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PubMedDate not supplied

Who continues using the diaphragm and who doesn't: implications for the acceptability of female-controlled HIV prevention methods.

OBJECTIVES: This study examines the acceptability of the diaphragm with the aim of facilitating the development of female-controlled human immunodeficiency virus (HIV) prevention methods. More specifically, we assess associations between being a current (vs. former) diaphragm user and characteristics that are hypothesized to influence the acceptability of contraceptive methods; and explore reasons for discontinuing use of the diaphragm among former diaphragm users. DESIGN: The study involved a cross-sectional telephone survey with women who were members of a nonprofit health maintenance organization and who were either a current (n = 215) or former (n = 172) diaphragm user. METHODS: Participants were interviewed about the importance of contraceptive attributes; perceptions for the diaphragm; diaphragm use self-efficacy; perceived risk of and motivation to avoid pregnancy, HIV, and other sexually transmitted infections; and demographic characteristics, sexual, and contraceptive behavior. RESULTS: The likelihood of being a current diaphragm user (vs. former) increased with age, greater confidence in being able to use the diaphragm, greater perceived risk of pregnancy and more positive perceptions of the diaphragm. Women who valued attributes of hormonal contraceptives were less likely to be current users. Former diaphragm users reported that the following reasons were moderately to extremely important in their decision to stop using the diaphragm: difficulty inserting or removing the diaphragm (50.8%), dislike of leaving the diaphragm inside the vagina (46.8%), and wanting a more effective method for preventing pregnancy (44.2%). CONCLUSIONS: The findings suggest that specific characteristics of a product influence continued use and have implications for improving the acceptability of existing and new female-controlled HIV prevention methods.

Adult↗

PubMed2006

Effects of frequent cannabis use on hippocampal activity during an associative memory task.

Interest is growing in the neurotoxic potential of cannabis on human brain function. We studied non-acute effects of frequent cannabis use on hippocampus-dependent associative memory, investigated with functional Magnetic Resonance Imaging (fMRI) in 20 frequent cannabis users and 20 non-users matched for age, gender and IQ. Structural changes in the (para)hippocampal region were measured using voxel-based morphometry (VBM). Cannabis users displayed lower activation than non-users in brain regions involved in associative learning, particularly in the (para)hippocampal regions and the right dorsolateral prefrontal cortex, despite normal performance. VBM-analysis of the (para)hippocampal regions revealed no differences in brain tissue composition between cannabis users and non-users. No relation was found between (para)hippocampal tissue composition and the magnitude of brain activity in the (para)hippocampal area. Therefore, lower brain activation may not signify neurocognitive impairment, but could be the expression of a non-cognitive variable related to frequent cannabis use, for example changes in cerebral perfusion or differences in vigilance.

Adult↗

PubMed2004

Linguistic sensitivity, indigenous peoples and the mental health system in Wales.

This paper presents findings from a pilot research project to explore the significance and availability of mental health services in the medium of Welsh in Wales, UK. Based on small-scale research with Welsh-speaking mental health service users this article argues that being bilingual can be a significant factor in the complex biopsychosocial matrix that underpins mental health problems amongst Welsh speakers. It also argues that the destructive effects of linguistic oppression, and the difficulties of second language communication for mental health service users, are such that an appropriate health and social care response in Wales involves providing services in a user's preferred language. Service users' views about the current state of bilingual service provision in Wales are presented, which suggests that insufficient attention is being paid to the linguistic needs of Welsh speakers. Eight principles are proposed for mental health service policy and practice in Wales.

Communication Barriers↗

PubMed2001

Mortality of opiate users in Vienna, Austria.

The purpose of this study was to investigate whether there are differences in overall and cause-specific mortality rates of opiate users in maintenance treatment and of opiate users not in any drug treatment program in Vienna, Austria. A cohort of opiate-users enrolled in maintenance treatment in Vienna and a cohort of individuals involved in opiate-related emergencies from 1995 to 1997 were retrospectively analyzed. The standardized mortality rate of opiate-users enrolled in maintenance treatment was 12.1 and that of individuals involved in opiate-related emergencies was 48.8. Excess mortality was found for all categories for both groups. In the face of the extremely high excess mortality of opiate users involved in opiate-related emergencies, measures have to be taken to get these individuals in drug treatment programs as soon as possible.

