SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
This study examines the effect of pretreatment role involvements and therapeutic environment on the level of in-treatment client perfromance in a sample of 704 nonopiate users. Within the sample, treatment type is found to have minimal predictive utility for success on selected measures of performance.
The development of a telemedicine system should not only take advantage of technological advances but also pay close attention to users and the human issues involved. In this paper we examine the utility of heuristic evaluation in improving the usability of a digital emergency medical services (EMS) system equipped on an ambulance. The digital EMS system used advanced communication technologies to help remotely located trauma specialists gain access to patient data in real-time and direct life-saving measures in a timely fashion. To improve its usability, three experts inspected prototypes of the system according to 14 software usability heuristics. The analyses revealed information on the prevalence, severity, and nature of heuristic violations in the user interface design. The results were subsequently utilized to guide the iterative software design process. A comparison between two consecutive prototypes showed that the second design had only half as many usability violations as the first prototype and had considerable improvement in a number of usability heuristic categories. The validity of heuristic evaluation was examined in an ethnographic study of paramedics using a prototype of the system in their work environment. Users' task performances partially verified heuristic evaluation results. However, they also revealed problems that were not identified in heuristic evaluation but only became prominent during field observation. In conclusion, we argue that usability should be given high priority in the development of a telemedicine system, and that heuristic evaluation can be an effective and efficient way to identify usability problems in the early stage of software development.
The frequency of senior center attendance was studied using the 1984 Supplement on Aging of the National Health Interview Survey. Unlike previous research, which focused on whether people ever attend a senior center, this study estimates a multinomial logistic regression model to distinguish between persons who rarely, sometimes, and frequently attend. There is evidence that the more frequent users are older, which may indicate difficulty in recruiting new active members. Greater frequency is associated with lower income and lower education but is unrelated to functional disability. The most frequent users are persons who are more socially involved. Finally, those who live in rural areas are more likely to be only occasional users, which may reflect a lack of accessibility or less frequent program availability in those areas.
A selected ion monitoring method for determination of the tobacco alkaloids anabasine, anatabine, nornicotine, metanicotine, dihydrometanicotine, and 2,3'-bipyridyl in urine of smokers and smokeless tobacco users is described. The method involves conversion of the secondary amine alkaloids to tertiary amine derivatives by reductive alkylation using an aldehyde and sodium borohydride, and chromatography on a 5% phenylmethylsilicone capillary column. These derivatives have good chromatographic properties, allowing determination of concentrations as low as 1 ng/ml. The alkaloid 2,3'-bipyridyl is unaffected by the derivatization procedure and may be determined simultaneously with the other alkaloids. The structural analogues 2-(3-pyridyl)hexahydroazepine, 5-methyldihydrometanicotine, and 6-methyl-2,3'-bipyridyl were synthesized for use as internal standards. Using the method, concentrations and 24 h excretion of anabasine, anatabine, and nornicotine in urine of twenty-two smokers, eight chewing tobacco users, and six oral snuff users were determined and compared with concentrations and excretion of nicotine and its metabolite cotinine. Excretion of nicotine and cotinine was similar in all tobacco users, but excretion of anabasine, anatabine and nornicotine was substantially greater in urine of smokeless tobacco users, presumably due to absence of pyrolysis of these alkaloids in smokeless tobacco products.
Explore the source record for details and available documents.
This study examines the relationship between involvement of grandmothers in child care and poor urban mothers' use of the emergency department (ED) for nonurgent care. Mothers with an index child between one and two years old were interviewed in the waiting room of a pediatric continuity clinic. They were asked about the proximity and involvement in child care of a grandmother, great-grandmother, or female family member. Frequency of ED use was abstracted from the index child's medical records. Results showed that mothers who frequently used the ED for nonemergent pediatric care were more likely to have the child's grandmother or great-grandmother living in close proximity or involved in care of the child than infrequent users (80 vs 45%, P < 0.05). This study suggests that proximity and involvement of the grandmother may influence health care decisions.
Absorption (a trait capacity for total attentional involvement) was reported to increase during episodes of marijuana intoxication. Several subsets of the absorption scale items specifically characterized marijuana intoxication, and groups of users and nonusers showed differential affective involvement with these experiences. Additionally, within the drug-using group, a positive correlation between frequency of marijuana use and affective ratings of these experiences was found. The findings support the hypothesis that a specific type of alteration in consciousness that enhances capacity for total attentional involvement (absorption) characterizes marijuana intoxication, and that this enhancement may act as a reinforcer, possibly influencing future use.
