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PubMedDate not supplied

Assumptions, ambiguities, and possibilities in interdisciplinary population health research.

The rhetoric of "interdisciplinary," "multi-disciplinary," and "transdisciplinary" permeates many population health research projects, funding proposals, and strategic initiatives. Working across, with, and between disciplines is touted as a way to advance knowledge, answer more complex questions, and work more meaningfully with users of research. From our own experiences and involvement in the 2003 CIHR Institute for Public and Population Health's Summer Institute, interdisciplinary population health research (IPHR) remains ambiguously defined and poorly understood. In this commentary, we critically explore some characteristics and ongoing assumptions associated with IPHR and propose questions to ensure a more deliberate research process. It is our hope that population health researchers and the CIHR will consider these questions to help strengthen IPHR.

Attitude of Health Personnel↗
PubMed2005

Primary care. Ringing the changes.

A 2000 DoH review called for out-of-hours services to be straightforward for users to access, and for service planning to involve multi-disciplinary co-operation from health professionals. Out-of-hours provision has evolved since then, but missed targets, insufficient staff numbers and inequalities between different providers continue to hamper progress.

After-Hours Care↗
PubMedDate not supplied

[Bioinformatics and GenEnv database in biological risk management].

Identification and molecular typing of environmental isolates by molecular techniques requires knowledge of the genetic characteristics of the microbe species being examined. The introduction of automated sequences has greatly speeded up the entire sequencing process as well as improved the accuracy of the collected information. Bioinformatics tools have become indispensable not only for setting up research studies, but also for storing, organizing and managing enormous quantities of sequencing data. Despite its great advantages, the use of bioinformatics is hindered by difficulties in learning how to use its software tools. The GenEnv database was developed to provide operators involved in biological risk management with a user-friendly tool for sequence analysis. Presently, there are over 20.000 sequence records, and over 9000 bacterial species represented in the database. The initial gene set comprises rDNA16S, rpoB, gyrB. The system allows sequence-driven microbe identification as well as the development of study protocols for research on specific microbe species. Nucleotide sequences are represented graphically. The GenEnv database was designed as a tool for public health operators but also offers wide prospects for scientific research.

Computational Biology↗
PubMedDate not supplied

[The occupational health physician in the factory].

In the absence of specific legislation, the rôle of the factory doctor is based on the employer's responsibilities and consists in practice of establishing a health surveillance programme for the exposed workers, using diagnostic protocols appropriate to the risks involved. It is important to supply information to users and the Local Health Units; the factory doctor must also be fully competent, especially for the purposes of assessment of results, which then dictate the direct measures he must take.

Humans↗
PubMedDate not supplied

Substance abuse by adolescents in Israel and France: a cross-cultural perspective.

Household surveys of urban youths 14-18 years of age were conducted in 1979 with 609 Israeli adolescents and in 1977 with 499 French adolescents. The overall order in the prevalence of use of legal and illegal drugs was identical in both countries. Cigarettes and alcohol were used by a larger proportion of young people than the illegal drugs; marijuana was used much more frequently than any other illicit drug. The same cumulative sequence of drug use appeared in the survey data for French and Israeli adolescents as in comparative data for adolescents in the United States--cigarette and alcohol use preceded the use of illicit drugs. Striking cross-cultural differences appeared in the overall lifetime and current prevalences of use of all drugs, in the frequency of use, and in the age- and sex-specific rates for adolescents in Israel and in France. French youths uniformly reported greater lifetime and current use of all alcoholic beverages, cigarettes, and illegal drugs, more extensive involvement, and smaller sex differences than the Israeli youths. Prevalence of the use of drugs in a culture appears to be associated with four social processes: higher number of times each drug has been used; greater persistence of involvement, as reflected by the proportions of current users among those who ever tried a particular drug; earlier age of first use; and a spread of the phenomenon throughout all groups in society that attenuates group differences in drug experiences. These cross-cultural results suggest a relatively conservative position with regard to accessibility and availability of substances: reducing availability may be one way to reduce individual consumption by impinging not on individual persons directly but on society.

Adolescent↗
PubMed1981

Toxic shock syndrome.

