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PubMed2005

Evaluation and deployment of evidence based patient self-management support program for Bulimia Nervosa.

OBJECTIVE: This article presents initial results from a European multi-centre study to determine the effectiveness and feasibility of an online self-help treatment support program for Bulimia Nervosa (BN). METHOD: The online program is based on Cognitive Behavioral Therapy (CBT) and consists of seven steps that patients work through progressively. An overall sample of 141 women suffering from BN used the program over a 6-month period. Patients were supported by three face-to-face evaluation interviews with a therapist, and a weekly e-mail contact. Data on general psychopathology and specific eating disorder symptoms were also collected at the evaluation interviews. RESULTS: Initial results from the Swiss sample (N=41) showed significant improvement of overall psychological health (p<.001) as measured by the Symptom Checklist (SCL-90R), and for all dimensions of the Eating Disorder Inventory (EDI-2). CONCLUSION: An online Self-Help program for BN can be used effectively to reduce eating disorder symptoms in Bulimic patients and user feedback showed that this approach contributed to increase patient involvement and service availability. Additional data from the other centers will further inform the efficacy and impact of this approach.

Adolescent↗

PubMed2002

Molecular epidemiology of Leishmania infantum on the island of Majorca: a comparison of phenotypic and genotypic tools.

In the Mediterranean basin, Leishmania infantum is the causative agent of both visceral and cutaneous leishmaniasis, and is an important opportunistic parasite in patients infected with human immunodeficiency virus (HIV). The commonest method used to study the variability of Leishmania spp. is isoenzyme analysis. In addition to this, we employed 3 assays based on the polymerase chain reaction (PCR): random amplified polymorphic deoxyribonucleic acid (RAPD), intergenic region typing (IRT), based on the amplification of ribosomal ribonucleic acid internal transcribed spacers and restriction fragment length polymorphism (PCR-RFLP). We used 54 L. infantum stocks isolated from HIV co-infected patients, 38 isolated from dogs, 3 isolated from immunocompetent patients and 3 isolated from 1826 sand files in the island of Majorca (Spain), a closed ecological niche. Zymodemes MON-1 (70%), MON-24 (11%) and MON-34 (18%) were found among the human isolates, and MON-1 (95%) and MON-108 (5%) among those from dogs. RAPD and IRT could not discriminate among the strains as they all gave the same pattern, even when different zymodemes were examined. In contrast, PCR-RFLP was able to distinguish the strains and, furthermore, a dendrogram (unweighted pair group method with arithmetic average [UPGMA]) was constructed from the genetic distances derived from RFLP data. The Leishmania isolates from HIV-infected subjects formed a single cluster, supporting the existence of an artificial anthroponotic cycle previously proposed by our group, in which syringes have been substituted for sand flies, and in which certain clones have been spread among intravenous drug users. This contrasts with the clusters representing a zoonotic cycle, involving dogs, sand flies and both immunocompetent and immunocompromised humans.

AIDS-Related Opportunistic Infections↗

PubMed2003

Factors affecting commercial application of embryo technologies in New Zealand: a modelling approach.

New reproductive technologies include sexed sperm and embryo-based technologies. The technology of sperm sexing, for various reasons, is not available in New Zealand and its use has not been modelled. Embryo technologies are however already in use on a limited scale and various scenarios for their use in both the dairy and beef industries in New Zealand have been modelled. This review briefly discusses the various technologies available and some of their potential strengths and weaknesses. In the dairy industry, modelling has been used to simulate the production of breeding bulls for large breeding companies and the production of replacement heifers in dairy herds. For the beef industry, similar modelling has been carried out to determine the opportunities for more efficient beef production. All the models confirmed that at current levels of performance, embryo-based reproductive technologies are usually not profitable in New Zealand except in niche market situations where the returns from the resulting offspring are significantly greater than can be obtained from natural mating or artificial insemination (AI) reproduction systems. This is confirmed by the low uptake of these technologies in this country to date. Even if performance lifts to levels similar to AI, profitability is likely to occur only if the costs of pregnancies to embryo-based reproductive technologies can occur at prices less than two to four times greater than AI or natural mating. This break-even requirement depends on the returns that can be achieved and the advantages that can be captured by the technology over and above those available from AI or natural mating. Two new uses for reproductive technologies in dairy cattle could be the proliferation of novel or rare genotypes from gene discovery programs and improving the female reproductive rate for optimal marker assisted selection. In both these uses the technology is not at present competing with AI or natural mating. The challenge exists therefore for the biological scientists to satisfy these requirements, coupled with the ethical and human factors involved in the introduction of any new technology. Potential end users of the technologies have been surveyed. They are quite positive about the technologies provided they can use them profitably and are keen to obtain more information about them.

