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PubMed2005

Changes in hearing aid use over the past 20 years.

The aim of this study was to find out how the use of hearing aids has been affected by the changes in hearing rehabilitation, hearing aids and society over the past 20 years. Seventy-six first-time hearing aid users were interviewed at their homes, and the results were compared with those of an earlier study made with the same method in 1983 in Finland involving both new and experienced hearing aid users. Hearing aid use and handling skills as well as satisfaction with the hearing aid were explored with interviews using the same questions in both studies. The number of first-time hearing aid users who did not use their hearing aids had decreased from 33.3% in 1983 to 5.3% at the present. Conversely, the number of regular users rose from 40.9 to 56.6%. The use of hearing aids was increased. The users were better able use their hearing aids and were more satisfied with them and the number of those who considered the counseling provided sufficient had also increased.

Aged↗

PubMed1981

A case study of reaching by a user of a manually-operated artificial hand.

Reaching involves both transport of the hand toward an object and opening of the hand by an appropriate amount before arrival at the object. Movements of a manually-controlled artificial left-hand are compared with movements of the natural right-hand of a proficient user of an artificial hand. Although picking up of objects was slower with the artificial hand, similarities in opening and transport movements were observed in the two hands. Depsite major mechanical differences in the systems subserving movement in the artificial and natural hands, the similarities extended to the separate movements of the thumb and finger. The strategy of artificial hand control employed by this subject is discussed and related to training new users of artificial hands.

Adolescent↗

PubMed2003

Hormone therapy and endometrial angiogenesis.

Irregular endometrial bleeding occurs in up to 60% of hormone therapy (HT) users and leads to discontinuation of therapy in up to one-third of these women. Aberrant endometrial angiogenesis has been implicated as a cause of abnormal endometrial bleeding. Vascular endothelial growth factor (VEGF) and thrombospondin-1 (TSP-1) are two well-characterized angiogenic modulators that play critical roles in endometrial angiogenesis. We have proposed a hypothesis that alterations in the expression of these two potent angiogenic modulators may be a mechanism involved in endometrial bleeding in HT users. 17beta-Estradiol increased VEGF levels in the endometrial glandular epithelium (Ishikawa cells) in vitro. Progesterone has no effect on VEGF expression. The synthetic progestins in HT preparations were found to increase VEGF expression to a greater extent than 17beta-estradiol. Progesterone increased TSP-1 mRNA in Ishikawa cells. 17beta-Estradiol had no effect on TSP-1 mRNA and the effect of synthetic progestins on TSP-1 expression was lower than that found with progesterone. We propose, based on these data, that progestins used in HT preparations may alter the balance between angiogenic promoters and inhibitors. These alterations could induce a unique pro angiogenic activity in the endometrial capillary plexus, with consequent aberrant vasculogenesis, which may result in irregular endometrial bleeding.

Endometrium↗

PubMed1998

Impact of menopausal hormone-replacement therapy on clinical and laboratory characteristics of breast cancer.

Hormone-replacement therapy (HRT) is widely used by post-menopausal women. Although this treatment may slightly increase the incidence of breast cancer, more and more cases are diagnosed while women are taking HRT. The purpose of this study was to ascertain the influence of HRT on prognostic factors and outcome of breast cancer. Data on all breast-cancer patients, including precise information on HRT, was prospectively and systematically recorded in a data base. From 1985 to 1995, 1379 post-menopausal women fulfilled the eligibility criteria for this study. All were treated by us (P.B. and L.P.) in our ward of a large public hospital of Marseilles, France. The clinical features, laboratory findings and survival rates in 142 HRT users who developed breast cancer while being treated were compared with those of 284 matched never user breast-cancer patients. Patients who developed breast cancer during HRT had fewer locally advanced cancers and smaller and better-differentiated cancers. Lymph-node involvement was significantly less frequent in the user group than in the non-user group (non-significant). Estradiol receptivity was both qualitatively and quantitatively lower in users. There was no significant difference with regard to recurrence and metastasis-free survival and overall survival. We conclude that HRT does not affect the prognosis of breast cancer. Regular surveillance during HRT allows early detection of smaller lesions. The higher number of well-differentiated cancers and the distribution of hormone receptivity may reflect interaction between neoplastic tissue and exogenous hormones.

Adult↗

PubMed2005

Designing better radiology workstations: impact of two user interfaces on interpretation errors and user satisfaction.

