Conhecimento e atitudes de pais de crianças/adolescentes sobre papillomavirus humano: estudo transversal / Conocimiento y actitudes de padres de niños/adolescentes sobre el virus del papiloma humano: estudio transversal / Knowledge and attitudes of parents of children/adolescents about human papillomavirus: cross-sectional study

Resumo Objetivo Analisar as características associadas aos pais de crianças e adolescentes que ouviram falar sobre o Papillomavirus humano, bem como o conhecimento sobre a infecção e a intenção de vacinar seus filhos. Métodos Estudo transversal com abordagem quantitativa, realizado por meio de entrevista utilizando instrumento estruturado. Entrevistaram-se 376 pais de crianças e adolescentes que aguardavam atendimento pediátrico em unidades de saúde de Três Lagoas/MS. Os dados coletados (características sociodemográficas; características reprodutivas e sexuais; conhecimento sobre o Papillomavirus humano e intenção de vacinar o/a filho/a) foram analisados por meio de técnica de estatística descritiva, teste de associação Qui-quadrado ou exato de Fisher e Teste T Student. Resultados Dentre os entrevistados, 327 (87,0%) afirmaram ter ouvido falar sobre o Papillomavirus humano. Identificou-se associação entre os pais que nunca ouviram falar sobre a infecção e sexo masculino, idade entre 18 e 25 anos e ensino fundamental incompleto. Dentre os pais que ouviram falar sobre o Papilomavírus Humano, 152 (46,5%) afirmaram que é uma infecção sexualmente transmissível, 245 (74,9%) garantiram que a transmissão ocorre através da relação sexual desprotegida, 275 (75,5%) desconhecem seus sinais e sintomas, 218 (66,7%) afirmaram erroneamente que tal infecção tem cura e 283 (86,5%) sabem da existência da vacina. Dentre todos os entrevistados, 98,1% levariam seu(ua) filho(a) para vacinar contra o vírus. Conclusão Observaram-se lacunas no conhecimento dos pais de crianças e adolescentes sobre o Papillomavirus humano, mostrando a necessidade de educação em saúde e divulgação de ações de enfrentamento à infecção em meios de comunicação e redes sociais.

Resumen Objetivo Analizar las características asociadas a padres de niños y adolescentes que escucharon hablar sobre el virus del papiloma humano, así como el conocimiento sobre la infección y la intención de vacunar a sus hijos. Métodos Estudio transversal, con enfoque cuantitativo, realizado por medio de encuesta con instrumento estructurado. Se encuestaron 376 padres de niños y adolescentes que esperaban atención pediátrica en unidades de salud de Três Lagoas, estado de Mato Grosso do Sul. Los datos recopilados (características sociodemográficas, características reproductivas y sexuales, conocimiento sobre el virus del papiloma humano e intención de vacunar al hijo/a) se analizaron por medio de técnica de estadística descriptiva, prueba de asociación ji cuadrado o prueba exacta de Fisher y test-T Student. Resultados Entre los encuestados, 327 (87,0 %) afirmaron haber escuchado hablar sobre el virus del papiloma humano. Se identificó relación entre los padres que nunca escucharon hablar sobre la infección y el sexo masculino, edad entre 18 y 25 años y educación primaria incompleta. De los padres que escucharon hablar sobre el virus del papiloma humano, 152 (46,5 %) afirmaron que es una infección de transmisión sexual, 245 (74,9 %) aseguraron que la transmisión ocurre a través de las relaciones sexuales sin protección, 275 (75,5 %) desconocen sus signos y síntomas, 218 (66,7 %) afirmaron erróneamente que tal infección tiene cura, y 283 (86,5 %) saben de la existencia de la vacuna. Entre los encuestados, el 98,1 % llevaría a su hijo/a vacunarse contra el virus. Conclusión Se observaron vacíos de conocimiento en los padres de niños y adolescentes sobre el virus del papiloma humano, lo que muestra la necesidad de educación para la salud y difusión de acciones para enfrentar la infección en medios de comunicación y redes sociales.

