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PubMed1980

An influence of binaural hearing aids on positioning of sound images.

An influence of binaural hearing aids on positioning of sound images produced by signals from two loudspeakers was investigated with normally hearing and hearing-impaired subjects. The image can be positioned along a horizontal line connecting the centers of the sources by adjusting the relative sound pressure levels of signals. When the listener is a symmetrical receiver, the image appears on the midline (0 degrees azimuth) for equal levels or away from the midline for unequal levels. Any asymmetry of the receiver causes a shift of the image away from the midline. In the study, the level differences, delta Ls, necessary to position sound images at 0 and +/- 12 degrees azimuths were measured. The baseline data were collected for 10 normally hearing subjects in unaided and aided conditions. In the aided conditions binaural aids were balanced (equal gains) or unbalanced (10 dB disparity in gains). The normally hearing subjects positioned the image on the midline with a group mean delta L of 0 dB in both unaided and balanced aided conditions. To position the image at +12 or -12 degrees azimuth they needed mean delta Ls that could be predicted from a theoretical equation. With unbalanced aids, a group mean delta L of +3 or -3 dB was needed for the midline image. The delta Ls for the side images also were shifted. For 12 hearing-impaired subjects with bilateral lossses, the midline delta Ls in unaided condition were within the normal range (+/- 2 dB). For two monaural hearing aid users with long experience, the midline delta Ls were greater than normal. The delta Ls for the side images were equal to or greatr than delta Ls for normally hearing subjects. In aided balanced and/or unbalanced conditions, some hearing-impaired subjects needed delta Ls for the midline image outside the normal range, and some could not position the image at the side azimuths. It was concluded that the binaural hearing aids can be a source of receiver asymmetry.

Adult↗
PubMed1994

Associations between condom experiences and beliefs, intentions, and use in a sample of urban, low-income, African-American and Hispanic youth.

This paper discusses negative experiences with using condoms reported by the condom user subsample of (n = 975) of a household probability sample of low income, urban, African-American and Hispanic youth. Condom users were asked about 12 specific experiences with condoms. Although the pattern of the association varied with the particular belief and experience, it appeared that, overall, having had a negative experience increased the likelihood that the user would agree with a negative belief about condoms (p < or = .005). In addition, users who had experienced a condom making it hard to move in and out of the vagina or anus were less likely both to intend to use a condom and to have used a condom at last intercourse (p < or = .005). Condom use was also less likely if the user had experienced condoms interrupting love-making or reducing feeling or sensation.

Adolescent↗
PubMed1994

The fitting, acceptance, and processing of standard curve data in automated immunoassay systems, as exemplified by the Serono SR1 analyzer.

Methodologies for establishing standard curves on automated immunoassay systems are dependent on the computational capability of the instrument, its throughput, and, perhaps, the technical experience of the user. Here, factors constraining this approach are discussed in general and the procedures used for the Serono SR1 analyzer are considered in detail. The SR1 is a moderate-throughput, fully automated immunoassay system capable of performing tests for (currently) 18 analytes. The associated user-generated standard curves are utilized not only for interpolation of results but also for evaluation of system performance. The choices of curve-fitting method, weighting of data, acceptance criteria, and outlier rejection are taken out of the hands of the user and are made a vital and integral part of the system. I justify this approach and demonstrate how a sensible mathematical approach must be tailored to the configuration of the instrument.

Autoanalysis↗
PubMed1993

Estrogen replacement therapy and endometrial cancer risk: unresolved issues. The Endometrial Cancer Collaborative Group.

