Antileukotrienes are well tolerated pain treatment center dr mckellar discount rizatriptan 10mg online, but data on their use during pregnancy are scarce best pain medication for uti buy discount rizatriptan 10mg line. The use of montelukast and zafirlukast may be considered in patients with recalcitrant asthma who have shown a uniquely favorable response prior to pregnancy pain treatment for lyme disease cheap 10 mg rizatriptan. The use of zileuton should be avoided sciatica pain treatment options generic rizatriptan 10mg free shipping, because of non-reassuring animal data (Namazy 2004) treatment pain from shingles order 10mg rizatriptan free shipping. In the case of first-trimester use of antileukotrienes pain joint treatment generic rizatriptan 10mg otc, a detailed fetal scan should be offered heel pain treatment urdu purchase rizatriptan 10mg. It has anti-inflammatory but no bronchodilating properties joint and pain treatment center thousand oaks rizatriptan 10mg, is orally available, and may be effective in chronic obstructive lung diseases. In two prospective studies with small numbers, no increased rates of congenital malformations, preterm births, or low birth weights were found (Bakhireva 2006, Sarkar 2005). Several prospective and retrospective cases of limb reduction defects have been reported to the manufacturer and in international reports, but a causative relationship between montelukast and limb defects has not yet been established. It should be used only in patients with recalcitrant asthma with known favorable response before pregnancy. N-acetylcysteine is a derivative of the amino acid L-cysteine, and is used as a mucolytic agent and an antidote in paracetamol (acetaminophen) poisoning. Although the documented data on its use as a mucolytic during pregnancy are scarce, it seems to be safe when used in low doses. Guaifenesin and guaiacol stimulate the clearance of viscous mucus via stimulation of the gastropulmonary vagal reflex, but they have no effect on the thickness of the mucus. There is no evidence of an increased risk of congenital malformations or other adverse effects on pregnancy outcome. Mesna is an expectorant that breaks the disulfide bonds in mucopolysaccharides present in the mucus. N-acetylcysteine, ambroxol and bromhexine are firstchoice mucolytics during pregnancy, if (oral) fluid therapy, and other nonmedical treatment is not effective. Iodine-containing mucolytics are contraindicated, especially after the first trimester. Inadvertent short-term use of the other expectorants and mucolytics does not require any intervention. It is a derivative of morphine, and has strong antitussive and analgesic properties. Because of its analgesic action, it is also used in compound antitussive preparations. An association between the prenatal use of codeine and congenital malformations has not been shown. When codeine is used in high doses for longer periods, or near term, respiratory depression and withdrawal symptoms can occur in the neonate (see also Chapter 2. Dextromethorphan has no analgesic properties, but its antitussive effect is similar to that of codeine. Einarson and associates reported pregnancy outcomes of women who had used dextromethorphan during pregnancy, most of them in the first trimester. In another recent study, an association between congenital malformations and prenatal exposure to dextromethorphan could not be established (Martнnez-Frias 2001). There is no experience in the use of other antitussives, such as benproperine, clobutinol, dropropizine, eprazinone, noscapin, pentoxyverin, and pipacetate, during pregnancy. In the case of persistent dry cough, codeine and dextromethorphan can be given in all trimesters of pregnancy. Higher doses given for longer periods, or use near delivery, can cause neonatal withdrawal symptoms and respiratory depression. These combinations do not follow good therapeutic practices, and are not recommended during pregnancy. Hexoprenaline, isoprenaline, and orciprenaline Pharmacology and toxicology Hexoprenaline, isoprenaline (isoproterenol), and orciprenaline have a stimulating effect on -receptors. They are non-selective -adrenergic agents that act on both 1- and 2-receptors, and therefore have unwanted side effects on cardiac and metabolic functions, central nervous system, and motility of the gastrointestinal tract. There is no experience in the use of orciprenaline and hexoprenaline during pregnancy. Limited experience with isoprenaline does not show adverse effects on embryonal and fetal development. Hexoprenaline, isoprenaline, and orciprenaline should not be given to pregnant women. It has both - and -adrenergic properties, and causes a slight vasoconstriction in the bronchi. Adverse effects on the cardiovascular system are so severe that it is not indicated for the treatment of bronchial asthma. In the case of acute spastic airway obstruction, adrenalin may be effective when given subcutaneously or as an aerosol. Due to -adrenergic effects, systemic application can impair uterine blood flow resulting in fetal hypoxia. There is no clear evidence of an increased risk of congenital malformations when using adrenalin in human pregnancy (Heinonen 1977). Adverse effects during pregnancy have not been reported following the use of such preparations. Ephedrine and other sympathomimetics Pharmacology and toxicology Ephedrine, pseudoephedrine, phenylephrine, and related compounds are -adrenergic receptor agonists, which cause bloodvessel constriction. It has been demonstrated that -adrenergic receptor agonists slow uterine blood flow, but their effects have not been sufficiently studied in relation to most reproductive outcomes in animals or humans. It causes an increased release of catecholamines, and has both - and -adrenergic properties. Ephedrine is no longer in use for the treatment of asthma because of the unwanted side effects, especially on the cardiovascular system. Pseudoephedrine, phenylephrine, and phenylpropanolamine are sometimes used in combination with dextromethorphan, doxylamine, etc. The systemic use of ephedrine and other sympathomimetics should be avoided during pregnancy. Asthma symptoms, severity and drug therapy: a prospective study of effects on 2205 pregnancies. Characterization of theophylline binding to serum proteins in pregnant and nonpregnant women. Fetal oxygenation, assessment of fetal well-being and obstetric management of the pregnant patient with asthma. Randomized trial of inhaled beclomethasone dipropionate versus theophylline for moderate asthma during pregnancy. Risk of ventricular septal defects was associated with decongestant use in pregnant women in one recent study (review in Werler 2006). The vasoconstrictive effects of these drugs raise the hypothesis that their use in early pregnancy might increase the risk of vascular disruption defects. Decongestant use in the first trimester has been discussed in association with small increases in risks of gastroschisis, small intestinal atresia, and hemifacial microsomia (review in Werler 2006). The majority of decongestant use is in oral form, and the question of whether intranasal formulations carry risk has not been adequately addressed. A review of pregnancy outcomes after exposure to orally inhaled or intranasal budesonide. Maternal theophylline administration and breathing movements in late-gestation human fetuses. Effect of bronchial asthma on the course of pregnancy, labour and perinatal