Adolescent↗

PubMed2001

Principles in practice: reflections on a 'postpositivist' approach to evaluation research.

User participation is currently seen as an ethically appropriate way to proceed when researching disadvantaged groups and it is encouraged by funding agencies. However, the literature rarely discusses the methodological and practical implications for researchers attempting to incorporate user participation into evaluation studies which are informed from an epistemologically opposed (positivist) research paradigm. The paper explores this issue by drawing on the evaluation of a community-based smoking intervention to describe and reflect upon the recruitment, training and employment of local residents as survey interviewers. While the evaluation methodology adopts a quasi-experimental approach, the appointment of local residents as survey interviewers reflects an alternative (interpretive) research tradition. The combined strategy constitutes a postpositivist methodology in that it combines a data collection strategy more akin to interpretive social science while retaining a positivistic epistemological framework. The paper describes some logistics of this approach and problems encountered during the course of survey. While many of the problems described may be routinely associated (although seldom aired) with survey work, particularly in disadvantaged areas, the paper suggests they are also a function of the postpositivist research strategy which we adopted. The failure to involve interviewers in the conception and development of the evaluation meant that they lacked identification with our endeavour and this had practical implications for the survey interviewing. Although the survey was successfully executed and the employment of local residents was a valuable and worthwhile experience, the authors recognize that this narrow conception of user involvement meant that many of the potential benefits (both to the research and the participants) associated with participatory approaches were forfeited.

Community Participation↗

PubMed2001

Potential benefits of restrictions on the transport of teenage passengers by 16 and 17 year old drivers.

OBJECTIVES: The presence of passengers is associated with fatal motor vehicle crashes of teenage drivers. A restriction against newly licensed teenage drivers carrying passengers has been included in some, but not all, graduated licensing systems. The purpose of this study was to predict the net effects on all types of road users, including vehicle occupants and non-occupants, of possible prohibitions against 16-17 year old drivers carrying passengers. METHODS: Two national datasets, a census of fatal crashes and a sample of trips in the United States, were used to compute 1995 road user death rates. Potential effects of restrictions on drivers ages 16-17 carrying passengers younger than 20 were estimated, based on road user death rates and potential choices made by passengers who would have traveled with 16-17 year old drivers if there were no restrictions. RESULTS: There were 1,181 road user deaths in 1995 involving drivers ages 16-17 whose passengers were all younger than age 20. The predicted number of lives in the United States that would be saved annually ranges from 83 to 493 (corresponding to reductions of 7-42% in road user deaths) for drivers ages 16 and 17 combined. Similar percentages of reductions (8-44%) were predicted solely for 16 year old drivers. Assuming passenger restrictions would apply to all 16 year old drivers and at least one third of 17 year old drivers, an estimated 60-344 fewer deaths per year may occur if restrictions are mandated. CONCLUSIONS: Restrictions on carrying passengers younger than 20 should be considered for inclusion in graduated licensing systems. Even if fewer than half the drivers obey the restrictions, a substantial reduction in road user deaths would be expected. Further evaluation based on real world experience is needed to confirm their efficacy.

Accidents, Traffic↗

PubMed2003

A clinically rooted approach to Knowledge Management in a large Italian community hospital.

A strategy for Knowledge Management (KM) implementation in a large hospital involved three areas: intranet/internet technologies for professional practice standardization and communication; multiprofessional group building for sharing and discovering of social perspectives; learning opportunities targeted to high quality information sources and information mastering methods. A cooperative prototyping approach assured high levels of user's acceptance and involvement, and initial results are encouraging, but measuring and sustaining clinical practice changes will require additional efforts.

Computer Communication Networks↗

PubMed1998

Simulating hospital patient flows.