OBJECTIVE: To clarify several unresolved issues regarding the relationship of estrogens to endometrial cancer risk. METHODS: We conducted a hospital-based case-control study involving 300 menopausal women newly diagnosed with epithelial endometrial cancer and 207 population controls matched to the cases for age, race, and residence. RESULTS: Estrogen use significantly increased endometrial cancer risk (adjusted relative risk [RR] 3.0, 95% confidence interval [CI] 1.7-5.1). Although both short- and long-term use appeared to elevate the risk of early-stage tumors, an effect of estrogens on late-stage tumors was observed only for long-term use (RR 2.1, 95% CI 0.7-6.4). A small proportion of women reported having used progestogens simultaneously with estrogens, which was associated with a lower risk (RR 1.8) than use of estrogens alone (RR 3.4). Although the highest risks were for recent users of estrogens, persistent excess risks were seen even for those who had discontinued use of 5 or more years. There were no striking relationships according to the type of estrogen or regimen used, and associations with dose were inconsistent, although women who used low-dose preparations exclusively had the lowest risk. Estrogen injections or creams, used by only 5.9 and 5.1% of the subjects, respectively, were not significant risk factors after adjustment for estrogen pill use. Women who were thin or who smoked cigarettes appeared to be most adversely affected by estrogen use. Estrogen users failed to experience the protective effect normally associated with oral contraceptive use. CONCLUSION: The effect of estrogens on endometrial cancer risk appears to vary both by usage patterns and by patient characteristics.

Case-Control Studies↗
PubMed1996

Patient satisfaction with a levonorgestrel-releasing contraceptive implant. Reasons for and patterns of removal.

OBJECTIVE: To investigate the experience of the users of a levonorgestrel-releasing contraceptive implant (Nor-plant) and reasons for early removal. STUDY DESIGN: Two hundred fifty-one women who had Norplant placed through the Ohio State University Department of Obstetrics and Gynecology were sent a questionnaire that included general demographic questions and questions regarding preplacement education; reasons for choosing Norplant; problems experienced due to Norplant; reasons for removal, if applicable; and overall satisfaction. RESULTS: One hundred eleven questionnaires (44%) were completed and analyzed. Twenty-four (21.6%) of patients had Norplant removed, 32 (28.8%) planned on early removal, and 55 (49.5%) desired continued use. Ninety-eight percent of women who planned continued use of Norplant had received reading material as part of their preplacement counseling and 95% felt adequately counseled. This is significantly higher than women who had Norplant removed or planned on early removal. Convenience, problems with other contraceptive methods and effectiveness were the most important reasons why patients chose Norplant. Menstrual changes were the most common side effect, experienced by 80% of all women in the study. Weight gain, headache, mood changes, mastalgia and acne were also frequently reported. Women who had Norplant removed were significantly more likely to have experienced dizziness when compared to women desiring continued use. Women planning early removal were also more likely to have experienced dizziness in addition to acne, headache, hair loss and other side effects. Menstrual irregularities, followed by mood changes and headaches, were the most important side effects associated with early Norplant removal. Overall, 68% of users were at least somewhat satisfied with Norplant. CONCLUSION: Norplant contraception was a satisfactory form of birth control for the majority of patients in the study despite the frequent occurrence of side effects. Reading material regarding benefits and side effects of Norplant is an important aspect of patient counseling and may improve long-term use of Norplant.

Adolescent↗
PubMed1998

[Measuring bone density with ultrasound--ready for general practice?].

Osteoporosis is characterized by low bone mass, loss of bone structure and/or typical fractures (vertebrae, radius, hip). The costs for the treatment of hip fractures in Germany are about 1 billion DM per year, the mortality rate after hip fractures is between 10 and 30% within the first year. Low bone mass is an important risk factor for the development of fractures; so far however, no procedure for the measurement of bone density has been able to 100 percent differentiate between patients with established osteoporosis and healthy people of the same age. This is due to the fact that the defect in bone structure causing the disease could not be measured so far. Quantitative ultrasonometry (QUS) is a new, non-invasive, radiation-free method for the in vivo measurement of bone density and bone structure. Measurements at the calcaneus and at the phalanxes have shown the equivalence of QUS compared to radiological methods in prospective studies with regard to the prediction of hip fractures. Furthermore it was shown that the beneficial osseous effects of postmenopausal estrogen/gestagen replacement therapy can be detected by QUS. Since QUS is considerably cheaper and the devices are easily transportable, this method is a valuable supplement in the range of diagnostic tools in osteology. Its clinical value however depends on the experience of the user and it should be applied in patients only together with medical history, physical examination and perhaps additional imaging procedures. It was not the inadequate methodology that has brought osteodensitometric methods into discredit but the undifferentiated handling by inexperienced users.

Bone Density↗
PubMed2005

Touch a screen or turn a knob: choosing the best device for the job.