outcome. Epidemiologic analysis of prenatal exposure to cough medicines containing dextromethorphan: no evidence of human teratogenicity. Managing asthma during pregnancy: recommendations for pharmacologic treatment 2004 update. Use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth. Normal pregnancy outcomes in a populationbased study including 2968 pregnant women exposed to budesonide. A population-based prescription study of asthma drugs during pregnancy: changing the intensity of asthma therapy and perinatal outcomes. Meta-analysis finds use of inhaled corticosteroids during pregnancy safe: a systematic meta-analysis review. Perinatal outcomes in the pregnancies of asthmatic women: a prospective controlled analysis. Adverse outcomes in pregnancies of asthmatic women: results from a Canadian population. Patients can be reassured of the benign nature of their condition and should be encouraged to use the various treatment options that have been proven efficacious with little risk to the fetus. Therapeutic pregnancy termination might be considered in severe intractable cases; however, this option is seldom utilized. Dietary measures are often suggested for the mildly symptomatic women, although little evidence supports these measures. Women may benefit from frequent and small meals, with high carbohydrate and low fat content. Salty foods may be tolerated better in the morning, and sour or tart beverages may be tolerated better than water (Quinlan 2003). It would seem sensible to start treatment with dietary measures, lifestyle modifications and vitamin B6. If symptoms persist, treatment with metoclopramide or diclectine (if available) should be started. The firstand some of the second-generation antihistamines are a good option, and if they fail then ondansetron would be the next choice. Intractable cases are best treated with intravenous antiemetics and steroids, and rehydration therapy; in severe cases, parenteral nutrition should be considered. Vitamin B1 should be administered in severe protracted cases in order to prevent thiamine deficiency. Alternative or complementary therapy such as acustimulation, hypnosis, and ginger can be considered at any stage. Ginger is safe and efficient when applied in the correct quantities and to women with certain yin-yang characteristics. These modes of therapy may be beneficial and are probably harmless to the pregnancy, and so may be worth a try if the woman is willing. Many people prefer complementary or "natural" therapy to medical therapy, believing that "natural" treatment is less harmful. Illness is thought to be the result of obstructed or misdirected energy flow, and stimulating of acupoints within the meridian system is believed to restore health by correcting this flow. By inserting very thin needles 5 mm deep under the skin, different organs can be influenced via the meridians. Many acupoints influence the upper gastrointestinal tract, but the acupoint studied most by Western scientists is the P6 (Nei Guan), located on the anteromedial aspect of the forearm at a three-finger distance from the wrist crease, between the palmaris longus and flexor carpi radialis tendons. This point can be activated using needles (acupuncture) or by pressure (acupressure) applied by an acupressure band. Numerous explanations have been proposed to explain the antiemetic influence of acupuncture and acupressure. Recently, acupuncture has been reported to have a relatively low incidence of complications, mostly temporary, in large population studies (total of 65 000 patients) (MacPherson 2001, Vincent 2001, White 2001). There was no difference between the groups with regard to the incidence of spontaneous abortion, stillbirth or neonatal death. The incidence of major malformations was no larger than the incidence in the general population (3% total), and the overall risk of pregnancy complications did not differ between groups (antepartum hemorrhage, pregnancyinduced hypertension, pre-eclampsia and preterm birth). There were no differences in any birth outcomes, such as gestational age, weight, length, and head circumference (Smith 2002B). Also, P6 acupressure was useful in reducing nausea, vomiting, and dry retching (Markose 2004, Dundee 1988). Meta-analysis of the studies in 1306 patients summarized in the Cochrane database demonstrated mixed evidence, and did not clearly prove acupressure or acupuncture to be more effective than standard dietary and lifestyle advice 2 Pregnancy 2. Acustimulation, which is electrical stimulation of the P6 acupoint, does seem to be effective, but further trials are warranted (Rosen 2003). In a study of 138 patients hospitalized with refractory hyperemesis gravidarum, 88% stopped vomiting after one to three sessions of medical hypnosis (Simon 1999, Fuchs 1994). The hypnotic state induces a deep state of psychological relaxation, with a corresponding decrease in sympathetic tone. Patients might be given suggestions during the hypnotic state to relax their stomach and throat muscles, causing their nausea, gagging, and vomiting to subside. It has been found to be effective in treatment of motion sickness and postoperative nausea (Bone 1990, Mowry 1982). The whole rhizome, however, is not mutagenic due to the substance zingerone, which suppresses the mutagenic activity of 6-gingerol (Nakamura 1982). Ginger has been claimed to inhibit platelet aggregation, and theoretically could affect testosterone receptor binding and sex steroid differentiation of the fetus; however, no clinical evidence has suggested that this is the case (Guh 1995, Backon 1991, Murphy 1988). In a large prospective trial following women who took various types of ginger during the first trimester, there was no evidence of an increased rate of major malformations (Portnoi 2003). The first trial involved 27 women hospitalized with hyperemesis gravidarum who were randomized to receive ginger capsules four times daily (total 1 g daily) versus placebo in a double-blind, crossover designed study. Ginger treatment was associated with reduced nausea and vomiting in one trial (70 participants), and nausea and retching only in the other trial (120 participants). The side effects were minor mostly mild gastrointestinal discomfort and no adverse effects were noted for the pregnancy or for the fetus (Willetts 2003, Vutyavanich 2001). Women with excess yang energy characteristically report nausea at other times of the day that worsens after meals. These women would benefit, according to the Chinese traditional medicine, from a yin or "cool" remedy such as peppermint (Tiran 2002). The antihistamines that are indicated for nausea and vomiting are buclizine, cyclizine, dimenhydranate, diphenhydramine, doxylamine, hydroxyzine, and meclizine. The drawback of the first-generation antihistamines is their sedative effect; however, the fact that they have been on the market for so long, with no evidence of adverse effects on the newborn, is very reassuring. Another large prospective study on antihistamine use in the first trimester, involving more than 18 000 infants, failed to demonstrate any adverse effect on the birth outcome. The outcome of the pregnancies was more favorable than the controls with respect to preterm births, low birth weight, and perinatal death (Kдllйn 2002). Buclizine is a piperazine-derivative antihistamine; it acts centrally and via the labyrinthine apparatus to suppress nausea and vomiting. There is very little evidence supporting use during