Patients' experiences with partial dentures: a qualitative study

Objective: The aim of the study was to gain insight into people's experiences of being given and using partial dentures. Methods: In‐depth semi‐structured interviews were carried out with 23 people of varied age, social background and denture wearing experience in Tayside, Scotland. Participants were encouraged to discuss how they came to have partial dentures, their day‐to‐day denture use and their interactions with dentists. The interview data were systematically coded using key theme headings, and summary charts were constructed to facilitate analysis. Results: The initial decision that a partial denture was needed was generally difficult to accept. People perceived the main benefits of partial dentures to be improved appearance and confidence, but experienced a variety of difficulties with their dentures and often coped with these by only wearing them on social occasions. Participants had not always told their dentists about the difficulties they experienced. Barriers to seeking help with denture problems included financial constraints, previous experience of rushed appointments or poor communication from dentists and a perceived lack of entitlement to help when partial dentures were issued free. Conclusions: Partial dentures can be difficult to cope with. People experience a range of difficulties in wearing them, not all of which have been discussed with dentists. Informative and supportive communication when partial dentures are first needed, and subsequently, can improve the quality of patients’ experiences and may help promote effective use and appropriate help‐seeking by partial denture wearers.     

Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

Background

Teen mothers face many challenges to successful breastfeeding and are less likely to breastfeed than any other population group in the U.S. Few studies have investigated this population; all prior studies are cross-sectional and collect breastfeeding data retrospectively. The purpose of our qualitative prospective study was to understand the factors that contribute to the breastfeeding decisions and practices of teen mothers.

Methods

This prospective study took place from January through December 2009 in Greensboro, North Carolina in the U.S. We followed the cohort from pregnancy until two weeks after they ceased all breastfeeding and milk expression. We conducted semi-structured interviews at baseline and follow-up, and tracked infant feeding weekly by phone. We analyzed the data to create individual life and breastfeeding journeys and then identified themes that cut across the individual journeys.

Results

Four of the five teenagers breastfed at the breast for nine days: in contrast, one teen breastfed exclusively for five months. Milk expression by pumping was associated with significantly longer provision of human milk. Breastfeeding practices and cessation were closely connected with their experiences as new mothers in the context of ongoing multiple roles, complex living situations, youth and dependency, and poor knowledge of the fundamentals of breastfeeding and infant development. Breastfeeding cessation was influenced by inadequate breastfeeding skill, physically unpleasant and painful early experiences they were unprepared to manage, and inadequate health care response to real problems.

Conclusions

Continued breastfeeding depends on a complex interplay of multiple factors, including having made an informed choice and having the skills, support and experiences needed to sustain the belief that breastfeeding is the best choice for them and their baby given their life situation. Teenagers in the US context need to have a positive early breastfeeding experience, be able to identify and claim a reliable support system supportive of breastfeeding, and gain through their experience, a belief in their own agency and competency as mothers.

     

Antimicrobial susceptibility profiles associated with bacterial meningitis among children: a referral hospital-based study in Iran

Bacterial meningitis continues to be associated with high morbidity and mortality rate worldwide, especially in the pediatric age group. This study was performed to identify the microbial etiologies of meningitis among 31 children, who were admitted in the Emergency Ward of a referral pediatric hospital in Iran. Culture identification showed that Streptococcus pneumoniae (12 subjects), Haemophilus influenzae (11 subjects) were the most common bacteria, followed by Escherichia coli (7 cases) and Neisseria meningitidis (only one case). Antibiotic susceptibility tests revealed that vancomycin had the best effect on S. pneumoniae in comparison with other antibiotics, whereas H. influenzae and E. coli were more susceptible to ceftriaxone, ceftazidime, and ceftizoxime than other antibiotics. In conclusion, despite the advances in antibiotic therapy and vaccine development, bacterial meningitis still is a health problem. S. pneumoniae, H. influenzae, and N. meningitidis are the main sources of bacterial meningitis, but other organisms such as E. coli should also be suspected, when a case is admitted to a referral pediatric hospital.     