Abstract Objective Analyze the characteristics associated with the parents of children and adolescents who have heard about the human papillomavirus, as well as the knowledge about the infection and the intention to vaccinate their children. Methods Cross-sectional study with quantitative approach, conducted through a structured interview. We interviewed 376 parents of children and adolescents who were awaiting pediatric care at health services in Três Lagoas/MS. The collected data (sociodemographic characteristics; reproductive and sexual characteristics; knowledge about human papillomavirus and intention to vaccinate the child) were analyzed using descriptive statistics, Fisher's exact test or the chi-square association test and Student's t-test. Results Among the respondents, 327 (87.0%) said they had heard about the human papillomavirus. An association was identified between parents who had never heard of the infection and male sex, age between 18 and 25 years and unfinished primary education. Among the parents who had heard about the human papillomavirus, 152 (46.5%) stated that it is a sexually transmitted infection, 245 (74.9%) assured that the transmission occurs through unprotected sexual intercourse, 275 (75.5%) are unaware of its signs and symptoms, 218 (66.7%) mistakenly stated that this infection is curable and 283 (86.5%) know of the existence of the vaccine. Among all respondents, 98.1% would take their child to get vaccinated against the virus. Conclusion Gaps were observed in the knowledge of the parents of children and adolescents about the human papillomavirus, showing the need for health education and dissemination of actions to cope with the infection in the media and social networks.

Spread of homeopathy in the early nineteenth century: the comparative approach and the cases of Sweden and Brazil / A difusão da homeopatia no início do século XIX: abordagem comparativa e os casos da Suécia e do Brasil

Abstract The comparative approach has been advocated to overcome some flaws inherent to case studies. Here, the spread of homeopathy in the early nineteenth century is addressed through a comparison of the cases of Sweden and Brazil, where homeopathy met diametrically opposed fates. The parameters used for the comparison are the standard for studies on the early spread of homeopathy, such as the concept of the "introducer," and reception by the medical and academic community, the government, and society at large. The results suggest that analysis of contexts, determinants, and the interactions of practitioners and institutions representing different health care approaches, whether dominant or alternative, seems to provide a more accurate picture of different moments in the global history of medicine.

Resumo A abordagem comparativa foi adotada com o intuito de suplantar algumas falhas inerentes aos estudos de caso. Nela, a difusão da homeopatia no início do século XIX é tratada por meio de uma comparação entre casos da Suécia e do Brasil, onde a homeopatia encontrou destinos diametralmente opostos. Os parâmetros usados para a comparação são padrão para estudos sobre o início da expansão da homeopatia, como o conceito de "introdutor", e a aceitação por parte de governo, comunidades médica e acadêmica, e sociedade como um todo. Os resultados sugerem que a análise de contextos, de determinantes, e das interações de médicos e instituições representando diferentes perspectivas de tratamento médico, fossem elas dominantes ou alternativas, parecem oferecer uma análise mais precisa de diferentes momentos da história global da medicina.

Tensiones y contradicciones en la intervención gubernamental para la promoción de la lactancia materna / Tensions and contradictions in government interventions for the promotion of breastfeeding

RESUMEN Con el propósito de esclarecer el abandono de la lactancia materna en zonas rurales de México, se aborda el modelo biomédico vigente y las políticas y acciones para la promoción de la lactancia materna que se derivan de su enfoque teórico, y se discuten las estrategias operativas del programa gubernamental de beneficio social Oportunidades. Para ello se retoman los testimonios de 39 madres jóvenes lactantes, 11 mujeres madres abuelas y 12 miembros del personal sanitario de la población náhuatl de Cuentepec, Morelos, México, recabados en un trabajo de investigación previo, realizado entre 2008 y 2009. Se constató que el modelo biomédico, que permea todas las acciones de promoción de lactancia materna, cosifica a las personas, limita la comunicación, devalúa los saberes tradicionales de las mujeres e impone un discurso que paulatinamente desalienta dicha práctica. Se propone adoptar un cambio epistémico del pensamiento biomédico que transite del paradigma de la simplicidad al de la complejidad, para lograr un acercamiento mayor a la comprensión de los procesos bio-psico-socio-culturales propios del ser humano.