pregnancy, although it is probably safe as are the other related antihistamines, such as cyclizine and meclizine. Cyclizine is a piperazine-derivative antihistamine with anticholinergic properties that exerts its antiemetic effect via direct effects on the labyrinthine apparatus, the chemoreceptor trigger zone, and possibly by increasing the muscular tone of the lower esophagus. Dimenhydrinate is the chlorotheophylline salt of diphenhydramine, and inhibits labyrinthine stimulation and the vestibular system. As with diphenhydramine, dimenhydrinate is safe during early pregnancy (Mazzota 2000), but should be avoided during the third trimester due to its potential to stimulate uterine contractions (Brost 1996). Diphenhydramine is an ethanolamine antihistamine that acts by competitively antagonizing histamine at the H1 histamine receptor. Diphenhydramine is a first-generation antihistamine that is mainly used as a sedative, although it is safe and effective as an antiemetic during pregnancy (Mazzota 2000). Diphenhydramine has oxyctocinlike effects, especially when given intravenously or in an overdose, and may cause uterine contractions (Brost 1996); therefore, it should not be given during the third trimester. In the mid-1970s, limb and various gastrointestinal malformations were suspected to be associated with the combination. Doxylamine should be the first choice, preferably combined with vitamin B6 (Diclectin, if available); otherwise, secondgeneration antihistamines such as meclizine should be used because of the sedative effects of the first-generation antihistamines. Metoclopramide counteracts some of the physiological changes during pregnancy that may lead to nausea or vomiting, such as decreased lower esophageal sphincter tone (van Thiel 1977), and decreased propulsive motility time and increased transit time of the small intestine. No adverse fetal effects were reported in a number of studies when metoclopramide was administered during the first and second trimesters, with no significant risk of major malformations (Berkovitch 2002, 2000, Magee 2002, Sшrensen 2000). A prospective follow-up of 175 women exposed to metoclopramide during the first trimester established that the rates of major malformations, spontaneous abortions, and birth weight were comparable with 2. Meclizine (meclozine) is a piperazine antihistamine with anticholinergic and antiemetic activity. The antiemetic effects appear to be related to inhibition of the emetic center in the brain stem, vestibular nucleus, and labyrinth. The onset of effect takes 1 hour, but the effect is prolonged usually 24 hours so once-daily dosing is appropriate. Meclizine is the antiemetic antihistamine of choice when doxylamine is unavailable. It has a long-lasting effect in approximately 90% of patients, and there is no evidence of adverse consequences to the child (Broussard 1998). No adverse birth outcomes (birth weight, major malformations, preterm delivery) were found in a study of 309 women, identified from the Danish Medical Birth Registry, exposed to metoclopramide during the first trimester of pregnancy (Sшrensen 2000). Domperidone shows no teratogenicity in animals (Shepard 1992), but there are insufficient data regarding use in humans. One trial combined droperidol with diphenhydramine for treatment of 80 women with hyperemesis gravidarum. This is the only published trial of exposure to droperidol in the first trimester. In comparison to another group exposed to various antiemetics, the combination of intravenous droperidol (11. Pooling the results of three studies on trimethobenzamide (two cohort and one case control), there was no increased risk for malformations.
Some marketing historians (Jones and Monieson gum pain treatment remedies 10 mg rizatriptan sale, 1990a; Savitt sciatic pain treatment videos discount rizatriptan 10mg fast delivery, 1983) favor heavy reliance on primary data; others (Fullerton back pain treatment nyc cheap rizatriptan 10mg with visa, 1988; Hollander allied pain treatment center boardman oh buy generic rizatriptan 10 mg, 1986b) have made good use of both types; and still others (Dixon pain management treatment goals buy discount rizatriptan 10 mg, 1995 hartford hospital pain treatment center ct generic 10 mg rizatriptan, 1998; Twede pain management utica new york trusted 10 mg rizatriptan, 2002; Witkowski fibroid pain treatment relief order 10 mg rizatriptan overnight delivery, 1989) have based their work upon fresh readings of existing literatures. The body of such secondary data, the literature of historical research in marketing, has grown dramatically during the past two decades. An enormous amount of primary material documents marketing practice and thought since the latter part of the nineteenth century. For earlier periods, original evidence is often much less abundant, scattered across numerous records and sometimes quite difficult to locate. It may be redundant for marketing historians to reanalyze the same primary sources that others have combed. For many years, scholars in marketing, advertising and consumer research have borrowed theoretical ideas and empirical findings from economics, psychology, sociology, anthropology and other fields. The large body of historical literature should also be mined for marketing insights. That said, researchers should familiarize themselves with the primary evidence from the earlier eras so that they can critically evaluate secondary sources. Types of primary sources Primary data sources can be divided into four groups: words, images, artifacts and memories elicited through oral history methods. Purely audio data, such as radio advertising or popular music, could be used as source material, but seldom is and then only as transcribed dialogue and lyrics. A particular piece of evidence can straddle more than one Qualitative historical research in marketing 73 category. Advertising, one of the most frequently consulted primary sources (see, for example, Belk and Pollay, 1985; Gross and Sheth, 1989; Pollay, 1985) and other ephemera (Neilson, 2005) often include both text and visuals. Paintings are images but also material objects, often with provenance, a history of sales and ownership (Witkowski, 2004). Whereas marketing and consumer histories draw from all kinds of data, biographies and histories of marketing thought are largely based upon written sources, although they too may be supplemented by oral history interviews. Historians have consulted written documents for a very long time, but not until the invention of the printing press in the mid-fifteenth century, accompanied by growing rates of literacy, did texts proliferate enough to become the dominant data source. By the middle of the nineteenth century, many academic historians were basing their research solely on this material and, partly to give their emerging discipline an identity of its own, began espousing the written record as the only creditable evidence (Thompson, 1988). Typical forms for marketing and consumer history, listed from the most public to the most personal, include the following. Public records such as legal documents, governmental records and other institutional records such as those of universities and scholarly organizations. Articles and letters in newspapers, magazines, trade publications and scholarly journals. The books and articles of academic marketing are a primary source for biographies (Jones, 1998) and histories of marketing thought (Shaw and Jones, 2005; Wilkie and Moore, 2003), and even relatively recent publications have been used for consumption research. For example, Cohen (2003) cited Journal of Marketing articles from the 1950s and 1960s as evidence of increasing social segmentation in postwar America. They are often incomplete, difficult to read if penned by hand, and not infrequently contradictory. More likely, however, is selective perception and retention on the part of their creators. Documents frequently were (and still are) drafted to protect and embellish the reputations of certain individuals, organizations, social groups and political interests. Usually created by elite males, documents tend to underrepresent the experiences of the lower classes, minorities and women. Their survival rate is also problematic since preservation choices are often made deliberately, but subjectively. The researcher needs to guard against overgeneralizing from written sources and be alert to possible biases. That is, social statistics are no more absolute facts than newspaper reports, private letters or published biographies. All represent, either from individual standpoints or aggregated, the social perception of facts; and 74 Handbook of qualitative research methods in marketing all are in addition subject to social pressures from the context in which they are obtained. With these forms of evidence, what we receive is social meaning, and it is this which must be evaluated (Thompson, 1988, p. Images or visual data sources, which include paintings, prints, photographs, films and videos, can reveal things about past marketing and consumption that cannot be conveyed by written records (Belk, 1986; Witkowski, 1999, 2004). They can show what buyers and sellers and their merchandise and accoutrements actually looked like. They can depict color, form, movement and other details people once took for granted and failed to mention in texts (Burke, 2001). Through narrative content and allegory, art can express social attitudes and, hence, validate or challenge written sources such as diaries, letters, newspaper accounts or probate records (Witkowski, 1994). Burke (2001) points out that, unlike written evidence, where usually only the investigator has had an opportunity to visit an archive and read the material, when images are reproduced in research reports, both authors and readers have access to the data and can examine them together. Consequently they can sometimes be a better guide to past social attitudes and cultural conventions than to the exact nature of people, things and consumer behavior. American genre painters, for example, sometimes distorted actual behavior in order to instruct or entertain the viewer and drew upon stock social characters that fulfilled the expectations of their patrons (Witkowski, 1996, 2004). Works of art have aesthetic qualities and polemical content that can elicit powerful, possibly biased, emotional responses in the researcher. Art must be read carefully and the analyst needs to distinguish a contemporary reading from a historical or period reading. Marketing historians have not very often consulted physical evidence, such as artifacts and architecture, although these alternative sources have potential for documenting the products actually sold, what they looked like, and how they may have been used (Witkowski, 1994, 2001). Material data can be classified as found objects, the bits and pieces archaeologists excavate at historical sites, or preserved objects, the antiques collected by private individuals and public institutions. Sometimes artifacts are all that remains of some goods deemed too trivial to be included in written records or captured in images. When they were used by a broad cross-section of the population, artifacts could be more representative data sources than texts. Moreover, objects are generally less selfconscious cultural expressions and, therefore, conceivably more truthful (Prown, 1982). Through their style, objects communicate tacit but fundamental values of a society (Prown, 1980). On the other hand, artifacts do not reveal beliefs, attitudes, values and meanings as directly as written records. In addition, physical data sources suffer from their own problems in representativeness. Found objects are generally restricted to certain materials, such as ceramics, glass or precious metals, that can survive many years of burial on land or under water. Leather, wooden and base-metal consumer goods rarely last under these conditions and textiles hardly at all. Aside from pure chance, preserved objects were saved because they possessed special attributes. They may have been of the highest quality, particularly artistic or originally owned by distinguished people or affluent families. More Qualitative historical research in marketing 75 common, often cruder artifacts experienced harder use, deteriorated more rapidly and were more likely to have been discarded as junk. Also preserved objects may have been altered over time, either innocently or with intent to deceive, and no longer are the evidence as they were when first produced and used. These historical accretions remind us that objects live in the present as well as the past. Today, these data are typically captured by audio/video equipment, although some situations still require note taking. Interview techniques can range from being very unstructured and free-flowing to obtaining open-ended answers to a specific list of questions. Sessions are then transcribed verbatim, save minor editing to clarify, to remove false starts or repetitions and to insert punctuation. Although time-consuming, transcription facilitates interpretation since most people can read and reread print faster than they can listen to and comprehend an audio or video recording. Further, given potential problems in accessing tape and/or digital storage media in the future, a written version helps preserve the findings. A few historians have dismissed oral history as little more than the collection of sentimental memories from old people. Human memories start from different points of view and are fallible, although most forgetting takes place soon after an event has occurred. Oral historians frequently encounter informant nostalgia, the remembering of the past as better than it was lived, and thus need to press for more candid and critical responses (Ritchie, 1995). All in all, however, interview data are probably no more subjective or less all representative than any other pieces of evidence and they have special advantages of their own. For one, respondents can be selected to ensure that many different points of view are being voiced. Oral history is democratic in its desire to gather information from a variety of social actors, including the more quiescent part of the population. Also oral interviews can elicit recollections of inner feelings and states of mind that are frequently absent from or disguised by written records. Finally, the interviewing process allows the astute investigator, in effect, to cross-examine informants and thereby reveal sources of bias. Oral interviews are especially useful for consumer history because they usually entail ordinary people recalling everyday experiences. The field of consumer research has made use of interview data for decades and, if anything, has seen a resurgence of interest over the past 20 years in more or less unstructured questioning and small samples. Interviews, in the sense of