The article reviews several films including "Standard Operating Procedure," directed by Errol Morris, "Stop-Loss," directed by Kimberly Peirce, and "In the Valley of Elah," directed by Paul Haggis.
AIMS:Cervical cancer and breast cancer have had the first and second highest occurrence rates among women in Taiwan since 1981 and have also been two of the leading causes of cancer death. In order to more effectively promote preventive medical care programs, it is important to identify the key determinants of women's behavior regarding their decisions to engage in screenings. This study aims to identify the major factors that affect the utilization of breast and cervical cancer screening among women in Taiwan, who are covered by universal National Health Insurance.METHODS:Data were obtained from the 2001 National Health Interview Survey for the Taiwan area and targeted women between 30 and 75 years old. The sample size consisted of 5,611 individuals for Papanicolaou (Pap) tests and breast examinations by a doctor. For breast ultrasounds and mammograms, 3,875 individuals were included. The propensity among women in Taiwan to use the two types of screening services, i.e., Pap test and breast examinations, were estimated by maximum likelihood probit regressions.RESULTS:The findings in this study show that the likelihood of a woman receiving a Pap test or a clinical breast examination depends on a variety of factors such as age, marital status, income level, education, and health status. Women with lower socioeconomic status were found to be much less likely to undergo the freely available cancer screening services. In addition, healthy behavior, such as not smoking and engaging in exercise, had a positive effect on the uptake of screening.CONCLUSIONS:The results of this study enable us to understand more thoroughly the characteristics of women who undergo a Pap test and breast examination, as well as the factors that influence them in Taiwan. The findings can help formulate related policies that are directed at removing the barriers to accessing medical care and targeting those at-risk groups. This analysis provides new evidence of the factors affecting the utilization of preventive care among women in a developing country, which are comparable to those of other countries, and may shed further light on the issue of promoting cancer screening and women's health.
Solar ultraviolet radiation (UVR) is a human carcinogen. The UK and the worldwide incidence of cutaneous (skin) melanoma are rising. It is now the second most common cancer in 15-34 year-olds in the UK, increasing by 49% in 1991—2000. The UK government prioritized skin cancer in 1992 in their public health strategy The Health of the Nation, and set the target for reducing the yearly rise in skin cancer incidence by 2005. In 1998 in the Saving Lives: Our Healthier Nation strategy, targets were set to reduce the death rate from cancer, including skin cancer, by 20% by 2010. As a consequence of these targets, since the mid-1990s public health campaigns to reduce sun exposure and skin cancer incidence in the UK have used specific interventions for at-risk groups and the mass media to reach the general population. Evidence indicates a shift in knowledge, with further work required to increase change in behaviour and attitudes. An associate health problem is vitamin D deficiency, which is prevalent across certain UK population groups. The main childhood health problem associated with vitamin D deficiency is the development of rickets, with evidence indicating those at high risk are exclusively breastfed dark-skinned infants, the elderly, those with dark skin pigmentation, and certain cultural groups that cover their bodies in clothing. Adolescents are the group with the highest incidence of low vitamin D status in the UK, with children of Asian descent at higher risk than Caucasian children. Increasing the outdoor activity levels of children in winter and during the cooler hours in summer is one way of increasing safe sun exposure. It is imperative to educate the general public on the risk of vitamin D deficiency, and offer advice on safe sun exposure, dietary sources of vitamin D, and dietary supplements. More research is required on recommendations for daily vitamin D supplements to determine optimal vitamin D levels in different population groups. There also needs to be reliable and accessible evidence on the links between vitamin D deficiency and lack of sun exposure, with sun safe messages adjusted accordingly.
The article reviews several films including "Standard Operating Procedure," directed by Errol Morris, "Stop-Loss," directed by Kimberly Peirce, and "In the Valley of Elah," directed by Paul Haggis.