ABSTRACT With the purpose of shedding light on the decrease in the practice of breastfeeding in rural areas of Mexico, this article looks at the current biomedical model and the policies and actions to promote breastfeeding derived from the model's theoretical approach. The article also discusses operational strategies of the governmental social welfare program Oportunidades. For this purpose, the study utilizes the testimonies of 39 young breastfeeding mothers, 11 mothers and grandmothers and 12 members of the health staff in the Nahuatl population of Cuentepec, Morelos, Mexico, which were collected during a previous study in 2008 and 2009. It was found that the biomedical model, which permeates all actions to promote breastfeeding, reifies people, limits communication, devaluates women's traditional knowledge and imposes a discourse that gradually discourages the practice of breastfeeding. The article's proposal is to adopt an epistemic change in biomedical thought that shifts from a paradigm of simplicity to one of complexity, with the purpose of achieving a greater understanding of the bio-psycho-socio-cultural processes of human beings.

Difficulties of Portuguese Patients Following Acute Myocardial Infarction: Predictors of Readmissions and Unchanged Lifestyles

PURPOSE: Myocardial infarction can occur due to known risk factors and lifestyle choices. The difficulties that patients experience after discharge can lead to readmission and nonadherence to lifestyle change. The purpose of this study was to analyze the difficulties experienced by patients after hospitalization due to myocardial infarction and to identify the predictors of readmission and unchanged lifestyles. METHODS: The study used a mixed-methods design across 106 patients who had experienced a first episode of acute myocardial infarction. The data were collected from two patient interviews and the patients' medical records. A logistic regression was used to predict unchanged lifestyle and readmission. RESULTS: In the first interview, 74.5% of the patients reported receiving information prior to discharge. Six months after discharge, 80.2% mentioned that they had changed their lifestyles, but only 59.4% reported that their health had improved, and 75.5% continued to have concerns regarding their health. Patients described difficulties with regard to psychological problems, family dynamics, professional issues, problems with managing cardiovascular symptoms, and complications associated with hospital interventions. A follow-up assessment revealed that 12.3% of patients had been readmitted for cardiovascular disease. CONCLUSIONS: The analysis revealed significant predictors of readmission amongst patients with hypertension and three-vessel disease. Specifically, the number of people in the household, per capita income, and a lack of information/education provided at discharge as well as problems related to mental health after discharge predicted unchanged lifestyle. An educational program might be advantageous to clarify doubts and involve patients in their own disease management.

Riesgos del trabajo y salud: percepción de mujeres indígenas jornaleras en el noroeste de México / Occupational risks and health: perceptions of indigenous female agricultural workers in Northwestern Mexico

El objetivo de este estudio fue conocer las percepciones de las mujeres indígenas jornaleras sobre los riesgos del trabajo relacionados con su salud, a partir de la caracterización que ellas mismas realizaron sobre las exigencias del trabajo agrícola. Se considera el concepto de riesgo del trabajo como un constructo maleable en el cual se relacionan las condiciones de trabajo con las distintas percepciones y vivencias de los actores. A partir de un modelo microestructural se explican y relacionan los riesgos del trabajo con las desigualdades sociales y su impacto en la salud. La metodología fue de corte cualitativo; se emplearon la observación no participante, talleres participativos y entrevistas grupales en los años 2011 y 2012. El grupo que participó en este estudio fue de 60 mujeres indígenas. Entre los resultados destaca que su percepción acerca de los riesgos laborales se va construyendo sobre la base de las prácticas cotidianas en el lugar de trabajo y que gran parte de las actividades laborales que realizan las coloca en situaciones de riesgo.

The objective of this study was to learn the perceptions of indigenous female day laborers regarding health-related risks in the workplace, based on their own characterization of the requirements of agricultural work. The concept of occupational risk is understood as a flexible construct in which work conditions and the different perceptions and lived experiences of social actors are interrelated. A microstructural model is employed to explain the occupational risks and their relationship to social inequalities and impacts in health. The methodology used was qualitative, employing non-participant observation, participatory workshops and group interviews during 2011-2012. Sixty indigenous women participated in the study. Results reveal that their perception regarding occupational risks is constructed from everyday practices in their place of work and that most of their work activities place them in situations of risk.

