Effective risk communication is essential in the field of health to ensure patients understand the information being presented to them by medical professionals and appreciate the level of risk involved in treatments. Cardiovascular disease, being the leading cause of death worldwide, is relevant to consider when examining risk communication in a health setting. Those afflicted with cardiovascular ailments are both high in number and exposed to information communicating risk. This research aims to identify presentation formats that are more effective communicating risk information to recovering cardiovascular patients at the University of Ottawa Heart Institute. The formats’ effectiveness is measured by gauging the population’s understanding of the material and perception of the information as it relates to risk and motivation. The research draws on Max Weber’s concept of rationality and subsequent scholars who developed social judgment theory, the heuristic-systematic model, expected utility theory, protection motivation theory, and the extended parallel process model. Utilizing an experimental research design, risk information handouts and questionnaires are distributed to, and completed by, a stratified sample of cardiovascular disease patients. Effective presentation formats are examined, and the results identify comparatively effective presentation formats for minimizing and maximizing risk perception. The results also identify presentation formats’ impact on a patient’s level of motivation to avoid / indulge in behaviours that may maximize or minimize risk. The results, synthesized herein, suggest a model (communicative cardiovascular physician-patient model of message preparation-perception), which may contribute to the effectiveness of risk communication between physicians and cardiovascular disease patients.

<p>The focus of this research is the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for tuberculosis. The goal of this&nbsp / research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis. The objectives to meet the goal were an exploration and description of patients&rsquo / experiences with regards to social and health service factors contributing to delays in seeking&nbsp / treatment for Tuberculosis. Another goal was to make recommendations on social and health service factors that contribute to patients&rsquo / delays in seeking treatment based on the findings. The research study had been of a qualitative nature exploring patients&rsquo / experiences of social and health services factors that contribute to delays in seeking treatment for Tuberculosis. Qualitative&nbsp / research was used in this study using semi-structured interviews with an interview guide. Data analysis was done according to the eight steps as recorded in Tesch in Creswell (1994: 155). The&nbsp / findings of this research were or include social factors contributing to patients&rsquo / delays in seeking treatment for TB. There were four categories related to social factors namely socio-economic,&nbsp / substance abuse, psycho-social and interpersonal relations factors. The findings also indicated that there were health service factors contributing to patients&rsquo / delay in seeking treatment for TB.&nbsp / These include quality of health care services, attitudes of medical staff and other medical conditions treatment. It was concluded that social and health services, as mentioned indeed contribute to patients&rsquo / delays in seeking treatment for Tuberculosis. Recommendations for practice included better case detection, treatment and health education. In order to address the various social&nbsp / factors as described above it is necessary to treat TB holistically and include a social worker as part of the multidisciplinary team.</p>

Effective risk communication is essential in the field of health to ensure patients understand the information being presented to them by medical professionals and appreciate the level of risk involved in treatments. Cardiovascular disease, being the leading cause of death worldwide, is relevant to consider when examining risk communication in a health setting. Those afflicted with cardiovascular ailments are both high in number and exposed to information communicating risk. This research aims to identify presentation formats that are more effective communicating risk information to recovering cardiovascular patients at the University of Ottawa Heart Institute. The formats’ effectiveness is measured by gauging the population’s understanding of the material and perception of the information as it relates to risk and motivation. The research draws on Max Weber’s concept of rationality and subsequent scholars who developed social judgment theory, the heuristic-systematic model, expected utility theory, protection motivation theory, and the extended parallel process model. Utilizing an experimental research design, risk information handouts and questionnaires are distributed to, and completed by, a stratified sample of cardiovascular disease patients. Effective presentation formats are examined, and the results identify comparatively effective presentation formats for minimizing and maximizing risk perception. The results also identify presentation formats’ impact on a patient’s level of motivation to avoid / indulge in behaviours that may maximize or minimize risk. The results, synthesized herein, suggest a model (communicative cardiovascular physician-patient model of message preparation-perception), which may contribute to the effectiveness of risk communication between physicians and cardiovascular disease patients.

