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PubMed1985

A return to maternal mortality studies: a necessary effort.

This report reviews the experience of the Santa Clara County Maternal Mortality Study Committee, which continued its local activity after the termination of California state-supported study groups in 1970. A study of 36 maternal deaths among approximately 262,000 live births was compiled over a 13-year period, between 1971 and 1983, in a population group representative of much of California. Although based on a small population sample, the results indicate an imperative need for such reviews to improve the quality of clinical care and to develop significant statistical information on the incidence and causes of maternal mortality. The historical development of study committees throughout the United States illustrates the necessity of standardized definitions and uniform methodology among study groups in all states and territories. A nationwide study is proposed to obtain a broad-based, cumulative maternal mortality series, directed toward the eventual elimination of preventable maternal deaths. The current effort by a special interest group in the American College of Obstetricians and Gynecologists is commended for beginning this task.

Adolescent↗

PubMed1989

A methodological study of a nonlinear stochastic model of an AIDS epidemic with recruitment.

A nonlinear stochastic model of an AIDS epidemic with recruitment of infectives, susceptibles, and AIDS cases into a randomly mixing population of male homosexuals was formulated and studied from a methodological point of view through intensive computer experimentation. Probability generating functions were used to formulate a model for the monthly probability that a susceptible individual becomes infected with HIV, under the assumption that the probability of infection per sexual contact varies as a function of the duration of infection. A method for taking into account the use of condoms to prevent infection with HIV was also introduced. Nonlinear difference equations, resembling deterministic epidemic models, were embedded in the stochastic population process by iterating an initial conditional expectation. Examples of Monte Carlo experiments are presented, illustrating that solutions of these nonlinear difference equations are not always good measures of central tendency for variations in the sample functions of the process. Two important substantive conclusions drawn from the Monte Carlo experiments were that efforts should be made to collect quantitative information on the probability of infection per sexual contact as a function of duration of infection and the frequency of condom use within and among risk categories in a population.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Smoking and male reproduction: a review.

Because of the large number of men worldwide who smoke and the fact that cigarette smoke contains known mutagens and carcinogens, there has been concern that smoking may have adverse effects on male reproduction. A review of the epidemiological literature indicates that cigarette smoking is associated with modest reductions in semen quality including sperm concentration, motility and morphology. The associations between male smoking and sperm concentration and motility are stronger among studies of 'healthy' men (e.g. volunteers and sperm donors) than among men from infertility clinic populations. Smoking has also been associated with alterations in hormone levels in males, for example increases in the levels of oestrone and oestradiol. Despite modest reductions in semen quality and altered hormone levels among smokers compared to non-smokers, studies have not shown a reduction in male fertility in association with paternal smoking. There is some evidence to suggest that paternal smoking is associated with congenital anomalies and childhood cancer (with ORs in positive studies generally < 2.0). Smoking has not been shown to be mutagenic to human spermatozoa, although studies have been small and have had methodological shortcomings. It is concluded that, although smokers as a group may not experience reduced fertility, men with marginal semen quality who wish to have children may benefit from quitting smoking, since several small studies indicate the potential for improved semen quality after quitting smoking. More research on the benefits of quitting smoking among men with marginal semen quality is needed. Methodological improvements in studies aimed at clarifying the association between paternal smoking and reproductive and developmental outcomes in offspring should include obtaining accurate paternal smoking dose information, evaluating smoking exposure information in relation to various time windows (e.g. prior to conception, during gestation), and controlling for potential confounders and modifying factors such as age and maternal smoking habits. More sensitive and specific laboratory assays and increased sample sizes are required to establish whether smoking induces mutations in human spermatozoa.

Abortion, Spontaneous↗

PubMed2006

Patients' perceptions of joint teleconsultations: a qualitative evaluation.