Ciências Sociais e saúde no ciclo de pesquisas no Vale do São Francisco (1950-1960) / Social Sciences and health in the research cycle of São Francisco Valley (1950-1960)

No período entre 1940 e 1960, houve ampla produção acadêmica no campo da sociologia e da antropologia dos chamados estudos de comunidade no Brasil. Na era dos grandes projetos no âmbito das Ciências Sociais na década de 1950, envolvendo pesquisas sobre relações raciais, educação e saúde, cabe destacar as pesquisas realizadas no Vale do São Francisco, sob a coordenação do sociólogo Donald Pierson. Privilegia-se, neste artigo, o tema da saúde nesses estudos como um meio para tornar inteligíveis questões relevantes à época, a saber: resistências culturais à mudança; relações entre tradição e modernidade, tensões e complementaridades entre conhecimento científico e práticas populares de cura, entre outros. O exame das pesquisas do Projeto do São Francisco permitiu identificar que a questão da saúde, atrelada aos aspectos socioeconômicos e culturais, emerge como uma chave para o conhecimento das condições de vida e da realidade social das comunidades investigadas. Os cientistas sociais buscaram descrevê-las de maneira pormenorizada e abrangente, tendo o processo de mudança cultural como principal eixo de investigação. Neste artigo apresentamos as pesquisas que compuseram o referido projeto e mostramos como os cientistas sociais abordaram o tema da saúde em seus trabalhos. Ligados pelo tema da saúde, as Ciências Sociais e o contexto do desenvolvimento dos anos 1950 encontram-se reunidos no Projeto do São Francisco, cuja investigação nos permite compreender a dinâmica da mudança social naquele período.

Between 1940 and 1960, there was extensive academic research in the field of sociology and anthropology of so-called community studies in Brazil. In the era of large projects in the social sciences in the 1950s, involving research on race relations, education and health, we highlight the research conducted in the São Francisco Valley, under the coordination of the sociologist Donald Pierson. Attention is given in this paper to the issue of health in these studies as a means to make intelligible the relevant issues at the time, namely: cultural resistance to change, relations between tradition and modernity, tensions and complementarities between scientific knowledge and folk healing practices, among others. The examination of the research project of San Francisco identified the issue of health, linked to socioeconomic and cultural aspects, emerges as a key to the knowledge of living conditions and social reality of the communities investigated. Social scientists have sought to describe them in detail and comprehensively, taking the process of cultural change as the main axis of research. This paper presents the research that formed the said project and shows how social scientists have addressed the issue of health in their work. Linked by the theme of health, social sciences and the development context of the 1950s are gathered in the San Francisco Project, whose research allows us to understand the dynamics of social change in that period.

Capacidad de respuesta al riesgo de ITS/VIH/SIDA: hombres en condición de desplazamiento forzado / Ability to respond to STI/HIV/AIDS risk: men in conditions of forced displacement

