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Are Racial and Ethnic Minorities Less Willing to Participate in Health Research?
Wendler,Kington,Madans,Wye
PLOS Medicine , 2005,
Abstract: BACKGROUND: It is widely claimed that racial and ethnic minorities, especially in the US, are less willing than non-minority individuals to participate in health research. Yet, there is a paucity of empirical data to substantiate this claim. METHODS AND FINDINGS: We performed a comprehensive literature search to identify all published health research studies that report consent rates by race or ethnicity. We found 20 health research studies that reported consent rates by race or ethnicity. These 20 studies reported the enrollment decisions of over 70,000 individuals for a broad range of research, from interviews to drug treatment to surgical trials. Eighteen of the twenty studies were single-site studies conducted exclusively in the US or multi-site studies where the majority of sites (i.e., at least 2/3) were in the US. Of the remaining two studies, the Concorde study was conducted at 74 sites in the United Kingdom, Ireland, and France, while the Delta study was conducted at 152 sites in Europe and 23 sites in Australia and New Zealand. For the three interview or non-intervention studies, African-Americans had a nonsignificantly lower overall consent rate than non-Hispanic whites (82.2% versus 83.5%; odds ratio [OR] = 0.92; 95% confidence interval [CI] 0.84-1.02). For these same three studies, Hispanics had a nonsignificantly higher overall consent rate than non-Hispanic whites (86.1% versus 83.5%; OR = 1.37; 95% CI 0.94-1.98). For the ten clinical intervention studies, African-Americans' overall consent rate was nonsignificantly higher than that of non-Hispanic whites (45.3% versus 41.8%; OR = 1.06; 95% CI 0.78-1.45). For these same ten studies, Hispanics had a statistically significant higher overall consent rate than non-Hispanic whites (55.9% versus 41.8%; OR = 1.33; 95% CI 1.08-1.65). For the seven surgery trials, which report all minority groups together, minorities as a group had a nonsignificantly higher overall consent rate than non-Hispanic whites (65.8% versus 47.8%; OR = 1.26; 95% CI 0.89-1.77). Given the preponderance of US sites, the vast majority of these individuals from minority groups were African-Americans or Hispanics from the US. CONCLUSIONS: We found very small differences in the willingness of minorities, most of whom were African-Americans and Hispanics in the US, to participate in health research compared to non-Hispanic whites. These findings, based on the research enrollment decisions of over 70,000 individuals, the vast majority from the US, suggest that racial and ethnic minorities in the US are as willing as non-Hispanic w
Comparison of two misoprostol regimens for cervical priming before surgical pregnancy termination at 13 to 16 weeks gestations  [PDF]
Dennis G. Chambers, Robin J. Willcourt, Anthony R. Laver, Jane K. Baird, Wye Y. Herbert
Open Journal of Obstetrics and Gynecology (OJOG) , 2011, DOI: 10.4236/ojog.2011.14036
Abstract: Background: The optimal regimen has still to be determined for the use of misoprostol in the surgical termination of pregnancy in the early second trimester. Objective: To compare the outcomes of two different regimens for cervical priming with misoprostol before dilatation and evacuation (D & E) in 13 weeks - 16 weeks gestation pregnancy terminations. Methods: A retrospective analysis was performed of the medical records of two cohorts of 334 women each who were treated with either 3 sublingual doses of 2 misoprostol 200 µg tablets 30 minutes apart on admission or the same dosage preceded by 1 oral tablet of misoprostol 200 µg at home 3 hours before admission. Results: The addition of the home tablet of misoprostol increased the rate of one day completion of D & E from 97.3% to 100% (P = 0.004), and the overall mean theatre time for D&E was reduced by 12.3% in parous women (P = 0.001) and 6.4% in nulliparous women (P = 0.003) with the reduction being consistent across all gestations. Conclusions: This retrospective study showed that the addition of 1 oral tablet of misoprostol 200 µg at home 3 hours before admission to a regimen of 3 sublingual doses of 2 misoprostol 200 µg tablets 30 minutes apart on admission significantly increases the probability of all women at 13 weeks - 16 weeks gestation completing a termination of pregnancy in one day with a single D & E procedure and with a reduced theatre time.