Aims: There has been a burgeoning interest in arts and the environment in healthcare. While research has been undertaken on the clinical impact of disciplines, relatively little research has studied the impact of broader arts for health interventions. This paper reports findings from a systematic review of the arts for health literature, encompassing research on the impact of visual art, design and the environment on the well-being of patients and staff in mental healthcare settings.Methods: A systematic review of over 600 papers published between 1985 and 2005 on the impact of arts, design and environments in mental healthcare was undertaken. The review includes a discussion of contextual and policy literature, as well as 19 reports of quantitative and qualitative studies that met our inclusion criteria.Results: The largest number of studies focused on the aspects of art, design and environment that were relevant to mental healthcare. These studies suggest that this can affect health, including physiological, psychological, clinical and behavioural effects. Exposure to stressful visual and aural environments may reduce levels of stress and enhance recovery. Architectural design consideration is important in mental health settings, especially for patients with conditions such as dementia that can make wayfinding difficult. Exposure to art in healthcare environments has been found to reduce anxiety and depression. Environment features have also been found to affect staff, and improvements in visual and acoustic conditions may reduce risks of errors in some care settings. Qualitative studies provide insights into factors affecting the impact of arts, including issues of power and control, perceptions and influence of key stakeholders, and user participation. A key issue to emerge from this study is that arts interventions do not necessarily address the lack of control exercised by patients in healthcare environments.Conclusions: While there is extensive literature on the impact of design, environment and the arts on health, there is still a need for further research that addresses methodological challenges of evaluating complex interventions. Our review found evidence that environmental enhancements can have a positive impact on health and well-being of staff and patients in mental healthcare. Arts, when considered within this framework of evidence-based design, can also contribute to well-being, offering reassurance and creating identity in healthcare settings. Further research is needed in this area, as well as research that explores the contribution of other models of art that do not fit within the framework of 'evidence-based design'. Finally, responses to the arts are contingent on a number of complex social and political factors; further understanding of these is needed in order to inform future research and evaluation of the arts in healthcare.
Langerhans' cell histiocytosis (LCH) is a neoplastic disease due to uncontrolled proliferation of Langerhans' cells (LCs); damage to organs involved appears to be due to the various cytokines secreted. The true cause of LCH remains a mystery. LCH can present at any age; there is female predominance and the skin is often the first site to be involved. Scaly papules, vesicles, purpuric nodules, plaques and ulcers are the main diverse presentations typically found on the scalp, flexures (including the perineum), crease below the breast, palms, soles and nails. The patient described here is a 35-year-old Saudi Arabian woman with a vulval ulcer that had been misdiagnosed as an infective lesion 11 months before the correct diagnosis of LCH was made by means of biopsy examination. Diffuse infiltration of LCs with large pale reniform/convoluted nuclei and abundant amphophilic cytoplasm in the company of neutrophils, eosinophils, lymphocytes and plasma cells were observed on light microscopy. Immunohistochemical staining, indicating S100 protein positivity in LCs and the demonstration of Birbeck granules by means of electron microscopy, confirmed the diagnosis. The 'skin-only' LCH may later progress to involve other organs; alternatively skin lesions may be part of the multisystem, disseminated disease. There is need for careful follow-up of all LCH patients, as the course of the disease cannot be reliably predicted from either the clinical presentation or histology of the lesion. In many cases the prognosis is good, there being limited involvement that does not progress. Surgery or local steroids might suffice as therapy. However, for severely symptomatic disease, in which there are complications associated with dysfunction (or failure) of vital organs such as the liver, lungs, and central nervous system, the use of a variety of immunosuppressive treatments--and the recently described 2-chloro-2-deoxyadenosine (2CdA) (cladribine)--have been suggested; however, the type and extent of disease that will respond to this therapy has not yet been clarified. Solid laboratory research and rigorous clinical trials are required for more effective and less toxic therapies for patients with progressive LCH.
A programme of `arts as healthcare', Time Being (TB), was established and delivered as arts on prescription (AoP) by Healing Arts on the Isle of Wight over the period October 2002—March 2005. Its aim was to demonstrate and identify the benefits arising to an individual's health as a result of participation in structured creative programmes and activity, with the objective of the programme becoming part of the locally commissioned NHS services of the primary care trust. Evaluation and testimony from participants demonstrate the impact creativity has in contributing to the improvement in health of an individual and the individual's appreciation and understanding of their own health. The response to the evaluation by the commissioning sector of the NHS, primary care trust, indicates the difficulties and reluctance of this sector to embrace and commission arts in health programmes. The conclusion is that providers such as Healing Arts are required to undertake further detailed cost—benefit, cash—efficiency, and quantified health—gain analysis on the role of arts and creativity as part of healthcare for it to become integrated into NHS healthcare delivery.