What kinds of psychological features do people have when they are overly involved in usage of the internet? Internet users in Korea were investigated in terms of internet over-use and related psychological profiles by the level of internet use. We used a modified Young's Internet Addiction Scale, and 13,588 users (7,878 males, 5,710 females), out of 20 million from a major portal site in Korea, participated in this study. Among the sample, 3.5% had been diagnosed as internet addicts (IA), while 18.4% of them were classified as possible internet addicts (PA). The Internet Addiction Scale showed a strong relationship with dysfunctional social behaviors. More IA tried to escape from reality than PA and Non-addicts (NA). When they got stressed out by work or were just depressed, IA showed a high tendency to access the internet. The IA group also reported the highest degree of loneliness, depressed mood, and compulsivity compared to the other groups. The IA group seemed to be more vulnerable to interpersonal dangers than others, showing an unusually close feeling for strangers. Further study is needed to investigate the direct relationship between psychological well-being and internet dependency.
The current basis for the health care policy on hepatitis C in The Netherlands is an advisory report of the national Health Council, published in 1997. The Council confirmed that: Chronic hepatitis C (HC) is to be considered as a serious disease; the hepatitis C virus (HCV) can be detected easily and accurately; transmission of HCV occurs mainly via blood; the prevalence of HC is low in The Netherlands and comparable to or somewhat lower than other countries in Northern Europe; treatment is possible and worthwhile; patients have the right to be provided spontaneously with relevant information; the general population lacks adequate knowledge about the essentials of HCV infection, preventing them from taking adequate measures for their own health. The Council recommended that: general tracing and testing of all people who received blood products in the past would be inefficient; hospitals should keep precise records of the origin and use of blood products; as practically all active drug users in The Netherlands are involved in medical care in connection with their addiction, they will be tested for HCV and qualify for treatment of HC; information should be provided to the general population; medical doctors are stimulated to participate in training courses on HC; medical and non-medical professionals involved in increased risk of HCV transmission must be informed on hygiene. Epidemiological research of HCV infection in the various population groups of The Netherlands is stimulated. Currently, an active approach to the health care policy on hepatitis C is supported by the Ministry of Health, Welfare and Sport, including awareness programs in risk groups and training courses for professionals. Such programs are typically aiming at supporting and stimulating the own initiatives in the society, based on responsibilities of professional and patient's organisations and individuals at risk. Treatment of HC, given in accordance with the current consensus, including long term combination therapy with interferon and ribavirin, is available and refundable for all Dutch citizens. A special program for HC screening and treatment of drug addicts is being started up, using the special infrastructure for drug user control programs in The Netherlands.
This ethnographic study describes part of the social context in which heterosexual transmission of the human immunodeficiency virus (HIV) may be taking place. Based on interviews with sex partners of intravenous (IV) drug users in an urban, African American community of the United States, the study documents the personal experience of 35 men and women to show how living with one's own and/or one's partner's heroin habit may structure one's response to public health information and one's possibility of becoming infected with HIV. As described by sex partners of intravenous drug users, people who use heroin habitually are drawn into social networks that are loosely organized according to their preferred route of drug administration, i.e. 'shooters' (intravenous) and 'tooters' (intranasal), both of which tend to exclude 'squares' (non-use). Social divisions such as these may slow rates of HIV transmission to those outside the drug life. But nevertheless, as sex partners explain, there are many types of social and sexual exchanges taking place among shooters, tooters and squares, including but not limited to the exchange of bodily fluids. Ethnography analyzes discursive representations of such exchanges, filling in and questioning the empty categories of epidemiological prediction. How does risky behavior actually figure in the lives of individuals who happen to fall in the category of 'sex partner'? How is sexual behavior shaped by drug use behavior? Being sexually involved with an IV drug user for some years alters a person's relative position betwixt and between the drug subculture, on the one hand, and mainstream pursuits of family, work and church, on the other. Differences in personal need and group identity create conflicts. Couples in long-term relationships develop rules to manage these. But in which terms will they interpret and negotiate the new threat of AIDS? If the strategic aspect of discursive representations of experience is taken into account, and if discursive representations are interpreted within appropriate social and historical contexts, they can provide a rich source of material for understanding the social impact of the AIDS epidemic. Without this discursive dimension, analytic power to interpret seroprevalence data cross-culturally would be lacking. In addition, and independently of the problem of interpreting seroprevalence data, ethnographic analysis links local, culturally-specific meanings through which AIDS is interpreted to our understanding of AIDS as a global phenomena.
