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PubMed1993

A multicenter study of the clinical performance of the Ortho Gyne-T380 Slimline intrauterine device in routine use in general practice and family planning clinics. UK Family Planning Research Network.

In a multiclinic use-effectiveness study, 505 parous women were fitted with an Ortho Gyne-T380 Slimline intrauterine device (IUD). Gross cumulative event rates, calculated by the Tietze-Potter life-table method, show the device to have a very low pregnancy rate and a low expulsion rate. The rate of removal following complaints of bleeding and/or pain was high. The incidence of infection was low and more likely to occur among younger users. The older parous women were more likely to have a satisfactory experience of IUD use than younger users. In accordance with current advice, and following a full discussion with the client, long-term use of the device beyond the manufacturer's recommended time period will continue among satisfied users.

Adult↗

PubMed1995

Cytochemical detection systems for in situ hybridization, and the combination with immunocytochemistry, 'who is still afraid of red, green and blue?'.

An overview is given of the different non-radioactive cytochemical detection methodologies that are currently utilized to localize nucleic acid sequences in chromosomes, cells and tissue sections. Dependent on the reporter molecule (fluorochrome, enzyme or hapten) that is used to modify the appropriate nucleic acid probe, and the sensitivity that is required, the in situ hybridized sequences can be detected either directly after hybridization or indirectly, using cytochemical detection and amplification layers. These may then contain antibody and/or avidin molecules conjugated to fluorochromes, enzymes or colloidial gold particles. Since the choice of a suitable probe-labelling method in combination with a fluorescence, enzyme cytochemical or immunogold-silver detection procedure is often determined by the user's own practical experience and applications, the different detection methodologies are compared with each other in detail with respect to sensitivity, resolution, applicability for multiple probe detection, and signal evaluation. Furthermore, procedures are reviewed for the combination of in situ hybridization with immunocytochemical detection of proteins and/or incorporated bromodeoxyuridine, which allow the simultaneous visualization of genomic phenotypic and/or cell cycle parameters in the same sample. Possible improvements with respect to sensitivity, specificity and multiplicity of the detection methods, which may be interesting for one's own experimental design, are finally being discussed.

Animals↗

PubMed2003

[Sheltering: whose responsibility is it? An experience report].

This paper is about the sheltering of users in a basic health unit in Porto Alegre/RS according to the experience during the Integrated Residency Program in Collective Health at the Public Health School and reflections about specific bibliography. Sheltering is the manner in which the health service is organized to attend to its users and to answer their demands, relying on health education processes aiming to build a different relation than that established in "emergency rooms". It is believed that the nurse is the professional indicated for this task because of its basic education in collectivity and integralized human care.

Attitude of Health Personnel↗

PubMed1987

Factors influencing frequency and appropriateness of utilization of the emergency room by the elderly.

The authors analyzed predictors of the frequency and appropriateness of utilization of an emergency room by a random sample of 75 noninstitutionalized persons aged 65 years and older in a large city in Canada, using the Andersen and Newman model of medical care utilization as a framework. The total amount of variance explained in the frequency of utilization (47%) exceeded that explained by other studies of utilization of various health services by the elderly. Attitude toward health care, prior experience with the hospital system, and number of sources of health care were important predictors of the frequency of presentation to the emergency room. Almost one half (46.7%) were appropriate users; younger age and prior experience were important predictors of appropriateness of use. The results suggest that the elderly are more appropriate users of the emergency room than younger persons; educational interventions by family physicians could contribute to further improvement.

Aged↗

PubMed1981

Acute effects of phencyclidine (PCP) on chronic and recreational users.

Snowball sampling techniques were used to generate a sample of 200 phencyclidine users from an area with a 10-year history of extensive PCP use. Three types of users were studied: heavy chronic, light chronic, and recreational users. The extent of PCP use varied from less than twice a month for a period of 6 months to daily use for several consecutive years. Each subject participated in a structured interview which lasted an average of 11/2 h. Subjects were asked about the acute effects of PCP, and about their moods before, during, and after using PCP. Scales based on previous research were used to measure the acute effects and moods. Results showed that heavy chronic users were more likely than recreational users to feel energized by PCP, and to experience negative ideations (thoughts about suicide and death). When age was controlled for, heavy chronic users were also more likely to experience violent effects. Analysis of moods over time showed some similar patterns between heavy chronic and recreational users, as well as some striking differences. Overall, heavy chronic users reported greater mood elevations while high on PCP, and a more dramatic drop in mood after the high wore off, than recreational users. Analysis of the results by user types clarified some of the confusion about contradictory descriptions of the effects of PCP, and point to the need to continue distinguishing between user types.

Adolescent↗

PubMed1992

[A guide dog in the life of the blind--experiences, insights, considerations].

