Women's attitudes to the use of AI image readers: a case study from a national breast screening programme.

BACKGROUND: Researchers and developers are evaluating the use of mammogram readers that use artificial intelligence (AI) in clinical settings. OBJECTIVES: This study examines the attitudes of women, both current and future users of breast screening, towards the use of AI in mammogram reading. METHODS: We used a cross-sectional, mixed methods study design with data from the survey responses and focus groups. We researched in four National Health Service hospitals in England. There we approached female workers over the age of 18 years and their immediate friends and family. We collected 4096 responses. RESULTS: Through descriptive statistical analysis, we learnt that women of screening age (≥50 years) were less likely than women under screening age to use technology apps for healthcare advice (likelihood ratio=0.85, 95% CI 0.82 to 0.89, p<0.001). They were also less likely than women under screening age to agree that AI can have a positive effect on society (likelihood ratio=0.89, 95% CI 0.84 to 0.95, p<0.001). However, they were more likely to feel positive about AI used to read mammograms (likelihood ratio=1.09, 95% CI 1.02 to 1.17, p=0.009). DISCUSSION AND CONCLUSIONS: Women of screening age are ready to accept the use of AI in breast screening but are less likely to use other AI-based health applications. A large number of women are undecided, or had mixed views, about the use of AI generally and they remain to be convinced that it can be trusted.

The uncut jade: differing views of the potential of expert users on staff training and rehabilitation programmes for service users in Hong Kong.

BACKGROUND: Service user participation in direct service provision and evaluation has been developing in the western world in the past 20 years. However, this recovery-based care model is relatively new in Asia. AIM: To understand the views and perceptions of the service users and of psychiatric nurses about the recruitment of peer specialists in a regional psychiatric unit in Hong Kong. METHOD: A qualitative study using probe questions to understand the above issues in the form of focus group discussion. A total of 13 psychiatric nurses and 16 mental health service users were recruited from a regional psychiatric unit for the study. RESULTS: Content analysis based loosely on grounded theory has identified several important themes. While service users are generally enthusiastic about the potential contribution of peer specialists in a service setting, they are much concerned about rejection and discrimination by the psychiatric staff. Psychiatric nurses are also sceptical about the involvement of peer specialists in the delivery of service, although for an entirely different set of reasons. In view of the divergent views of the service users and the psychiatric nurses, a second round of focus group discussion was conducted seven months later to understand whether the themes distilled were consistent with their views expressed in the first round of focus group discussion. CONCLUSION: It is encouraging is that, for those psychiatric nurses who worked with volunteer service users in the pilot scheme of 'expert user participation', there was a change in view towards positive acceptance about peer specialist involvement in service delivery. The study provides some insight into the potential obstacles to and opportunities in the implementation of peer specialist services in routine psychiatric services in Hong Kong.

Is something better than nothing? An evaluation of early childhood programs in Cambodia.

This study evaluated the relative effectiveness of home-based, community-based, and state-run early childhood programs across Cambodia. A total of 880 five-year-olds (55% girls) from 6 rural provinces in Cambodia attending State Preschools, Community Preschools, Home-Based Programs, or no programs were assessed twice using the Cambodian Developmental Assessment Test. Controlling for baseline differences, children who participated in any early childhood programs performed significantly better in posttest than those of children who did not participate in any programs. Children in State Preschools scored significantly higher than those in either Community Preschools or Home-Based Programs; scores did not differ as a function of attending Community Preschools or Home-Based Programs. The results indicate that some preschool experience is better than none at all.

Older Chinese men and women's experiences and understanding of sexuality.

This study explored the meaning of sexuality for older Chinese people from diverse backgrounds and the role of traditional Chinese cultural values in shaping sexual expression. A total of 20 Hong Chinese elders were interviewed. Most reported a rigid definition of sexual behaviour, confining it to heterosexual sexual intercourse. Kissing, hugging and caressing were not considered 'sexual', and same-sex relationships were virtually absent from respondents' conceptions of sexuality. Traditional patriarchal values in relation to sexuality prevailed. Men and women attached different meanings to sexuality. Neither believed that sex was enjoyable for women or that women needed sex in the same way as men. Female participants saw sex as part of their responsibility to procreate and to fulfill their husband's needs. Male participants considered sex to be important for fulfilling their physical drives. The lack of an appropriate partner due to widowhood, the partner's physical condition or a poor spousal relationship apparently accounted for the low levels of sexual activity reported by informants.