deliberately collected field data, have seldom been utilized by consumer historians. One exception is Hill, Hirschman and Bauman (1997) who based their account of Depression consumers on oral data originally collected by academics, journalists and writers between 1933 and 1935 under the direction of Harry Hopkins, director of the Federal Emergency Relief Administration. First, collecting different sources, both within and across categories, is highly desirable. Words, images, artifacts and oral histories can clarify, validate and sometimes dispute each other, leading to a deeper, more nuanced view of marketing history. Multiple methods are standard procedure in ethnography and other forms of qualitative marketing and consumer research. Numerous archival collections in museums contain sources to study marketing practice and many universities have collections relevant to the study of the history of marketing thought. Archives collect unpublished primary source materials, provide for their physical preservation, arrange and describe them for prospective users and usually provide reference service on their collections. Private records and personal (unpublished) writings are the bread and butter of archival collections, although photographic images and oral histories are also not uncommon forms of archival data. The effective use of archives including the importance of various types of finding aids, types of archives and so on is described in detail by Brooks (1969). Jones (1998) describes a sample of actual archival collections that are relevant to studying the history of marketing thought. Although distant archives may pose a barrier to investigating some sources, many have been published and widely distributed. University libraries have long maintained good microfilm or microprint collections of newspapers, magazines and journals and have become better at fetching material from other libraries. All kinds of primary data, especially images, are increasingly available online from a tremendous variety of providers ranging from museums to eBay dealers. Hartmann Center for Sales, Advertising, and Marketing History at Duke University has made accessible thousands of advertisements from its growing collections. Analysis and writing the analysis of qualitative historical data involves interpretation and synthesis. Narrative, telling the story of the past, is the most common structure for presenting historical findings (Hexter, 1971; Lavin and Archdeacon, 1989). Four basic elements, character, setting, action and happening, interact to produce narrative (Megill, 1989). Character and setting are called existents, whereas actions (taken by characters) and happenings (how settings impinge upon characters) are events. Although conventional wisdom identifies narration with the recounting of events, many historians emphasize existents. Qualitative historical research in marketing 77 the sine qua non of historical writing is clarity. The dense jargon and convoluted phrasing of some social science prose, not to mention all too much critical writing in the humanities, is simply inappropriate. Some historians prefer a more dramatic and literary style than others who favor heavy documentation and elaborate presentation of empirical findings, but all must write in a straightforward and interesting to read manner. Good narrative depends upon a correct determination of historical tempo, the art of expanding and contracting the scale of time to establish the significance of events (Hexter, 1971). Sometimes, however, a paucity of evidence leaves no alternative to the impressionistic approach. Marketing history needs to cover a topic adequately, but should also strive for economy in its written presentation. Many scholars in the social and behavioral sciences, not to mention quite a few professional historians, view description as a less serious task than explanation. Explanation is deemed to be more scientific and generalizable than description of particulars. This position has been challenged, however, as evidenced by the debates between positivistic and interpretive consumer researchers (Hudson and Ozanne, 1988). Moreover, as Megill (1989) and Nevett (1991) point out, even nominally descriptive historical writing will have a large component of explanation. That is, the ordering of events chronologically implies (but does not prove) causality. Organizing the narrative the narration of marketing history can be arranged chronologically, topically, geographically, or in some combination of the three (Shafer, 1974). In argumentative or justificatory pieces the writer might limit the discussion to an analysis of sources or, in the case of Fullerton (1988) and Morris (1990), assemble and criticize evidence in order to evaluate alternative representations of the past. In historiographic essays or surveys of prior studies, narration of events is likely to be relatively less important than thematic issues. Whatever the organization, it should be synthesized through appropriate linkages, such as the comparative method, and it should be adequately balanced in its coverage (Daniels, 1981). Periodization is the process of dividing the chronological narrative into separately labeled sequential time periods with fairly distinct beginning and ending points. They summarize and structure historical narrative in a way that makes it more understandable. Other methods include context-driven periodization where the chronology is punctuated by the occurrence of some external event or events, justified when the event is likely to have precipitated a change in the direction of the material under study; and periodization by turning points 78 Handbook of qualitative research methods in marketing in the events themselves. Periodization is essentially a way of compressing a stream of complex events into a single catchword or catchphrase, and that oversimplification or reductionism must be guarded against. Narrative history that concentrates on character or setting does not require a chronological arrangement. John Demos (1970) organizes his highly regarded history of family life in the Plymouth Plantation (16201691) by subject matter. He begins with a discussion of physical setting, moves to household structure and then examines themes of individual development. Demos chose this approach not only because it seemed a better way to highlight analytical issues, but also because changes in family structure generally come very slowly and, hence, elements of stability and continuity loom unusually large. Marketing historians need to consider how closely their papers should adhere to existing models of marketing scholarship. How marketing history is packaged determines not only the likelihood of acceptance by top journals in the field, but ultimately its contribution to the advancement of marketing thought. Three topics of particular import are how to introduce the secondary literature, present the methodology and handle the issue of research implications. The literature review Unlike the typical article in marketing and consumer research, papers written by professional historians often proceed without a separate section integrating previous work on the subject into the body of the text. When included, such material is usually placed in footnotes, a hallmark of the rhetoric of history. It makes historical research seem atheoretical, which it frequently is, and consequently irrelevant to the accumulation of knowledge, which it