73 research outputs found
Trust, openness and continuity of care influence acceptance of antibiotics for children with respiratory tract infections: a four country qualitative study
Background. Clinicianâparent interaction and health system influences on parental acceptance of prescribing decisions for children with respiratory tract infections (RTIs) may be important determinants of antibiotic use.
Objective. To achieve a deeper understanding of parentsâ acceptance, or otherwise, of cliniciansâ antibiotic prescribing decisions for children with RTIs.
Methods. Qualitative interviews with parents of child patients who had recently consulted in primary care with a RTI in four European countries, with a five-stage analytic framework approach (familiarization, developing a thematic framework from interview questions and emerging themes, indexing, charting and interpretation).
Results. Fifty of 63 parents accepted cliniciansâ management decisions, irrespective of antibiotic prescription. There were no notable differences between networks. Parents ascribed their acceptance to a trusting and open clinicianâpatient relationship, enhanced through continuity of care, in which parents felt able to express their views. There was a lack of congruence about antibiotics between parents and clinicians in 13 instances, mostly when parents disagreed about cliniciansâ decision to prescribe (10 accounts) rather than objecting to withholding antibiotics (three accounts). All but one parent adhered to the prescribing decision, although some modified how the antibiotic was administered.
Conclusions. Parents from contrasting countries indicated that continuity of care, open communication in consultations and clinicianâpatient trust was important in acceptance of management of RTI in their children and in motivating adherence. Interventions to promote appropriate antibiotic use in children should consider a focus on eliciting parentsâ perspectives and promoting and building on continuity of care within a trusting clinicianâpatient relationship
Adverse childhood experiences and suicide attempts in morbidly obese adults
Introdução: As tentativas de suicĂdio surgem frequentemente associadas a problemas alimentares, tanto anorexia quanto bulimia. Do mesmo modo, tem-se verifi cado uma elevada ocorrĂȘncia de suicĂdio entre obesos. InvestigaçÔes tĂȘm mostrado que a adversidade na infĂąncia pode ser um fator de
risco para as tentativas de suicĂdio.
Objetivos: Caracterizar e compreender a relação entre experiĂȘncias de adversidade na infĂąncia e tentativas de suicĂdio em 100 obesos mĂłrbidos
candidatos a cirurgia bariĂĄtrica.
Métodos: Um total de 100 pacientes foram selecionados de setembro de 2007 a outubro de 2007 e de janeiro de 2008 a janeiro de 2009, sendo que 20 pacientes eram do sexo feminino. A média de idade era de 38,89±9,87 anos, e a média do peso måximo era de 136,43±14 kg. O Questionårio da
HistĂłria de Adversidade na InfĂąncia foi utilizado para avaliar experiĂȘncias adversas.
Resultados: 88% dos pacientes relataram a existĂȘncia de pelo menos uma experiĂȘncia de adversidade na infĂąncia, e 25% relataram jĂĄ ter realizado pelo menos
uma tentativa de suicĂdio. A adversidade na infĂąncia esteve associada a um risco aumentado para realizar tentativas de suicĂdio (odds ratio = 2,026).
Conclusão: Esses dados devem ser levados em consideração na avaliação e no acompanhamento desses pacientes.Introduction: Suicide attempts are often associated with eating disorders, both anorexia and bulimia. Likewise, a high incidence of suicide has been
observed among obese patients. Previous studies have shown that adverse experiences in childhood may be a risk factor for suicide attempts.
Objectives: To characterize and to understand the relationship between adverse experiences and suicide attempts in 100 morbidly obese patients
referred for bariatric surgery.
Methods: A total of 100 patients were selected from September 2007 to October 2007 and from January 2008 to January 2009. Of these, 20 patients
were females. Mean age was 38.89±9.87 years, and mean maximum weight was 136.43±14 kg. The Portuguese version of the Family ACE (Adverse
Childhood Experiences) Questionnaire was used to assess the occurrence of adverse events.
Results: 88% of the patients reported the existence of at least one adverse experience in childhood, and 25% reported at least one previous suicide
attempt. Adversity in childhood was associated with an increased risk for suicide attempts (odds ratio = 2.026).