Effective risk communication is essential in the field of health to ensure patients understand the information being presented to them by medical professionals and appreciate the level of risk involved in treatments. Cardiovascular disease, being the leading cause of death worldwide, is relevant to consider when examining risk communication in a health setting. Those afflicted with cardiovascular ailments are both high in number and exposed to information communicating risk. This research aims to identify presentation formats that are more effective communicating risk information to recovering cardiovascular patients at the University of Ottawa Heart Institute. The formats’ effectiveness is measured by gauging the population’s understanding of the material and perception of the information as it relates to risk and motivation. The research draws on Max Weber’s concept of rationality and subsequent scholars who developed social judgment theory, the heuristic-systematic model, expected utility theory, protection motivation theory, and the extended parallel process model. Utilizing an experimental research design, risk information handouts and questionnaires are distributed to, and completed by, a stratified sample of cardiovascular disease patients. Effective presentation formats are examined, and the results identify comparatively effective presentation formats for minimizing and maximizing risk perception. The results also identify presentation formats’ impact on a patient’s level of motivation to avoid / indulge in behaviours that may maximize or minimize risk. The results, synthesized herein, suggest a model (communicative cardiovascular physician-patient model of message preparation-perception), which may contribute to the effectiveness of risk communication between physicians and cardiovascular disease patients.

Cortisolkonzentrationen steigen während der Schwangerschaft und sind essentiell für die Organogenese und Einleitung der Geburt (Smith & Shearman, 1974). In dieser Studie haben wir einen Anstieg der HCC und HCNC vom 2. zum 3. Trimester in der Schwangerschaft nachgewiesen. Dabei stieg die HCC um den Faktor 1,3 und die HCNC um den Faktor 1,5. Frühere Studien konnten bereits einen ähnlich hohen physiologischen Anstieg von Cortisol nachweisen um den Faktor 1,5 im Haar und Speichel (D’Anna- Hernandez et al., 2011) und um den Faktor 3 im Urin und Plasma (Jung et al., 2011). Nach bestem Wissen wird in dieser Dissertation zum ersten Mal ein Anstieg der HCNC in der Schwangerschaft beschrieben. Dabei war die HCNC um das Dreifache höher als die HCC in beiden Trimestern, welches die Bedeutung der Inaktivierung von Cortisol zu Cortison durch das Enzym 11B- HSD Typ 2 hervorhebt. Höhere Werte für die HCNC wurden auch in nichtschwangeren Probanden beschrieben (Ullmann et al., 2016). In unserer Studie ergaben sich negative Assoziationen mit den PHQ- Subscores und der HCNC und dem Verhältnis von HCNC/HCC jedoch nie mit der HCC allein. Die gleichzeitige Bestimmung beider Steroide ist somit sinnvoll, gerade im Hinblick auf deren Verhältnis, welches ein indirekter Marker für die 11B- HSD Typ 2 Aktivität ist (Ghaemmaghami et al., 2014, Wilson & Thayer, 2017). Der Zusammenhang zwischen steigenden Stressscores und sinkender HCNC sowie sinkendem Verhältnis von HCNC/HCC lässt vermuten, dass Schwangere mit steigenden Stresssymptomen eine geringere Cortisonkonzentration aufweisen, möglicherweise durch niedrigere Aktivität der 11B- HSD Typ 2, und damit eine geringere Umwandlung von Cortisol zu Cortison. Als einziger Einflussfaktor auf die Konzentration der Steroide im Haar konnte häufiges Haarewaschen identifiziert werden (signifikant niedrigere Konzentrationen beider Steroide). Dies unterstreicht die Bedeutung einer genauen Datensammlung bei Probenabnahme durch gezieltes Erfragen der Haarbehandlung, nicht nur über Manipulation durch Haarfärbung und -tönung, sondern auch über alltägliche Handhabung des Waschens. Das Verhältnis HCNC/HCC wurde weder signifikant durch häufiges Haarewaschen noch durch andere untersuchte potentielle Einflussfaktoren beeinflusst und stellt daher einen robusteren Messparameter auch für zukünftige Studien dar.:I. Abkürzungsverzeichnis 1. Vorbemerkung ……………………………………………………………....…….. 1 2. Einführung in die Thematik 2.1 Definition Stress ……………………………………………………………....... 3 2.2 Physiologische Stressreaktion ……………………………………………....... 3 2.3 Modulation der Stresshormone durch das Enzym 11β- Hydroxysteroid-Dehydrogenase Typ 2 ……………………………………………………...........…… 5 2.4 Messung von Stress ……………………………………………………..……... 6 2.4.1 Messung von Stress durch Biomarker ………………………………..... 6 2.4.2 Messung von Stress durch Fragebögen ……………………………….. 8 2.5 Stress in der Schwangerschaft ………………………………………………... 9 3. Fragestellung …………………………………………………………………….... 11 4. Publikation …………………………………………………………………………. 13 5. Zusammenfassung der Arbeit ……………………………………………………. 21 6. Literaturverzeichnis ………………………………………………………………... 27 II. Anlagen II.A Tabellen ………………………………………………………………………........ 37 II.B Ergänzungsunterlagen zur wissenschaftlichen Publikation …………………. 41 III. Darstellung des eigenen Beitrags ……………………………...……………….. 46 IV. Erklärung über die eigenständige Abfassung der Arbeit ……….…………….. 47 V. Danksagung …..……………………………………………………....................... 48