Eight cases of toxic shock syndrome, confirmed by Center for Disease Control criteria, involved women who were menstruating and were tampon users. Each patient had severe febrile illness with rash, associated hypotension, renal and liver function abnormalities, pharyngitis and vaginitis. An examination of the literature indicates that cases that were reported as adult Kawasaki disease may actually have been toxic shock syndrome.

Adolescent↗
PubMed1997

Community-acquired lower respiratory tract infection: implementation of an antibiotic protocol.

Enthusiastic formulation of clinical guidelines continues to increase but although theoretical difficulties in guideline implementation have been recognised, little attention has been paid to their effectiveness in everyday clinical practice. The introduction of a protocol for empirical treatment of lower respiratory tract infection (PETRI) to an acute medical take-in unit in Belfast is described. Early involvement of all relevant staff, preparation of user-friendly flow charts, and imaginative publicity, resulted in an initial implementation rate of 75%. The role of implementation as a significant rate-limiting step in the audit cycle is emphasised.

Anti-Bacterial Agents↗
PubMedDate not supplied

Developing the theoretical basis for service user/survivor-led research and equal involvement in research.

AIMS AND METHODS: This article, written from a service user/survivor perspective, explores a hypothesis which seeks to offer a more systematic basis for the full and equal involvement of mental health service users/survivors in both the research process and research structures more generally. The hypothesis challenges traditional emphasis on positivist assumptions about the priority of values of 'distance', 'neutrality' and 'objectivity' (which it argues discriminate against service users and their experiential knowledge). It explores instead the idea that 'the shorter the distance between direct experience and its interpretation, then the less likely resulting knowledge is to be inaccurate, unreliable and distorted.' RESULTS AND CONCLUSIONS: The proposal discusses ways in which such (objective and subjective) distance may be reduced, to improve the quality of research, to enable more equal involvement of service users and their direct experience and to make it possible for non-service user researchers to work alongside service users on more equal terms.

Attitude to Health↗
PubMed2005

Participation for understanding: an interactive method.

INTRODUCTION: There are many available models that help evaluate the effectiveness of safety and health measures, but many are complex and require input from many departments within an organization. There is a need to develop a more user-friendly model. METHOD: A participative model was developed that involves face-to-face interviewers with workers, maintenance department, purchasing department and health and safety experts. They were asked about costs, efforts, benefits, and effects of gauging the effects of prevention efforts. RESULTS: Cost effectiveness analyses are essential in all cases and can include whatever the end-user requires, whether it is a small or lasting improvement. Having management participate helps validate the data. CONCLUSIONS: Organizations who collaborate with someone with at least some skill in cost-benefit evaluations will find that they will be able to establish policies and procedures from the data. The end result is a calculation that is understood by all involved.

Cost-Benefit Analysis↗
PubMed2006

Reflective testing--what do our service users think?

BACKGROUND: Reflective testing incorporates the clinical judgement, knowledge and experience of an individual biochemist to request additional tests appropriate to the clinical scenario. Despite being vigorously debated within the biochemistry profession, little is known about how the clinicians directly involved in patient care feel about it. We have conducted a survey to elicit our service users' opinion of reflective testing. METHODS: Ten clinical scenarios, each involving the possible addition of a specific test, were circulated to 520 hospital doctors and 152 general practitioners. The four response options were to add further tests, phone and discuss the case, add a comment to the original results or do nothing. RESULTS: A total of 216 (32%) responses were received. Overall, the majority were in favour of 'adding on' free triiodothyronine (86%), gamma-glutamyltransferase (78%), lipid profile (59%), thyroid peroxidase antibodies (63%), pituitary hormones (58%), troponin (55%) and serum electrophoresis (68%) in the given scenarios. However, only 30% would like a pregnancy test added and only 45% a prostate-specific antigen added without prior consultation. The response differed according to grade and specialty. CONCLUSIONS: Reflective testing is generally welcomed by our service users, provided the nature and implications of the specific test is considered in addition to the full clinical scenario.

Adolescent↗
PubMed2002

[Analysis of biases in epidemiological knowledge of road accidents in France].

