Ethical problems in clinical trials concerning minimal residual tumors.
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Clinical Trials as Topic↗
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Ethical problems in clinical trials concerning minimal residual tumors.
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Clinical Trials as Topic↗
Nonnegligible increasing temporal trends in unprotected anal intercourse among men who have sexual relations with other men in montreal.
OBJECTIVE: To determine temporal trends in unprotected anal intercourse (UAI) among men who have sex with men (MSM) participating in the Omega Cohort Study, 1997 through 2003. METHODS: The Omega Cohort Study was a longitudinal study of HIV-negative MSM aged 16 years or older and living in Montreal. Participants completed self-administered questionnaires and interviews every 6 months. Trend analysis using the generalized estimating equation was done for length of cohort membership (visits) and by calendar time for all visits per type of sexual partner. Odds ratios (ORs) were calculated to measure the odds of increasing UAI per 6-month period. RESULTS: Among subjects who were followed for at least 4 years, UAI increased with regular seroconcordant partners (OR = 1.06, 95% confidence interval [CI]: 1.04 to 1.09) and any type of partner (OR = 1.05, 95% CI: 1.03 to 1.07). There was a nonnegligible increase in UAI with casual partners (OR = 1.05, 95% CI: 1.01 to 1.09). For the analysis by calendar time, there were increases in UAI between regular seroconcordant partners (OR = 1.04, 95% CI: 1.02 to 1.05) and any type of partner (OR = 1.03, 95% CI: 1.02 to 1.04). There were nonnegligible increases in UAI with casual partners (OR = 1.03, 95% CI: 1.00 to 1.05) and with any type of partner except a regular seroconcordant partner from 15.7% to 18.8% (OR = 1.02, 95% CI: 1.00 to 1.04). CONCLUSIONS: There was a nonnegligible and consistent increase in UAI among Omega Cohort Study participants between 1997 and 2003. Continuous trend analysis is important because it allows us to follow UAI closely and to implement intervention strategies that may help to stop or reduce the present trend.
Adolescent↗
Nonnegligible increasing temporal trends in unprotected anal intercourse among men who have sexual relations with other men in Montreal.
OBJECTIVE: The objective of this study is to determine temporal trends in unprotected anal intercourse (UAI) among men who have sex with other men (MSM) participating in the Omega Cohort Study, 1997-2003. METHODS: The Omega Cohort Study was a longitudinal study of HIV-negative MSM aged 16 years or older and living in Montreal. Participants completed self-administered questionnaires and interviews every 6 months. Trend analysis using the generalized estimating equation was done for length of cohort membership (visits) and by calendar time for all visits, per type of sexual partner. Odds ratios (ORs) were calculated to measure the odds of increasing UAI per 6-month period. RESULTS: Among subjects who were followed for at least 4 years, UAI increased with regular seroconcordant partners (OR, 1.06, 95% CI 1.04-1.09), and any type of partner (OR, 1.05, 95% CI 1.03- 1.07). There was a nonnegligible increase in UAI with casual partners (OR, 1.05; 95% CI, 1.01-1.09). For the analysis by calendar time, there were increases in UAI between with regular seroconcordant partners (OR, 1.04; 95% CI, 1.02-1.05) and any type of partner (OR, 1.03; 95% CI, 1.02-1.04). There were nonnegligible increases in UAI with casual partners (OR, 1.03; 95% CI, 1.00-1.05) and with any type of partner except regular seroconcordant partner from 15.7% to 18.8% (OR, 1.02; 95% CI, 1.00-1.04). CONCLUSIONS: There was a nonnegligible and consistent increase in UAI among Omega participants, between 1997 and 2003. Continuous trend analysis is important because it allows us to closely follow UAI and to implement intervention strategies that may help to stop or reduce the present trend.
Adolescent↗
Antiplatelet therapy: a neurology perspective.
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Aspirin↗
Antiplatelet therapy: a neurology perspective.
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Aspirin↗
[Problems in improving information supply in the public health administration].
F. G. Grigoriev (Soviet Public Health, 1989, No. 2, p. 31-36) raised an issue of the necessity to considerably reduce the amount of annual statistical reporting of curative and preventive institutions. The preparation and drawing up of such a report in its present form require an unjustified lot of time and means. But it is advisable to broaden this task and to solve it as a problem of optimizing the information supply of public health management with allowance made for its present state and prospects of development for the nearest 8-10 years. The problem could be solved by rationally reducing the number of insufficiently informative and duplicating forms of reporting, sections (tables) of annual statistical reports and by a wider introduction of paperless informatics system.