A guide dog user himself, the author nevertheless sets out to put forth in as unprejudiced a manner as possible the pros and cons of this mobility aid for blind persons. After a brief outline of the history and present situation of guide dog use in Germany, the author addresses the skills such a service animal must be provided with, dealing both with genetic and biographic issues relative to his or her suitability and training. Also, the team, conceived as a differentiated action entity, is set out in some detail due to its unique structure and dynamics, dealing also with its intricate relationship with the environment. Concluding, the author on the one hand addresses the psychologically important adjustment difficulties a person without previous experience in using this aid may be faced with, and on the other the partnership-based position of the guide dog in private and occupational social interaction.

Animals↗

PubMed1998

Personal stories within virtual environments: creating three experiences in cancer information software.

Virtual environments can create a relaxed mood, increasing a patient's receptivity to learning. Personal stories and an individual approach to the content, rather than abstract facts, make the CD-generated experience vivid and informative. With the user in control, selecting content and interacting constantly with the program, the virtual experience is more meaningful than the one created by simply retrieving information. This chapter explains how three CD-ROMs containing cancer information--Breast Cancer Lighthouse, Easing Cancer Pain and Cancer Prevention Park--embody personal stories and medical information in virtual environments.

Breast Neoplasms↗

PubMed1996

Overdose among heroin users in Sydney, Australia: II. responses to overdose.

A sample of 329 heroin users were interviewed about their experiences at other peoples' heroin overdoses. The overwhelming majority (86%) had witnessed a heroin overdose, on a median of six occasions. Heroin users were reluctant to seek medical attention, with an ambulance being called on only half (56%) of the most recent overdose occasions. At only 17% of most recent overdoses was calling an ambulance the first action taken. Males reported taking significantly longer than females to call an ambulance. Nearly half (44%) of subjects reported that there were factors that had delayed or stopped them seeking medical assistance, the most common impediment being a fear of police involvement. The importance of interventions to encourage help-seeking at overdoses are discussed.

Adolescent↗

PubMed2003

Development of a framework for knowledge translation: understanding user context.

OBJECTIVE: To develop a framework that researchers and other knowledge disseminators who are embarking on knowledge translation can use to increase their familiarity with the intended user groups. METHODS: The framework was derived from a review and analysis of the knowledge translation literature and from the authors' own experience with a variety of user groups. RESULTS: The framework consists of five domains: the user group, the issue, the research, the knowledge translation relationship, and dissemination strategies. Within each domain, the framework includes a series of questions. The questions provide the researcher with a way of organizing what he or she already knows about the user group and the knowledge translation project, of identifying what still is unknown, and of flagging what is important to learn. CONCLUSIONS: Most researchers wishing to engage in knowledge translation are moving out of their own familiar contexts. By using this framework, researchers will learn about the new contexts in which they find themselves. The insights they gain will increase their familiarity with the user group, thus aiding in the implicit goal of the interactive model of knowledge translation: making the researcher a part of the user group context.

Evidence-Based Medicine↗

PubMed2004

Relationship between methamphetamine use and risky sexual behavior in adolescents.

Substance abuse and risky sexual behavior have been identified as behaviors that can endanger adolescent psychosocial development. This study examined the relationship between methamphetamine (MAMP) use and risky sexual behavior in adolescents. Risky sexual behavior was compared not only between MAMP users and non-users, but also between high-frequency and low-frequency MAMP users. We compared the sexual intercourse histories of 85 adolescents formally charged as MAMP users with those of 170 gender-matched adolescents with no record of MAMP use. MAMP usage characteristics were compared between users who had and those who had not experienced sexual intercourse. Previous sexual experience was more likely in MAMP users than in non-users. MAMP users were also more likely to have had a greater total number of sexual partners and were more likely to have had unplanned sex under the influence of alcohol. High-frequency MAMP use was associated with increased tendencies to engage in unprotected sex and to use MAMP before sexual intercourse. In general, the chance of sexual intercourse increased in proportion to frequency of MAMP use. Given the clear link between MAMP use and risky sexual behavior, risk-reduction programs directed at teen MAMP users are urgently needed.

Adolescent↗

PubMedDate not supplied

Best practice management strategies for mental health nurses during the clinical application of civil commitment: an overview.

AIM: The aim of this article is to outline best practice management strategies for nurses during the clinical application of civil commitment of mentally ill persons. METHOD: A thorough literature search on 'coercion' and 'civil commitment' was undertaken using MEDLINE, CINAHL and PSYCHINFO. Published and unpublished research undertaken by the authors in New Zealand on this topic was drawn upon. This research considered the use of civil commitment during admission to acute mental health services, acute forensic mental health services and community mental health services. RESULTS: The experience of coercion by service users coincides with the degree of restriction associated with the service they are involved in. Socio-demographic factors, clinical factors and the experience of coercive events have little bearing on the amount of coercion experienced. Rather it is the pattern of communication and the use of 'procedural justice' that has the potential to ameliorate the amount of perceived coercion. CONCLUSIONS: 'Procedural justice' aligns with the emphasis placed on the therapeutic relationship in mental health nursing and is an important consideration for nurses during the clinical application of civil commitment.