Many researchers have suggested positive patient-health provider relationships can positively impact patient outcomes. A few focused explicitly on bariatric weight loss surgery (BWLS) professional-patient interactions. This study is significant because BWLS is a recommended tool to combat obesity. The purpose of this study was to analyze the perceptions of BWLS education nurses regarding their patient encounters. This mixed methods research study used an online survey combining quantitative Likert scale questions and open-ended qualitative questions, with social cognitive theory as the theoretical foundation. These explored viewpoints relate to their patient relations expressed by a health professional. Health professional beliefs incorporated into patient interactions has merit within BWLS continuum from presurgery requirements, to the procedure, and post-surgery lifestyle. Many respondents are employed in obesity services programs and received 'snowballs' from other contacted health professionals. The analyzed written response word clouds favor patient-focused care. Participation reluctance by not answering or skipping short answer perspective questions was a quantitative trend. Data revealed survey specific noticeable qualitative tendencies favorable toward patient-centered care and patient health accountability. The anticipated positive social change is a better understanding of issues surrounding the choice for and against BWLS and improved healthcare and health professional-patient communications.

Indiana University-Purdue University Indianapolis (IUPUI) / Importance: Despite its widespread use in clinical settings and in behavioral medicine research, little is known about the psychometric performance of the PHQ-9 across major U.S. sociodemographic groups. Thus, utilizing a large sample representative of the U.S. population and confirmatory factor analysis (CFA), we determine the factor structure and measurement invariance of the PHQ-9 across groups based on sex, race/ethnicity, and education level. Objective: Our objective was to address key knowledge gaps by definitively determining the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups based on sex, race/ethnicity, and education level. Design: The continuous National Health and Nutrition Examination Survey (NHANES) is a cross-sectional, epidemiologic study designed to assess the health and nutritional status of the U.S. population. We examined data from the 2005-2014 survey years. Setting: NHANES is uses a stratified multistage probability sampling approach to enroll civilian, non-institutionalized adults and children in the U.S. Participants: For our final sample, we selected the 26,202 adult respondents with no missing PHQ-9 data. The factors of interest were sex (49.3% men, 50.7% women), race/ethnicity (48.9% non-Hispanic White, 23.7% non-Hispanic Black, 17.8% Mexican American, 9.7% other Hispanic), and education level (9.9% less than 9th grade, 16.6% 9th-12th grade but no diploma, vii 23.7% high school graduate/GED or equivalent, 28.9% some college or Associate’s degree, 20/8% college graduate or above). Main Outcome(s) and Measure(s): The Patient Health Quessionnaire-9 (PHQ-9) Results: Results revealed that the best solution for the PHQ-9 consists of a cognitive/affective factor (items 1. anhedonia, 2. depressed mood, 6. feelings of worthlessness, 7. concentration difficulties, 8. psychomotor disturbances, and 9. thoughts of death) and a somatic factor (items 3. sleep disturbance, 4. fatigue, and 5. appetite changes; RMSEA = 0.034, RMSEA 90% CI = 0.032–0.036, TLI = 0.984, CFI = 0.988). To evaluate measurement invariance, we then conducted single-group and multiple-group CFAs to carry out the 5 steps of measurement invariance testing. Dimensional, configural, weak factorial, strong factorial, and strict factorial invariance was established for the PHQ-9 across the sex, race/ethnicity, and education level groups, as all models demonstrated close fit and the ΔCFI was < 0.010 for all steps. Conclusions and Relevance: Using a U.S. representative sample, we determined that a two-factor solution for the PHQ-9 with a cognitive/affective factor and a somatic factor is invariant across sex, race/ethnicity, and education level groups. Therefore, clinically, the PHQ-9 is an acceptable measure to utilize in major U.S. sociodemographic groups, extending the use of this depression screener from the primary care clinic to the community. Additionally, we show that PHQ-9 cognitive/affective and somatic subscale scores have the same meaning and can be compared across major U.S. sociodemographic groups and provide a consistent, evidence-based approach to computing PHQ-9 subscale scores to be used in future studies.

Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient’ (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-05 00:18:04.617

The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.

Thesis (M.S.)--University of North Carolina at Wilmington, 2005. / Includes bibliographical references (leaves: [25]-33)