The trend in being overweight and obesity has moved steadily upwards for both adults and children, raising concerns about risk factors for cancer, diabetes and heart disease. Evidence suggests that around two thirds of the population are now overweight or obese, and if present trends continue, obesity will surpass smoking as the greatest cause of premature loss of life. In common with most public health problems, the impact of obesity mirrors many other health inequalities. Evidence suggests that obesity is more prevalent in the lower socio-economic groups and that regional variations also exist. Many areas in north east England suffer from multiple deprivation, a picture which can be seen locally in Redcar and Cleveland, with nine of the 22 wards falling into the top 10% deprived wards nationally. Obesity and lack of uptake of physical activity are more prevalent in these wards. This has resulted in one in six adults being classified as obese, while four in ten men and three in ten women are overweight. In order to address this increasing public health problem, Redcar and Cleveland developed an Obesity Strategy in 2003. This strategy was one of the first Obesity Strategies to be developed nationally, focusing on strong partnership working. The management of obesity requires specialist knowledge, training and ongoing support for individuals if effective interventions are to be implemented. In light of this, Redcar and Cleveland Primary Care Trust (PCT) developed a weight management training package in 2004, which was accredited by the Open College Network North East Region (OCNNER) to Level 3. The multi-component training encompasses a mixture of practical and theoretical training in diet and nutrition, behavioural change approaches and physical activity. This minimum standard of training underpins the obesity pathways and prevention services currently being delivered across Redcar and Cleveland and ensures that consistent messages are delivered in relation to nutrition and weight loss. Within the past two decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. The aim of empowerment is to bring about change in individuals, families and communities through the development of skills, awareness, increased confidence and the redistribution of power and decision-making. The weight management training aims to build such skills and, through accreditation, engage volunteers to support the delivery of future services within their communities. The impact this has had on the local community has been very positive. Three current health improvement employees engaged through this process are now employed by the PCT as health trainers, a new role developed by the Department of Health as a means of improving health and reducing health inequalities. Health Trainers are to be recruited from local communities and will be trained to support individuals in adopting healthier lifestyles. The initiative is targeted at the most disadvanted areas and aims to empower both individuals and communities to make their own decisions regarding their health. To ensure sustainability of the weight management service, two community groups have been supported by health trainers to develop into health forums. These constituted groups support the delivery of health improvement programmes and are encouraged to make decisions regarding the health improvement priorities for their community. To date, these health forums have provided reduced-price physical activity sessions, away days, weight management sessions, and a social support network for the local community. The weight management training has been very successful since it was accredited and first delivered in 2004. To date, 50 people from varying backgrounds within Redcar and Cleveland have been trained to deliver Trim and Slim, the local weight management service. Trim and Slim is designed as a referral and support service for clients who are overweight or obese. The service aims to motivate clients to make small, sustainable lifestyle changes as an aid to help them lose weight. This model of delivery encourages sustainability of services within communities and therefore allows the health improvement specialist to build capacity in other areas of need.
Wales is developing a unique integrated system of governance to improve public health, which is diverging from some recent developments in the rest of the UK but shares many common features. There is a focus on strengthening collaborative working and co-ordination between bodies inspecting, regulating and auditing health and social care. Systems are being developed that are proportionate to the level of risk, eliminate unnecessary burdens of external review and support the improvement of services for patients, service users and carers. This is consistent with the Assembly Government's aim to improve the way that public services are delivered in Wales, including strengthening input from the public in the planning, delivery and reporting of regulation and inspection work. The test in the future will be how far we can demonstrate quantitatively and qualitatively the added value from our uniquely Welsh approach, built as it is on devolution and the aspirations for small-country governance.
This article outlines the rationale, evidence base, method and qualitative evaluation of a project that uses the performing arts to challenge the stigma surrounding mental illness and promote social inclusion of people with mental health problems. The partnership project has run for three years with students of Reigate Sixth Form College and staff and users of voluntary and statutory mental health services in East Surrey. Collation of three years of evaluation data showed it as a successful approach to: positively influence students' attitudes, knowledge and empathy around mental health issues; and positively affect mental health service clients' mood and their feelings of achievement, confidence and inclusion. Key elements of the project's success and sustainability are summarised.