OBJECTIVE: To determine patient perceptions of joint teleconsultations (JTC), with particular reference to reasons underlying, and factors contributing to, patient satisfaction and dissatisfaction with this mode of health delivery. BACKGROUND: Telemedicine has been welcomed as one way of improving health-care delivery, by improving patient access to secondary care and specialist services hence widening patient choice, particularly for patients outside major conurbations. However, a recent systematic review found currently available data on patient satisfaction with telemedicine to be methodologically flawed. Qualitative evaluations offer the opportunity to elucidate the details of patient satisfaction with this mode of health-care delivery. DESIGN: Qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS: Purposive sample of 28 participants of a major randomized controlled trial (Virtual Outreach study) of JTC conducted in one urban and one rural area in Britain. INTERVENTION: Joint teleconferenced consultations with the patient, patient's general practitioner (GP), and a hospital specialist. The patient and GP were sited in the local practice, while the hospital specialist was in the hospital outpatient department, and the two parties were connected by an ISDN2 link and video-conferencing software. MAIN OUTCOME MEASURES: Patient experiences of JTC, with particular reference to reasons underlying, and factors contributing to, overall satisfaction or dissatisfaction. RESULTS: Two major themes were identified: customer care and doctor-patient interaction. Patients appreciated the customer care aspects of JTC, particularly the enhanced convenience, reduced costs and improved punctuality associated with JTC. However, there were divergent views about the doctor-patient interactions with some patients expressing a sense of alienation arising from the use of technology, and problems with doctor-patient communication. CONCLUSIONS: These data add significantly to the existing literature on patient satisfaction with telemedicine, by elucidating the factors underlying overall satisfaction scores and hence have implications for future service delivery and implementation of telemedicine.

England↗

PubMed2005

Hong Kong families and breast cancer: beliefs and adaptation strategies.

In Chinese society the family not the individual is the basic structural and functional unit. Family beliefs significantly determine the impact of the illness, choice of coping patterns and ultimately the physical and behavioral reactions of both the women and their family members. The purpose of this study was to identify the family beliefs about breast cancer and how the beliefs influenced family functioning. Twenty Hong Kong Chinese families where the woman had breast cancer (N=59) were interviewed using a minimally structured schedule. Interpretive phenomenology was the qualitative methodology used in the study. Gadamer's philosophical hermeneutics related to the process of understanding, application and interpretation was used to guide the analysis. Patterns of disharmony related to stress and emotion, diet, exercise, genetics and fate were evident in the family beliefs about the causes of breast cancer and guided the cognitive, emotional and behavioral strategies they adopted to negotiate the illness experience.

Adaptation, Psychological↗

PubMed1993

[Dynamics of female single parenthood in Canada].

"In this article we look at the timing and duration of episodes of single parent status during the life course of various cohorts of women. The analysis was carried out with the help of retrospective data from a Canadian family survey carried out in 1984 which had a sample size of over 7,000 women. The results, derived from life-table techniques, show that over one woman in three was likely to experience a period of single-parent status at some time in her life at the risks current in 1984." (SUMMARY IN ENG)

Americas↗

PubMed2006

Relationships among trait, situational, and comparative optimism: clarifying concepts for a theoretically consistent and evidence-based intervention to maximize resilience.

Research evidence identifies trait optimism as the strongest individual predictor of adolescent resilience when framed within Lazarus's theory of stress and coping. As a precursor to the development of an intervention to maximize resilience, this study clarifies the concept of optimism. Relationships among trait, situational, and comparative optimism were explored. The sample (N = 132) consisted of rural adolescents between 14 and 18 years old who were attending public school. The results demonstrate weak correlations, suggesting that adolescents' perceptions of situations may be amenable to an intervention to maximize resilience but that adolescents also do not expect to experience health or environmental problems. Implications for developing an intervention are discussed.

Adaptation, Psychological↗

PubMed2006

Making sense of grounded theory in medical education.