GPs' experiences of the Returner (Induction and Refreshment) scheme in Severn: a qualitative study

The introduction of the General Practice Returner (since renamed the Induction and Refreshment) scheme in England by the Department of Health and London Deanery in 2002 provided placements providing training for qualified GPs seeking to return to the primary care workforce after significant time away from clinical general practice. This qualitative research study sought to explore issues around such placements and involved in-depth telephone interviews with an opportunistic sample of 14 GP returners and five trainers on their experiences of the GP returner scheme within Severn Deanery. Findings showed unequivocal and universal support from both returners and trainers for the value of the scheme. However, issues around the 'two-year rule' and funding arrangements whilst returning to practice may need to be re-addressed. GP returners reported significant improvements in their clinical skills and knowledge, understanding of changing NHS policy/protocols and enhanced perceived self-confidence. The importance of a peer-respected scheme organiser, easily accessible internationally, was felt to be crucial. Opportunities for the transferability of unique experiences from GPs returning from overseas should also be further explored.     

Family caregivers' experiences of involuntary psychiatric hospital admissions of their relatives--a qualitative study

Background

Family caregivers of people with mental disorders are frequently involved in involuntary hospital admissions of their relatives.

Objective

To explore family caregivers'' experience of involuntary admission of their relative.

Method

30 in-depth interviews were conducted with family caregivers of 29 patients who had been involuntarily admitted to 12 hospitals across England. Interviews were analysed using thematic analysis.

Results

Four major themes of experiences were identified: relief and conflicting emotions in response to the relative''s admission; frustration with a delay in getting help; being given the burden of care by services; and difficulties with confidentiality.Relief was a predominant emotion as a response to the relative''s admission and it was accompanied by feelings of guilt and worry. Family caregivers frequently experienced difficulties in obtaining help from services prior to involuntary admission and some thought that services responded to crises rather than prevented them. Family caregivers experienced increased burden when services shifted the responsibility of caring for their mentally unwell relatives to them. Confidentiality was a delicate issue with family caregivers wanting more information and a say in decisions when they were responsible for aftercare, and being concerned about confidentiality of information they provided to services.

Conclusion

Compulsory admission of a close relative can be a complex and stressful experience for family caregivers. In order for caregivers to be effective partners in care, a balance needs to be struck between valuing their involvement in providing care for a patient and not overburdening them.     

Parents' experiences discussing pediatric vaccination with healthcare providers: a survey of Canadian naturopathic patients

Background

Parents who choose to selectively vaccinate or avoid vaccination for their children may do so at risk of compromising relations with their family physician or pediatrician. Groups that are associated with reduced rates of pedicatic vaccination, such as parents who access naturopathic care, may be particularly vulnerable to this issue.

Methodology/Principal Findings

In March through September 2010, we administered a 26-item cross-sectional survey to 129 adult patients, all of whom were parents with children ≤16 years of age, presenting for naturopathic care in Ontario, Canada. Ninety-five parents completed the survey (response rate 74%), and only 50.5% (48 of 95) reported that their children had received all recommended vaccines. Most parents (50.5%; 48 of 95) reported feeling pressure to vaccinate from their allopathic physician and, of those who discussed vaccination with their physician, 25.9% (21 of 81) were less comfortable continuing care as a result. Five percent (4 of 81) of respondents were advised by their physician that their children would be refused care if they decided against vaccination. In our adjusted generalized linear model, feeling pressure to vaccinate (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.14 to 8.26) or endorsing a naturopathic physician as their most trusted source of information regarding vaccination (OR = 3.57; 95% CI = 1.22 to 10.44) were associated with greater odds of having a partially vaccinated or unvaccinated child. The majority (69.6%; 32 of 46) of parent''s with partially vaccinated or unvaccinated children reported a willingness to re-consider this decision.

Conclusions/Significance

Use of naturopathic care should be explored among parents in order to identify this high-risk group and engage them in discussion regarding pediatric vaccination to encourage evidence-based, shared decision making. Physicians should ensure that discussions regarding vaccination are respectful, even if parents are determined not to vaccinate their children.     

Health care experiences of people with dementia and their caregivers: a meta-ethnographic analysis of qualitative studies

Background:

Understanding the health care experience of people with dementia and their caregivers is becoming increasingly important given the growing number of affected individuals. We conducted a systematic review of qualitative studies that examined aspects of the health care experience of people with dementia and their caregivers to better understand ways to improve care for this population.