Translating genomic research into care for people with schizophrenia in China.

The implications of increased understanding of the genetic contribution to schizophrenia for patients and their families remain unclear. We carried out a study of Chinese patients'(n=118) and relatives' (n=78) views of illness severity, attribution of cause, concern about developing illness, and effect of schizophrenia on family planning. A comparison sample of English-survey respondents was also obtained, using the same series of questions (n=42 patients, n=127 relatives). Fewer Chinese patients and family members rated schizophrenia as very severe (33%) than did the predominantly North American respondents (67%, p<0.0001). The pattern of attribution of cause differed between samples (p<0.0001), favoring environmental alone in the Chinese sample (52%), with a low frequency of genetics alone (9%). Although comparatively fewer Chinese respondents were very concerned about developing schizophrenia themselves or about the risk of illness in their families (21%), this high level of concern was more common in family members (28%). Finally, Chinese respondents were somewhat less likely to indicate that schizophrenia impacted on family planning decisions (31%) than were English-survey respondents (45%, p=0.02). The descriptive findings contribute to understanding schizophrenia in China. The comparative findings must be regarded as preliminary, since differences in demographics could influence results. The present findings suggest that understanding patients' and families' attributions of cause of schizophrenia may be important for developing a shared model of illness in order to decrease stigmatization, and improve therapeutic alliances.

What does recovery from psychosis mean? Perceptions of young first-episode patients.

BACKGROUND: This study explored the experience of first-episode psychosis from the patients' perspective and the meanings they attach to the illness and their recovery. METHOD: A qualitative methodology was used based on a focus group. Audio tapes were transcribed verbatim and three researchers participated in a content analysis that identified four major themes: the meaning of psychosis and psychotic experience; the meaning of recovery; stigma; and having an optimistic view of recovery. DISCUSSION: Participants' view of recovery was broader than that often held by psychiatrists, extending beyond symptom control and medication compliance, and they identified positive features that the experience of illness had brought. Their concerns included the side effects of medication and the fear of their illness being disclosed (to employers, university authorities, acquaintances, etc.) in the face of societal stigma. CONCLUSION: Ideas about what constitutes recovery need to take account of patients' views and experience in order to emphasize therapeutic optimism rather than pessimism, and to inform treatment contexts and the views of medical staff.

What does recovery from schizophrenia mean? Perceptions of medical students and trainee psychiatrists.

BACKGROUND: The attitudes of medical professionals towards recovery from schizophrenia are key in defining the therapeutic encounter and may change as they move through their medical career. METHOD: A qualitative methodology was used based on three focus groups of medical students and trainee psychiatrists in Hong Kong. Both held pessimistic attitudes towards recovery in schizophrenia. Four major categories and one central theme emerged, with little difference between students and doctors. The four categories were: (1) recovery is defined by the cessation of medication and the resumption of normal psychosocial functioning; (2) formal recovery requires medical confirmation plus the patient's admission of illness; (3) recovery should be discussed, but largely in terms of the contribution of drug compliance; and (4) participants recognized that stigma was an impediment to recovery while holding attitudes that were as unaccepting towards people with schizophrenia as lay people's. CONCLUSIONS: Traditional medical education over-emphasizes symptomatic recovery and ignores the need for a more flexible construction of the concept. Professional knowledge must incorporate both quantitative and qualitative data and inculcate humanitarian concern through active contact with users, and acceptance of the legitimacy of their expert experience. Medical education should seek effective ways to change entrenched negative attitudes in students about schizophrenia and the possibility of recovery. Further large-scale research should be carried out to establish attitudes of medical professionals towards recovery from schizophrenia and how this changes during typical career trajectories. This information could then be used to devise effective means within medical education to combat stigma and change attitudes.