This case study development has benefited by the use of clear on-screen logic which has facilitated useful discussions between the analyst and end-users. The screen displays enable a realistic depiction of a system to be developed. A simple first model was gradually made more realistic in a step-by-step process involving both analyst and end-users. The investigation is continuing and the model is being further refined. Data collection is underway, and system data will be used to provide the model's input parameters of arrival and service rates. Times and lengths of queues of patients and total time in the system will be compared with their model equivalents. The resulting model is likely to be acceptable to the end-users because of their involvement in its development. This involvement has been facilitated by a simulation environment which enables on-screen iconic representations of system components to be created by analyst and end-user together.

Ambulatory Care Facilities↗

PubMed1991

Organizing as a new approach to AIDS risk reduction for intravenous drug users.

This paper looks at an innovative approach to AIDS risk reduction among intravenous drug users who are not in treatment. The new method utilizes an organizing model that involves the mobilization of drug users to promote risk reduction. This strategy targets the group as well as the individual for change. Standard outreach techniques have had some success in achieving HIV risk reduction, particularly for behavior that reduces risk through altering drug use behavior, but still leaves many users at risk. Intravenous drug users in the Netherlands and gays in the United States have organized around HIV-related issues with some success. Preliminary evidence from New York City suggests that organizing drug users may be an effective approach for achieving significant HIV risk reduction for individual users as well as those they associate with.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Drug information management through the intranet of a hospital center].

OBJECTIVE: This paper describes the methodology used for the implementation and validation of a network resource incorporated to the intranet of the Hospital, in order to retain and disseminate information from the Drug Information Center (DIC) of a pharmacy service in a hospital center. METHOD: A working group designed the structure, contents, memory needs, priority of access for users and a quality assessment questionnaire. RESULTS: The resource developed by the working group had a capacity of 70 Gb and its structure was based on HTML documents, including files with different format and 12 theme areas. Two levels of priority of access were established depending on the user and two persons were in charge of the resource. The questionnaire was delivered after three months of use. Sixty nine per cent of the users regarded the resource as very useful and 31%, as useful. The final structure, according to the results of the survey, had 11 theme areas. CONCLUSIONS: The use of the hospital Intranet in order to include and organize DIC information can be very simple and economic. Furthermore, the involvement of all the users in its design and structure can facilitate the practical use of this tool and improve its quality.

Computer Communication Networks↗

PubMed2005

'Working the system'. Achieving change through partnership working: an evaluation of cancer partnership groups.

AIMS AND OBJECTIVES: To investigate the characteristics and achievements of cancer partnership groups--collaborative service improvement groups formed of NHS staff and service users--in the 34 cancer networks in England, and in particular to explore the influence that such groups had on local cancer services. DESIGN: A qualitative approach employing a structured telephone survey, face-to-face interviews and documentary analysis. PARTICIPANTS AND SETTING: Thirty cancer networks in England with an active Partnership Group completed the telephone survey. From these 30 networks, six networks were subsequently selected from which service users and NHS professionals involved in partnership groups and NHS professionals who were non-members were recruited to take part in face-to-face interviews. RESULTS AND CONCLUSIONS: Partnership groups were established in the majority of cancer networks. Typically, these groups were at network level, been established for less than a year, met once every 2 months, and were populated with both service users and health-care professionals. Five common activities and achievements were identified: establishment of the group itself; acting as a 'reference' group for consultation; networking and representation on other groups; patient information and communication and proactive influencing. Activities progressed in scale and complexity as groups evolved. Groups had learnt the basics of change management and some identified a more sophisticated understanding of change processes in the NHS as essential for the group's motivation and survival. When gauging the impact of involvement strategies it would seem important to subscribe to broad indicators of success that include both process and outcome measures.

Cancer Care Facilities↗

PubMed2003

Skin diseases associated with the cosmetic use of bleaching products in women from Dakar, Senegal.