Methods:

We searched the electronic databases MEDLINE, Embase, PsychINFO and CINAHL to identify relevant articles. We extracted key study characteristics and methods from the included studies. We also extracted direct quotes from the primary studies, along with the interpretations provided by authors of the studies. We used meta-ethnography to synthesize the extracted information into an overall framework. We evaluated the quality of the primary studies using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results:

In total, 46 studies met our inclusion criteria; these involved 1866 people with dementia and their caregivers. We identified 5 major themes: seeking a diagnosis; accessing supports and services; addressing information needs; disease management; and communication and attitudes of health care providers. We conceptualized the health care experience as progressing through phases of seeking understanding and information, identifying the problem, role transitions following diagnosis and living with change.

Interpretation:

The health care experience of people with dementia and their caregivers is a complex and dynamic process, which could be improved for many people. Understanding these experiences provides insight into potential gaps in existing health services. Modifying existing services or implementing new models of care to address these gaps may lead to improved outcomes for people with dementia and their caregivers.The global prevalence of Alzheimer disease and related dementias is estimated to be 36 million people and is expected to double in the next 20 years.¹ Several recent strategies for providing care to patients with dementia have highlighted the importance of coordinated health care services for this growing population.^2–5 Gaps in the quality of care for people with dementia have been identified,^6–8 and improving their quality of care and health care experience has been identified as a priority area.^2–5Incorporating the health care experience of patients and caregivers in health service planning is important to ensure that their needs are met and that person-centred care is provided.⁹ The health care experience of people with dementia and their caregivers provides valuable information about preferences for services and service delivery.¹⁰ Matching available services to patient treatment preferences leads to improved patient outcomes^11,12 and satisfaction without increasing costs.¹³ Qualitative research is ideally suited to exploring the experiences and perspectives of patients and caregivers and has been used to examine these experiences for other conditions.¹⁴ We performed a systematic review and meta-ethnographic synthesis of qualitative studies exploring the health care experience of people with dementia and their caregivers in primary care settings, and we propose a conceptual framework for understanding and improving these health care experiences.     

Prevalence and factors associated with atrophic gastritis and intestinal metaplasia: A multivariate,hospital-based,statistical analysis

BackgroundAtrophic gastritis (AG) and intestinal metaplasia (IM) play an essential role in gastric carcinogenesis. This study aimed to determine the prevalence of AG and IM and their associated factors.MethodsSubjects who underwent upper endoscopy at Chiang Mai University Hospital from January 2018 to Dec 2021 were included. All participants were interviewed using a structured questionnaire to collect their personal histories. In addition, clinical and histological data and associated factors of AG and IM were analyzed.ResultsA total of 947 subjects (mean age, 53.61 ± 9.73 years; 60% male) were included. The prevalence of AG and IM, diagnosed by histopathology, was 39% and 19%. Prevalence of AG and IM increased from 28% and 9% in those under 50 years to 43% and 30% in those above 60 (p < 0.05). In a multivariate analysis, Helicobacter pylori (H. pylori) infection, age 50–59 and over 60 years were significantly associated with higher odds of AG (odds ratio (OR), 2.07, 2.06, and 1.98) and IM (OR, 2.07, 2.18, and 4.46), respectively. Conversely, ingestion of spicy food was significantly associated with lower odds of AG and IM (OR, 0.75, and 0.62).ConclusionsThis study confirms that age and H. pylori infection are risk factors, whereas spicy food intake is a protective factor against AG and IM, which are common in patients over 50. Therefore, upper endoscopy and gastric mapping sampling are recommended for patients with chronic dyspepsia older than 50 to reduce gastric cancer risk.     

Health behavior and experiences of physicians. Results of a survey of Palo Alto Medical Clinic physicians.

The results of a health practice questionnaire submitted to the 152 physician members of the Palo Alto Medical Clinic, 126 of whom responded, indicate a generally favorable profile of preventive medicine strategies. Physicians generally smoke less, drink about the same, exercise more, and use their seat belts more than the population at large. They also can expect to live longer. These results are compared with those of other physician surveys and surveys of the general public.     

Understanding of elderly patients' resuscitation preferences by physicians and nurses.