The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations
Lesley Wye, Deborah Sharp, Alison Shaw
BMC Complementary and Alternative Medicine , 2009, DOI: 10.1186/1472-6882-9-5
Abstract: We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations).Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources.To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.To make informed decisions about the usefulness of complementary therapies, service users, clinicians and NHS commissioners need good quality information on the contribution complementary therapies can make to improving health outcomes and reducing NHS costs. Although there has been extensive debate on the best way to assess the impact of complementary therapy treatments on health outcomes [1-3], randomised controlled trials tend to dominate. Randomised controlled trials are conducted in tightly controlled experimental environments in which a particular intervention is targeted to a medically defined symptom (e.g. acupuncture for migraine headaches). When treatments are removed from this experimental context and integra
Designing a 'NHS friendly' complementary therapy service: A qualitative case study
Lesley Wye, Alison Shaw, Debbie Sharp
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-173
Abstract: Using a case study approach, two sites offering complementary therapies on NHS premises were studied using interview and documentary data. We conducted interviews with 20 NHS professionals, including PCT managers and clinicians. We used descriptive content analysis to analyse interview data. We collected and analysed documentation, such as referral data, funding bids and evaluations, to compare reported and documented behaviour.Ideally, a 'NHS friendly' complementary therapy service should offer a limited number of therapies for a specific condition for high priority patient populations (e.g. acupuncture for addictions). In this service model, the therapies should be perceived to have 'good' evidence for conditions where there are 'effectiveness gaps' (i.e. current treatments are limited). The service should be evaluated and regularly promoted. Inter-professional relationships would flourish through opportunities for informal contact and formal interactions, such as observations of consultations. However, the service should include gatekeeper mechanisms to control demand and avoid picking up 'unmet need' (i.e. individuals currently not accessing NHS services). The complementary therapy service should pay for itself and reduce NHS costs elsewhere, such as hospital admissions.The service design model identified in this study is problematic. For example, it is contradictory to provide specific interventions for specific conditions within a holistic healthcare framework. It is difficult to avoid providing for 'unmet need' while concurrently filling 'effectiveness gaps'. In addition, demonstrating the impact of a community service on reducing hospital admissions is challenging. Those seeking to establish a NHS complementary therapy service might be well-advised to meet as many of the criteria of a 'NHS friendly' model as possible, recognising that its full realisation may be impossible. However, during periods of innovation and financial security, some relaxation of expe
Labour Market Structure in Malaysia: Pre- and Post-Market Gender Comparison
Chung-Khain Wye,Rahmah Ismail
International Journal of Academic Research in Business and Social Sciences , 2012,
Abstract: Gender inequality in Malaysian labour market can be observed through labour force participation, unemployment, occupational distribution, top management employment involving decision making, and average monthly salary. Such an inequality generally works to the disadvantage of females, notwithstanding their outperformance of educational attainment over their males’ counterparts. Case study in the ICT services subsector points to the importance of imparting employability skills among females to have its bearing on wagedetermination. As such, future research is expected to analyse gender wage decomposition taking into considerations of different types of labour market discrimination, occupational preferences, and gender differences in employability skills.
Perception Differential between Employers and Undergraduates on the Importance of Employability Skills
Chung-Khain Wye,Yet-Mee Lim
International Education Studies , 2009, DOI: 10.5539/ies.v2n1p95
Abstract: This paper attempts to investigate if the undergraduates’ core competencies are able to meet with the requirements set by the employers and to analyse the effectiveness of personal qualities and employability skills development in private university in Malaysia. Questionnaires survey, mean score comparison, and independent sample t-test are used to capture the perception differential between 30 employers and 600 undergraduates from a local private university on the importance of employability skills. Our results show that the undergraduates are all highly competent in possessing the said personal qualities and skills. However, such skills as critical analysis, planning, problem solving, oral communication, decision making, and negotiating report a slightly higher level of mismatch between employers’ and undergraduates’ perception on their importance and development in the University.
Does Random Treatment Assignment Cause Harm to Research Participants?
Cary P Gross ,Harlan M Krumholz,Gretchen Van Wye,Ezekiel J Emanuel,David Wendler
PLOS Medicine , 2006, DOI: 10.1371/journal.pmed.0030188
Abstract: Background Some argue that by precluding individualized treatment, randomized clinical trials (RCTs) provide substandard medical care, while others claim that participation in clinical research is associated with improved patient outcomes. However, there are few data to assess the impact of random treatment assignment on RCT participants. We therefore performed a systematic review to quantify the differences in health outcomes between randomized trial participants and eligible non-participants. Methods and Findings Studies were identified by searching Medline, the Web of Science citation database, and manuscript references. Studies were eligible if they documented baseline characteristics and clinical outcomes of RCT participants and eligible non-participants, and allowed non-participants access to the same interventions available to trial participants. Primary study outcomes according to patient group (randomized trial participants versus eligible non-participants) were extracted from all eligible manuscripts. For 22 of the 25 studies (88%) meeting eligibility criteria, there were no significant differences in clinical outcomes between patients who received random assignment of treatment (RCT participants) and those who received individualized treatment assignment (eligible non-participants). In addition, there was no relation between random treatment assignment and clinical outcome in 15 of the 17 studies (88%) in which randomized and nonrandomized patients had similar health status at baseline. Conclusions These findings suggest that randomized treatment assignment as part of a clinical trial does not harm research participants.