Animals↗

PubMed2000

Heroin modulates the expression of inducible nitric oxide synthase.

The use of heroin (diacetylmorphine) is associated with a high incidence of infectious disease, and the immunologic alterations responsible for heroin-induced changes in resistance to infection have not been well characterized. The present study tests the hypothesis that expression of inducible nitric oxide synthase (iNOS) is modulated by the administration of heroin. The initial study using rats showed that heroin administration (0, 0.01, 0.1, or 1.0 mg/kg s.c.) results in a pronounced reduction in lipopolysaccharide (LPS)-induced expression of iNOS mRNA in spleen, lung, and liver tissue as measured by RT-PCR. Heroin also produced a reduction in the level of plasma nitrite/nitrate, the more stable end-product of nitric oxide degradation. In a subsequent study, administration of the opioid receptor antagonist, naltrexone (0.1 mg/kg) prior to the injection of heroin (1.0 mg/kg) blocked the heroin-induced reduction of iNOS expression and plasma nitrite/nitrate levels indicating that the effect is mediated via the opioid-receptor. This study provides the first evidence that heroin induces an alteration of iNOS expression, and suggests that a reduction in nitric oxide production may be involved in the increased incidence of infectious diseases amongst heroin users.

Animals↗

PubMed2000

"That original tension". Negotiating abstinence in clinicians' accounts of harm reduction in nonresidential treatment of heroin withdrawal.

The aim of this article is to examine how drug and alcohol clinicians, guided by a policy of harm reduction, approach their withdrawal work in their encounter with injecting heroin users seeking nonmethadone withdrawal treatment. The study, qualitative in design, involved detailed interviews with all seven clinicians who worked in the nonmethadone withdrawal program of a nonresidential drug and alcohol center in Melbourne, Australia. I draw attention to the difficulties that these clinicians have in their withdrawal work, especially concerning the place of abstinence in withdrawal and in harm reduction. Abstinence is a legitimate goal of harm reduction. Yet, how harm-reduction knowledge is practiced and reproduced in the clinical encounter is underpinned by dominant and taken-for-granted assumptions about abstinence as 'other' to harm reduction. The ideal of abstinence in drug and alcohol treatment and its decentering within the concept of harm reduction, make introducing harm-reduction strategies in the clinical encounter precarious. The work of withdrawal is compromised with an unresolved tension brought about through the paradox of legitimating illicit drug use in one context (the medical) when it is not legitimate in another context (the sociopolitical).

Adult↗

PubMed2000

A 3D generalization of user-steered live-wire segmentation.

We have been developing user-steered image segmentation methods for situations which require considerable human assistance in object definition. In the past, we have presented two paradigms, referred to as live-wire and live-lane, for segmenting 2D/3D/4D object boundaries in a slice-by-slice fashion, and demonstrated that live-wire and live-lane are more repeatable, with a statistical significance level of P < 0.03, and are 1.5-2.5 times faster, with a statistical significance level of P < 0.02, than manual tracing. In this paper, we introduce a 3D generalization of the live-wire approach for segmenting 3D/4D object boundaries which further reduces the time spent by the user in segmentation. In a 2D live-wire, given a slice, for two specified points (pixel vertices) on the boundary of the object, the best boundary segment is the minimum-cost path between the two points, described as a set of oriented pixel edges. This segment is found via Dijkstra's algorithm as the user anchors the first point and moves the cursor to indicate the second point. A complete 2D boundary is identified as a set of consecutive boundary segments forming a "closed", "connected", "oriented" contour. The strategy of the 3D extension is that, first, users specify contours via live-wiring on a few slices that are orthogonal to the natural slices of the original scene. If these slices are selected strategically, then we have a sufficient number of points on the 3D boundary of the object to subsequently trace optimum boundary segments automatically in all natural slices of the 3D scene. A 3D object boundary may define multiple 2D boundaries per slice. The points on each 2D boundary form an ordered set such that when the best boundary segment is computed between each pair of consecutive points, a closed, connected, oriented boundary results. The ordered set of points on each 2D boundary is found from the way the users select the orthogonal slices. Based on several validation studies involving segmentation of the bones of the foot in MR images, we found that the 3D extension of live-wire is more repeatable, with a statistical significance level of P < 0.0001, and 2-6 times faster, with a statistical significance level of P < 0.01, than the 2D live-wire method, and 3-15 times faster than manual tracing.

