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PubMed1997

The strategic approach to contraceptive introduction.

The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.

Africa↗

PubMed2026

Female genital mutilation knowledge, attitudes and training needs among health professionals in non-practicing countries: A literature review.

BACKGROUND: With increasing globalization and migration, the number of women affected by female genital mutilation who reside in countries where the practice is not traditionally performed is constantly increasing. Healthcare providers in these settings are required to address the complex health needs of this vulnerable population. We aimed to synthesize recent literature on their knowledge, preparedness, and educational background. METHODS: We conducted a systematic review across PubMed, Scopus and Embase, identifying papers published from January 2015 onwards, examining providers' knowledge, education and attitudes toward female genital mutilation in non-practicing countries. Both quantitative and qualitative observational studies were eligible. Given heterogeneity in study populations, outcome definitions, and assessment tools, findings were synthesized narratively. The review protocol was registered with the International Prospective Register of Systematic Reviews (CRD420251044761). FINDINGS: 1046 records were screened by title and abstract, and 140 full-text articles were assessed for eligibility. 31 studies met the inclusion criteria (23 quantitative, 8 qualitative). Many providers reported clinical experience with women affected by female genital mutilation, yet substantial variability was observed in knowledge, training, and attitudes. Gaps were particularly evident regarding legislation, World Health Organization classification, clinical guidelines, referral pathways, workplace protocols. Midwives and younger professionals tended to demonstrate higher knowledge levels. Training exposure ranged from 5% to 91%, and many participants perceived it as insufficient. Qualitative findings echoed these patterns, highlighting challenges in female genital mutilation classification, legal awareness, documentation systems, the impact of providers' cultural beliefs on care delivery. CONCLUSION: Considerable efforts are needed to equip healthcare providers to deliver high-quality, culturally competent care to women affected by female genital mutilation. Research should develop validated tools to assess preparedness, adopt mixed-methods strategies to capture patient and provider perspectives, and guide standardized, up-to-date training programs, strengthening knowledge in managing female genital mutilation.

Humans↗

PubMed2026

BMT4me En Español: Multisite Feasibility and Usability Testing of a Spanish-Language mHealth Adherence Support App for Spanish-Speaking Caregivers of Children After Hematopoietic Stem Cell Transplantation and Cancer Treatment.

BACKGROUND: Medication nonadherence during the first 100 days after pediatric hematopoietic stem cell transplantation (HSCT) and during oncology treatment increases risk for complications. BMT4me is a caregiver-facing mobile health (mHealth) application providing medication reminders, symptom tracking, and note-taking features to support medication management. Spanish-speaking caregivers are frequently excluded from digital adherence interventions due to the lack of language-accessible tools. PROCEDURE: We conducted a multisite, mixed-methods usability testing of a Spanish-language version of BMT4me ("BMT4me en Español") with Spanish-speaking caregivers of children (ages 2-17 years) post-HSCT or with an oncology diagnosis on active treatment. Caregivers completed a facilitated, three-step usability session (unobtrusive observation, interactive observation, and debriefing), followed by a semi-structured interview, and then completed the system usability scale (SUS). Quantitative outcomes were summarized descriptively; qualitative data were analyzed using content analysis with constant comparison. RESULTS: Fifteen participants enrolled at each site for a total of 30 participants. Across both sites, the recruitment rate was 91%. All participants completed all parts of the study. The SUS score (M = 80.09; SD = 17.35) was above average (>68). Two key qualitative themes emerged: (1) the perceived positive impact of BMT4me on managing a serious illness and (2) the acceptance and sociocultural relevance of BMT4me for Spanish-speaking families. Caregivers also shared suggestions to add educational content and multiuser functionalities to BMT4me. CONCLUSIONS: The acceptance and perceived positive impact of the Spanish BMT4me app indicates that socioculturally relevant, Spanish mHealth interventions have strong potential to support Spanish-speaking caregivers in pediatric oncology and HSCT settings. CLINICAL TRIALS NCT: NCT06361173.

Adolescent↗

PubMed1995

The prevalence and incidence of systemic lupus erythematosus in Birmingham, England. Relationship to ethnicity and country of birth.