This paper presents our solution for supporting radiologists' interpretation of digital images by automating image presentation during sequential interpretation steps. We extended current hanging protocols with support for "stages" which reflect the presentation of digital information required to complete a single step within a complex task. We demonstrated the benefits of staging in a user experiment with 20 lay subjects involved in a comparative visual search for targets, similar to a radiology task of identifying anatomical abnormalities. We designed a task and a set of stimuli that allowed us to simulate the interpretation workflow from a typical radiology scenario-reading a chest radiography exam when a prior study is also available. The simulation was enabled by abstracting both the radiologist's task and the basic workstation navigation functionality. The staged interface was significantly faster than the traditional user interface, provided a 37% reduction in the interpretation errors, and improved user satisfaction.

Analysis of Variance↗

PubMed2001

Supporting the habit: income generation activities of frequent crack users compared with frequent users of other hard drugs.

US Federal sentencing guidelines punish possession of crack cocaine very differently from powder cocaine, based partially upon the assumption that crack users engage more frequently in criminal behavior to pay for their habit. This article analyzed frequent users (those who have used at least 15 of the last 30 days) of crack with subgroups of less frequent hard drug users in terms of various income generation activities reported during the past 30 days. The sample consists of 602 African-Americans who were current (in past 30 days) users or sellers of cocaine powder, crack, and heroin. They were carefully recruited from randomly selected blocks in the Central Harlem area of New York City and interviewed extensively in 1998-1999. Their IGAs were classified into six categories. Compared with not-frequent (less than 15 days) hard drug users, frequent crack and multiple hard drug users were equally likely to be involved in drug distribution activities, but were significantly less likely to have full-time jobs, part-time jobs, aid to families with dependent children or welfare support. They had much higher odds ratios for non-drug related illegal (theft mainly) income generation activities and sex work among women. Often, gender and birth cohort variables had higher odds ratios with specific income generation activities than the frequent use of the primary drug(s). This evidence suggests that very frequent crack users have been stigmatized by, are largely excluded from, and perform very marginal economic roles in the legal economic system (jobs and welfare), the illegal economic system, and even in the hard drug distribution system.

Adult↗

PubMed1993

Special report. Update on EAS (electronic article surveillance) systems: protecting against patient wandering, infant abduction, property theft.

Concern about wandering patients and infant abduction on the part of hospitals has sparked renewed interest in Electronic Article Surveillance (EAS) systems. Such systems had their origins in department stores and libraries where they are almost universally used. They also have applications in hospitals for preventing the theft of supplies and equipment. A number of companies provide EAS products for the health care field. How do you select the system that is best for your needs? "Talk to users. Pick out a number of profit and non-profit hospitals to get their views," advises Ted Algaier, vice president, marketing and sales, Innovative Control Systems, Inc., Waukesha, WI. "Examine the history of the company or vendor to determine if it understands the health care market and find out if the product really works." In this report, we'll review a number of EAS systems currently on the market, and present information on how they work, how effective they are, and costs involved. Also included are comments from users who have installed such systems.

Aged↗

PubMed2005

Comparing endoscopic systems on two simulated tasks.

Endoscopes are slender instruments for performing medical procedures through small incisions or natural body orifices. Three experiments examined the performance effects of various endoscope systems when naive participants executed tasks in a bladder-like environment. The systems involved a direct endoscope, requiring the user to look through a lens at the outer part of the endoscope, and a video endoscope that picks up the image via a camera attached to the endoscope and displays it on a video monitor. The results indicate that the participants performed the tasks better with video than with direct endoscopes, and showed more transfer of practice with video endoscopic surgery from a small to a large task environment than vice versa. The optimal position of the monitor with video endoscopic surgery appeared to involve a reasonable angle relative to the operating area (45 degrees was used). Performance was less at a greater angle (90 degrees), but also at a small angle (10 degrees). It did not matter whether the monitor was located left, right or above the operating area. As performance did not fully transfer to differently sized task environments, endoscopists should initially train with task environments of different, and especially small, sizes.

Adult↗

PubMed2002

Paying for healthy rivers.

Concerted efforts are being made at state and federal levels to restore Australia's rivers and waterways to a healthy condition. Yet, there is little consensus on what constitutes a "healthy river" and even less on how to achieve this, or how far to go towards restoration. Some advocate removal of storages and weirs along rivers to revert to some natural state. Others, particularly water users, question the trade-offs involved in leaving more water in the rivers and how the costs of restoration are to be met. At present it seems that the major share of the costs is borne by irrigators, with the wider community essentially enjoying a "free-ride". This situation is justified on the basis of the impactor pays principle whereby water diversions, primarily for irrigation, are held to have contributed most to degradation of the river systems. The altemative-beneficiary pays principle--is of more relevance where demands are made on resource users to mitigate environmental impacts or bring about environmental improvements, eg. healthy rivers, where the beneficiaries are the wider public and the general community. Many resource users are voluntarily undertaking action on private land to conserve biodiversity and achieve sustainability. In these circumstances, the cost-sharing principle should apply, with governments, interest groups and the community contributing to the investment required to attain the desired resource condition objectives.