is not. In order to be published in marketing journals, historical studies will usually need to make explicit mention of the secondary literature and sometimes provide a thorough review. This will be natural for papers taking a positivistic stance, such as theoretically driven content analyses (Belk and Pollay, 1985; Gross and Sheth, 1989), where finding loose theoretical ends precedes developing hypotheses. Essays and argumentative pieces Qualitative historical research in marketing 79 also discuss relevant literature, sometimes in great detail. Incorporating prior research will probably be most difficult for the more qualitative narrative works, especially case studies that emphasize events. Methods section Professional historians are sometimes cavalier about explaining their data sources and analytical methods. His text does not describe his sample of ads or say how they were interpreted, although his references do suggest he consulted several archival collections. Other historians are more explicit, but often relegate their methodological statements to footnotes or bibliographic essays. Data sources and their selection should be carefully described, along with the plan for their analysis. A good example of one such methods section can be found in Fullerton (1988), who first discusses the philosophical support for his historical approach, including the rationale for a cross-national investigation, and then describes his sample of primary and secondary sources. Implications of historical research Marketing journal editors and reviewers may insist that historical research either demonstrate some utilitarian purpose, such as relevance for marketing practice or public policy making, or contribute to marketing theory. Nevett (1991) provides useful guidelines on ways that historical investigation can be applied to marketing practice as a supplement to positivistic thinking. Historical research also can pay its way by formulating hypotheses and developing and appraising theories. The processes of assembling and analyzing the historical record can generate emergent themes just as readily as do ethnographic and other qualitative methods (Belk, Sherry and Wallendorf, 1988), yet historians disagree about the relationship between historical research and theory building. The commitment is to the study of individual facts, the events, institutions and personalities that have historical significance, rather than to the discovery of broad conceptual constructs.
In the majority of studies pain treatment sciatica cheap rizatriptan 10 mg without prescription, the risk of bias from not blinding trial personnel were identified as high risk or unclear pain wrist treatment purchase rizatriptan 10mg otc, while for blinding outcome assessors treatment pain ball of foot order 10 mg rizatriptan visa, the majority of articles (five studies) were unclear pain management treatment options buy rizatriptan 10mg with visa. One study was assessed as having a high risk of bias in the random sequence generation (Bodurtha et al anterior knee pain treatment generic rizatriptan 10 mg overnight delivery. Three studies were assessed as having a high risk of bias for addressing incomplete outcome data (Wang et al pain management utica new york discount rizatriptan 10mg mastercard. Reporting bias Selective reporting Low Other bias High Wu and Lin 2015 Wang et al pain management after shingles generic rizatriptan 10mg online. This review sought to provide information on the programme characteristics that could potentially inform the development of future interventions for the Maltese population advanced pain treatment center union sc purchase rizatriptan 10mg overnight delivery. Nevertheless, it is also important to consider opportunity costs, even in the Maltese health setting. Few trials reported changes in theoretical constructs and in those that did, results were inconsistent. There was also limited reporting of how constructs were operationalized as part of the intervention. Hence, this review confirms that perceived barriers are the strongest constructs in predicting mammography behaviours, compared to other model constructs. One reason for this effect of perceived barriers is that participants may have paid more attention to the barriers than to the benefits in performing screening behaviours. These reveal that following the intervention, participants were more aware of barriers that impeded them from performing the screening behaviours, and tried to resolve those barriers. When people consider that the benefits gained can outweigh barriers, then it is more likely that they perform the screening behaviour (Assari 2011). As for benefits to mammography and selfefficacy, the mean scores were significantly higher in the intervention group in Secginli and Nahcivan (2011) but appeared not to be associated with positive behaviour change in Wu and Lin (2015). Given the crossover between theoretical constructs and behaviour change techniques, the positive results in the latter may be a result of the individual behaviour change techniques employed, such as self-regulatory behaviours, rather than the theoretical constructs. These cultural features might lead women in general to over report screening uptake. Verifying attendance to mammography through medical records is a reliable way of confirming data accuracy, though retrieving such records may prove difficult, particularly if women attend private clinics. Furthermore, the use of standardised, valid and reliable tools to measure outcomes can help to produce high quality data (Chan and So 2015). However, different measures were adopted by studies in this review to measure uptake rates, health beliefs and/or knowledge, making comparison and findings interpretation among studies difficult. Caution should be utilised in the interpretation of results as tool reliability and validity are not reported, and hence the quality of data is questionable. Any one or a combination of the latter mediates behavioural change, in order to enact positive health action (Orji et al. Hence, besides using screening uptake as an indicator of intervention effectiveness, major intermediate outcomes, such as health beliefs, knowledge and screening intentions, were added in this review. By controlling these potential confounding factors during analyses, a more accurate estimate of the intervention effect on outcome measures can be achieved (Chan and So 2015). Four studies adjusted for these covariances during analysis in this review (Wu and Lin 2015; Wang et al. During sub-group analyses, older age, insurance coverage, and low acculturation were associated with greater screening intentions and uptake in the intervention group during sub-group analyses (Wu and Lin 2015; Wang et al. Culture is a powerful and multifaceted construct that influences beliefs, attitudes and behaviour (Pasick et al. Additionally, exploring these factors helps to facilitate the design of adequate strategies in terms of age, literacy and income. Second, different patterns were found in relation to intervention design and effectiveness. Among the six intervention studies with valid outcome measures, only two used multiple intervention strategies (Wang et al. Evidence was found to support multiple strategies in increasing mammography uptake among certain Asian ethnic women: reminder letter and health education booklet delivered during a home visit (among Chinese, Malay, and Indian women in Singapore) (Seow et