OBJECTIVE: To establish the point prevalence of systemic lupus erythematosus (SLE) on January 1, 1992, and the incidence of SLE during 1991, in Birmingham, England, a large city with a broad ethnic mix. METHODS: Six sources were used to ascertain patients with diagnosed SLE, including notification by attending and primary care physicians, the lupus patient support group, and hospital inpatient and laboratory data. RESULTS: There were 242 SLE patients (227 females, 15 males) identified: prevalence rate 27.7/100,000 (95% confidence interval 24.2-31.2/100,000) in the population and 206.0/100,000 in Afro-Caribbean females. No significant differences in female ethnic prevalence rates by place of birth were observed. Thirty-three patients developed SLE in 1991: incidence rate 3.8/100,000/year (95% confidence interval 2.5-5.1/100,000/year). CONCLUSION: This study illustrates dramatic differences in incidence and prevalence rates in the UK, depending on ethnic group and irrespective of place of birth.

Adolescent↗

PubMed1989

The potential risk of thrombosis during coronary angiography using nonionic contrast media.

The influence of contrast media on coagulation has an important association with thromboembolic complication during coronary angiography. In this study, whole blood was methodically mixed with nonionic contrast medium, Iohexol (IOH), conventional ionic contrast medium, Hypaque-76 (H76), and low osmolar ionic dimer Hexabrix (HB) in vitro. The thrombotic propensity of contrast agents can be evaluated by measuring the clot formation of the mixtures. The experiments were repeated with whole blood after systemic heparinization. In the in vitro study, 5 ml of canine (N = 10) and 3 ml of human (N = 11) whole blood was incubated for 30 min in glass tubes with equal volumes of IOH, H76, HB, and 0.9% NaCl before heparinization. Clot formation with IOH and 0.9% NaCl were seen both in dogs (4.0 +/- 0.7 gm and 5.6 +/- 0.8 gm) and in patients (1.4 +/- 0.9 gm and 2.9 +/- 1.3 gm), whereas no clot was seen with H76 or XB. Following heparinization, no clot was visualized in any mixture of whole blood with contrast media or 0.9% NaCl. Similar results were observed in the catheter-syringe system with canine blood (N = 11) mixed with the contrast agents. Blood clots found in 15 min and 30 min of IOH were 0.07 +/- 0.08 gm and 0.44 +/- 0.20 gm (P less than 0.01) and of NaCl were 0.29 +/- 0.37 gm and 0.69 +/- 0.38 gm (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗

PubMed2004

5-fluorouracil-induced oligodendrocyte death and inhibitory effect of cycloheximide, Trolox, and Z-VAD-FMK in murine cortical culture.

BACKGROUND: 5-fluorouracil (5-FU) is a widely used anticancer drug. One of the adverse effects of this drug is selective cerebral white matter injury, but to the authors' knowledge its mechanism has not been well documented. The current study was performed to investigate the mechanism of cerebral white matter injury caused by 5-FU and to develop the intervention to attenuate its injury in vitro. METHODS: Mixed oligodendrocyte/astrocyte cells were dissociated from specimens taken from approximately 2-day-old postnatal mouse cortex and cultured for 3-4 weeks. The culture cells were exposed to 5-FU, cycloheximide, emetine, Z-VAD-fmk, 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(F)-quinoxaline (NBQX), Trolox, and epigallocatechin gallate. Oligodendrocyte cell death was assessed by counting the number of viable galactocerebroside-positive cells per x 100 field. RESULTS: Mixed oligodendrocyte/astrocyte culture cells that were exposed to 5-FU (at doses of 10 microM, 30 microM, and 100 microM) for 24 hours ensued concentration-dependent oligodendrocyte death. The majority of oligodendrocytes, but few astrocytes, were injured by 100 microM 5-FU. Trolox, a vitamin E analog antioxidant, as well as cycloheximide (a protein synthesis inhibitor) and Z-VAD-fmk (a caspase inhibitor), significantly attenuated the 5-FU-induced oligodendrocyte death. However, NBQX, an alpha-amino-2,3-dihydro-5-methyl-3-oxo-4-isoxazolepropionic acid (AMPA) receptor antagonist, did not appear to effect the 5-FU-induced oligodendrocyte death. CONCLUSIONS: The findings of the current study suggested that 5-FU led to oligodendrocyte death rather than astrocyte death by way of the apoptotic process, whereas antioxidants may prevent the 5-FU-induced oligodendrocyte cell death in vitro.