AIMS:Habits of leisure time sports activity, similar to other health behaviours, are established during late childhood and early adolescence. While regular leisure time sports activity is a natural part of children's lifestyle, it starts to decrease during adolescence, particularly among girls. Among the factors influencing children's sports activity, the role of parents, peers, and other members of children's social networks seem to be crucial. The purpose of this study was to determine the role of social influences in early adolescents' leisure time sports activity and to examine gender differences.METHODS:Data were collected from middle school students using randomly selected classes from four schools in distinct school districts in Szeged, Hungary, using a self-administered questionnaire (n = 548) in which a response rate of 91% was achieved. Respondents were 10-15 years of age (mean = 12.2 years, SD = 1.2 years) with 54.9% of the sample male and 45.1% female.RESULTS:Results show significant others as an important influence on sport-related behaviours and suggest that during early adolescence girls' sports participation is particularly influenced by the social influence of peers (e.g. friends, classmates, boy/girlfriend).CONCLUSIONS:Our findings suggest that health promotion programmes should build on possible social influences, i.e. the role of peers, parents and significant others in general, in fostering adolescents' physical activity.
This paper surveys some recent developments in media criticism and recent developments in film and media representations of mental distress. Focusing on a representations drawn from various forms of media, the paper argues that media and film images of mental distress are in many cases `positive' and sympathetic, although they can also contain sexist, racist and other problematic elements that are not commonly identified by anti-stigma campaigners. It also suggests that while still valid in many ways, existing anti-stigma criticism tends to focus on a rather undifferentiated notion of `violence to others' as the sole criterion against which media images are judged. Finally, the paper proposes that critics and campaigners pay closer attention to how the particular form or genre of any media text influences its treatment of psychological distress.
Aims: Central obesity and insulin resistance are strongly implicated in the etiology of polycystic ovarian syndrome (PCOS) and their reduction is therefore a central treatment focus. Weight loss has been consistently successful in reducing insulin resistance and restoring ovulation and fertility in women with PCOS. The purpose of the current study is to investigate the general attitudes towards dieting and exercise in women with PCOS, together with the extent of implementation of the dietary and lifestyle advice that these women are given as part of their treatment. General knowledge of patients about their condition (PCOS) has also been assessed. Methods: Fifty three pre-menopausal women, over the age of 18 years, with a confirmed diagnosis of PCOS, were recruited from the Endocrinology Department, Middlesex Hospital, London. Subjects were interviewed individually using an interview-guided questionnaire. Results: Sixty four per cent of the subjects were overweight (BMI > 25 kg/m2) and 55% of those were obese (BMI > 30 kg/m2). All subjects identified the importance of weight control in the management of their condition. However, only nine out of the 35 overweight women had actually been referred to a dietician and only 22 reported taking moderate exercise at least once a week in order to improve their health. The main sources of information on weight management were the internet and their consultant endocrinologist, who they normally see only twice a year. Conclusion: In spite of the fact that weight loss and weight maintenance are absolutely vital in the treatment of PCOS, our study has shown that the support given to PCOS patients to help reduce and control their weight is inadequate and needs to be improved.
There is a worldwide pandemic of HIV infection. The WHO has compiled estimates of cases of HIV/AIDS for each country. In sub-Saharan Africa, HIV infection is causing decreased life expectancy. There is an overall increase in the number of orphans as a result of AIDS. Poverty, the lack of technologies and adequate resources are widening the gap between Africa and industrialized countries. In the instance of HIV positive children in Africa, we should aim to look into ways to identify and treat those with mental health issues or at risk for future mental health problems. This will help those affected to cope with the chronic illness associated with HIV infection, and to better comply with treatment that may lead to improved outcomes in terms of their quality of life.
Since the 1990s the US and UK healthcare systems have increasingly sought to measure the quality of services in order to stimulate improvement and publish the results. Despite the very different healthcare systems, there are some striking similarities in the results of these schemes. In both countries information that creates the threat of reputational damage and the possibility of gaining kudos is particularly effective in stimulating a response. However, these responses may be perverse: gaming, falsifying of data and measurement fixation have all been uncovered. In the UK context, information is closely aligned to the regulatory and performance management framework, and there should be a role for the new Care Quality Commission in the emerging `information landscape' of the NHS in England.