OBJECTIVE: To investigate the numbers of visits required to obtain interviews with users and non-users of cervical screening, and to determine the workload involved to enable an optimum visit plan to be developed. DESIGN: Case-control study of users and non-users of cervical screening using a flexible visit plan that involved up to eight attempts at contact. Visits were made in mornings, afternoons, and evenings, the visit pattern being determined by information gained from local sources. PATIENTS: Altogether 660 non-users of cervical screening (cases), aged 20-64 and registered with 23 randomly selected general practitioners (GPs), were identified from the Tayside computerised register of cervical smears. These women were selected from the computerised lists of 18 GPs in Dundee and five in Perth. A total of 417 women recorded as having a smear within the previous three years (controls), matched by age and GP, were also identified from the computerised register. RESULTS: Altogether 1834 attempts were made to contact the cases, of whom 339 were interviewed, giving a workload of 18 interviews per 100 attempts. For the controls 1359 attempts were made at contact to yield 339 interviews, a workload of 25 interviews per 100 attempts. Refusals (19%) and incorrect addresses (23%) were the two major reasons for failing to achieve interview. Only for four (0.6%) of the cases and one (0.2%) of the controls was no information gained. The proportion of attempts which led to interview remained constant with increasing numbers of call-backs (up to six for the cases and eight for the controls). CONCLUSIONS: A flexible approach to visit scheduling that takes account of local knowledge can lead to interviews with 66% of non-users of health screening, when incorrect addresses are removed. It is preferable to plan for many (up to six) visits to achieve interview. This will minimise non-response bias without increasing the workload per successful interview.
The aim of this analysis was to evaluate the efficacy of the SSRI antidepressant fluoxetine versus placebo for the marijuana use of depressed alcoholics. There are no previous reports involving and SSRI antidepressant for marijuana abuse. This analysis involved a subsample of 22 depressed alcoholic marijuana users out of a total of 51 depressed alcoholics. The entire sample was involved in a 12-week double-blind, placebo-controlled study evaluating the efficacy of fluoxetine versus placebo in depressed alcoholics. During the course of the trial, the cumulative number of marijuana cigarettes used was almost 20 times as high in the placebo group as in the fluoxetine group. Also, the number of days of marijuana use during the study was five times higher in the placebo group than in the fluoxetine group. These data suggest efficacy for fluoxetine in decreasing marijuana use of depressed alcoholics.
A Reproductive Risk Factors Survey was carried out in 1982 in conjunction with a community-based distribution (CBD) program in Matamoros, Mexico, to determine whether the distribution of oral contraceptives to women through CBD programs exposes any demonstrable group of users to more health risks than if the program had not been put in place. The methodology involved interviews by nurses of program pill users and non-program pill users. Health indicators related to cardiovascular accidents were the main focus of comparison between the groups. The data indicate that respondents were well informed about their own health status, and, in terms of the conditions studied, program users were found to be similar in health status to non-program pill users whether or not they were ever examined for contraindications to pill use. The study indicates that this CBD program has not increased the risks associated with pill use for its clients and has, in fact, given protection from pregnancy to women who may otherwise not have had access to oral contraceptives.
Hybrid RARE (rapid acquisition with relaxation enhancement) is a family of magnetic resonance (MR) imaging techniques whereby a set of images is phase encoded with more than one spin echo per excitation pulse. This increases the efficiency of obtaining T2-weighted images, allowing greater flexibility regarding acquisition time, resolution, signal-to-noise ratio, and tissue contrast. Hybrid RARE techniques involve several important new user-selectable parameters such as effective TE, echo train length, and echo spacing. Choices of other parameters, such as TR, sampling bandwidth, and acquisition matrix, may be different from those of comparable conventional T2-weighted spin-echo images. Different hybrid RARE implementations can be used for abdominal screening, with T2-weighted or T2-weighted and inversion-recovery contrast, or for characterizing liver lesions or imaging the biliary system with an extremely long TE. High-resolution images may be obtained by averaging multiple signals during quiet breathing, or images may be acquired more rapidly during suspended respiration. In this review, the authors discuss the basic principles of hybrid RARE techniques and how various imaging parameters can be manipulated to increase the quality and flexibility of abdominal T2-weighted MR imaging.