Amino Acid Chloromethyl Ketones↗

PubMed2003

If the price is right: vagueness and values clarification in contingent valuation.

The use of willingness to pay to value the benefits of health care is increasing. Much of this work assumes that health preferences are well formed or 'complete' and readily revealed if the right question is asked in the right way. We examined this assumption, seeking evidence in a mixed-methods study that explored the meaning and implications of vague responses to a payment-scale based willingness to pay exercise.One-half of the sample said that their vagueness meant that their maximum willingness to pay was actually greater than the amount that they had previously said it was. Thirty percent agreed that they would probably pay pound 10 more than a sum that they had previously said they would most definitely not pay, if they found this to be the cost of the vaccine. Interview data supported the view that the payment scale had failed to elicit the maximum willingness to pay and that some participants used the information on cost to help clarify their values, in contrast to the theory underpinning willingness to pay. The results suggest a need to consider values-clarification in health economic evaluations.

Attitude to Health↗

PubMedDate not supplied

The experience of parenting an adolescent with spina bifida.

Parents of adolescents with spina bifida (SB) face unique challenges of which they may not be aware. The purpose of this study was to heighten awareness of the challenge of parenting such adolescents. This enhanced understanding can help rehabilitation professionals optimize their interventions with families. In this qualitative study, which was part of a larger mixed-method descriptive investigation exploring adaptation by adolescents with SB, we used content analysis to evaluate 20 parent interviews for common domain, themes, and subthemes. The analysis yielded four major domains: (a) daily life experiences, (b) the dance of individuation, (c) reflections on parenting, and (d) practice suggestions for healthcare professionals. Overall, experiences of the parents were positive. Parents described meeting daily demands and balancing independence-dependence needs with the adolescent as major challenges. Rehabilitation professionals must provide guidance to foster autonomy, decision making, cognitive skill building, and coping skills to help parents and adolescents manage independence-dependence issues and multiple life demands.

Adaptation, Psychological↗

PubMed2006

Advanced nanocomposite materials for orthopaedic applications. I. A long-term in vitro wear study of zirconia-toughened alumina.

The use of ceramic-on-ceramic (alumina- and zirconia-based) couplings in hip joint prostheses has been reported to produce lower wear rates than other combinations (i.e., metal-on-polyethylene and ceramic-on-polyethylene). The addition of zirconia into an alumina matrix (zirconia-toughened alumina, ZTA) has been reported to result in an enhancement of flexural strength, fracture toughness, and fatigue resistance. The development of new processing routes in nonaqueous media has allowed to obtain high-density ZTA nanocomposites with a very homogeneous microstructure and a significantly smaller and narrower particle-size distribution of zirconia than conventional powder mixing methods. The aim of the present study was to set up and validate a new ZTA nanocomposite by testing its biocompatibility and wear behavior in a hip-joint simulator in comparison with commercial alumina and experimental alumina specimens. The primary osteoblast proliferation onto ZTA nanocomposite samples was found to be not significantly different from that onto commercial alumina samples. After 7 million cycles, no significant differences were observed between the wear behaviors of the three sets of cups. In this light, it can be affirmed that ZTA nanocomposite materials can offer the option of improving the lifetime and reliability of ceramic joint prostheses.

Aluminum Oxide↗

PubMed2006

Ethnography's role in assisting mental health research and clinical practice.

In this article, the author discusses the utility of qualitative approaches in mental health research and clinical practice. He highlights the value of conceptualizing research designs and procedures that include relevant cultural information about study participants. Emphasis is placed on African American women participants, consumers, and others who are understudied, underrepresented, and underserved in large-scale studies and treatment. Limitations and strengths are noted. Contributions of qualitative methodology are described, particularly the functions of ethnography and grounded theory in conceptualization, hypotheses building, and hypotheses testing of outcome data on African American women and culturally diverse groups. Clinical researchers are encouraged to utilize qualitative and mixed methods approaches to bolster outcomes and better inform their clinical practice.