BACKGROUND: Grounded theory is a research methodology designed to develop, through collection and analysis of data that is primarily (but not exclusively) qualitative, a well-integrated set of concepts that provide a theoretical explanation of a social phenomenon. OBJECTIVE: This paper aims to provide an introduction to key features of grounded theory methodology within the context of medical education research. OVERVIEW: In this paper we include a discussion of the origins of grounded theory, a description of key methodological processes, a comment on pitfalls encountered commonly in the application of grounded theory research, and a summary of the strengths of grounded theory methodology with illustrations from the medical education domain. DISCUSSION: The significant strengths of grounded theory that have resulted in its enduring prominence in qualitative research include its clearly articulated analytical process and its emphasis on the generation of pragmatic theory that is grounded in the data of experience. When applied properly and thoughtfully, grounded theory can address research questions of significant relevance to the domain of medical education.

Biomedical Research↗

PubMed2005

Telephone interviewing in healthcare research: a summary of the evidence.

Increasing numbers of healthcare researchers in the UK are using telephone interviews in their research. In this paper, Elizabeth Smith summarises the context in which the method is used to target purposive samples of service users or patient, carers, clinicians and other staff, or key individuals in the field of inquiry. The aim is to gain detailed and specific data about perceptions, experiences and views of healthcare services. It is useful to identify the circumstances under which the advantages and disadvantages of telephone interviewing have been realised to contextualise concerns about the quality of the data compared to other methods and provide practical advice for researchers considering using the method.

Humans↗

PubMedDate not supplied

The correspondence between intention to avoid childbearing and subsequent fertility: a prospective analysis.

CONTEXT: Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. METHODS: Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. RESULTS: Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. CONCLUSIONS: There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.

Adolescent↗

PubMed2004

Induced sputum methodology: Validity and reproducibility of total glutathione measurement in supernatant of healthy and asthmatic individuals.

Glutathione (GSH), a major antioxidant, has repeatedly been linked to the pathogenesis of pulmonary disease. The measurement of GSH in induced sputum (IS) offers a noninvasive tool for the study and monitoring of oxidative stress in airway diseases. In this study we assessed the validity and reproducibility of GSH quantification in IS from healthy subjects and individuals with mild asthma. We spectrophotometrically quantified total GSH in the IS of 31 healthy nonsmoking volunteers and 12 individuals with mild asthma. IS was processed with varying concentrations of dithiothreitol (DTT) in an effort to evaluate the effect of DTT on GSH measurements. We performed spiking experiments with defined concentrations of GSH and quantified the percentage of recovery and also analyzed the effect of induction time on GSH levels through sequential sampling of sputum portions (15, 30, and 45 minutes' induction). Finally we tested the reproducibility of GSH measurements at 2 separate time points (0 and 72 hours) and expressed it as an intraclass correlation coefficient (R(i)) with a coefficient of reliability (CR). Processing with DTT increased GSH values in IS (P <.05 for each DTT concentration > 0.001%). Recovery of GSH after spiking was complete, with a mean recovery of 102% +/- 4.8%. Increasing duration of induction led to an increase in sputum GSH (15 minutes, 10.2 +/- 2.3 micromol/L; 30 minutes, 18.4 +/- 3.5 micromol/L; 45 minutes, 26.1 +/- 4 micromol/L; P <.05 for all comparisons). Reproducibility of sputum GSH both in healthy subjects and asthmatic individuals was good (R(i) =.78, P <.001; and R(i) =.51, P =.003, respectively). With the use of standardized protocols for duration of induction and sample processing, sputum GSH measurement in healthy subjects and asthmatic individuals is valid and reproducible.

Administration, Inhalation↗

PubMed1999

Mortality among involuntarily admitted psychiatric patients: a survival analysis.

