Browsing by Subject "Attitude to Health"
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ItemAcceptability of Screening for Sexually Transmitted Infections in an Urban Pediatric Emergency Department in the Southern Region of the United States(2016-01-19) Pfaff, Jamie; Johnson, DawnBACKGROUND: Adolescents age 13 to 24 years old are the demographic most affected by sexually transmitted infections (STIs) in the USA. The CDC, USPSTF and the AAP recommend screening sexually active females less than 25 years old in all health care settings for Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) and all high-risk females of this age group also for HIV and Syphilis. In regions with a high prevalence of STIs, such as Dallas County, the diagnosis and treatment of STIs is a vital step toward reducing the spread of these communicable diseases in this population. METHODS: All adolescents age 13-24 presenting to the Pediatric Emergency Department (PED) during the study period who met the study criteria were asked to participate. A total of 197 adolescents and 198 parents, 183 of which comprised parent-child dyads, were enrolled and completed separate surveys. Participants answered questions about adolescent and parent acceptability of STI screening, STI risk behaviors, and adolescents' history of STI screening and treatment. RESULTS: Analysis thus far shows that non-invasive STI screening is acceptable to the majority of both adolescents (70%) and parents (84%). Among patient/parent dyads, 59% had positive responses from both. No demographic factors demonstrated statistical significance. However, some factors displayed greater variability than others. In terms of age, adolescents greater than 15 years old were more likely to indicate acceptance of STI testing (73%) than those younger than age 15 (62%). Breakdown by adolescent race and ethnicity demonstrated a range of acceptability with 83% for those who identified as White or Caucasian, 59% for those identifying as Black or African American, 64% for those identifying as Hispanic, and 100% of the five participants identifying outside of the previous categories, "other". CONCLUSIONS: These acceptability results are similar to those found in a study performed in Jefferson County, AL where adolescents reported a 71% acceptance rate for GC and CT screening. This suggests that implementation of STI screening in the PED would be successful and well tolerated by the majority of adolescents and their parents. The variation in acceptability demonstrated by age and race were not statistically significant but may be useful in determining the minimum age of PED intervention and preparing culturally sensitive answers for questions from adolescents and patients in future testing interventions. Implementation of new PED HIV screening protocols are utilizing evidence based on this study and will further be assessed for continued improvement of Dallas adolescent health. ItemAssessing Self-Care Perception in Patients Living with Type 2 Diabetes and Their Physicians(2021-05-01T05:00:00.000Z) Balakrishnan, Naveen Kishore; Day, Philip; Kale, Neelima; Schneider, DavidBACKGROUND: Type 2 diabetes mellitus (T2D) is chronic illness affecting millions in the United States. Patients living with T2D require highly individualized care and significant patient effort. This effort is comprised of the patient's self-care with regards to medication, diet, lifestyle, and mental health. Self-efficacy is a patient's ability to feel agency over their illness and therefore feel able to maintain self-care. Previous literature suggests that improving a patient's self-efficacy through various behavioral health interventions may improve a patient's ability to manage their T2D. Additionally, interventions on self-efficacy are thought to work regardless of health literacy level and might be a generalizable intervention. However, while validated surveys assessing patient diabetes distress, quality-of-life, social determinants of health, adverse childhood events, and more exist, no literature was found attempting to understand a patient's perspective on their self-care, and by extension, their self-efficacy. Under the premise that consistent beliefs between patient and physician regarding self-care are necessary to make meaningful plans promoting self-care and self-efficacy, the authors developed the term self-care perception consistency to assess relationship between patient and physician perceptions of a patient's self-care. OBJECTIVE: The objective is to assess the consistency between patient and physician perceptions of patient self-care through a biopsychosocial and structural/social determinants of health lens. METHODS: This study uses a cross-sectional, quantitative data set obtained by the Research Residency Network of Texas (RRNeT) through a 71-item survey study. This survey was completed across 12 Family Medicine residencies in Texas and included individuals between 18-75 who were living with T2D. Responses ranged from short free response to Likert-scale based questions and covered topics such as demographics, social determinants of health, patient