Black or African American↗

PubMed2003

A classification of pregnancy losses after invasive prenatal diagnostic procedures: an approach to allow comparison of units with a different case mix.

OBJECTIVE: Pregnancy loss rates after prenatal invasive procedures such as amniocentesis (Amnio), chorionic villous sampling (CVS) and fetal blood sampling (FBS) vary with an underlying indication for the procedure and due to different background risk of miscarriage. Loss rates need to be quantified and available for counselling. We developed a classification of pregnancy losses that will help in calculating procedure-related pregnancy loss rates and allow comparison between units with a different case mix. METHODS: The procedure-related pregnancy loss rate was obtained by subtracting the losses in pregnancies with known lethal conditions and those occurring more than two weeks after the procedure from total pregnancy losses. RESULTS: Out of 436 CVSs, there were 18 losses. Of these, 14 had a known lethal condition and 3 occurred after 2 weeks of CVS. In only one case, there was no known lethal abnormality and the loss occurred within 2 weeks. Thus, the total pregnancy loss rate was 4.1% and the procedure-related loss rate was 0.23% (95% CI; 0.0061-1.28). The procedure-related loss rates for Amnio 0.7% (95% CI; 0.2-1.8) and FBS 1.19 (95% CI; 0.14-4.23) were calculated in a similar way. CONCLUSIONS: We present a method of recording pregnancy loss after prenatal invasive procedures, which would be useful for benchmarking comparison between units and pre-procedural counselling.

Abortion, Spontaneous↗

PubMed2005

Follow-up in breast cancer clinics: reassuring for patients rather than detecting recurrence.

Despite evidence that questions the value of routine hospital follow-up after treatment for breast cancer, there is little evidence to indicate what actually takes place during follow-up consultations and whether patients benefit from the experience. This study aimed to investigate the nature and content of hospital follow-up visits following treatment for breast cancer using a mixed methods approach. Methods included direct observation and audio-recording of 104 consultations, semi-structured interviews with 14 health care professionals (HCP) involved in follow-up service provision and a patient survey. Consultations were focused on detection of recurrent disease by clinical examination, despite this being a rare event. HCPs' style of interaction could foster the illusion that follow-up visits were intended to detect recurrence. Consultations were generally of brief duration (mean 6 min) and were overwhelmingly optimistic, although patients gained reassurance from minimal interaction. Few opportunities were available to meet information and psychosocial needs. The costly system of follow-up currently in operation is historically rather than evidence based, and subject to increasing demands and limited resources. Alternative approaches are needed that address the diversity of patients' needs rather than searching for recurrent disease. However, when formulating policy and evaluating new approaches, patients' expectations of what constitutes follow-up care need to be clearly addressed.

Adult↗

PubMed2006

Perceptions of changes in weight among African American breast cancer survivors.

BACKGROUND: Although African American breast cancer survivors are most likely to gain weight following diagnosis and treatment compared to women from other ethnic groups, limited information is available on psychological and behavioral reactions to weight change in this population. OBJECTIVES: To explore perceptions and reactions to weight change in African American breast cancer survivors. METHODOLOGY: A parallel mixed methods approach was used to explore experiences with and reactions to weight change following breast cancer diagnosis and treatment. Participants were 16 short- and long-term African American breast cancer survivors. RESULTS: Nine out of 16 participants gained weight following diagnosis and treatment and most participants were concerned about these changes. Most participants were also interested in diet and exercise programs; however, a holistic and common sense approach to diet and physical activity emerged as key themes. CONCLUSIONS: Although prior reports have found that African American women in the general population report a greater tolerance for larger body sizes, most participants in this study were concerned about changes in their weight and were actively trying to minimize weight gain. Several themes emerged regarding physical activity and dietary behaviors; overall, participants described a holistic and practical approach to these behaviors.

Adult↗

PubMedDate not supplied

Binary synthesis of multicomponent peptide mixtures by the portioning-mixing technique.