Objetivo: Describir la capacidad de respuesta de hombres con situación de desplazamiento forzado frente a problemas de salud sexual y reproductiva, particularmente frente a las ITS/VIH/SIDA. Metodología. Se realizó un estudio etnográfico, utilizando las técnicas de observación y entrevista semiestructurada entre marzo y noviembre de 2010. La selección de los participantes se realizó en un principio con un muestreo con propósito y luego mediante la técnica bola de nieve, hasta cumplir los criterios de saturación teórica. Se entrevistaron 19 hombres entre 18 y 60 años de edad, con y sin pareja con menos de 1 año de estar en condición de desplazamiento y que asistieran a la UAO o vivieran en los diferentes albergues de la ciudad de Medellín. Los resultados se analizaron con los lineamientos de la teoría fundamentada. Resultados: Se construyeron 3 categorías centrales: 1.Condiciones del desplazamiento con 3 sub-categorías (los efectos en la vida cotidiana, los sentimientos y lo más difícil) 2. Aspectos relacionados con la sexualidad con 3 sub- categorías (Percepción sobre las relaciones sexuales, deseo sexual y conocimiento y percepción del riesgo a ITS/VIH/SIDA y 3. Capacidad de respuesta con 2 sub-categorías (Aspectos que limitan la capacidad de respuesta al riesgo de ITS/VIH/SIDA y factores que favorecen la capacidad de respuesta). Conclusiones. Los hombres en condición de desplazamiento no se perciben en riesgo frente las ITS/VIH/SIDA y ante la inminente posibilidad de tener sexo, no llevan las medidas preventivas frente al riesgo de enfermar, la prevención entonces no fue un aspecto relevante y casi todos los participantes asumieron diversas conductas de riesgo en relación a su Salud sexual y reproductiva; además su condición apremiante los impulsó a satisfacer sus necesidades básicas y sexuales por medio de establecimiento de relaciones de conveniencia y de sexo en contextos de vulnerabilidad para ITS/VIH/SIDA. (AU)

Objective: To describe the response capacity of men in a forced displacement situation toward sexual and reproductive health issues, particularly those relating STD/HIV/AIDS. Methodology: An ethnographic study was carried out by using observation techniques and a semi-structured interview, between March and November 2010. The selection of the participants was initially carried out with an intended sample, and then, by means of the snowball technique, until the theoretical saturation criteria were met. 19 men, aged between 18 and 60 years were interviewed, with or without a couple, with less than a year of being under a displacement condition and who were attending the Attention and Orientation Unit ­UAO­ or who were living in different shelters around the city of Medellin. The results were analyzed based on the guidelines of Grounded Theory. Results: 3 main categories were developed: 1. Conditions of displacement made up of 3 sub-categories (the effects of everyday life, feelings, and the most difficult aspects) 2. Issues related to sexuality made up of 3 sub-categories (Perceptions about sexual relations, sexual drive and knowledge and risk perception) regardingSTD/HIV/AIDS and 3. Response capacity made up of 2 sub-categories (Issues which hinder response capacity to the risk of STD/HIV/AIDS and issues which favor the response capacity. Conclusions: The men, who are in a condition of displacement, do not perceive themselves at risk in issues relating to STD/HIV/AIDS and in issues relating to the imminent possibility of having intercourse, they do not take the preventive measurements in front of the risk of becoming sick, prevention then was not a key issue and almost all of the participants adopted several risk behaviors relating to their sexual and reproductive health, besides their urgent conditions drove them to satisfy their basic and sexual needs by means of the establishment of relationships of advisability and of sex, in vulnerability contexts for STD/HIV/AIDS. (AU)

attitude towards disclosure of bad news to cancer patients in Saudi Arabia

Disclosing the diagnosis or prognosis to cancer patients in Saudi Arabia can be a serious challenge to the physician in his daily clinic practice. The public attitude towards full disclosure is still conservative, and in order to appropriately deal with such an attitude, physicians need to deeply understand its sociocultural background. This article attempts to look into what governs the public attitude towards disclosure in Saudi Arabia as an example of what may affect attitudes in developing countries. It also brings some data from local surveys among physicians and patients as well as from public surveys to describe the changing trend in attitude over the years with a comparative analysis of the Western literature