Algorithms↗

PubMed2004

British Diabetic Association review of the AIDA v4 diabetes software simulator program.

AIDA is a diabetes-computing program freely available from www.2aida.org on the Web. The software is intended to serve as an educational support tool, and can be used by anyone who has an interest in diabetes, whether they be patients, relatives, health-care professionals, or students. In 1996, during the beta-testing phase of the AIDA v4 project, the British Diabetic Association (BDA)-now called Diabetes UK-was approached and offered the AIDA software by the author, without charge, as a noncommercial contribution to continuing diabetes education. The BDA undertook their own independent assessment of the program, which involved distributing AIDA to a panel of potential end-users (health-care professionals and patients). Comments were solicited regarding the utility, clarity, and perceived safety of the software from users outside the BDA, as well as from various internal assessors. As a result of the feedback, a decision was taken by the BDA to offer AIDA to health-care professionals through the BDA's health-care professional brochure. One thousand copies of the software were produced on diskette, and 1,000 copies of the BDA's version of the program's user guide-printed as a small book-were made available for distribution by post. In this Diabetes Information Technology & WebWatch column an overview is given of the anonymous feedback provided to the BDA by some of the external evaluators. Looking back, nearly 8 years after the launch of AIDA, it is interesting to review some of the comments received and compare these with what has actually happened with the software. To date over 400,000 visits have been logged at the AIDA Web pages, and over 80,000 copies of the program have been downloaded free-of-charge. It is highlighted that this widespread downloading of, and interest in, the AIDA software seems to largely have been fuelled by the program's free availability on the Internet. The use of the World Wide Web to enhance the distribution of other medical (diabetes) programs is highlighted.

Computer Simulation↗

PubMed1997

Search the Human cDNA Database at TIGR.

MOTIVATION: The Human cDNA Database (HCD) at the Institute for Genomic Research (TIGR) is the most complete, non-redundant and structured collection of human expressed DNA sequences available to date. Sequences and other data can be retrieved by users having opened an account at HCD/TIGR. A HCD search involves composing and sending queries one by one and this can become time consuming if many queries must be sent. Moreover, a large amount of time is required thereafter to process the results. RESULTS: The HCDSearch system described here automatically composes and sends the queries by e-mail using information provided in a text file; it also greatly accelerates the processing of results, generating lists of HCD numbers and library identifiers in a format that renders them very easy to examine. The programs run on Unix platforms.

Algorithms↗

PubMedDate not supplied

Immunoassay for detection of cocaine/metabolites in oral fluids.