By introducing a new operation (non-coupling), our portioning-mixing method has become suitable for preparing binary peptide libraries. We demonstrate that all the expected components of a simple library are present in the mixture. The number of components in such libraries, the molar ratio of peptides as well as the possibilities of screening are discussed.

Amino Acid Sequence↗

PubMed2001

High-resolution analysis of a 144-membered pyrazole library from combinatorial solid phase synthesis by using electrospray ionisation Fourier transform ion cyclotron resonance mass spectrometry.

A compound library consisting of 144 pyrazole carboxylic acids and six sublibraries consisting of 24 components was analysed using electrospray ionisation Fourier transform ion cyclotron resonance mass spectrometry (ESI-FTICR-MS). The library was synthesised by the split-mix method and investigated by direct infusion analysis by which 134 compounds were detected. FTICR-MS is predestined for the direct characterisation of complex compound libraries because of its outstanding mass resolution and mass accuracy. However, discrimination within the electrospray ionisation process sometimes leads to signal suppression and thus to misinterpretation of the synthetic results. Using micro-HPLC/MS we were able to assign all 144 compounds including all pairs of isobaric pyrazoles. We also show that, due to partial separation, FTICR-MS is indispensable for proper detection of co-eluting compounds.

Chromatography, High Pressure Liquid↗

PubMed2000

Adolescent and Maternal Perspectives of Quality of Life and Neuropsychological Status Following Epilepsy Surgery.

A convenience sample of 13 adolescents who had undergone epilepsy surgery and their mothers reported their perceptions of change in areas affecting quality of life (physical, affect/behavior, social, cognition/academics, and family). A mixed method approach was used, with self-report and maternal-report narratives (qualitative measures), as well as neuropsychological profiles (quantitative measures). The results demonstrate that change after epilepsy surgery is multifaceted, and that adolescent and maternal perceptions are notably different. Whereas most adolescents experienced positive changes, mothers simultaneously reported many more negative changes along with positive changes. Furthermore, mothers frequently described aspects of their adolescent's life that continued to be of concern, whereas adolescents did not. The findings strongly suggest that the processes involved in postsurgical adjustment are complex. The development of a theoretical model is essential to help build an understanding of factors that contribute to positive and negative outcomes.

Journal Article↗

PubMed1996

The performance of SAPS II in a cohort of patients admitted to 99 Italian ICUs: results from GiViTI. Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva.

OBJECTIVE: To assess the validity of SAPS II (new Simplified Acute Physiology Score) in a cohort of patients admitted to a large sample of Italian intensive care units (ICU). DESIGN AND SETTING: The ability of the SAPS II scoring system to predict the probability of hospital mortality was assessed with calibration and discrimination measures obtained using published coefficients. A new logistic regression equation was then developed and further formal calibration and discrimination measures were estimated for the customized model. PATIENTS: From the 2202 consecutive patients recruited during a 1-month period in 99 ICUs, a total of 1393 patients were included in this validation study. RESULTS: When the parameters based on the standard model were applied, the expected probability of mortality did not fit those actually observed in the cohort (p < 0.001), although it showed satisfactory discrimination (area under the receiver operating characteristic curve = 0.80). Such lack of fit yields an overall under prediction of mortality (observed/expected ratio = 1.14) that reflects a uniform pattern across a preselected set of subgroups. Customization allowed new mortality estimates to be calculated, with satisfactory calibration (p = 0.82) and a more uniform pattern across subgroups. CONCLUSIONS: SAPS II maintained its validity in an independent sample of patients recruited in a large network of Italian ICUs only after appropriate adaptation (first-level customization). Whether the determinants of this relatively poor performance are related to differences in unmeasured case-mix, methods of application, or quality of care delivered is a matter for discussion that cannot be solved with the data presently available. However, these findings suggest that caution is warranted before implementing the standard SAPS II scoring system parameters outside formal research projects.

APACHE↗

PubMed1994

Relationship between severity, costs and claims of hospitalized patients using the Severity of Illness Index.

The results of the prospective application of Horn's 'Severity of Illness Index' in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.

Adolescent↗