Conclusion: These data should be taken into account in the assessment and monitoring of these patients.Fundação para a CiĂȘncia e a Tecnologia (FCT); (SFRH/BD/37069/2007)
How adolescents who cut themselves differ from those who take overdoses
The aims of this study were to identify in what ways adolescents who cut themselves differ from those who take overdoses, and to investigate the role of contagion in these behaviours. Data from an anonymous self-report questionnaire survey of 6,020 adolescents in 41 schools were analysed. Comparison of 220 adolescents who reported self-cutting in the previous year with 86 who had taken overdoses in the previous year as the sole method of deliberate self-harm (DSH) showed that far more of those who cut themselves had friends who had also engaged in DSH in the same period (OR 2.84, 95% CI 1.5â5.3, PÂ <Â 0.001), and fewer had sought help from friends before cutting (OR 0.5, 95% CI 0.3â0.9, PÂ <Â 0.02). Self-cutting usually involved less premeditation. Analyses at both the individual and school level showed that the association between engaging in DSH and exposure to DSH amongst peers was largely confined to girls who cut themselves. There are important differences between adolescents who cut themselves and those who take overdoses. Contagion may be an important factor in DSH by adolescents, especially in girls who cut themselves. These findings are relevant to the design of prevention and treatment programmes
Is relatively young age within a school year a risk factor for mental health problems and poor school performance? A population-based cross-sectional study of adolescents in Oslo, Norway
BACKGROUND: Several studies have shown that children who are relatively young within a school year are at greater risk for poorer school performance compared with their older peers. One study also reported that relative age within a school year is an independent risk factor for emotional and behavioral problems. The objective of this study was to test the hypothesis that relatively younger adolescents in the multiethnic population of Oslo have poorer school performance and more mental health problems than their relatively older classmates within the same school year. METHODS: This population-based cross-sectional study included all 10(th)-grade pupils enrolled in 2000 and 2001 in the city of Oslo. The participation rate was 88%. Of the 6,752 pupils in the study sample, 25% had a non-Norwegian background. Mental health problems were quantified using the abbreviated versions of Symptom Check List-25 (SCL-10) and the Strength and Difficulties Questionnaire (SDQ). Information on school performances and mental health problems were self-reported. We controlled for confounding factors including parental educational level, social support, gender, and ethnicity. RESULTS: The youngest one-third of pupils had significantly lower average school grades than the middle one-third and oldest one-third of their classmates (p < 0.001). Of the mental health problems identified in the questionnaires, the groups differed only on peer problems; the youngest one-third reported significantly more problems than the middle and oldest groups (p < 0.05). Age within a school year and gender showed significant interactions with total SDQ score, SDQ peer problems score, SDQ pro social score, and SCL-10 score. After stratifying for gender, the peer problem scores differed significantly between age groups only among boys. The SCL-10 score was significant, but only in girls and in the opposite direction to that expected, with the oldest pupils having significantly higher scores than the other two groups (p < 0.05). CONCLUSION: In adolescents from a multicultural city in Norway, relative age within a school year significantly influenced academic performance. In contrast to data from Great Britain, relative age within a school year was not an important risk factor for mental health problems in adolescents in Oslo
Personal factors associated with health-related quality of life in persons with morbid obesity on treatment waiting lists in Norway
Purpose To explore relationships of socio-demographic
variables, health behaviours, environmental characteristics
and personal factors, with physical and mental health
variables in persons with morbid obesity, and to compare
their health-related quality of life (HRQoL) scores with
scores from the general population.
Methods A cross-sectional correlation study design was
used. Data were collected by self-reported questionnaire
from adult patients within the first 2 days of commencement
of a mandatory educational course. Of 185 course
attendees, 142 (76.8%) volunteered to participate in the
study. Valid responses on all items were recorded for 128
participants. HRQoL was measured with the Short Form
12v2 from which physical (PCS) and mental component
summary (MCS) scores were computed. Other standardized
instruments measured regular physical activity, social
support, self-esteem, sense of coherence, self-efficacy and
coping style.
Results Respondents scored lower on all the HRQoL subdomains
compared with norms. Linear regression analyses
showed that personal factors that included self-esteem,
self-efficacy, sense of coherence and coping style
explained 3.6% of the variance in PCS scores and 41.6% in
MCS scores.
Conclusion Personal factors such as self-esteem, sense of
coherence and a high approaching coping style are strongly
related to mental health in obese persons
Cannabis use and deliberate self-harm in adolescence: a comparative analysis of associations in England and Norway.
The objective of this study was to test hypotheses on causality and selection regarding associations between cannabis use and deliberate self-harm (DSH) among adolescents. School surveys were conducted among 9,800 adolescents in England and Norway applying identical measures on deliberate self-harm, suicidal thoughts, cannabis use, and various potential confounders. Cannabis use was more prevalent in England than in Norway. It was associated with DHS, suicidal thoughts and various risk factors for DSH. However, these associations were stronger in Norway than in England. The adjusted associations between cannabis use and suicidal thoughts were non-significant in both countries. The adjusted cannabis-DSH association was non-significant in England but significant in Norway. Elevated risk of DSH in adolescent cannabis users seems to be mainly due to selection mechanisms. Thus the association is not likely to be direct but due to other shared contributory factors
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