Coercion↗

PubMed2000

Measuring satisfaction with social care amongst older service users: issues from the literature.

Issues of quality and accountability in social care for older people are of increasing importance. A key factor in determining quality is the extent to which older people themselves are satisfied with both the assessment of their needs and the services provided. The 1997 White Paper, Modernising Social Services, stated that local authorities will need to establish authority-wide objectives and performance measures to improve the quality and efficiency of services. In measuring quality, the White Paper stipulated that social service departments would need to design and administer satisfaction surveys as one means of capturing user and carer perceptions and experiences of services. This paper attempts to highlight some of the main issues to be considered when designing and conducting such surveys with older users of community care services. Through a review of the British and North American literature on older people's satisfaction with services, current approaches to measuring satisfaction are outlined and the relationship between the characteristics and circumstances of older people and their responses to satisfaction questions is examined. The paper concludes by offering some solutions to overcoming current problems by drawing conclusions about quality from survey findings, so that older people's opinions about the services they receive can begin to be assessed in a more meaningful way.

Journal Article↗

PubMed2003

Patterns of use and harms associated with non-medical ketamine use.

AIM: To (1) identify current patterns of non-medical ketamine use; and (2) identify potential harms associated with non-medical ketamine use. DESIGN: Cross sectional survey of lifetime ketamine users. SETTING: Semi-structured interviews took place in public and private settings in Sydney Australia. PARTICIPANTS: One Hundred ketamine users. MEASUREMENTS: Self-reported experiences with and attitudes towards ketamine use. FINDINGS: Ketamine appeared to be added to an already extensive drug use repertoire of a well-educated and informed sample. Many users reported regularly experiencing effects such as an inability to speak, blurred vision, lack of co-ordination and increased body temperature, which resulted in some either reducing their dose or stopping use. CONCLUSIONS: Many users had experienced significant negative effects, such that some had either reduced their dose or stopped use altogether and expressed concerns over some others. This study reinforces the need to develop harm minimisation campaigns that match the experiences and attitudes of their target group through careful needs assessment and appropriate evaluation.

Adult↗

PubMed2006

Hedonic ratings and perceived healthiness in experimental functional food choices.

The associations of liking and perceived healthiness ratings between repeated food choices were studied in two experiments. Participants' snack bar (n=41, Experiment I) and beverage (n=60, Experiment II) choices among six product alternatives were monitored for 4 and 3 weeks, respectively. In Experiment I, participants were allowed to familiarise themselves with snack bar alternatives ("familiar assortment") prior to making choices. In Experiment II, the participants started making their beverage choices without familiarising themselves ("unfamiliar assortment"). In both experiments, the participants were divided into three groups according to their choice behaviour for each alternative: non-interested (0 choices), experimenters (1 choice) and potential frequent users (2 or more choices). In Experiment I, the overall difference between non-interested and potential frequent users of a product was 1.3 points in expected liking and 2.6 points in actual liking on a 7-point scale (ANOVA, p<0.001). In Experiment II, the overall differences in blind hedonic ratings between non-interested participants and potential frequent users of a product were within a range of 0.9 points (p<0.001). The difference was wider for expected liking ratings, 1.3 points (p<0.001). Neither the perceived healthiness of the samples nor the background attitudes could be consistently associated with the choices (Pearson's correlation coefficient).

Adult↗

PubMed2002

Septic deep venous thrombosis in intravenous drug users.

OBJECTIVE: To review diagnostic and therapeutic experience in seven patients with septic deep vein thrombosis (DVT) after intravenous use of illicit drugs. METHODS: Retrospective review of medical records and prospective data collection in intravenous drug users (IVDU) who presented with a confirmed diagnosis of DVT and sepsis during a period of 18 months in a single institution. RESULTS: Of seven long-term IVDU (age 24-40 years), who had repeatedly attempted venous access to proximal veins, five had femoral DVT and one each jugular and brachial DVT. All DVT were confirmed by contrast-enhanced helical CT or ultrasonography. Median C-reactive protein (CRP) was 215 mg/l (range 76-386). Multiple blood cultures grew Gram-positive bacteria in 7 of 8 patients, chiefly Staphylococcus aureus, confirming an intravascular infection with continuous bacteraemia. Therapy consisted of intravenous b-lactamase-resistant penicillin until normalisation of CRP (3-4 weeks), initially combined with an aminoglycoside for a few days. The mean defervescence time was 7.4 days (range 3-12). All patients were given intravenous heparin overlapping with oral anticoagulation without major side effects. Surgical exploration of the venous vasculature was never necessary. Mean hospital stay was 25.7 days (range 10-47). CONCLUSION: Septic DVT in IVDU is a potentially life-threatening disorder that may become more frequent as the number of long-term IVDU increases. Helical CT or colour-coded Doppler ultrasound is the confirmatory imaging procedure of choice. Empirical antibiotic therapy should include a ss-lactamase-resistant penicillin since S. aureus is the most common pathogen isolated. Anticoagulation can be safely initiated once the diagnosis of DVT is confirmed. Surgery is necessary only in rare instances of septic DVT.

