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Selected Abstracts

Use and toxicity of complementary and alternative medicines among emergency department patients

EMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2004
David McD Taylor
Abstract Objective:, To determine the prevalence and type of complementary and alternative medicines (CAM) used by ED patients, to identify patient subgroups more likely to use CAM, the conditions for which they were taken, and the prevalence of side-effects and toxicity associated with CAM use. Methods:, This was an analytical cross-sectional survey of patients at a large tertiary referral ED. Consenting patients completed a specifically designed study questionnaire, in their preferred language if required. Information was collected on CAM use on the day of presentation and within the previous week and previous year. Results:, Four hundred and four patients were enrolled (participation rate 97.1%). Fifty (12.4%, 95% CI 9.4, 16.1) patients had taken a CAM on the day of presentation, 203 (50.2%, 95% CI 45.3, 55.2) within the previous week and 275 (68.1%, 95% CI 63.2, 72.5) within the previous year. CAM users were significantly younger, better educated and more likely to be female than non-CAM users (P < 0.01). 103 different CAM had been taken for a wide variety of reasons. Side-effects were experienced in 53 of the 1182 CAM courses taken (side-effect rate of 4.5%). One patient presented suffering specifically from CAM toxicity. Conclusion:,, Complementary and alternative medicines are used by a considerable proportion of ED patients. The potential for side-effects, toxicity and interaction with traditional medication indicates the need for consideration of CAM use in patient assessment. [source]

Survey Conditioning in Self-Reported Mental Health Service Use: Randomized Comparison of Alternative Instrument Formats

HEALTH SERVICES RESEARCH, Issue 2 2007
Naihua Duan
Objective. To test the effect of survey conditioning (whether observed survey responses are affected by previous experience in the same survey or similar surveys) in a survey instrument used to assess mental health service use. Data Sources. Primary data collected in the National Latino and Asian American Study, a cross-sectional household survey of Latinos and Asian Americans residing in the United States. Study Design. Study participants are randomly assigned to a Traditional Instrument with an interleafed format placing service use questions after detailed questions on disorders, or a Modified Instrument with an ensemble format screening for service use near the beginning of the survey. We hypothesize the ensemble format to be less susceptible to survey conditioning than the interleafed format. We compare self-reported mental health services use measures (overall, aggregate categories, and specific categories) between recipients of the two instruments, using 2 × 2 ,2 tests and logistic regressions that control for key covariates. Data Collection. In-person computer-assisted interviews, conducted in respondent's preferred language (English, Spanish, Mandarin Chinese, Tagalog, or Vietnamese). Principal Findings. Higher service use rates are reported with the Modified Instrument than with the Traditional Instrument for all service use measures; odds ratios range from 1.41 to 3.10, all p -values <.001. Results are similar across ethnic groups and insensitive to model specification. Conclusions. Survey conditioning biases downward reported mental health service use when the instrument follows an interleafed format. An ensemble format should be used when it is feasible for measures that are susceptible to survey conditioning. [source]

Linguistic sensitivity, indigenous peoples and the mental health system in Wales

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2004
Iolo Madoc-Jones
Abstract: This paper presents findings from a pilot research project to explore the significance and availability of mental health services in the medium of Welsh in Wales, UK. Based on small-scale research with Welsh-speaking mental health service users this article argues that being bilingual can be a significant factor in the complex biopsychosocial matrix that underpins mental health problems amongst Welsh speakers. It also argues that the destructive effects of linguistic oppression, and the difficulties of second language communication for mental health service users, are such that an appropriate health and social care response in Wales involves providing services in a user's preferred language. Service users' views about the current state of bilingual service provision in Wales are presented, which suggests that insufficient attention is being paid to the linguistic needs of Welsh speakers. Eight principles are proposed for mental health service policy and practice in Wales. [source]

Subjective pain experience of people with chronic back pain

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2000
Professor Lorraine H De Souza Chair of Rehabilitation
Abstract Background and Purpose Studies into the effect of pain experience on those who have it have largely focused on the views and interpretations of researchers gained by the use of assessment tools aimed at measuring pain. The purpose of this study was to explore and describe pain, as experienced by those with chronic back pain, and to document ,insider' accounts of how pain is perceived and understood by those who have it. Method Unstructured interviews using the framework approach. Subjects were sampled for age, sex, ethnicity and occupation, from new referrals with back pain to a rheumatology outpatient clinic. Eleven subjects (5 M; 6 F) agreed to be interviewed. Interviews were unstructured, but followed a topic guide. Subjects were interviewed in English (nine) or their preferred language (two). Tape-recordings of interviews were transcribed verbatim and read in depth twice to identify the topics or concepts. Data were extracted in the form of words and phrases by use of thematic content analysis. The themes were pain description and amount of pain. An independent researcher reviewed the data and confirmed or contended the analysis. Results All subjects, except one, provided descriptors of the quality of their pain. The use of simile was common to emphasize both what the pain was, and what it was not. Five subjects expressed a loss of words in trying to describe their pain. Only 13 of 29 different pain descriptors used were commensurate with those in the McGill Pain Questionnaire (Melzack, 1983). Subjects had great difficulty quantifying their pain intensity. Several explained how the pain fluctuated, thus, quantifying pain at one point in time was problematic. Only one subject offered a numerical description of pain intensity. Conclusions Subjects provided graphic and in-depth descriptions of their pain experience, but these bore little resemblance to commonly used assessment tools. The findings challenge the appropriateness of such formal instruments. Copyright © 2000 Whurr Publishers Ltd. [source]