A saúde na percepção do adolescente / Health in the adolescent's viewpoint

Na fase da adolescência, o indivíduo experimenta os melhores índices de saúde, os quais podem ser mantidos e/ou melhorados, dependendo da percepção e valorização dos mesmos, influenciando na sua qualidade de vida. O estudo avaliou a opinião de adolescentes (n=493) da Fundação Mirim do Município de Araçatuba - SP, quanto à saúde geral e bucal, bem como sua percepção sobre elas, por meio questionário semiestruturado, durante o ano letivo de 2006, já que os mesmos possuem acesso à atenção à saúde bucal e palestras sobre saúde. Dentre os entrevistados 34,5 por cento conceituaram a saúde como coisa ou algo que precisa(mos) cuidar; 26,6 por cento, como bem-estar; 18,1 por cento, como a própria existência; e 14,5 por cento, como ausência de doença. Em relação aos conceitos de saúde bucal, 68,4 por cento definiram como higiene; 16,2 por cento, como aparência; e 15,5 por cento, como ausência de doenças bucais. A percepção desses jovens quanto a sua saúde em geral foi para 46,5 por cento, ótima, e 44,1 por cento, boa, enquanto que a da sua saúde bucal foi para 53,6 por cento, boa, e 24 por cento, ótima. Pode-se concluir que os adolescentes têm uma ideia tanto sobre saúde geral como saúde bucal, porém a classificação é menor no que tange à saúde bucal, pois envolve aspectos afetivos, estéticos e sociais. Ademais, percebe-se a necessidade de programas educativo-preventivos direcionados a esse grupo.

During adolescence, the individual experiences the best health indexes, which can be maintained and/or improved, depending on their perception and valorization influencing their quality of life. The study assessed the opinion of adolescents (n=493) from the Mirim Foundation of the Araçatuba county in São Paulo State, Brazil, about their oral and general health, as well as their perception about them, through a semi-structured questionnaire, in the school year period of 2006, since they have access to information on oral health care and speeches about health in general. Among the interviees, 34.5 percent referred to health as something to be cared of; 26.6 percent defined it as well-being;ç 18.1 percent, as related to their very existence, and 14.5 percent, as an absence of disease. In relation to the concepts of oral health, 68.4 percent defined it as hygiene; 16.2 percent, as physical appearance and 15.5 percent, as to the absence of oral diseases. The perception of these youngsters about their health in general was excellent for 46.5 percent, and good for 44.1 percent. Concerning their oral health, for 53.6 percent it was good, and for 24 percent, excellent. One can conclude that the adolescents have an idea about general health, as well as oral health, but the oral health classification is lower, since it involves emotional, esthetic and social aspects. Moreover, the need of prevention-educative programs designed for this group is indubitable.

Contraceptive practice of the tribal women in tea garden area of North Bengal.

A total of 860 tribal tea garden women in the Jalpaiguri district were surveyed by means of detailed questionnaires to obtain information of their contraceptive knowledge and practices and also to see the literacy rate among themselves. Analysis was done of their literacy level, family planning awareness, access to information and communication, methods of contraception adopted and utilisation of healthcare facilities. Majority (85%) of the tea garden women including all the age groups were illiterate. The overall contraceptive prevalence was 40.2% but most of the current users (22.6%) subjected to tubal sterilisation for family planning, couples were not enthusiastic about using the reversible methods; 59.7% women had lack of adequate information regarding various contraceptives. Contraceptive practice, as birth spacing method, needs to be given tremendous emphasis in order to improve the reproductive health of the tribal women. Education, information, choices and rights for decision-making only can achieve this.

Changing ethics in medical practice: a Thai perspective.

The pace of social change in Thailand has seen the rise of various medical services and a global clientele. Currently, medical tourism and cosmetic surgery have an important role in medical practice here. A growing medical market offers a range of services at competitive rates and high levels of efficiency. This essay provides an overview of medical practices in Thailand and their effect on ordinary people.

Modern medicine and indigenous health beliefs: malaria control alongside "Sadsana-phee" (animist belief system) in Lao PDR.

The major religion in Lao PDR is Buddhism, but many ethnic groups in rural Lao PDR hold an animist belief system called "Sadsana-pee". At the same time, the Bourapar District study site in Khammouane Province, Lao PDR is at high risk of malaria infection. Due to their belief in traditional ways of healing, the promotion of malaria prevention and treatment with modern medicine was not always welcomed by the villagers. Based on the results of questionnaire interviews with 240 heads of households from February to March of 2003, the effect of local beliefs on malaria control activities was discussed. Despite widely available western medicine and widely conducted health education, some people still believe that evil spirits cause malaria and rely on traditional medicine and/or religious ceremonies for treatment. Based on our findings, we recommend that future education and malaria control programs be revised and made sensitive to those people holding indigenous beliefs.

Health promotion for middle-aged Isan women, Thailand: a participatory approach.