self-care, diabetes distress, quality-of-life, adverse childhood events, and more. The physicians of each patient were asked to complete a shorter 10-item survey with broader analogous questions to the patient survey. This data was collected through RedCap and analyzed through RStudio. RESULTS: The term self-care perception consistency was coined to describe the relationship between the patient's and physician's perception of the patient's self-care. Self-care perception consistency was found to be lacking 31.2% of the time. Only HgA1c (p<0.01) was inversely correlated with self-care perception consistency in both the univariate and multivariate analyses of demographic factors and social determinants of health. Additional analysis was completed to assess the relationship of HgA1c control, patient diabetes distress, patient quality-of-life, and the physician survey with self-care perception consistency. Self-care perception consistent and inconsistent groups were found to have significantly different HgA1c control distributions (p < 0.01) in the subset of patients that rated their self-care positively, but no significant difference was found in the group that rated their self-care negatively. Patient self-care ratings were best correlated with their diabetes distress (p<0.01) and HgA1c (p<0.01) while physician ratings of patient self-care were best correlated with their perception of HgA1c, perception of patient diabetes distress, perception of patient quality-of-life, and perception of patient social connectedness (p<0.01 for all). Notably, trending diabetes distress, quality-of-life, the physician survey, and social determinants of health across patient self-care ratings in self-care perception consistent versus inconsistent groups revealed that only the physician survey showed opposite trends across the consistent and inconsistent groups. CONCLUSION: Self-care perception consistency was found to be lacking 31.2% of the time. Notably, HgA1c is correlated with patient and physician perceptions of patient self-care (p<0.01 for both); however, in instances of patient-physician self-care perception inconsistency, HgA1c is not correlated with patient self-care perception. Instead, diabetes distress remains predictive of patient self-care rating in all instances (p<0.01). Patient-physician self-care perception inconsistency is also associated with inconsistency in patient and physician perceptions of the patient's diabetes distress. As diabetes distress remains consistently correlated with patient self-care rating, using the validated diabetes distress survey-17 with an additional question regarding self-care may help physicians better understand patients and therefore target appropriate education and psychosocial interventions. ItemInBasket burden: what physicians and health systems can do to address the "elephant in the room"(2023-10-20) Anshasi, Ahmad ItemRecognizing racially motivated diagnosis and treatment(2014-10-14) Hoberman, John M.The racially motivated thinking and behaviors of American physicians receive inadequate attention in the medical literature and medical curricula. Doctors have always absorbed the racial stereotypes and folkloricbeliefs about racial differences that permeate the general population. Racial folklore about black people infiltrated all of the medical sub-disciplines during the twentieth century, and some of these inaccurate ideas remain influential today. These medico-racial stereotypes have produced racially differential diagnoses and treatments that can harm black patients. American medicine has demonstrated a disturbing unwillingness to acknowledge and address racially motivated medical thinking along with the race relations problems that continue to affect doctor-patient relationships. The "cultural competency" instruction offered at many medical schools has proven to be inadequate to reform racial attitudes in American medicine. Medical school curricula should, therefor, include a substantial curriculum on race relations in medicine as well as the origins and consequences of medical racism. ItemStruggling to catch up: families, identities, and narrative care(2014-12-09) Lindemann, HildeFamilies perform many morally valuable functions for their own members, not the least of which is providing care when they are ill or injured. Hilde Lindemann, Ph.D., argues that a second family function -- that of sustaining their members' personal identities -- is deeply implicated in that care. After explaining the narrative nature of identity maintenance, she discusses three cases where family care givers must find the right stories to repair the identity of one of their own: where the identity has been repudiated, where the identity lies at the limits of responsibility, and where the patient has lost her second nature. As Dr. Lindemann examines these cases, she argue that if health care professionals recognize and respect this familial caring labor, they can do a better job of providing the patient with their own form of care. ItemTrust in the medical profession: rebuilding trust one patient at a time(2021-07-02) Newman, Jason