Input devices enable users to interact with systems. In two experiments, we assessed whether and how task demands and user age influenced task performance for a direct input device (touch screen) and an indirect input device (rotary encoder). In Experiment 1, 40 younger (18-28 years) and 40 middle-aged to older adults (51-65 years) performed tasks using controls such as sliders, up/down buttons, list boxes, and text boxes while using a system. The optimal input device to facilitate performance was dependent on the task being performed and the age of the user. In Experiment 2, touch screen use was assessed for 20 younger (19-23 years) and 20 older adults (51-70 years). Task demands were manipulated through button size, movement distance, direction, and type of movement. Performance was moderated by the age of the user and by task demands. Actual or potential applications of this research include guidance for the optimal selection of input devices for different user populations and task characteristics.

Adolescent↗
PubMed2006

Positive outcomes of participatory ergonomics in terms of greater comfort and higher productivity.

UNLABELLED: Ergonomics sometimes has a negative connotation, as it is seen to be connected to illness or guidelines that limit innovations. This paper is focused on the positive aspects of ergonomics in improvement of the working environment. It consists of a part that studies the literature on success factors in the process towards higher productivity and greater comfort, the formulation of a model and a hypothesis, which is illustrated by four cases. The model distinguishes the success factors in 'goal', 'involvement' and 'process'. GOALS: evidence is found in the literature that a positive approach has benefits in terms of shareholder value and productivity, and for comfort. Involvement: the literature shows that participation of end-users and management contributes to success. PROCESS: in the process it is essential to have a good inventory of the problems, a structured approach, a steering group responsible for the guidance, and end-users involvement in testing of ideas and prototypes. It is hypothesized that the chance of success increases by empowerment (making the end-user responsible for deciding on the next step in the process) and positive experiences of end-users with the potential improvement (end-users feel or see the benefits). The four cases illustrate that the hypothesis can be used in evaluating cases.

Community Participation↗
PubMed1996

Initial independent results with the Clarion cochlear implant.

OBJECTIVE: This paper reports some preliminary findings from patients, implanted at the University of Iowa, using the Advanced Bionics Clarion cochlear implant (version 1.0). We compared the performance of patients using both simultaneous analog and nonsimultaneous pulsatile processing strategies. The performance of Clarion patients was also compared with a group of patients who were using either the feature-extraction Nucleus cochlear implant or the compressed-analog Ineraid cochlear implant. DESIGN: One aim was to compare the analog and pulsatile stimulation in 19 patients using the Clarion implant. This aim could be accomplished only partially because of difficulties encountered in adequately fitting patients with the analog strategy. A second aim was to compare the Clarion users' performance with feature-extraction Nucleus and compressed-analog Ineraid patients. Comparisons were made with all patients having 9 mo experience postimplantation. RESULTS: Subjects performed better using the pulsatile mode compared with the analog mode. All subjects chose to use the pulsatile strategy after the first 3 mo of the study. Results comparing performance at 9 mo with our compressed-analog Ineraid and feature-extraction Nucleus patients indicated, in general, better average performance for the Clarion users. CONCLUSIONS: We conclude that the pulsatile version of the Clarion cochlear implant typically produces superior performance to the analog version of that device at this stage in its development. After 9 mo of experience, users of the Clarion implant are performing better than are users of the feature-extraction Nucleus and compressed-analog Ineraid cochlear implants with comparable amounts of experience.

Adult↗
PubMed1976

An analysis of the subjective marijuana experience.

Two hundred and thirty-six marijuana users who volunteered for a study in which they would use the drug were administered a Drug History and a Marihuana Effects Questionnaires. In addition to obtaining descriptive information of drug experiment volunteers and a factor analysis of the marijuana experience, the relationship between experience and effect variables were studied. The results of the above analysis suggest that the "typical" subject in marijuana experiments is not a "typical" user, that the marijuana experience is verbally definable, and that prior expectancies and histories of effect alter the experience.

Adolescent↗
PubMed1991

Barrier versus oral contraceptive use: a study of female college students.

Although they provide birth control and are easier to use, oral contraceptives (OCPs) are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowledge, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their first year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p less than .03) and greater perceived vulnerability to STDs (p less than .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy.

Adolescent↗
PubMed2006

A comparative study of mortality among Puerto Rican injection drug users in East Harlem, New York, and Bayamon, Puerto Rico.

Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY-HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR-HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.