What does recovery from schizophrenia mean? Perceptions of long-term patients.

BACKGROUND: The study investigated the meaning of recovery to eight people with chronic schizophrenia. METHOD: A qualitative methodology was used based on a 3-hour focus group. The material was transcribed and analysed into 18 subcategories and 4 categories; namely recovery as a multi-dimensional construct, the relationship of medication to recovery, a sense of hopelessness and helplessness about recovery, factors that promoted recovery. DISCUSSION: Respondents believed that full recovery could not be said to have been achieved until they stopped medication and had a steady job. The support and care of family and friends were also vital, although sometimes problematic. Independent living has a different meaning in Chinese culture. CONCLUSIONS: Further research directions are suggested as well as ways to change attitudes to the inclusion of medication in recovery.

Family burdens, Chinese health beliefs, and the mental health of Chinese caregivers in Hong Kong.

This study explored the types of family burdens, mental health and Chinese health beliefs of Chinese caregivers with relatives suffering from a serious mental illness. It also examined the impacts of these beliefs on caregivers' burdens and mental health. A structured questionnaire was administered to 125 Chinese caregivers in out-patient clinics in Hong Kong. Measures included distress (General Health Questionnaire), family burdens and belief in traditional Chinese medicine. Family burdens exerted a significant impact on the mental health of caregivers. Significant differences were found between believers and non-believers of traditional Chinese medical beliefs in terms of financial burdens, disruptions to family interactions and decline in physical health. No [corrected] moderating effect of Chinese health beliefs on family burdens and mental health was found. The lack of a moderating effect of health belief on family burdens may be related to caregivers' changes in perspectives from a traditional Chinese cultural perspective to a psychosocial and personality perspective. Implications for research and service development are discussed.

Ling's death: an ethnography of a Chinese woman's suicide.

Over the past decade, great concern has been expressed about the high suicide rates in China, especially among women and young women in particular. However, most of the information that has been presented has considered macro-level data and speculated on why women are so vulnerable to self-harm. This article presents the detailed story of one village woman who killed herself and suggests that motives and behavior are more complex than the cultural script and statistics suggest. Although depression is said to be commonly present in people who kill themselves in Western countries, this may not be the case in China.

Attempted suicide among young rural women in the People's Republic of China: possibilities for prevention.

This article reports on a sample of 147 women under age 35 living in rural areas in China who had attempted suicide and were treated in the emergency room of hospitals in four different locations. The interview instrument took 2 to 3 hours to complete and included audiotaped in-depth interviews with the patient and family members (separately); detailed evaluation of the circumstances surrounding the attempt, life events, and the family environment; and a formal psychiatric evaluation by an attending-level psychiatrist. Overwhelmingly, the method used by the attempters was poisoning with highly lethal pesticides and organic fertilizers. The women's suicidal behavior was characterized by high levels of impulsivity; little effort to seclude themselves before and after ingesting poison; and low rates of mental illness, including depression. Detailed suggestions are made about ways to implement suicide prevention strategies within the particular social and economic context of China.

Stigma and expressed emotion: a study of people with schizophrenia and their family members in China.

BACKGROUND: The most damaging effect of stigma is the internalisation of others' negative valuations. AIMS: To explore the factors that mediate patients' emotional and cognitive responses to stigma. METHOD: Based on responses to 10 open-ended questions about stigma appended to the Chinese version of the Camberwell Family Interview, trained coders rated the effect of stigma on both patients and family members in 1491 interviews conducted with 952 family members of 608 patients with schizophrenia at 5 sites around China from 1990 to 2000. RESULTS: Family members reported that stigma had had a moderate to severe effect on the lives of patients over the previous 3 months in 60% of the interviews, and on the lives of other family members in 26% of the interviews. The effect of stigma on patients and family members was significantly greater if the respondent had a high level of expressed emotion, if the patient had more severe positive symptoms, if the respondent was highly educated and if the family lived in a highly urbanised area. CONCLUSIONS: Clinicians should assess the effect of stigma as part of the standard work-up for patients with mental illness, and help patients and family members reduce the effect of stigma on their lives.