BACKGROUND: In France, as in many countries, road casualty statistics are mostly based on police reports. It is generally recognized that these data are incomplete but no measurement has been made of the degree of under-reporting and thus of associated biases. This study aims to demonstrate and quantify these biases. METHODS: The study compares, after data linkage, the 10,202 people reported injured or killed in 1996 in the medical road accident victims Register in the Département du Rhône (France), with the 4,572 victims reported by the police during the same year and in the same area. This Département was chosen, as it is the only region in France where these two independent data sources coexist. Two types of possible biases are studied: injury severity classification bias and selection bias induced by underreporting. RESULTS: The study shows that the definition of "serious injury" used by the police exaggerates the severity of the victim's condition in over half the cases. This bias depends on road user group. This bias is maximum for pedestrians: compared to a slightly injured car occupant, a pedestrian with the same injury severity level has significantly more chance to be considered as severely injured (RR=1.78; 95% CI: 1.11-2.87). Conversely, significant selection biases are related to data collection by the police. The multivariate analysis shows that the underreporting of victims increases if no third party is involved (i.e. without any other vehicle or pedestrian), and reduces with injury severity. It also varies by road user group (with the largest underreporting for cyclists). Among the most seriously injured in accidents involving third parties, motor cyclists and car users are the most reported category and pedestrians the least (RR=0.80; 95% CI: 0.70-0.92). Biases in Register selection are much more limited and basically concern underreporting of victims of minor accidents who did not require medical care. CONCLUSIONS: This study confirms and quantifies misleading distortions in police statistics used to assess road accidents. These results concern the relevant indicators to be used to define road safety issues.

Accidents, Traffic↗
PubMed2006

The potential for accurately measuring behavioral and economic dimensions of consumption, prices, and markets for illegal drugs.

There are numerous analytic and methodological limitations to current measures of drug market activity. This paper explores the structure of markets and individual user behavior to provide an integrated understanding of behavioral and economic (and market) aspects of illegal drug use with an aim toward developing improved procedures for measurement. This involves understanding the social processes that structure illegal distribution networks and drug users' interactions with them. These networks are where and how social behaviors, prices, and markets for illegal drugs intersect. Our focus is upon getting an up close measurement of these activities. Building better measures of consumption behaviors necessitates building better rapport with subjects than typically achieved with one-time surveys in order to overcome withholding and underreporting and to get a comprehensive understanding of the processes involved. This can be achieved through repeated interviews and observations of behaviors. This paper also describes analytic advances that could be adopted to direct this inquiry including behavioral templates, and insights into the economic valuation of labor inputs and cash expenditures for various illegal drugs. Additionally, the paper makes recommendations to funding organizations for developing the mechanisms that would support behavioral scientists to weigh specimens and to collect small samples for laboratory analysis-by providing protection from the potential for arrest. The primary focus is upon U.S. markets. The implications for other countries are discussed.

Cross-Sectional Studies↗
PubMed2002

System for assisted mobility using eye movements based on electrooculography.

This paper describes an eye-control method based on electrooculography (EOG) to develop a system for assisted mobility. One of its most important features is its modularity, making it adaptable to the particular needs of each user according to the type and degree of handicap involved. An eye model based on electroculographic signal is proposed and its validity is studied. Several human-machine interfaces (HMI) based on EOG are commented, focusing our study on guiding and controlling a wheelchair for disabled people, where the control is actually effected by eye movements within the socket. Different techniques and guidance strategies are then shown with comments on the advantages and disadvantages of each one. The system consists of a standard electric wheelchair with an on-board computer, sensors and a graphic user interface run by the computer. On the other hand, this eye-control method can be applied to handle graphical interfaces, where the eye is used as a mouse computer. Results obtained show that this control technique could be useful in multiple applications, such as mobility and communication aid for handicapped persons.

Activities of Daily Living↗
PubMed2006

Enhanced lipid peroxidation and nitric oxide products with deranged antioxidant status in patients with head and neck squamous cell carcinoma.