Animals↗

PubMed1999

p53 mutations in basal cell carcinomas arising in routine users of sunscreens.

Sun exposure histories were obtained from a series of patients age 35 or younger following diagnosis and removal of a basal cell carcinoma (BCC). The DNA was extracted from tumor biopsy samples derived from BCC of 10 patients who reported that they did not use sunscreens during youth (age 18 or younger) and 10 patients who routinely employed sunscreens during this age period. Exons 5-9 of the p53 gene were then amplified in three fragments from these samples using a nested polymerase chain reaction (PCR) approach and screened for mutations using an RNA heteroduplex assay. All PCR products displaying evidence of a mutation were sequenced. It was found that 6 of the 10 patients who were not routine sunscreen users displayed mutations in these p53 exons. All of the mutations were located at dipyrimidine sites, five of the six were C-->T transitions and one mutation was a tandem double mutation, consistent with a role for solar UVB in BCC formation. In contrast, only one p53 mutation was detected in the group of 10 patients who routinely employed sunscreens during childhood and adolescence. Hence, a significantly (P = 0.029) lower level of p53 mutations was detected in the BCC obtained from sunscreen users compared with tumors derived from nonusers. These findings suggest that the mechanisms involved in the etiology of skin carcinogenesis differ in sunscreen users compared with people who did not routinely employ sunscreens. These data are also indicative of a protective effect associated with sunscreen use against the formation of p53 mutations. It is possible that the patients who were diagnosed with BCC despite their use of sunscreens possessed a genetic susceptibility for skin cancer formation and developed BCC through a p53-independent pathway. Alternatively, solar UVA wavelengths, that were generally not blocked by the suncare products employed by the sunscreen users, may have played a significant role in BCC development through induction of a mutation(s) in an oncogene and/or a tumor suppressor gene, other than p53, for these patients.

Adolescent↗

PubMedDate not supplied

Parental alcohol and other drug (AOD) use and health beliefs about parent involvement in AOD prevention.

Because the family plays an important role in predicting alcohol and other drug (AOD) use among youth, prevention efforts must begin in early childhood and involve parents. The purpose of this study was to determine differences between parent AOD users and nonusers in relation to health beliefs about parent involvement in AOD prevention with preschool children. A convenience sample of 200 Head Start parents in East Central Indiana completed self-report instruments measuring Health Belief Model constructs. Almost half (45%) reported alcohol use, over half (54%) smoked cigarettes, and 11% admitted using illicit drugs. Compared to nonusers, illicit drug users were more likely to perceive their children as susceptible to future AOD use, but less likely to view AOD use by their children as serious. Compared with nonsmokers, tobacco users were more likely to perceive their children as susceptible to future AOD use and had less interest in maintaining health through early prevention activities.

Adult↗

PubMed1992

Evaluation of requirements and planning for picture archiving and communication systems.

Successful implementation of a picture archiving and communication system (PACS) requires extensive planning and the input of the users in the planning and evaluation stages. System design is conducted in nine stages: systems analysis, stages 1-4; system design, stages 5 and 6; and system implementation, stages 7-9. Users of the PACS are actively involved in systems analysis. At stage 1, problems are identified, project scope is defined, and whether the problems can be successfully addressed with a PACS is determined. If the project is feasible, current systems are studied at stage 2. Data are collected on the volume of image data to be transmitted, stored, retrieved, and displayed; distribution of imaging through the day; radiologists' reading patterns and volumes; job functions of technologists; characteristics of images to be included; types of equipment to be interfaced; physical placement of cables, connections, and equipment; and operational restrictions. All these data and more are used in stage 3 to specify requirements of the PACS. Rigorous specifications are needed to ensure that the final system performs at the desired level. At stage 4, users evaluate alternative solutions to problems. Although consultants and equipment manufacturers do much of the design, implementation, and installation, users must understand project scope and limitations of the technology and must ultimately be responsible for planning a system that meets their needs.

Cluster Analysis↗

PubMed1984

Development of a friendly, self-teaching, interactive statistical package for analysis of clinical research data. The BRIGHT STAT-PACK.