There is growing interest in the use of alternate biological fluids for drug testing. An advantage of oral fluids is that collection can be made from individuals under direct observation without undue embarrassment or invasion of privacy. This study evaluated the STC Cocaine Metabolite MICRO-PLATE EIA for use in detection of cocaine and metabolites in oral fluids. Intra- and interassay precision of the EIA was < 10%. The EIA was cross-reactive to benzoylecgonine (100%), cocaine (> 12.9%), and cocaethylene (13.8%), but did not demonstrate detectable cross-reactivity with other commonly encountered medicants. Evaluation of a series of potential adulterants of oral fluids indicated that common household chemicals and foodstuffs did not alter the outcome of EIA testing for cocaine metabolite. Analysis by EIA and by gas chromatography-mass spectrometry (GC-MS) of oral fluids and urine specimens collected from current drug users in treatment programs and subjects participating in research studies involving controlled dosing of cocaine provided assessment of the clinical sensitivity and specificity of the STC Cocaine Metabolite EIA. Analysis of the data by means of receiver operating characteristic (ROC) plot indicated that the optimal cutoff concentration for the oral fluids EIA was 10 ng/mL. In comparison to GC-MS (10-ng/mL combined cutoff concentration for cocaine and benzoyleogonine), the EIA (10-ng/mL cutoff concentration) demonstrated a sensitivity, specificity, and accuracy of 95%, 82%, and 88%, respectively. The oral fluids EIA was slightly less sensitive than the urine EIA (300-ng/mL cutoff concentration) for the detection of cocaine metabolite with a sensitivity, specificity, and accuracy of 73%, 85%, and 88%, respectively. Overall, testing of oral fluids for cocaine metabolite with the STC Cocaine Metabolite MICRO-PLATE EIA appears to offer a viable alternative to urine for detection of recent cocaine use.

Cocaine↗

PubMedDate not supplied

Clinical engineering in the southeast.

A fully developed in-house clinical engineering program has much to offer to a large community hospital. In the southeast U.S., many community hospitals-600 beds or fewer-have implemented partial programs and, as a result, have received only a partial return on their investment. A comprehensive program extends maintenance support to all patient-care devices, is intimately involved in the new device specification, evaluation, and selection process with the medical staff-standardizing whenever appropriate- and significantly involved in the continuing education program for in-house users of devices.

Biomedical Engineering↗

PubMed1991

Estimating hidden populations: a new method of calculating the prevalence of drug-injecting and non-injecting female street prostitution.

This paper outlines a new method we have developed for estimating the prevalence of streetworking prostitution and the proportions of female street-working prostitutes who are injecting drug users. This method is based on the capture/recapture approach and involves distinguishing new fieldwork contacts from repeat field work contacts. The size of the overall population can be modelled from records of the increasing ratio of repeat to new fieldwork contacts. The method may have a relevance beyond a concern with prostitution and drug injecting, and may be of value in estimating other hidden populations.

Female↗

PubMed1995

Research design and methodology for a local mental health needs assessment.

The development of a methodology for the assessment of the mental health needs of a local population is described. A framework of corporate consultation was adopted to include methods of accessing the views of key stakeholders. This involved a provider perspective from a survey of clinicians, a user perspective gained through a series of focus groups and a purchaser perspective obtained from semi-structured interview and focus groups. The method adopted for the focus groups was based on an 'ideal research and change practice', which offers potential for development and usage by service planners, including mental health nurses. This article explores issues around qualitative research and the implications for mental health nurses.

Attitude to Health↗

PubMed1992

The depiction of guns on prime time television.

Two weeks of regular prime-time programming on four major networks (ABC, CBS, Fox, and NBC) was monitored for scenes in which guns were either used or displayed. Guns were seen most often on CBS, Saturdays and Sundays, and later in the evenings. Middle-aged, white males were depicted as gun users in better than 75% of the scenes. Most scenes involved pistols. Most often the person who used the gun suffered no repercussions. When a victim was depicted as being shot, seldom was the pain of the victim, the victim's family, or friends demonstrated.

Adolescent↗

PubMed1998

Pathologists dislike sound? Evaluation of a computerised training microscope.

AIM: To evaluate the use of multimedia enhancements, using a computerised microscope, in the training of microscope skills. METHODS: The HOME microscope provides facilities to highlight features of interest in conjunction with either text display or aural presentation. A pilot study was carried out with 10 individuals, eight of whom were at different stages of pathology training. A tutorial was implemented employing sound or text, and each individual tested each version. Both the subjective impressions of users and objective measurement of their patterns of use were recorded. RESULTS: Although both versions improved learning, users took longer to work through the aural than the text version; 90% of users preferred the text only version, including all eight individuals involved in pathology training. CONCLUSIONS: Pathologists appear to prefer visual rather than aural input when using teaching systems such as the HOME microscope and sound does not give added value to the training experience.