al. It is clear that intervention effectiveness appears to vary among diverse populations, methods of program delivery, and study setting. Hence, it cannot be concluded in this systematic review whether employing a combination of multiple strategies based on theory was more or less effective than single interventions in increasing mammography uptake among populations. Similarly, no meta-analysis was carried out in this systematic review and hence, the most effective strategy could not be determined. There was also little evidence that the association between intervention and mammography uptake rates varied by source outcome (self-reports), location (urban or rural), whether control was usual care or not, whether mammography was free-of-charge or not, or by level of randomisation. In addition, five interventions were carried out in a community setting (Wu et al. However, only three community-based intervention studies revealed significant effects: (i) the culturally-targeted video (Wang et al. Evidence has shown that home visits, invitation letters, media campaigns, and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake (Lu et al. Cultural awareness training for health care professionals and outreach educators is likely to improve cancer screening uptake as it can help women overcome language and cultural barriers (Lu et al. On the other hand, cultural taboos, fatalistic views and attitudes towards cancer and screening may make it challenging to recruit women to participate in studies focused on breast or other cancer screening uptake (Ho et al. Although five studies reported statistical power to determine significance (Wu and Lin 2015; Wang et al. A meta-analysis on invitation letters and telephone calls to increase mammography undertook a cost-effectiveness analysis (Page et al. Hence, further research is required to determine which interventions are most cost-effective. Primarily, it includes studies published in the English language, omitting studies published in other languages. Further research is clearly warranted in other countries and other ethnic minority groups. Further systematic searches for articles have not been conducted since the searches carried out until 2016 due to resource constraints. The variation in research methods used in the identified studies is another limitation. Therefore, the findings are to be interpreted with caution due to the variation of tools for assessing outcomes, the varying validity of the translated instruments and the differences in random assignment. Such experiences would be useful in highlighting important issues to researchers who are planning future interventions. Examples of these issues include the benefits to be gained from participation other than behaviour modification, and the challenges to implementing interventions. Although the present 203 review is consistent with previous findings supporting the notion that theory-based interventions are somewhat effective in promoting screening uptake (Han et al. Interventions need to be described in their entirety to allow for the identification of effective components and replication. This would help to link the identified common factors and mediators influencing screening outcomes, such as demographics, knowledge, beliefs and attitudes, as well as the cognitive and emotional representations of an illness in order to guide the design, implementation and evaluation of interventions and enhance their adaptation across cultures and populations. Notwithstanding the effectiveness of multiple health behaviour models, factors such as culture are often omitted. There is need for a comprehensive model that includes such characteristics as well as other factors and mediators altogether to improve health behaviours. The following chapters present the rationale and methods for such qualitative studies. Identified experts were contacted by myself mainly through email to determine individual availabilities to schedule the meetings. This led to the choice of several ideas for practical intervention techniques derived from theory-based methods which were identified in the literature and translated into practical ideas, aided by the experience of the international experts. All experts gave written informed consent (by email) prior to participation in the steering groups and written consent on the day of the group meetings 208 (Refer to Information Sheets (Appendix 6. Both steering groups were audio-recorded and transcribed verbatim by the researcher. No compensation was provided to the experts, except for one expert who travelled from Leeds to Stirling. A summary and collation of findings was presented by myself to the experts (Table 6. There was a high level of consistency in personal and environmental factors identified through the literature and cross-sectional data. Health beliefs were the strongest significant predictors to describe the variance between lifetime attendees and non-attendees. Variable names found in different cells represent the significant variables under each construct/category. Both groups discussed whether the most important target group were attendees, non-attendees or those who attended privately. It was agreed that lifetime non-attendees were the most difficult to reach group and challenging to recruit for group discussions. Knowledge, barriers and benefits, self-efficacy, perceived social norms on screening and awareness of peer behaviour regarding mammography were selected as the most important determinants for women. Other important environmental determinants were the availability of screening and its accessibility. Socio-cultural determinants were considered not to be changeable in a short intervention, but were considered to tailor the interventions culturally. Attitude was also considered an important determinant to be incorporated in a future intervention and was added to the determinants. Healthcare providers will design and develop culturally and linguistically tailored intervention/s and related materials. Recognize that guidelines for referral to mammography are met by other providers 217 6. These included modelling (Bandura 1986), information transmission (Fernandez et al. Proposed methods included culturally congruent role models and their stories, guided practice and counseling for problem-solving and overcoming barriers, and persuasion. Hence, the logic model of change was completed by adding theory- and evidence-based change methods that were suited to influencing the determinants. Community-based interventions involving linguistically appropriate material and cultural sensitive components. Since a wide range of interventions were contained within this grouping, common elements were the focus on building, strengthening and maintaining social networks through the use of strategies such as buddy systems and discussion groups. Common elements of these interventions include: behavioural self-monitoring, prompting barrier identification and reinforcement through self-rewards. Problem-solving could occur through barrier-focused counseling (change method) delivered via a telephone call by a navigator (delivery) to cope with barriers. The use of steering committees also served to instil a framework of collaboration between experts on theory- and evidence-based development of health interventions (Wolfers et al. In the literature, the concept and responsibilities of a steering committee is neither clearly defined (Lechler and Cohen 2009) nor perceived