BACKGROUND: Only a few studies have examined mortality among committed psychiatric patients, and most of them suffer methodologically from selected populations, small samples, and inappropriate methods of data analysis. The purpose of this study was to determine whether involuntarily admitted psychiatric inpatients are a high risk group for mortality compared to a group of voluntarily admitted psychiatric inpatients. METHOD: A retrospective cohort design was used with a maximum 9-year variable follow-up. A multistage sampling procedure was used to generate the sample, which consisted of 1064 involuntarily admitted patients and 1078 voluntarily admitted patients. RESULTS: During the follow-up period, 107 deaths were identified, 58 involuntary and 49 voluntary [chi 2 (1) = 0.9255, P = 0.336]. No significant differences were observed between the cohorts when survival analysis was used to examine survival experiences in the community. CONCLUSIONS: Compared to voluntary patients, involuntary patients do not appear to be at a higher risk for mortality. The high standard mortality ratios observed in both cohorts, however, are consistent with previous findings of high mortality among psychiatric patients in general, and support the need for intensive follow-up in the community following discharge from a psychiatric inpatient unit.

Adult↗

PubMed2001

Psychophysiological arousal in older adults: a critical review.

In spite of the relatively high prevalence rates of anxiety disorders (AD) and related symptoms, very little is known about the experience, presentation, and assessment of anxiety in later life. Because the physiology of the autonomic nervous system changes with age, an enhanced understanding of how these developmental changes affect the somatic-physiological response patterns to anxiety-evoking stimuli among older adults may help explain whether we can generalize current assessment and treatment practices and procedures for AD from younger to older adults. In this paper, we describe and critically evaluate studies that have employed psychophysiological recording of autonomic arousal to anxiety-arousing or stressful stimuli among samples of younger and older adults. The conclusions one can draw from the review are quite limited by both the paucity of relevant literature and the methodological limitations of the published studies.

Adolescent↗

PubMed2004

Oral health status of children and adults in urban and rural areas of Burkina Faso, Africa.

OBJECTIVES: To analyse the oral health status of children and adults in rural and urban areas of Burkina Faso; to provide epidemiological data for planning and evaluation of oral health care programmes. DESIGN: Cross-sectional survey including different ethnic and socio-economic groups. SAMPLE AND METHODS: Multistage cluster sampling of households in urban areas and random samples of participants selected based on the recent population census in rural areas. The final study population covered four age groups: 6 years (n = 424), 12 years (n = 505), 18 years (n = 492) and 35-44 years (n = 493). Clinical oral health data collected according to WHO methodology and criteria. RESULTS: At age 6, 38% of children had caries, with prevalence higher in urban than rural areas. At age 12, the mean DMFT was 0.7 with prevalence significantly higher among urban than rural children. Mean DMFT was 1.9 in 18-year-olds and 6.3 in 35-44-year-olds and figures were higher for women than men. In adults, no differences in caries experience were found by location whereas the caries index was significantly affected by ethnic group and occupation. CPI score 2 (gingivitis and calculus) was dominant for all ages: 6 years (58%), 12 years (57%), 18 years (58%), 35-44 years (49%). In addition, 10% of 35-44-year-olds had CPI score 4. Rural participants had more severe periodontal scores than did urban individuals. CONCLUSIONS: Health authorities should strengthen the implementation of community-based oral disease prevention and health promotion programmes rather than traditional curative care.

Adolescent↗

PubMed2002

Nurses' attitudes to palliative care in nursing homes in Western Australia.

Nursing homes are one of the care settings in Western Australia where older people may spend their final years. Residents should be able to receive palliative care where appropriate, but this type of care is not always available at some nursing homes in the state. This study investigated nurses' attitudes to palliative care in nursing homes by examining their cognitive, affective and behavioural information. A sample of 228 nurses working in nursing homes completed a questionnaire, using a free response methodology. Results showed that participants had either a positive or negative attitude to palliative care. Cognitive and affective information significantly and independently predicted the attitudes of nurse, whereas knowledge of palliative care did not contribute significantly to these attitudes. Nurses currently working in palliative care were more positively disposed towards such care, but this disappeared when they ceased working in the area. There is an emphasis on education in the literature which does not take into account the beliefs and emotions of the nurse. Therefore, there is a need to consider these in undergraduate and postgraduate training for nurses. Current experience is also important in palliative care education. The results obtained from nurses in this study should be incorporated into policy for introducing palliative care into nursing homes and used to provide support and assistance to nurses working in this field.

