be explicit to allow for international comparisons to be drawn.</p> <p>Summary and Authors Reflections</p> <p>The importance of HL research and its possible contribution to health disparities is becoming increasingly recognised internationally. International collaborations and comparative studies could illuminate some of the possible determinants of disparities, and also possibly provide a vehicle to examine other research questions of interest.</p

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)

Objective To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making. Patients and Methods Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes

The life of freelance film production workers in the New Zealand film industry : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

Eleven male and 10 female freelance production workers were interviewed about their experiences of life within the New Zealand film industry. Respondents’ accounts contrast sharply with glamorous images of the industry portrayed in the media. Respondents enjoyed the creative challenges, camaraderie, excitement, and intensity of their working lives and identified strongly with their work. However, they also experienced continual financial insecurity, unpredictable and demoralising periods of unemployment, and recurrent problems maintaining a reasonable work-life balance. Many of the older respondents cited these factors as their main reason for attempting to find work outside the industry. Female production workers appeared to pay a particularly high price for their involvement in the industry and often sacrificed other areas of their lives for their careers. Women frequently compensated for this imbalance by becoming even more career focussed, thus compounding the problems in non-work areas of their lives. Respondents’ accounts are interpreted in relation to current structural conditions, working practices, and power imbalances within the New Zealand film industry. It is argued that freelance production workers’ complex psychological relationship with their work is simultaneously a product of their work environment and helps to perpetuate industry conditions which disadvantage the workforce

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ISBN: 1 920952 91

Testing Practices and Attitudes Toward Tests and Testing : An International Survey

On behalf of the International Test Commission and the European Federation of Psychologists' Associations a world-wide survey on the opinions of professional psychologists on testing practices was carried out. The main objective of this study was to collect data for a better understanding of the state of psychological testing worldwide. These data could guide the actions and measures taken by ITC, EFPA, and other stakeholders. A questionnaire was administered to 20,467 professional psychologists from 29 countries. Five scales were constructed relating to: concern over incorrect test use, regulations on tests and testing, internet and computerized testing, appreciation of tests, and knowledge and training relating to test use. Equivalence across countries was evaluated using the alignment method, four scales demonstrated acceptable levels of invariance. Multilevel analysis was used to determine how scores were related to age, gender, and specialization, as well as how scores varied between countries. Although the results show a high appreciation of tests in general, the appreciation of internet and computerized testing is much lower. These scales show low variability over countries, whereas differences between countries on the other reported scales are much greater. This implies the need for some overarching improvements as well as country-specific actions