Reactive oxygen species (ROS) and reactive nitrogen species (RNS) can function both as initiators and promoters in carcinogenesis. Antioxidants provide protection against cellular and molecular damage caused by ROS and RNS. We conducted a study to evaluate the levels of lipid peroxidation products, nitric oxide (NO) products and antioxidants in patients with head and neck squamous cell carcinoma (HNSCC). Fifty one HNSCC patients, 33 healthy tobacco smokers/chewers as tobacco user controls, and 37 non-smokers/chewers as normal controls were recruited for this study. Lipid peroxidation products, NO products and antioxidants were measured using spectrophotometric methods. Lipid peroxidation products, including lipid hydroperoxide (LHP) and malondialdehyde (MDA), nitric oxide (NO) products, including nitrite (NO(2)(-)), nitrate (NO(3)(-)), and total nitrite (TNO(2)(-)) were found to be significantly elevated with a concomitant depletion of antioxidants in HNSCC patients as compared to tobacco users and normal controls. These derangements were also evident albeit to a lesser degree in tobacco users as compared to normal controls. Results from this study demonstrate a potential involvement of both ROS and RNS in the pathogenesis of HNSCC and also illustrate the risk of ROS/RNS induced damage healthy tobacco users are exposed to, implicating their higher risk for upper aerodigestive tract cancer.

Adult↗
PubMed1998

[Last word on hormone replacement and breast cancer?].

A very large meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer has revealed an increasing risk of breast cancer with longer durations of use of hormonal replacement therapy (HRT). This risk increase is restricted to current users of HRT or women who ceased use recently. A 35% increase of the relative risk of breast cancer was found after 5 years of HRT use or longer. After cessation of HRT use the excess breast cancer risk disappeared in 5 years, even after long durations of use. The risk increase was greater for women of normal or lean body weight than for more obese women. Tumours found in women who ever used HRT were diagnosed at a lower clinical stage, which suggests that enhanced screening might be involved. However, the increased breast cancer mortality in HRT users, as found in other studies, rather suggests a biologic mechanism Long-term use of HRT is not yet common in the Netherlands, but an increasing trend is present. Thus, the benefits of long-term use of HRT must be carefully weighted against the risks.

Aged↗
PubMed1987

AIDS-related glomerulopathy: occurrence in specific risk groups.

The histopathology and incidence of AIDS-related glomerulopathy was evaluated by renal biopsy (N = 24) or at autopsy in 159 patients, including 131 adults and 28 infants and children with AIDS. Thirty-five patients had overt clinical manifestations of renal disease characterized by a nephrotic syndrome with focal and segmental glomerular sclerosis (FSS). Fifteen patients had diffuse glomerular mesangial hyperplasia (MH) without or with minimal clinical renal disease and 109 had intact or minimally involved glomeruli. Whereas 15 of 30 (50%) i.v. drug users with AIDS had evidence of renal disease, only one of 53 (2%) homosexuals had clinical renal disease and only 6 (11%) had histologic evidence of glomerular pathology. The study confirms the important risk of i.v. drug use as a pathogenic factor of renal disease and shows a rarity of renal disease in homosexual or bisexual men with AIDS. On the other hand, 30% of adult Haitians with AIDS had FSS or diffuse MH, although i.v. drug use is not an important risk factor in this population. Moreover, eight of 28 (29%) children with perinatal AIDS had evidence of renal involvement, including four with a nephrotic syndrome and FSS. The data provide strong evidence for the existence of an AIDS-related glomerulopathy independent of i.v. drug use, but suggest that unrecognized co-factors may be important in the development of renal disease.

AIDS-Related Complex↗
PubMed2000

[Abdominal-pelvic actinomycosis with urinary tract involvement, secondary to gynecologic infection caused by intrauterine device].

Abdomino-pelvic actinomycosis is a condition caused by Actinomyces israelii, a Gram-positive opportunistic bacteria that triggers and develops the infection only in previously injured tissues, and then slowly progresses and spreads until it extrinsically affects the urinary tract. Use of an intrauterine device is a known risk factor to suffer from this disease. Relative risk in IUD users is two- to four-fold higher compared to IUD non-users. Risk increased with prolonged IUD use. Treatment is by removal of the causative agent, surgical resection of necrotic tissues and administration of intravenous Penicillin G, 4 million units every 4 hours for 30 days, followed by Amoxicillin 500 mg every 8 hours for 12 months. This paper contributes two cases of abdomino-pelvic actinomycosis with urinary tract involvement in IUD users. Standard treatment was employed with good evolution.

Actinomycosis↗