The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study.

BACKGROUND: Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. METHODS: A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. RESULTS: Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. CONCLUSIONS: The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

The Patient-Provider Relationship and Antenatal Care Uptake at two Referral Hospitals in Malawi: A Qualitative Study

Background.Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however; most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.Methods. A qualitative study; consisting of interviews with 20 urban pregnant mothers and eight health workers; was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results.Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship; clinic wait times; family and friend support; distance from home to the clinic; transportation; cost; and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally; health workers revealed that; due to staff shortages; patients often do not receive the care they deserve. Conclusions.The results of this study suggest that; in addition to other factors; healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease complications during pregnancy. Professional development opportunities and quality improvement programmes would help improve patient care and health outcomes while the continued staff shortages in the country are addressed

Quality of parent-child relationship and adolescent HIV risk behaviour in St. Maarten.

The highest incidence rates of HIV/AIDS in the Caribbean are recorded in heterosexual and youth populations. With sparse prevention and intervention programmes in place, there is a pressing need to address the HIV/AIDS risk of youth. The objective of this analysis was to describe the extent of youth risk behaviour in St. Maarten and explore the relationship between quality of parental-child relationship and adolescent HIV risk behaviours. The sample consisted of 1,078 students (age range 14-18, mean 15.6 (s.d. 1.7). The data were collected by self-report survey in the Spring of 2001 in the classrooms of all seven secondary schools in St. Maarten. The survey instrument included demographic information, and used questions derived from the Center for Disease Control's (CDC) Youth Risk Behavior Survey (YRBS) to assess health risk behaviour prevalence, including tobacco, alcohol, and drug use, and sexual activity. The survey also asked youth to rate their relationship with their parents. Analysis showed a relatively high rate of risk behaviour in this school population. Multi-variate analysis showed that a 'great' relationship with both parents, as perceived by the student, was significantly associated with lower rates of tobacco and alcohol use as well as lower rates of sexual activity.

Patient participation in physical therapy goal setting.

BACKGROUND AND PURPOSE: An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. SUBJECTS AND METHODS: Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (mean of 76.4 years of age, SD = 7.1, range = 65-94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. RESULTS: Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. DISCUSSION AND CONCLUSION: In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.

The effect of hormone replacement therapy and exercise on cardiovascular disease risk factors in postmenopausal women.

Following menopause, women show an increased risk of heart disease to a level equal that of men. This elevated risk is thought to be due, at least partly, to changes in blood lipid and fibrinogen levels. The purpose of this article is to review the published research on the relationship between both exercise and hormone replacement with regards to common cardiovascular disease (CVD) risk factors and the relative importance of each. Menopause is associated with increased total serum cholesterol, triglycerides and fibrinogen, and a decrease in high density lipoprotein (HDL) cholesterol levels. The major reason for these changes following menopause is believed to be a result of fluctuations in hormonal status, primarily a deficiency in estrogen. Intervention may be justified since estrogen replacement therapy has been shown to decrease the risk of developing CVD and to have a significant impact on many of the CVD risk factors. The results vary from study to study, but generally estrogen replacement has been found to decrease total cholesterol and fibrinogen, while increasing HDL cholesterol and triglycerides. All of these changes, other than the increase in triglycerides, are seen as positive. The addition of progestogen to estrogen may negate some of the beneficial changes of estrogen, most notably the increase in HDL cholesterol levels. However, progestogen has also been reported to offset the increase in triglycerides seen with unopposed estrogen replacement. Thus, there are contradictory effects (both positive and negative) of hormone replacement on CVD risk factors in women. Regular aerobic exercise and resulting improvements in cardiorespiratory fitness have consistently been shown as preventive of CVD. This decreased CVD risk is in part because of the impact of exercise on blood lipids and fibrinogen. Increased aerobic exercise is thought to improve the risk profile, mainly through an increase in HDL cholesterol levels and decreases in triglycerides and fibrinogen. Unfortunately, the majority of research supporting the effects of exercise on CVD risk factors has been done on men. Even when research has included women, very few studies have focused on postmenopausal women. However, the research done on postmenopausal women points to a significantly improved CVD risk factor profile with regular cardiorespiratory exercise.

AIDS risk among students attending Seventh-day Adventist school, in North America.

In 1995, a survey was conducted among students attending 69 Seventh-day Adventist (SDA) high schools within the United States and Canada. The survey assessed the extent that these students practiced sexual and drug-use behaviors which place them at risk for contracting or transmitting the human immunodeficiency virus (HIV). A total of 1,748 respondents enrolled in grades 9 through 12 completed questionnaires similar to the instrument used in the 1993 Youth Risk Behavior Survey (YRBS). Data were collected and compared to results from the 1993 YRBS. Students who attended SDA parochial schools reported lower rates of sexual intercourse compared to YRBS school counterparts (16.3% vs. 53.1%) and lower rates of all substances measured. Furthermore, respondents were more likely to engage in substance use and sexual intercourse if they had at least one parent who used tobacco, alcohol, or marijuana, as reported by the students.

AIDS concerns among adolescents attending seventh-day adventist high schools in trinidad and tobago.

The purpose of this study was to identify AIDS-related knowledge, attitudes, beliefs, and short-term behavioral intentions of adolescents attending five Seventh-day Adventist (SDA) parochial high schools in the Republic of Trinidad and Tobago. This is the first known research on AIDS to be conducted in parochial and specifically, SDA schools in the Caribbean and particularly, Trinidad and Tobago. Information gathered from this research will be useful in planning appropriate AIDS education and prevention programs for the schools represented in this survey.

Nuclear Orientation Thermometry.

Low temperature nuclear orientation thermometry, in particular γ-ray anisotropy thermometry, is discussed both from a theoretical and practical point of view. Detailed information is given on the most often used γ-ray anisotropy thermometers, along with a comprehensive description of the γ-ray anisotropy technique. The 60Co in (hcp) cobalt single crystal γ-ray anisotropy thermometer is discussed in considerable detail since it is used more frequently in comparison experiments with other primary thermometers. Recent experimental results using γ-ray anisotropy thermometers are also reviewed.