BACKGROUND: The cosmetic use of bleaching products is considered a common practice in dark-skinned women from sub-Saharan Africa. However, there are few studies on this subject. OBJECTIVES: To increase the knowledge about the dermatological consequences of this practice in Dakar, the capital of Senegal. METHODS: A representative sample of 368 adult women presenting at our dermatological centre was selected. Each woman was questioned about her cosmetic use of bleaching products. Next, the following data were recorded in 425 women who used bleaching products: names and types of products used; modalities of the skin bleaching practice; skin diseases motivating the dermatological visit, with recording of their clinical features; and results of a full skin examination. The active substances of the bleaching products were determined mainly by reading the indications on their packages; with products of unknown composition, a pharmacological analysis of samples was done. A statistical analysis was performed. RESULTS: Of the 368 women questioned, 194 (52.7%) were current users of bleaching products. Concerning the 425 users enrolled, products were applied on the whole body in 92% of users, with a median duration of use of 4 years. The active principles used included hydroquinone (used by 89% of users), glucocorticoids (70%), mercury iodide (10%) and caustic agents (17%); 13% of users used products of unknown composition. In the samples that were analysed, hydroquinone was found at concentrations of between 4% and 8.7%. Concerning steroids, superpotent (class 1) glucocorticoids predominated. The main skin complaints in bleaching products users included dermatophyte infections (n = 105) and scabies (n = 69), both often unusually extensive and severe; acne (n = 42), often severe; eczema (n = 41); irritant dermatitis (n = 14); and dyschromia (n = 26, including 14 cases of exogenous ochronosis). The skin examination noted features apparently disregarded by users: striae (noticed in 39% of users), and macular hyperchromia involving the face, mainly the periocular area (33%). The statistical analysis showed that glucocorticoid use was associated with the presence and severity of infectious skin diseases, and of acne. CONCLUSIONS: More than half of the adult women presenting at our dermatology centre were using bleaching products. Most skin diseases observed in bleaching products users appeared to be induced, aggravated or modified by this practice. Superpotent topical glucocorticoids appeared to be the main agents responsible for the observed complications. The cosmetic use of bleaching products therefore has a major impact on our current dermatological practice.

Acne Vulgaris↗

PubMed1982

Prognostic features of endometrial cancer in estrogen users and obese women.

In a case-control study to evaluate risk factors for endometrial cancer in Italy, use of noncontraceptive estrogens was associated with a moderately increased risk, whereas obesity appeared to be the most important single risk factor related to cancer of the endometrium. This report considers the estrogen and obesity-related relative risks with regard to various prognostic features of tumors (clinical stage, histologic grade, extent of myometrial invasion, lymph node involvement). In both estrogen users and obese women, the increase in relative risk was greater for earlier than for more advanced tumors. These findings, therefore, provide further support for a specific role of both exogenous and endogenous estrogens in endometrial cancer.

Adult↗

PubMed1991

The impact of HIV upon injecting drug users: a longitudinal study.

This paper provides quantitative and qualitative material relating to concern about HIV infection and AIDS, HIV status and patterns of drug use, and sexual behaviour amongst 14 injecting drug users. It is part of a longitudinal study involving interviews with 115 regular illicit drug users conducted between December 1987 and June 1988, of whom 21 were current injectors. Follow-up interviews with 14 of these injectors were conducted between September 1989 and April 1990. Whilst there are some encouraging signs of behaviour change in relation to needle-sharing, sexual behaviour change was less apparent. It is concluded that there is still a long way to go in terms of encouraging, facilitating and supporting continued safer practices.

Adult↗

PubMed1987

Estimating fatality reductions from increased safety belt use.

Fatality reductions from increases in safety belt use are estimated taking into account that drivers who change from being nonusers to being users have lower accident involvement rates than the remaining nonusers, a process referred to as "selective recruitment." Analytical functions are derived which express expected fatality reductions in terms of changes in safety belt use rates from an initial rate. The function parameters are determined by requiring that computed average crash rates for nonusers be 53% higher than the rates for users, a recently determined empirical value. These functions show that, depending on the initial use rate and use rate increase, selective recruitment may increase or decrease expected fatality reductions. However, effects are relatively small, in no case exceeding +/- 5.3%.

Accidents, Traffic↗

PubMed2006

GeneLibrarian: an effective gene-information summarization and visualization system.