Injuries in the elderly population have more considerable consequences (more difficult treatment, higher costs,worse outcome) than in the younger population. Therefore, the prevention is especially important. The majority of the injuries are caused by traffic accidents and falls. TRAFFIC ACCIDENTS: An analysis of the current injury situation in elderly road users (65 years and older) involved in road traffic accidents was intended to allow conclusions regarding future prophylaxis. FALLS: Falls are mostly caused by numerous factors. The most important predictors for falls are dementia,Parkinson-Syndrome and neurologic deficits after cerebrovascular insults. The most important symptoms, that indicate an increased risk for fall are gait abnormalities, balance lack and underweight. The most important anamnestic indications are more than one falls in the recent 90 days, need for assistance in daily living and prevailing medication. Another important factor is the residential setting (lighting, stairs, floor conditions,bath installations). The most affective protective interventions involve multiple factors. The incidence of falls could be reduced by 30%. The hip protector is an effective protection against proximal femur fractures. which is the most frequent fracture in the elderly population that requires treatment as an inpatient. Injury prevention in the elderly population is an interdisciplinary task as for example shown by the successful fall clinics in the anglo-american area.
A study of the density of mast cells in the human endometrium was carried out on biopsy specimens prepared for light microscopy in 87 cases with three types of IUDs (stainless steel ring SS-type, copper Cu-T 220 and LNG-IUD levonorgestrel-releasing device) pre- and post-insertion. The results revealed that, in general, there was an increase of mast cells after 3 to 24 months' use of IUD, independent of type (p < 0.01 when compared with the pre-insertion value). The increase in number of mast cells was most prominent in women having used the Cu-T220 IUD for 24 months (p < 0.05 when compared with the SS-IUD and p < 0.01 when compared with the LNG-IUD). The difference between the SS-IUD and the LNG-IUD as to the number of mast cells was not significant. No significant difference was found between the "bleeders" and "non-bleeders" in any of the three types of IUDs. It is noteworthy that patients using the Cu-T220-IUD had the highest percentage of patients with abnormal bleeding (> 50%) and that this group also had the highest density of mast cells per mm2 after 24 months' use. Although no significant difference with regard to the density of mast cells could be found between the "bleeders" and the "non-bleeders" in the present study, the number of "bleeders" of the three study groups is usually small and sometimes this number does not allow an adequate statistical analysis for comparison. Further investigations, involving larger number of IUD users, may yield a better understanding with regard to the potential relationship between the number of bleeding episodes and the density of mast cells in the human endometrium.
INTRODUCTION: Police crash data, which are the basis for safety research in most countries, are incomplete and biased. We focus here on the extent of under-reporting in France, and how it is related to casualty and crash characteristics. METHODS: Police data are compared with a road trauma registry, on the Rhône county, after record-linkage. The study covers the 1997-2001 period, totalling 59,714 casualties. A multivariate analysis is conducted, modelling the probability of being police-reported among casualties in the registry, as a function of crash and casualty characteristics. Results are expressed as relative risks (RR) and adjusted probabilities. RESULTS: Police reporting rate is 37.7%. Under-reporting varies mainly according to injury severity (RR=0.35 for slightly injured versus severely injured), to road user type and third party involvement (yes/no): comparing casualties with no third party versus those with one, RR=0.32 among motorcyclists whereas RR=0.78 among car occupants. Under-reporting also varies with road type, road environment (metropole/rural) and type of police force, all of which are structurally dependent. CONCLUSION: Any study based on police crash data may be quite misleading. We are therefore working on obtaining unbiased estimates of road casualties figures, by extrapolating the Rhône road trauma registry to the nation-wide level.
PURPOSE: To assess the interobserver variability of optical coherence tomography (OCT) measurements in patients with macular edema. DESIGN: Noninterventional case series using a diagnostic instrument. METHODS: Ordinary least products analysis of OCT data obtained by two masked observers from a set of 20 eyes from 10 patients. SETTING: Private retina practice. RESULTS: Foveal zone thickness measurements were operator dependent. Fixed and proportional bias was found between the two observers. Total macular volume measurements were independent of observers. CONCLUSION: Foveal zone thickness measurements are not directly comparable across different observers, but total macular volume measurements are directly comparable. Multicenter studies involving OCT measurements and clinical users of OCT data will need to factor interobserver variability into conclusions drawn from pooled OCT foveal zone thickness measurements.