Adult↗
PubMed1991

Mood changes during the menstrual cycle and their relation to the use of oral contraceptive.

The relation between the use of oral contraceptives and changes in positive and negative affect over the course of the menstrual cycle was studied in 50 women who completed a mood questionnaire daily during their menstrual cycle. Results indicated that users of oral contraceptives experience a higher level of positive affect during the cycle than do non-users. Positive affect scores were significantly higher than negative affect scores in the menstruation, follicular and luteal phases of the cycle. There were no significant differences between the groups and no discernible phasic changes on negative affect. Discussion of these findings centers on their implications concerning the relation between positive affect and oral contraceptives, the support they provide for the independence of positive and negative affect, and future directions for research in this area.

Adolescent↗
PubMed2004

Mortality risk among new onset injection drug users.

AIMS: To characterize mortality experience among those who only recently started injection. DESIGN: Prospective study. SETTING: Independent study clinic within high drug use neighborhoods. PARTICIPANTS: In 1988-1989, we enrolled 256 adult injection drug users (IDUs) recruited through street outreach who had initiated injection within the prior 2 years. MEASUREMENTS: Consenting participants underwent venipuncture for HIV antibody testing and interviews. We prospectively ascertained date and cause of death through follow-up contact and registry linkages. Analyses included standardized mortality ratios (SMRs) with local, state and national mortality data, adjusted for age, gender and race. FINDINGS: Baseline median age was 30 years, 70% were male, 95% were African-American and 90% injected within the prior 6 months. We identified 69 deaths through October 2000; mortality rate was 3.3/100 person-years. The adjusted SMR with the USA (and Baltimore) as the reference for IDUs was 4.40 (2.43) for 1991-1992, which increased to 8.12 (4.13) by 1993-1994, decreased to 4.43 (2.13) by 1997-1998 and increased slightly to 5.35 (2.79) during 1999-2000. Excluding HIV-related mortality, SMRs remained elevated. Decline in SMRs was not linked to drug abuse treatment. CONCLUSIONS: These data demonstrate excess mortality among new-onset IDUs compared with demographically similar peers in the general population, indicating the need for interventions to prevent premature death among young IDUs.

Adult↗
PubMed2004

Service users, metaphors and teamworking in mental health.

Despite the United Kingdom's recent governmental mental health policy directives aimed at strengthening professional collaboration and increasing service user involvement, the prevailing mental health care culture remains steeped in a discourse of treatment and care, control and compliance and professional expertise. Drawing upon the data collected during the two phases of a 2-year national evaluation undertaken for the English National Board for Nursing, Midwifery and Health Visiting, the perceptions of a group of mental health service users in relation to their experiences and contact with the multi-professional team are explored. A series of metaphorical descriptions were developed with these service users drawn from their experience. These begin to illuminate a realistic way of thinking about how teams are set up, how and why they carry out their various roles, and the need to think in non-professional terms about the relationships that are developed with service users. A hierarchy of power was noted that was congruent with the outcomes of other studies. However, there was also a concurrent acknowledgement of the 'usefulness'(to the individual service user) of each of the professional group members. This appeared to have been constructed alongside the power hierarchy and serves to illustrate how individual service users sought to find an accommodation within the social system they were placed in. This paper argues however, that the use of metaphors, as a form of shared communication, can be an effective first step in working towards this objective. Working in the way described here can allow for a greater shared understanding of what each group is experiencing and help ensure that future service development reflects a broader view of the mental health care world.

Attitude to Health↗
PubMed2006

Recruiting injection drug users: a three-site comparison of results and experiences with respondent-driven and targeted sampling procedures.

Several recent studies have utilized respondent-driven sampling (RDS) methods to survey hidden populations such as commercial sex-workers, men who have sex with men (MSM) and injection drug users (IDU). Few studies, however, have provided a direct comparison between RDS and other more traditional sampling methods such as venue-based, targeted or time/space sampling. The current study sampled injection drug users in three U.S. cities using RDS and targeted sampling (TS) methods and compared their effectiveness in terms of recruitment efficiency, logistics, and sample demographics. Both methods performed satisfactorily. The targeted method required more staff time per-recruited respondent and had a lower proportion of screened respondents who were eligible than RDS, while RDS respondents were offered higher incentives for participation.

Adolescent↗