BACKGROUND: Abundant information about gene products is stored in online searchable databases such as annotation or literature. To efficiently obtain and digest such information, there is a pressing need for automated information-summarization and functional-similarity clustering of genes. RESULTS: We have developed a novel method for semantic measurement of annotation and integrated it with a biomedical literature summarization system to establish a platform, GeneLibrarian, to provide users well-organized information about any specific group of genes (e.g. one cluster of genes from a microarray chip) they might be interested in. The GeneLibrarian generates a summarized viewgraph of candidate genes for a user based on his/her preference and delivers the desired background information effectively to the user. The summarization technique involves optimizing the text mining algorithm and Gene Ontology-based clustering method to enable the discovery of gene relations. CONCLUSION: GeneLibrarian is a Java-based web application that automates the process of retrieving critical information from the literature and expanding the number of potential genes for further analysis. This study concentrates on providing well organized information to users and we believe that will be useful in their researches. GeneLibrarian is available on http://gen.csie.ncku.edu.tw/GeneLibrarian/.

Algorithms↗

PubMedDate not supplied

MECHGEN: computer aided generation and reduction of reaction mechanisms.

The paper describes selection rules implemented in a software generating "possible reaction mechanism", i.e. a set of elementary reactions chosen from all stoichiometrically possible reactions. The novelty of the approach lies in the fact that the user has to define all species involved (reactants, intermediates, products), and the rules applied with user-set limits reduce the resulting mechanism to a reasonable set of possible elementary reactions. The computer code consists of five parts: (i) definition of species, and introducing its characteristics (structure and thermodynamic data); (ii) definition of the reacting system and generation of all stoichiometrically possible reactions; (iii) reduction of the mechanisms using complexity and thermodynamic constraints based on user-set limits; (iv) calculation of the resulting pathways (routes of the various atoms or groups of atoms transferred from one species to another); and (v) tools to help visualization of the process by finding those elementary processes which realize a given pathway. Reasonable flexibility is ensured for using selection rules based on various criteria with limits set by the user. The various pathways are shown (in a matrix form), which offers an overview of the entire process.

Journal Article↗

PubMed2002

The changing clinical aspects of infective endocarditis: descriptive review of 90 episodes in a French teaching hospital and risk factors for death.

OBJECTIVE: We wanted to describe the epidemiological aspects of infective endocarditis (IE) in a French hospital and identify the prognostic factors. METHODS: We reviewed the clinical, echocardiographic and microbiological features, and the outcome of 89 patients (90 episodes, median age 60 years) with IE over 18 months. Logistic regression analysis was used to identify prognostic factors for death. RESULTS: A native valve was involved in 68 cases (75.5%); in 7 of these the patient was an intravenous drug user. A prosthetic valve was involved in 22 cases (24.5%); 5 of these were of early onset. Diagnosis was definite in 87% of cases. Median time to diagnosis was 3 days. Twenty-five patients (28%) were immunocompromised. A portal of entry, usually cutaneous, was identified in 65% of cases. Sixty-two percent of patients had an underlying heart disorder, usually degenerative. The infection involved the left heart in more than 75% of cases. One or more vegetations were detected in 75% of cases. The median size of vegetation was 15 mm. Isolated agents were mainly staphylococci (n=40 (44%), including 12 coagulase-negative isolates), and streptococci (n=23 (25%), including 7 enterococci). In 11 cases (12%), cultures remained negative. Nineteen episodes were nosocomial and Staphylococcus aureus was implicated in 11 of them. Fifty percent of patients had at least one complication: heart failure (n=42), kidney failure (n=44), embolism (n=35), septic shock (n=19). Surgery was performed in 49 cases (54%) due to heart failure (n=19), cerebral embolism (n=12), and/or severe valve lesions (n=27). Eighteen patients died, 10 of whom were infected with S. aureus. Nosocomial IE (P=0.0008), heart failure (P=0.004) and prosthetic valve (P=0.01), but not S. aureus were independently associated with death. CONCLUSIONS: S. aureus was the main microorganism isolated in our patients. However, it was not independently predictive of fatal outcome.

Adult↗