Annual Reports as Topic↗
Identifying marginal housing for people with a mental illness living in rural and regional areas.
OBJECTIVE: Homelessness among people with a mental illness is a serious issue. The purpose of the present study was to identify the types of housing available for people with a mental illness in the region, to develop an audit tool to assess the housing of patients of the mental health service, and to pilot this audit tool. METHODS: Key informants were interviewed to obtain information about the type of housing options available in the Loddon Campaspe Southern Mallee Region, Victoria, Australia. This information was used to develop a survey to audit the housing status of existing patients of the area mental health service. A pilot study using the survey was completed by case managers for 81 patients who were being case managed by the area mental health service. RESULTS: There was a wide variety of housing options in the region but housing availability was not evenly distributed. Although most patients lived in owned or rented accommodation, a substantial proportion of patients had difficulties with accessing the required services, the affordability of their housing, uncertainty of tenure or were at risk of violence within their housing. CONCLUSIONS: A substantial proportion of patients treated by a rural area mental health service had lived in impoverished housing.
Case Management↗
Identifying marginal housing for people with a mental illness living in rural and regional areas.
OBJECTIVE: Homelessness among people with a mental illness is a serious issue. Objective: The study aimed to identify the types of housing available for people with a mental illness in the region; to develop an audit tool to assess the housing of patients of the mental health service; and to pilot this audit tool. METHOD: Key informants were interviewed to obtain information about the type of housing options available in the Loddon Campaspe Southern Mallee Region. This information was used to develop a survey to audit the housing status of existing patients of the area mental health service. A pilot study using the survey was completed by case managers for 81 patients who were being case managed by the area mental health service. RESULTS: There were a wide variety of housing options in the region, but housing availability was not evenly distributed. Although most patients lived in owned or rented accommodation, a substantial proportion of patients had difficulties with accessing the required services, the affordability of their housing, uncertainty of tenure or were at risk of violence within their housing. CONCLUSIONS: A substantial proportion of patients treated by a rural area mental health service had lived in impoverished housing.
Case Management↗
Evaluation of the effectiveness of a clean delivery kit intervention in preventing cord infection and puerperal sepsis among neonates and their mothers in rural Mwanza Region, Tanzania.
A study was carried out in Misungwi and Kwimba Districts, Tanzania to determine the effectiveness of clean delivery kits in preventing cord infection and puerperal sepsis and to provide qualitative information on community acceptability, correct use, and appropriateness of the kits. This study involved pregnant women aged 18-45 years old. In the delivery kit intervention population, the Maternal and Child Health Aide (MCHA) assigned to the health facility provided pregnant mothers with a clean delivery kit on their first antenatal visit. She explained how to use each of the kit components, with the aid of pictorial instructions included in the kit. The pregnant mothers were asked to convey the information to whoever assisted them during delivery. The MCHA also gave them health education based on the principles of the "six cleans" recognized by WHO (i.e., clean hands, clean perineum, clean delivery surface, clean cord cutting and tying instruments, clean cutting surface). Women received the clean delivery kit free of charge in accordance with the randomised stepped-wedge design schedule. During the first week following delivery, the Village Health Workers (VHWs) from both the intervention and control groups made two visits to the households of mothers who had delivered. They administered questionnaire about delivery to mother and birth attendant. During the two scheduled postpartum visits, those who were suspected to have puerperal sepsis or cord infection of the baby were referred to the health facility clinician for confirmation. Results indicated that use of clean delivery kit had a positive effect on reducing both cord infection and puerperal sepsis. The use of a clean home delivery kit coupled with an educational intervention about the "six cleans" had a significant effect on reducing the incidence of cord infection and puerperal sepsis among women enrolled in the study. In low resource settings where home birth is common and clean delivery supplies are scarce, disposable kits can be made available through health clinics, markets, pharmacies or other channels to help reduce rates of infection.
Adolescent↗
Role of the journal editor in sustaining integrity in research.
Editors have important but indirect roles in sustaining integrity in research, and they have major and highly visible roles in maintaining the integrity of science literature. They must publish the policies and the standards to which they will hold authors and reviewers, and then must enforce those policies. Editors cannot be responsible for the accuracy of what they publish, but they must respond thoroughly and consistently to allegations of misconduct concerning papers under consideration or already published. They must conduct appropriate inquiries and notify authors' or reviewers' institutions about possible misconduct found by those inquiries. Further, to maintain the integrity of the literature, editors must publish corrections, retractions, and notices of duplicate publication according to the standards set down by the National Library of Medicine.