It is increasingly clear that non-communicable diseases (NCDs), including cancer, diabetes, hypertension and atherosclerosis, are important not only for the developed but also the developing world. Prevention efforts depend on community-based interventions and for these to be successful a participatory approach is necessary. The present paper describes experiences with middle-aged females living in a village in Isan, the Northeastern area of Thailand, focusing on the steps necessary to develop trust between researcher and subjects, the actual conditions of the women involved and their problems. From this base a number of interventions are planned taking into account the wishes of the villagers themselves, including a project to facilitate participation in physical exercise, a prime measure for prevention of cancer and other NCDs.

Cancer screening, reproductive history, socioeconomic status, and anticipated cancer-related behavior among Hmong adults.

In the United States, breast, cervical, colorectal and prostate cancer screening rates are low or non-existent in the Hmong population compared to non-Hispanic Whites. No Hmong adults report ever participating in prostate (male only) and colorectal cancer screening. US-born Hmong women, those living in the US 20 years, and those 39 years old are more likely to be screened for breast and cervical cancer than other women. The Hmong, in general, are a young population (median age = 34 years) with low socioeconomic status. As a function of these characteristics, 52% of Hmong women reported having their first child at 15-19 years old and continued to bear children until 40-54 years old. The combination of young age at first pregnancy and multiparity probably protects Hmong women from breast cancer but elevates cervical cancer risk.

Chewing of betel, areca and tobacco: perceptions and knowledge regarding their role in head and neck cancers in an urban squatter settlement in Pakistan.

The link of betel, areca and chewable tobacco with head and neck cancers is clearly established. Fifty eight percent of the global head and neck cancers occur in South and Southeast Asia, where chewing of betel, areca and tobacco are common. This study was carried out to establish the pattern of use of Paan, Chaalia, Gutka, Niswar, Tumbaku and Naas among population of squatter settlement of Karachi and to determine the perceptions and knowledge regarding their role in the etiology of head and neck cancers. It was a cross-sectional study, performed at Bilal colony in Karachi. Through systematic sampling, 425 subjects [a male and female from a household] were interviewed with a structured questionnaire. Knowledge regarding etiology of head and neck cancers was classified in ordinals of "good", "some" and "poor", for each substance separately, while practices were classified into "daily user", "occasional user" and "never user". About 40% of the participants were chewing at least one item [betel, areca or tobacco products] on daily basis. This prevalence was 2.46 times higher among males than females and 1.39 times higher among adolescents than adults. At least 79% of the participants were classified as having poor knowledge about the carcinogenicity of each of these items. Knowledge increased with age and level of education. Health hazards of these items were poorly recognized and about 20% perceived at least one of these items to be beneficial. Positive attitudes were seen regarding the steps to curb the production, business and consumption of these substances. In conclusion, prevalence of chewing of betel, areca and tobacco among adults and adolescents is high. Deficiency in knowledge and wrong perception of favorable effect of chewing products is common. Besides curtailing the availability of chewing products, correct knowledge regarding its ill-effects should be inculcated among population to decrease the burden of head and neck cancers.

Measurement Issues across Different Cultures / 간호학회지

PURPOSE: The purposes of this methodologic paper are to (1) describe theoretical background in conducting research across different cultures; (2) address measurement issues related to instrument administration; and (3) provide strategies to deal with measurement issues. METHODS: A thorough review of the literature was conducted. A theoretical background is provided, and examples of administering instrument in studies are described. RESULTS: When applying an instrument to different cultures, both equivalence and bias need to be established. Three levels of equivalence, i.e., construct equivalence, measurement unit equivalence, and full score comparability, need to be explained to maintain the same concept being measured. In this paper, sources of bias in construct, method, and item are discussed. Issues related to instrument administration in a cross-cultural study are described. CONCLUSION: Researchers need to acknowledge various group differences in concept and/or language that include a specific set of symbols and norms. There is a need to question the philosophical and conceptual appropriateness of an assessment measure that has been conceptualized and operationalized in a different culture. Additionally, testing different response formats such as narrowing response range can be considered to reduce bias.