Conditions required for a law on active voluntary euthanasia: a survey of nurses' opinions in the Australian Capital Territory.
OBJECTIVES: To ascertain which conditions nurses believe should be in a law allowing active voluntary euthanasia (AVE). DESIGN: Survey questionnaire posted to registered nurses (RNs). SETTING: Australian Capital Territory (ACT) at the end of 1996, when active voluntary euthanasia was legal in the Northern Territory. SURVEY SAMPLE: A random sample of 2,000 RNs, representing 54 per cent of the RN population in the ACT. MAIN MEASURES: Two methods were used to look at nurses' opinions. The first involved four vignettes which varied in terms of critical characteristics of each patient who was requesting help to die. The respondents were asked if the law should be changed to allow any of these requests. There was also a checklist of conditions, most of which have commonly been included in Australian proposed laws on AVE. The respondents chose those which they believed should apply in a law on AVE. RESULTS: The response rate was 61%. Support for a change in the law to allow AVE was 38% for a young man with AIDS, 39% for an elderly man with early stage Alzheimer's disease, 44% for a young woman who had become quadriplegic and 71% for a middle-aged woman with metastases from breast cancer. The conditions most strongly supported in any future AVE law were: "second doctor's opinion", "cooling off period", "unbearable protracted suffering", "patient fully informed about illness and treatment" and "terminally ill". There was only minority support for "not suffering from treatable depression", "administer the fatal dose themselves" and "over a certain age". CONCLUSION: Given the lack of support for some conditions included in proposed AVE laws, there needs to be further debate about the conditions required in any future AVE bills. (+info)
How physician executives and clinicians perceive ethical issues in Saudi Arabian hospitals.
OBJECTIVES: To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN: Self-completion questionnaire administered from February to July 1997. SETTING: Different health regions in the Kingdom of Saudi Arabia. PARTICIPANTS: Random sample of 457 physicians (317 clinicians and 140 physician executives) from several hospitals in various regions across the kingdom. RESULTS: There were statistically significant differences in the perceptions of physician executives and clinicians regarding the existence of various ethical issues in their hospitals. The vast majority of physician executives did not perceive that seven of the eight issues addressed by the study were ethical concerns in their hospitals. However, the majority of the clinicians perceived that six of the same eight issues were ethical considerations in their hospitals. Statistically significant differences in the perceptions of physician executives and clinicians were observed in only three out of eight attributes that might possibly lead to the existence of ethical issues. The most significant attribute that was perceived to result in ethical issues was that of hospitals having a multinational staff. CONCLUSION: The study calls for the formulation of a code of ethics that will address specifically the physicians who work in the kingdom of Saudi Arabia. As a more immediate initiative, it is recommended that seminars and workshops be conducted to provide physicians with an opportunity to discuss the ethical dilemmas they face in their medical practice. (+info)
Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.
BACKGROUND AND PURPOSE: The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. SUBJECTS AND METHODS: Twenty-seven female survivors (aged 19-62 years) participated in semistructured interviews in which they described their reactions to physical therapy. RESULTS: Survivors' reactions to physical therapy, termed "long-term sequelae of abuse that detract from feeling safe in physical therapy," are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. CONCLUSIONS AND DISCUSSION: Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor. (+info)
Sexual problems: a study of the prevalence and need for health care in the general population.