We compared the understanding by family physicians and nurses of their elderly outpatients'' preferences for cardiopulmonary resuscitation and mechanical ventilation under 3 scenarios reflecting varying qualities of life. Physicians and nurses correctly predicted patients'' treatment preferences in from 59% to 84% and 53% to 78% of cases, respectively, for the various decisions. For most decisions, neither physicians nor nurses were significantly more accurate in their predictions than expected by chance alone. Moreover, nurses and physicians did not significantly agree with one another in their predictions of patients'' preferences for any of these decisions. These results suggest that while nurses'' and physicians'' perceptions of patients'' preferences for life-sustaining treatment are not necessarily similar, neither nurses nor physicians systematically understand their elderly patients'' resuscitation preferences.     

Factors associated with practice of colorectal cancer screening among primary care physicians in a Chinese population: A cross-sectional study

Objectives: Primary care physicians (PCPs) are influential in colorectal cancer (CRC) screening uptake in the community. This study aims to evaluate the factors associated with PCPs’ practice of CRC screening among asymptomatic patients in a Chinese population. Methods: A validated postal questionnaire was sent to all practicing PCPs who were members of a community-based network in Hong Kong. Three separate rounds of reminder letters were sent to non-respondents. Binary logistic regression analysis was used with ever-referral for CRC screening in the past 12 months as the outcome variable. Predictor variables include physicians’ gender, clinical experience, types of practice, and attitudes towards CRC screening. Results: Of 428 eligible physicians, 263 (61.4%) responded. A total of 187 physicians (71.1%) had referred patients for CRC screening in the past 1 year. Among all asymptomatic patients aged 50 years or older, physicians reported referring only 3.0% (1.0–10.0%) [median (interquartile range)] of patients. Colonoscopy (57.0%) and fecal occult blood testing (FOBT) (46.4%) were the most commonly recommended tests for these asymptomatic patients. Family history of CRC (58.6%) and patients’ concern about CRC (50.2%) were major reasons for referral. PCPs in private practice (adjusted odds ratio [aOR] 2.60, 95% C.I. 1.21–5.59) and those with positive attitude towards CRC screening (aOR 2.27, 95% C.I. 1.15–4.48) were more likely to recommend CRC screening. Conclusions: PCPs’ attitude towards CRC screening is a significant determinant of its practice. Future studies should identify and strengthen the influencers of PCPs’ attitude to enhance CRC screening rates.     

Low educational attainment is still associated with late melanoma diagnosis: A cross-sectional study from a European setting with universal healthcare

BackgroundAn early diagnosis of cutaneous melanoma remains determinant for improved survival. Low educational attainment has been associated with a late-stage diagnosis in settings where access to healthcare is restricted. Little evidence is available from regions with universal healthcare. We aimed at analysing whether educational attainment was associated with Breslow thickness at diagnosis in a peripheral European region with universal healthcare (in the Canary Islands, Spain).MethodsWe conducted a cross-sectional study with prospectively collected data (2010–2017). Patients were recruited at diagnosis, and information about Breslow thickness, age at diagnosis, gender, highest educational attainment and site of melanoma were registered. Univariate and multivariate linear regression analyses were performed.ResultsLow educational attainment was associated with thicker tumours at diagnosis. The association remained true after adjustment for age, gender and site of melanoma. In the multivariate analysis, tumours diagnosed in patients with low educational attainment were on average 1.08 mm thicker (95% confidence interval: 0.36–1.81; p = 0.003) than those diagnosed in patients with high educational attainment.ConclusionPublic health strategies targeting this vulnerable group are currently needed in the Canary Islands (Spain).     

Subjective experiences associated with thermal biofeedback treatment of hypertension

Reports of subjective experiences of 73 hypertensive patients who were treated with thermal biofeedback for hand warming were obtained over 16 treatment sessions. Most of the differential responding in subjective report occurred in the first 5 sessions. Differences in reports of throbbing were associated with medication status during treatment (presence of sympatholytic antihypertensive agent). From 4 to 9% of patients report negative subjective experiences at any one session. When short-term clinical successes (either elimination of medication or reduction of BP) were compared with short-term failures, it was found that successes reported more warmth, more likelihood of falling asleep, and more dreamlike experiences. The latter were more likely to occur suddenly for the successes. Correlational analyses revealed consistent positive associations between reports of warmth and relaxation with highest temperature achieved in the session and consistent negative associations between experiencing physical sensations and degree of temperature change within the session.This research was supported in part by grants from NHLBI, HL-27622 and HL-31189.