Attitude of Health Personnel↗

PubMed2000

Attachment style in the context of clinical and health psychology: a proposal for the assessment of valence, incongruence, and accessibility of attachment representations in various working models.

By combining the Adult Attachment Interview and the Autobiographical Memory Test, a structured interview was developed as a 'quick and dirty' measure for the assessment of attachment representations in clinical settings. The interview intends to assess valence, incongruence, and accessibility of the attachment representations that are organized in various mental models of relationships. In this study the mental models of relationships involving parents and current partner were addressed, as well as the more general model of self in relationships with significant others. Validity was examined in a sample of couples from the general community. Interrelationships between the different models of attachment relationships were strong enough to warrant the conclusion that each contributes to the same construct (style). Correlations with theoretically proposed consequences of insecure attachment style showed salience of specific working models: valence of self and partner (but not of parents) representations, and incongruence of parental representations related to depressive symptomatology, trait anxiety, relational quality, and communication efficiency. Results indicated that assessment of representations in the working models of different attachment relationships might prove useful in clinical settings, as it might enable localization of those representations that are related to the individual's experience of adversity in interpersonal relationships and affect regulation. Methodological shortcomings are discussed in this context.

Adult↗

PubMed2003

A novel method for diagnosing chronic rhinosinusitis based on an electronic nose.

The nasal out-breath of persons with chronic nasal and/or paranasal infections may have characteristic strange odors, which in our experience are in most cases related to bacterial and/or fungal infections of the sinuses. The objective of the present study was to examine nasal out-breath samples from patients with chronic rhinosinusitis (CRS) (with or without polyposis) and healthy control volunteers using the electronic-nose (EN) technology. We developed a simple technique for collecting samples of nasal out-breath in disposable sterile plastic sacks with a tight closing seal. The principal component analysis correctly classified all individual EN patterns for CRS patients and misclassified 2 samples from the healthy controls (80.0% successful classification rate). The artificial neural network analysis correctly classified 60.0% of the patterns of both groups. We believe that the use of methodologies based on EN technology, combined with conventional clinical examinations, may improve the diagnosis of chronic rhinosinusitis.

Adult↗

PubMedDate not supplied

Industrial hygiene sampling and applications to ambient silica monitoring.

Interest in ambient exposures to silica has prompted an evaluation of the applicability of the industrial hygiene sampling and analysis experience. Exposure to excessive levels of silica in the workplace has long been recognized as a risk factor for the development of a variety of disabling and sometimes fatal lung diseases. Initial efforts to control occupational exposure to dust were based on reducing exposures as measured by particle-counting techniques. Because silicosis, the disease resulting from exposure to silica, occurs in the lower airways, which can be reached only by small "respirable dust" particles, size selective sampling procedures were introduced for dust monitoring. The analysis of silica in collected dust samples also has undergone development. Initial methods used involved acid digestion of soluble silicates, with subsequent chemical analysis of the insoluble "free silica" fraction. Current methodology relies on the use of X-ray diffraction and infrared technologies to quantify these materials. However, these methods are sensitive to the particle size distribution of the samples. Standard reference materials (SRMs) have been developed for use with respirable size dust samples. Ambient particulate matter is now measured using the U.S. Environmental Protection Agency sampling methods for particulate matter < or = 10 microns, which approximate the collection efficiency for thoracic fraction samplers. Because the existing calibration SRMs were produced for the measurement of occupational crystalline silica, the need to develop appropriate standards and methods for ambient silica measurements should be evaluated.

Air Pollutants, Occupational↗