BACKGROUND: There has been little research carried out on the prevalence and types of sexual dysfunction in the general population, although the indications are that such problems are relatively common. Most common sexual problems are potentially treatable. However GPs have estimated the prevalence of sexual problems to be far lower than survey estimates. OBJECTIVE: To provide an estimate of the prevalence of sexual problems in the general population, and assess the use of and need for professional help for such problems. METHODS: We used an anonymous postal questionnaire survey. The study was set in four general practices in England*, and the study population was a stratified random sample of the adult general population (n = 4000). The subjects were 789 men and 979 women who responded to the questionnaire. The main outcome measures were the presence and type of current sexual problems in men and women, and the provision and use of treatments for sexual problems. RESULTS: A response rate of 44% was obtained. The median age of the responders was 50 years. A third of men (34%) and two-fifths of women (41 %) reported having a current sexual problem. The most common problems were erectile dysfunction (n = 170) and premature ejaculation (n = 88) in men; in women the most widely reported problems were vaginal dryness (n = 186) and infrequent orgasm (n = 166). In men, the proportion of responders reporting sexual problems increased with age, but there was no similar trend in women. Of those responders who reported a sexual problem, 52% said that they would like to receive professional help for this problem, but only one in ten of these people (n = 50) had received such help. CONCLUSION: Among responders there was a high level of reported sexual problems. The most frequently reported problems (vaginal dryness, erectile problems) may be amenable to physical treatment in practice, and yet few had sought or received help. However, many said that they would like to receive help. These figures suggest that there may be an important burden of potentially reversible sexual problems in the general population. (+info)
House calls in Lebanon: reflections on personal experience.
BACKGROUND: Home health services play an important role in decreasing hospital admissions and physicians' medical house calls play an integral role in home health services. There is no national survey of physicians' house call practice in the Lebanon. OBJECTIVES: The aim of this study was to provide some information about house call practice in the Lebanon. METHOD: Data on patients examined during house call visits between 1 January and the end of December 1995 were reviewed. RESULTS: During this period, 137 patients were seen at their home. Eighty-four patients (62%) were female and 53 patients (38%) were male. Ages ranged from 1 to 85 years. The number of cases seen in 1 month averaged 11. The diagnosis differed according to the age group of patients examined. Most of the house call visits occurred between 6.30 p.m. to 12.00 p.m. (47%). Fifteen patients (11%) were admitted to the hospital. CONCLUSION: The rate of cases per month was similar to those reported elsewhere. Physicians might feel reluctant to conduct house calls out of hours. Our study revealed that the majority of patients were seen between 6 p.m. and 12 p.m., and only 6% were seen after 12 a.m. It is our belief that house calls are an integral part of family practice and need to be stressed during the internships of all primary care physicians. (+info)
The promotion of healthy eating: food availability and choice in Scottish island communities.
Communities in rural areas are in receipt of health education messages on healthy eating aimed at the population. These messages are invariably composed without regard to where people reside, and, in particular, to the availability of, and access to, foodstuffs in rural areas. In this paper the authors present data derived from a participative health needs assessment on the topic of food, diet and health. The research was conducted in a number of islands of the Western Isles of Scotland and comprised seven focus groups, 33 semi-structured interviews, one community and one policy workshop, and a final community feedback session. The needs assessment demonstrated a dichotomy between local experiences of food availability, island food cultures and the contents of healthy eating advice. As a result of the research, local people and health care professionals developed a range of activities on the topic of the traditional island diet. People noted the potentially positive elements of this diet for health but also the possibility of promoting social cohesion through the consideration of food and diet histories. In addition, lobbying at a national level was also identified as necessary to the development of a 'healthy food policy'. (+info)
Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa.
Noncommunicable diseases (NCDs) such as hypertension, asthma, diabetes and epilepsy are placing an increasing burden on clinical services in developing countries and innovative strategies are therefore needed to optimize existing services. This article describes the design and implementation of a nurse-led NCD service based on clinical protocols in a resource-poor area of South Africa. Diagnostic and treatment protocols were designed and introduced at all primary care clinics in the district, using only essential drugs and appropriate technology; the convenience of management for the patient was highlighted. The protocols enabled the nurses to control the clinical condition of 68% of patients with hypertension, 82% of those with non-insulin-dependent diabetes, and 84% of those with asthma. The management of NCDs of 79% of patients who came from areas served by village or mobile clinics was transferred from the district hospital to such clinics. Patient-reported adherence to treatment increased from 79% to 87% (P = 0.03) over the 2 years that the service was operating. The use of simple protocols and treatment strategies that were responsive to the local situation enabled the majority of patients to receive convenient and appropriate management of their NCD at their local primary care facility. (+info)
Mortality among homeless shelter residents in New York City.
OBJECTIVES: This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS: Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS: Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS: For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness. (+info)