Biomedical Research↗
A ladder curriculum in clinical microbiology.
A continuum of four microbiology courses for medical technology majors has been developed by the Medical Laboratory Science Program at Northeastern University. Using a system approach to curriculum design, the academic and clinical faculty identified career-entry capabilities, delineated appropriate subject content, and developed an instructional system which placed individual topics into one of four courses in the ladder curriculum: a basic, second-year, university-based clinical microbiology course stressing microbial technique and common organism identification; third-year microbiology and cellular physiology courses developing theoretical aspects; a fourth-year, hospital-based clinical microbiology rotation emphasizing isolation and identification techniques for significant pathogens; and a fourth-year, university-based, didactic course covering host defense-organism virulence interactions, infectious disease principles, and new techniques and unusual isolates as reported in the recent journal literature. Based on four years of experience with this system and in light of the publication of the 1978 American Society for Medical Technology (ASMT) Competency Statements, the Northeastern Medical Laboratory Science Program faculty is currently reexamining the continuum to insure completeness and appropriateness of overall subject content, to provide reinforcement, and to remove unnecessary duplication among the courses in the curriculum.
Certification↗
The science and politics of medicines control.
Drug development and regulation are often presented as purely matters of technical science. In this paper it is argued that, in principle, toxicology, clinical pharmacology and pharmacovigilance in drug testing and regulation are necessarily a combination of science and politics. This has important implications for how one attempts to make progress in drug regulation, such as in interpreting technical evidence and in the setting of regulatory standards with which evidence should be evaluated. In practice, drug testing and regulation are shown to be hybrids of science and politics. Moreover, drawing on existing empirical evidence, it is suggested that this mixture currently, and for some time, has had the wrong ingredients for optimal drug safety and public health outcomes. For example, too often the balance of the scientific doubts about drug safety are weighed to the interests of manufacturers rather than to those of patients and public health, while some scientific standards with which drug safety is to be interpreted are being reshaped in ways that give insufficient priority to the protection of public health. Finally, it is proposed that: drug regulation should include comparative efficacy testing; regulatory agencies should conduct some key tests, charging the costs to industry and without duplication; and the regulatory system should be less secretive and more accountable to public scrutiny. Greater efforts should be made to eliminate experts' conflicts of interest within the regulatory process.
Animals↗
Effect of low-dose latrunculin B on anterior segment physiologic features in the monkey eye.
OBJECTIVES: To determine if low doses of topical latrunculin B (LAT-B) will increase outflow facility and decrease intraocular pressure without damaging the cornea and if they will inhibit miotic and accommodative responses to pilocarpine in monkeys. METHODS: We measured intraocular pressure (Goldmann tonometry) before and after 1 and 9 doses of 0.005% and 0.01% topical LAT-B and vehicle given twice daily on successive weeks; outflow facility (perfusion) following 15 doses; central corneal thickness (ultrasonic pachymetry) before and after 1 and 9 doses of 0.01% LAT-B and vehicle; pupillary diameter (calipers); and accommodation (refractometry) before and after 1 dose of 0.005% and 0.02% LAT-B. RESULTS: Latrunculin-B dose-dependently decreased intraocular pressure, multiple doses more than a single dose. Maximal mean +/- SEM hypotension after 1 dose was 2.5 +/- 0.3 mm Hg (0.005% LAT-B; n = 8; P<.001) or 2.7 +/- 0.6 mm Hg (0.01% LAT-B; n = 8; P<.005); maximal mean +/- SEM hypotension after 9 doses was 3.2 +/- 0.5 mm Hg (0.005% LAT-B; n = 8; P<.001) or 4.4 +/- 0.6 mm Hg (0.01% LAT-B; n = 8; P<.001). Outflow facility was increased by mean +/- SEM 75% +/- 13% (n = 7; P<.005). Central corneal thickness was not changed after 1 or 9 doses of 0.01% LAT-B. Miotic and accommodative responses to intramuscular pilocarpine were dose-dependently inhibited. With 0.02% LAT-B, inhibition of miosis was substantial, whereas the inhibition of accommodation was only about 25%. With 0.005% LAT-B, the effects were trivial. CONCLUSIONS: In ocular normotensive monkeys, 0.005% and 0.01% LAT-B administered topically increases outflow facility and/or decreases intraocular pressure without corneal effects. Multiple doses reduce intraocular pressure more than a single dose. Latrunculin-B dose-dependently relaxes the iris sphincter and ciliary muscle, with some separation of miotic and accommodative effects. Clinical Relevance Multiple treatments with low topical doses of LAT-B may substantially reduce outflow resistance in eyes with glaucoma without adversely affecting the cornea.