Adult↗

PubMed1998

Patients' views of direct access to specialists: an Israeli experience.

CONTEXT: Surveys carried out among users of medical services can be a useful tool for health care organizations in designing proper services. Specifically, patients' views of direct access to specialists can be useful to health organizations considering the gatekeeper model. OBJECTIVE: To assess patients' opinions about direct access to specialists and referral to specialists through their primary care physician. DESIGN: An intercept survey, in which patients were interviewed at the randomly selected service provision sites, was carried out in 3 districts in Israel during 1995. A total of 1445 and 1289 patients were interviewed in primary care and specialty clinics, respectively. SETTING: Primary care and specialty clinics in 3 regions in Israel serving 750000 members of Kupat Holim Clalit, Israel's largest sick fund. PARTICIPANTS: Hebrew-speaking members of Kupat Holim Clalit who visited the primary care or specialty clinics in the 3 regions during the study period. MAIN OUTCOME MEASURES: Rate of preferences for direct access to specialists and preferences for referral through primary care physician. RESULTS: Fifty-two percent of the respondents preferred direct access to specialists, while 48% preferred a referral from their primary care physician. Multivariate logistic regression analysis indicated that the preference for direct access was significantly lower among patients older than 45 years (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.62-0.91); patients whose primary care physician was a specialist in family medicine (OR, 0.80; 95% CI, 0.67-0.97); and patients who were satisfied with their primary care physician (OR, 0.34; 95% CI, 0.27-0.44). Preference for direct access was significantly higher among more highly educated patients (OR, 1.38; 95% CI, 1.16-1.65) and patients residing in Jerusalem (OR, 2.46; 95% CI, 2.05-2.95) and those younger than 45 years who were dissatisfied with their family physician or a primary care physician who was not board certified. If direct access was not available, 33% of respondents would leave the sick fund and 48% would remain; 19% did not know. CONCLUSIONS: Informing sick fund members, particularly the younger and more educated among them, about the advantages of consulting with the primary care physician, as well as providing specialty training in family medicine to primary care physicians, may reduce patients' preference for direct access to specialists.

Adult↗

PubMed1994

Mortality study on a cohort of Italian licensed pesticide users.

This study describes the mortality experience in a cohort of 23,401 farmers, residing in southern Piedmont, Italy, and licensed to use pesticides. From 1970 to 1986 the cohort included 340,794 person-years and 2683 deaths were observed. A strong attenuation of the death risk was found due to the healthy worker effect (seen as an active role in the application for the license by the members of the cohort) and due to the limited comparability of the cohort with respect to the reference population. The standardized mortality ratios (SMRs) were remarkably < 100 for all causes (SMR = 59; 95% confidence interval = 57-61) and for all tumors (SMR = 60; 95% CI 55-64), but they increased with the increasing duration of the follow-up. A risk increase was observed with respect to melanomas and eye tumors in the entire cohort and lymphoma and tumors of the connective tissue in the subcohort of subjects living in villages with mainly arable land.

Adolescent↗

PubMed2006

Progestogen-only contraception and bone mineral density: a systematic review.

Questions have been raised about the effects of progestogen-only contraceptive use on bone health, particularly among young women who have not yet reached peak bone mass and perimenopausal women who may be starting to lose bone mass. We conducted a systematic review that evaluated the association between progestogen-only contraceptive use and fracture risk or bone mineral density (BMD). We identified 39 articles from MEDLINE and EMBASE, published through July 2005. One study reported that depot medroxyprogesterone acetate (DMPA) users were more likely to experience stress fractures than nonusers; this association was not statistically significant after controlling for baseline bone density. In cross-sectional studies, the mean BMD in DMPA users was usually below that of nonusers, but within 1 SD. In longitudinal studies, BMD generally decreased more over time among DMPA users than among nonusers, but women gained BMD upon discontinuation of DMPA. Limited evidence suggested that use of progestogen-only contraceptives other than DMPA did not affect BMD.

Age Factors↗