Attitude of Health Personnel↗

PubMed2003

Trust in health Websites: a survey among Norwegian Internet users.

Whether consumers feel able to trust the information presented on a health-related Website is as important a quality criterion as more objective criteria. We investigated whether trust was related to five aspects of health Websites: the involvement of health professionals, a facility for interactive communication, information about those responsible for the site, a picture of those responsible for the site, and the impression of site update frequency. A polling agency invited, by email, a sample of 600 Norwegian users of e-health information to participate in the study and 476 subjects did so (a 79% response rate), by completing a questionnaire online. Their mean age was 41 years and 53% were female. All five aspects of health Websites were related to the trust placed in the site but they were not consistently related to gender or age. Trust in Websites that were frequently updated was related to being a frequent e-health user, while those who trusted interactive e-health sites were low-frequency users who tended to order drugs and health products from the sites. The probability of taking action as a result of e-health information was related to the frequency of visits to health Websites but not to the five aspects of them investigated in relation to trust. However, respondents who trusted sites that were perceived as being frequently updated and to have health professionals involved were more likely to be frequent users of e-health information.

Adult↗

PubMed1999

Cocaine use among Miami's public school students, 1992: religion versus peers and availability.

This analysis examines the use of cocaine by 507 adolescents in Dade County, Florida public schools during 1992. Statistically significant factors which tend to increase the probability of cocaine use by adolescents include: the fact that their peers are using cocaine, the fact that they are white, and the ready access these adolescents have to the substance. Although not statistically significant, adolescents were more likely to use cocaine if they knew of the risks associated with cocaine use. Hence the typical user may be a risk-taker, enjoying the dangers involved with cocaine use. The only statistical significant variable which inhibits the use of cocaine by Miami adolescents is the fact that religion is an important part of their lives.

Adolescent↗

PubMed2003

A human drug metabolism database: potential roles in the quantitative predictions of drug metabolism and metabolism-related drug-drug interactions.

Previous attempts to predict drug metabolism and drug-drug interaction possibilities by deploying databases that house established drug metabolism results have been only marginally successful. Consideration of some of the key issues and concerns derived from these efforts suggests that three major hurdles loom in front of using xenobiotic metabolism databases more effectively in the future. These hurdles include: the need for an improved treatment of chemical structure in three-dimensions (3D); a better quantitative accounting of competitive and complementary biotransformation pathways; and, the critical need for a comprehensive, human drug metabolism database (hDMdb) that can serve as a bio/chemoinformatic resource pertaining to drug metabolism and drug metabolism-related drug-drug interactions in general. Approaches that might be taken to traverse each of these hurdles are discussed herein where: the first involves maturation of chemical structures from simple 2D entries into more sophisticated 3D displays that can also account for interactions with relevant biological surfaces; the second involves a systematic, pair-wise comparison of various metabolic options in a statistically driven manner relative to chemical structure descriptors; and, the third involves mounting a hDMdb on the Internet in a user-friendly manner that it is available via a non-profit format.

Databases, Factual↗

PubMed1983

Actinomyces israelii in the genital tract of women with and without intra-uterine contraceptive devices.

Actinomycosis involving the female genital tract is more common among IUD users than others. The diagnosis is difficult and often delayed. It has been suggested that the finding of Actinomyces-like organisms or A. israelii in cervical smears indicates a risk of developing actinomycosis. A. israelii has not been regarded as a part of the indigenous genital flora. A group of IUD users without symptoms of genital tract infections were compared with a control group without IUDs. No Actinomyces-like organisms were found on cytological examination of cervical smears. Immunofluorescent staining and cultures identified A. israelii in 4% of the IUD users and in 3% of the non-users. Serologic precipitin tests for actinomycosis were negative in all women. None developed actinomycosis on follow-up of positive cases. The study indicates that A. israelii is a commensal of the female genital tract. The identification of A. israelii alone does not indicate that the patient risks developing actinomycosis. Other methods such as a serology test should be useful in defining the clinical significance of the findings.

Actinomyces↗