Accommodation, Ocular↗
Establishing the European Research Area in Ageing: a network of national research programmes.
The following paper gives a summary of the European Commission's research policy with regard to the ERA-NET scheme and especially with regard to the ERA-AGE project that was launched in March 2004. All the partner institutions in the ERA-AGE project are main national funding agencies, research councils or ministries. Some selected examples of programme funding by the partner institutions may demonstrate their different ways of funding research and show the great variety of programmes. The long-term objective of the ERA-AGE project is to create a sustainable basis for the planning, implementation and exploitation of transnational research. In future, the European Research Area in Ageing could gain an added value from research investments by integrating existing funding mechanisms and research infrastructures, by commonly deciding on research priorities for funding activities in order to reduce fragmentation and duplication, and by the recruitment of young researchers.
Aged↗
The highly effective use of topical zinc pyrithione in the treatment of psoriasis: a case report.
Psoriasis is a common condition which, at times, can be difficult to treat. Patients with psoriasis face many social challenges and can suffer a great deal with their disease. As a result, any new topical agent is a welcomed addition to our therapeutic armamentarium. We present here a report of a case using a novel topical preparation of zinc pyrithione for the treatment of psoriasis. Topical zinc pyrithione appears to be a safe and effective treatment for psoriasis.
Adult↗
Community genetic services in Latin America and regional network of medical genetics. Recommendations of a World Health Organization consultation.
The World Health Organization sponsored a Consultation on Community Genetic Services and a Regional Network of Medical Genetics in Latin America in Porto Alegre, Brazil, on June 19, 2003. The main recommendations of the meeting included: (a) the call for government funding of services, research and education in medical genetics; (b) the conduct of epidemiological research on the prevalence and types of birth defects, genetic disorders and genetic predispositions to common diseases; (c) the education of health professionals in genetics; (d) the education of genetic professionals in community health and public health genetics; (e) the fostering of interactions between clinical geneticists, public health personnel, primary health care workers and community organizations, and (f) a better planning of regionalized services to avoid duplication and inefficiency.
Community Networks↗
Effects of latrunculin B on outflow facility, intraocular pressure, corneal thickness, and miotic and accommodative responses to pilocarpine in monkeys.
PURPOSE: To determine if low doses of topical latrunculin B (LAT-B) will increase outflow facility and decrease intraocular pressure (IOP) without adversely affecting the cornea, and inhibit miotic and accommodative responses to pilocarpine, in ocular normotensive monkeys. METHODS: Intraocular pressure was measured by Goldmann tonometry before and after one and nine dose(s) of 0.005% and 0.01% topical LAT-B/vehicle given twice daily on successive weeks. Outflow facility was then measured by perfusion following 15 doses. Central corneal thickness was measured by ultrasonic pachymetry before and after one and nine dose(s) of 0.01% LAT-B/vehicle. Pupillary diameter (calipers) and accommodation (refractometry) before and after one dose of 0.005% and 0.02% LAT-B were determined. RESULTS: LAT-B dose-dependently decreased IOP, multiple doses more than a single dose. Maximal hypotension after one dose was 2.5 +/- 0.3 mm Hg (0.005% LAT-B; n = 8; P < .001) or 2.7 +/- 0.6 mm Hg (0.01% LAT-B; n = 8; P < .005); maximal hypotension after nine doses was 3.2 +/- 0.5 mm Hg (0.005% LAT-B; n = 8; P < .001) or 4.4 +/- 0.6 mm Hg (0.01% LAT-B; n = 8; P < .001). Outflow facility was increased by 75 +/- 13% (n = 7; P < .005). Central corneal thickness was not changed after one or nine dose(s) of 0.01% LAT-B. The miotic and accommodative responses to intramuscular pilocarpine were dose-dependently inhibited. At 0.02% LAT-B, the inhibition of miosis was essentially complete when compared with the pre-LAT-B value, whereas the inhibition of accommodation was only about 25%. At 0.005% LAT-B, the effects were trivial. CONCLUSIONS: In ocular normotensive monkeys, 0.005/0.01% LAT-B administered topically increases outflow facility and/or decreases IOP, but does not affect the cornea. Multiple doses reduce IOP more than a single dose. LAT-B dose-dependently relaxes the iris sphincter and ciliary muscle, with some separation of the miotic and accommodative effects.
Accommodation, Ocular↗