We have developed a new statistical analysis package for use by the clinical investigator, the clinician, and the laboratory researcher. This package attempts to implement the following philosophy: The programs should be essentially self-teaching, friendly, and forgiving; the programs should educate the user regarding the underlying theory, assumptions, and interpretation of the statistical methods involved; the programs should automatically test relevant assumptions and warn the user when these assumptions appear to have been violated; the programs should make recommendations about the availability of alternative statistical methods and automatically perform such analyses when indicated; the programs should interpret the results; and the programs should mimic, insofar as possible, the logic used in a routine, elementary statistical consultation. Several programs have been developed, extensively tested, and used.

Computer-Assisted Instruction↗

PubMed2001

Evaluation of a primary school drug drama project: methodological issues and key findings.

This paper describes the impact evaluation of a primary school drug drama project developed by a health promotion service and a theatre's education department in England. The project targeted 10-11 year olds in 41 schools with an interactive drama production and workshop day on attitudes, choices, decisions and risks of alcohol, tobacco and illegal drug use. Parents were also involved in parents' evenings and watching children's performances. The research consisted of both process evaluation, consultation with pupils, teachers, parents, actors and health promotion staff on the project itself, and impact evaluation which looked at potential changes in children's knowledge, attitudes and decision-making skills. This paper reports findings of the impact evaluation, from six of the schools participating in the project. The impact evaluation consisted of pre- and post-project testing using a 'draw and write' and a problem-solving exercise. These findings suggest that the project had a significant impact on the children's knowledge of names of specific illegal drugs, and on their awareness that alcohol and cigarettes were also drugs, and secondly encouraged the children to think in less stereotypical terms about drugs and drug users. The problem-solving exercise, involving decision-making scenarios, showed small but positive trends between pre- and post-project solutions in more than half of the response categories. Methodological difficulties relating to evaluating such a project are discussed.

Child↗

PubMed2001

Stroke pathways.

Stroke pathways are task-orientated structured multidisciplinary care plans which detail essential steps and interventions during the period of care of a "typical" stroke patient. Pathway development and implementation are best achieved by an appointed champion leading a multidisciplinary team of health care workers and administrators, who will also be the end users of the pathway. Pathway development involves reviews of existing clinical practice guidelines and pathways, followed by documentation, interdigitation and prioritization of care requirements at different time points in the various spheres, taking into consideration local philosophies and practices. These spheres could include investigations, pharmacologic treatment, rehabilitative therapy, nursing measures, and patient education. This would result in evidence-based holistic quality care, wide support base, efficient service provision, reduced costs and length of stay, less practice variation, improved communication among disciplines, enhanced patient-staff relationship, ease of audit and research opportunities. Components of the pathway could include a patient summary sheet, multidisciplinary record of the various activities structured on a day-to-day basis, sign-off columns for staff responsible for performing those activity, variance sheet, and separate protocols for specific issues. Implementation requires training of users, pilot runs, feedback, regular revisions, monitoring of compliance, and analysis of variances. Widespread implementation of pathways may be hindered by lack of support, and concerns about increased time requirements and costs, stifling of innovation, restriction of application of clinical judgement, lack of applicability to all patients, misuse and legal issues. However, a well-designed pathway will ensure quality care in a cost-efficient manner, benefiting the patient, carer and the health care service.

Critical Pathways↗

PubMed2004

Are older drivers actually at higher risk of involvement in collisions resulting in deaths or non-fatal injuries among their passengers and other road users?

OBJECTIVES: With more older drivers on the road, public concern has been expressed about their impact on traffic safety. This study revisited the question of driver age in relation to the risks of older drivers and others sharing the road with them, including pedestrians, passengers in the same vehicle, and occupants of other vehicles. METHODS: Using United States federal data on fatal and non-fatal crashes, injury rates per driver were calculated for different types of road users. In addition, using data supplied by nine insurers, insurance claims per insured vehicle year were examined by driver age. The reference drivers were aged 30-59. RESULTS: For fatal crashes, older drivers' major impact on road users other than themselves was an increase in death rates among their passengers, who also tended to be elderly and thus more vulnerable to injuries (rate ratio (RR) for drivers aged 75+ 2.52; 95% confidence interval (CI) 2.39 to 2.66). For non-fatal crashes, drivers aged 75+ had a RR of 1.10 (95% CI 0.98 to 1.24) for involvement in collisions resulting in injuries to other passenger vehicles' occupants compared with 30-59 year old drivers. The oldest drivers (aged 85+) had significant increases in insurance claims for injuries to other road users in crashes in which they were deemed at fault (RR 1.8; 95% CI 1.71 to 1.89). CONCLUSIONS: These findings suggest that the oldest drivers, a group with low average annual mileage, do pose some increased risks to occupants of other vehicles, and pose the most serious risks to themselves and their passengers.