in the context of screening programmes. The literature suggests that steering groups solely responsible for the implementation of projects do not widely exist (Lechler and Cohen 2009). Committees are often set up by senior management teams of an organization to initiate and monitor projects by providing oversight into project budget, duration, risk, number of competencies (technologies), and visibility (Lechler and Cohen 2009). The knowledge of time and resources are unavailable in the day-to-day practice of public health services (Wolfers et al. The collaboration between experts and myself was most helpful to combine the setting of specific practical objectives with theoretical insights of more general validity. Therefore, I made every effort to ensure that the discussions were consistently in accordance with the theoretical strategies and fitted within the change objective matrices. A variety of interventions were suggested by both steering groups to change behaviour by targeting knowledge, barriers, cues to action, self-efficacy and emotional representations as the key essential constructs. Although the committees were valuable to provide expert advice based on change methods and practical strategies, more research in this field is warranted in order to develop evidence-based interventions. The composition of the committees varied, consisting of Maltese experts and a broader international representation with varying contexts. This affirms the importance of improving research effectiveness through the use of steering groups. From an organizational perspective, understanding their role will help form the integrative structural elements that need to be in place to gain full value from their investment in health management processes. This chapter also served to discover gaps in knowledge, the realisation for further research with non-attendees, and identifying potential methods. It also allowed to create systematic and visual matrices, and logic models to share an understanding of the relationships among the activities required to carry out an intervention and the changes required, focusing particularly on barriers, cues to action, self-efficacy, knowledge and emotions. The next chapter presents findings gathered from the World Cafй event as a participatory method for community engagement. This method facilitates group dialogue and reflection in a relaxed and comfortable atmosphere. World Cafйs allowed for participant engagement through sharing individual and collective ideas (Sheridan et al. The World Cafй concept originated in California at the home of Juanita Brown and David Isaacs in 1995 when a morning large-circle dialogue was disrupted by rain. The method is based on the realisation that best ideas emerge from informal processes, such as coffee breaks and dinners (Sheridan et al. In World Cafйs, all participants are regarded as experts of their own lived experience and experiential knowledge. In cafй conversations, participants are allowed to set their own direction in response to the main cafй question, therefore no perspective is privileged over others. Cafйs thus build a collective network of authentic knowledge among the participant community 226 (Brown and Isaacs 2005), with the key principle being that local community knowledge is privileged as it sets the agenda (Sheridan et al. Moreover, there is no pressure to reach consensus among participants since diverse perspectives are encouraged and valued. Focus groups encourage peer-to-peer interactions by exploring areas of divergence and convergence (Hiratsuka et al. These interactions provide a setting for enabling discussion on multiple issues and exploring possible solutions (Duggleby 2005). World Cafй type focus groups have not been utilised in primary care or prevention (MacFarlane et al. The renovated centre consists of several interconnected buildings and outdoor spaces, with main exhibition halls, landscaped gardens and activity centres for visitors to experience hands-on workshops and entertaining science shows. A creative exhibition touring in the 29 countries combined research with hands-on activities to engage patients and the public through Science Espressos. Although World Cafйs tend to have at least twelve participants, no upper limit is recommended (Dickson and Tholl 2014). For example, a World Cafй event hosted 1,000 tables in several cities on a single day in Israel as part of a series of social justice protests (Hartman 2011), while sixty people attended a Cafй event in Ohio in 2005 on hunger issues (Wheatley and Frieze 2011). Event advertising was also done through Facebook promotion among community organizations and female closed groups (Figure 7. I conducted the Science Espresso on a late afternoon to accommodate participants with various work schedules. Husbands and wives were encouraged to attend the event together; this strategy helped recruitment dramatically, particularly that of men. Prior to the start of the session, all attending members of the public were provided with an information sheet (Appendix 7. Socio-demographic data were gathered prior to the start of the Science Espresso (Appendix 7. The attendees were then seated around two tables (females and males respectively) with coloured markers and large flipcharts provided to encourage participants to write, draw and capture key emerging ideas. I welcomed the participants, outlined the topic of the Cafй, together with the background and main findings of Studies 2-5 (Table 6. Since all men and women were comfortable to communicate in both languages, the discussions were conducted in English and Maltese as they 230 pleased. In the final round of the Science Espresso, participants were encouraged to synthesize key points. In conclusion, I summarised and discussed all the feedback received in a large group conversation, making the key points visible to all participants to share insights with everyone. The sample included women with a level of education that varied between secondary level (n=4) and a tertiary education level (n=6). Two women had undergone a mammogram within the past 12 months, 3 women had undergone a mammogram within the past 2-3 years, while 5 women had never experienced a mammogram. The sample included men with a level of education that varied between diploma level (n = 4) and degree level (n = 2). The discussions focused on barriers and facilitators to screening and reasons for the latter perceptions. Regarding objective 2, the discussions sought to understand what communication channels and interventions would be effective to increase mammography uptake in Malta. The findings are divided into six categories as presented during the debriefing at the end of the cafй. This was dependent on their satisfaction with mammography, the environment and support staff at the facilities. Female members who had participated in screening commented on their personal experiences of the procedure. On the contrary, some female members spoke about how they "hated it" and that mammography "felt so cold". Women discussed the need for reassurance and a step-by-step explanation of the procedure. Men discussed how women may instigate fear between themselves by exaggerating the level of mammography pain. Women and men discussed how they look for information from health providers and are eager to learn about screening information and prevention practices from their doctors.
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