Total smoking bans in psychiatric inpatient services: a survey of perceived benefits, barriers and support among staff
Paula Wye, Jenny Bowman, John Wiggers, Amanda Baker, Jenny Knight, Vaughan Carr, Margarett Terry, Richard Clancy
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-372
Abstract: Cross-sectional survey of both clinical and non-clinical staff in a large inpatient psychiatric hospital immediately prior to the implementation of a total smoking ban.Of the 300 staff, 183 (61%) responded. Seventy-three (41%) of total respondents were clinical staff, and 110 (92%) were non-clinical staff. More than two-thirds of staff agreed that a smoking ban would improve their work environment and conditions, help staff to stop smoking and improve patients' physical health. The most prevalent clinician perceived barriers to a successful total smoking ban related to fear of patient aggression (89%) and patient non-compliance (72%). Two thirds (67%) of all staff indicated support for a total smoking ban in mental health facilities generally, and a majority (54%) of clinical staff expressed support for a ban within their unit. Clinical staff who believed a smoking ban would help patients to stop smoking were more likely to support a smoking ban in their unit.There is a clear need to more effectively communicate to staff the evidence that consistently applied smoking bans do not increase patient aggression. There is also a need to communicate the benefits of smoking bans in aiding the delivery of smoking cessation care, and the benefits of both smoking bans and such care in aiding patients to stop smoking.Smoking remains responsible for the greatest disease burden in Australia [1] and elsewhere [2]. For those with psychiatric disorders, the prevalence of smoking [3,4] is much higher than among the general population [5]. In mental health inpatient settings in Australia [6,7] and elsewhere [8], high smoking rates have been reported. Consequently, those with a mental illness are more likely to develop and die from smoking-related diseases than are those without such an illness [9].The introduction of total smoking bans represents an important step in addressing the harm caused by tobacco smoking for people with a mental illness [10]. The World Health Organisation [11]
Complementary or alternative? The use of homeopathic products and antibiotics amongst pre-school children
Lesley Wye, Alastair D Hay, Kate Northstone, Jackie Bishop, Judith Headley, Elizabeth Thompson
BMC Family Practice , 2008, DOI: 10.1186/1471-2296-9-8
Abstract: Questionnaires data were completed by the parents of 9723 children while aged between 3–4.5 years in Bristol UK. Univariable and multivariable analyses were used to explore the relationships between antibiotic and homeopathic product use.Six percent of children had received one or more homeopathic products and 62% one or more antibiotics between the ages of 3 and 4.5 years. After adjustment for factors associated with antibiotic use, there was no association between homeopathic product and antibiotic use (adjusted OR = 1.02, 95% CI 0.84, 1.24). Factors independently associated with child homeopathic product use were: higher maternal education, maternal use of homeopathic products, maternal lack of confidence in doctors, mothers reporting that they were less likely to see doctor when the child was ill, children being given vitamins, watching less television and suffering from wheeze and food allergies.In this observational study, the use of homeopathic products was not associated with decreased antibiotic consumption, suggesting the use of homeopathic product complements rather than competes with the use of antibiotics in pre-school children. The characteristics of mothers giving homeopathic products to their children are similar to those associated with adult self-administration.The use of medicines in children has now risen to the top of the political and research agendas [1,2]. Regarding antibiotics in particular, pre-school children consume more than any other age group [3]. In 1996, a study found that up to 57% and 54% of pre school boys and girls respectively had received an antibiotic [4] and studies since have shown that UK prescribing is still up to 30% higher than our Northern European counterparts [5].Inappropriate or unnecessary use of antibiotics for viral infections in children causes concern for policy makers, commissioners, clinicians, complementary therapists and parents [6-8] for two reasons. First, because it may promote the transmission of both an
Obesity and Diabetes in New York City, 2002 and 2004
Gretchen Van Wye, PhD,Bonnie D. Kerker, PhD, MPH,Thomas Matte, MD, MPH,Shadi Chamany, MD, MPH
Preventing Chronic Disease , 2008,
Abstract: Introduction Obesity and diabetes have increased rapidly nationwide, yet reliable information on these disease trends in local urban settings is unavailable. We undertook this study to characterize trends in obesity and diagnosed diabetes from 2002 to 2004 among white, black, and Hispanic adult residents of New York City.Methods We used data from the Community Health Survey, an annual random-digit–dial telephone survey of approximately 10,000 New York City adults aged 18 years or older, and from the Behavioral Risk Factor Surveillance System, a similar nationwide survey. Main outcome measures were body mass index (BMI), calculated from self-reported height and weight, and self-reported diabetes.Results In 2 years, the prevalence of obesity increased 17% in New York City, from 19.5% in 2002 to 22.8% in 2004 (P < .0001). The prevalence of diagnosed diabetes also increased 17%, from 8.1% in 2002 to 9.5% in 2004 (P < .01). Nationally, the prevalence of obesity increased by 6% during this same time period (P < .05), and diabetes prevalence did not increase significantly. The median BMI among white adults in New York City was 25.1 kg/m2, significantly lower than among Hispanics (26.4 kg/m2) and blacks (26.6 kg/m2, P < .05). The prevalence of diabetes increased across all BMI categories.Discussion The rapid increase in obesity and diabetes in New York City suggests the severity of these twin epidemics and the importance of collecting and analyzing local data for local programming and policy making.
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