Accidents, Traffic↗

PubMed2005

Gender differences among regular injecting drug users in Sydney, Australia, 1996-2003.

Previous research has found that female injecting drug users (IDU) are younger and more likely to be involved in risky behaviours such as needle sharing and sex work than male IDU. Aboriginal female drug users, in particular, are over-represented in IDU and prison populations. These factors place female IDU at increased risk of health problems and complicate issues such as homelessness, unemployment and poverty. Although a substantial body of research exists, little trend analysis has been done in Australia and much of the previous literature has focused on treatment populations. Cross-sectional data from 1996 to 2003 from regular IDU in Sydney interviewed as part of Australia's drug monitoring system, the Illicit Drug Reporting System (IDRS) were examined for trends over time. The demographic characteristics, drug use patterns and self-reported risk behaviours of the most recent sample (2003) were analysed for gender differences. Female IDU were younger in all sample years. Female IDU were more likely to identify as Aboriginal or Torres Strait Islander (ATSI) and engage in sex work. There has been a steady increase in these proportions over time. Female IDU were less likely to have a prison history, although there has been an increase among both male and female IDU over time. There were no gender differences in drug use patterns or frequency of drug use. Larger proportions of females report lending needles. Reports of lending and borrowing needles have decreased over time among both male and female IDU. Female IDU may place themselves at greater risk than male IDU by being more likely to share injecting equipment and engage in sex work. Treatment and other measures to reduce harm may need to be targeted specifically at women and, in particular, indigenous women.

Adult↗

PubMed1999

Demographic and psychosocial characteristics of substance-abusing pregnant women.

Women who abuse drugs and alcohol during pregnancy are an elusive population who often remain unidentified to practitioners and researchers and hence have not been well studied. In trying to understand better the characteristics of women who use drugs during pregnancy, the present article relies extensively on information gathered in studies of women in substance abuse treatment who, as epidemiologic studies show, may be more severely impaired than other substance-abusing women and, therefore, may not be typical of substance-abusing women identified in the course of obstetric practice. Yet, those pregnant women who are actually identified by medical providers as substance users are often those whose behavior raises concerns with health providers (such as presenting for labor having had no prenatal care) and thus also may represent only a relatively impaired group of substance-abusing women. The most objective picture available of the universe of women who use drugs during pregnancy comes from blinded urine toxicology screens conducted at samples of representative hospitals across states and across the country. The startling finding to emerge from these studies is that common perceptions of substance abuse as a problem of poor, ethnic minority, and young individuals is inaccurate and that this perception may all too often be acted on by medical providers in a prejudicial manner. These studies show similar rates of substance use during pregnancy by women of different racial, social class, and age categories. Demographic features are only related to type of substance used, with black women and poorer women more likely to use illicit substances, particularly cocaine, and white women and better educated women more likely to use alcohol, the substance whose teratogenic effects have been most clearly documented. Despite the even distribution of substance use across demographic categories, poor women and women of color are far more likely to be reported to health and child welfare authorities for use of substances during pregnancy than are other women, even when their base rates for use of illicit drugs are considered. Data from both epidemiologic studies and samples of women seeking treatment for substance abuse problems indicate that the lives of substance-abusing women are fraught with difficulties past and present. Substance-abusing women are likely to have been raised by parents who were substance abusers, particularly alcoholics. Although the intergenerational patterns of substance abuse may have some genetic basis, there is also ample evidence suggesting problematic relationships in families with a substance-abusing parent that raises concerns about intergenerational transmission of problematic parenting behavior. Perhaps the most startling research finding reported in studies reviewed in this article is the high proportion of substance-abusing women who have experienced early sexual abuse. Although most studies have not had adequate comparison groups of non-substance-abusing women, the fact remains that most studies suggest a third to a half of substance abusing women experienced some kind of sexual abuse during childhood. Substance-abusing women's lives remain complicated as adults. They are commonly involved with men who are also users of drugs, they are often the victims of domestic violence, and they suffer from a variety of psychiatric disorders. Studies of epidemiologic and treatment populations indicate that the majority of substance-abusing women have one or more types of comorbid mental disorders, with depression being the most common and the most elevated compared with substance-abusing men, but antisocial personality being extremely high compared with samples of non-substance-abusing women. These findings are of great concern given a growing body of research with non-substance-abusing women, suggesting that family violence and maternal psychopathology can have a profound effect on women's parenting and development o

Adult↗