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Outcomes of assistive technology use on quality of life.

The results from many research efforts on the use of assistive devices are reviewed and summarized. Further, conceptual and methodological issues related to the use and abandonment of assistive technologies are discussed. Overall, this review should be helpful to professionals making device recommendations, documenting the need for a device, and assessing short- and long-term device utilization. The available literature lends support to a model of matching person and technology that considers environments of device use, characteristics of the user's preferences and expectations, and device features and functions. To ensure that assistive technologies enhance users' quality of life, future emphases should focus on consumer involvement in the selection and evaluation of appropriate assistive technology, and ways to make technologies more widely available and affordable.

Communication Devices for People with Disabilities↗

Drug treatment: explaining the gender paradox.

There is something of a gender paradox in drug user treatment. Research consistently indicates that women possess "risk factors" associated with drug use relapse, yet women are no more likely, and possibly less likely, to relapse to drug use. Efforts to explain this paradox involve a longitudinal study of 330 women and men participating in outpatient drug-user treatment associated with the evaluation of the Los Angeles Target Cities Project funded by the Center for Substance Abuse Treatment. The findings offer no support for the drug severity and social support hypotheses, but some support for the treatment engagement hypothesis. Specifically, women participate more frequently in group counseling which, in turn, lowers their rate of relapse in spite of having more "risk factors." Further analyses indicate that the greater participation of women in group counseling does not stem from child-custody or other gender differences in the reasons for entering treatment, nor does it result from the enhanced services associated with the Target Cities Project. Rather, the differences in treatment engagement for women and men may result from gender norms concerning help-seeking, personal independence, strength, and control. The treatment and policy implications of these findings and recommendations for further research are discussed.

Adolescent↗

[For or against peridural analgesia?: a psychological approach based on the parturient's needs].

The present study investigates why some women, before and during delivering, request peridural analgesia or, on the contrary, refuse it. On the basis of a literature review and of an empiricial study involving 57 women, a psychological differentiation is attempted to discriminate users from non-users of peridural analgesia. Pain perceptions, health locus of control, when internal (IHLC), family and couple adaptability appear to be discriminating factors. Our results indicate a higher chance locus of control (externality) in non-users then in users, as well as a more rigid couple functioning. The incidence of Internal Health Locus of Control of pain perception is outlined.

Adult↗

[Evaluation of health surveillance at several primary care units in Cuba].

BACKGROUND: The organization and operation of the epidemiological monitoring carried out at several Primary Care facilities in Cuba was assessed by means of a study conducted for the purpose of ascertaining the effectiveness of the monitoring in question and of contributing to further improve the mechanisms thereof and thus improve the health conditions of the population. This assessment was implemented at eight Polyclinics in the city of Havana throughout the 1998-1999 period. METHOD: By means of the implementation of an integral methodology, an assessment was made of the three factors involved in the monitoring system at the facilities in question, that is, the organization, the process and the results thereof. For this purpose, a survey which quantified some aspects of the system (sensitivity, opportunity, representativeness, usefulness) and a semi-structured survey of epidemiologists and other physicians involved in the monitoring in question in addition to the users of the system was used. RESULTS: The assessment of the organization revealed the monitoring organization to be adequate. In the assessment of the process, sensitivity was found to be low at some polyclinics, problems existing at many of them with regard to the opportunity and flexibility of the system. The assessment of the results of the monitoring revealed them to be satisfactory as regards their effectiveness for detecting acute events, as well as in the perception of the users with regard to the usefulness of these results for solving the problems pinpointed. CONCLUSIONS: The monitoring done at the polyclinics assessed is indicative of there being an adequate organization of the monitoring, although some shortcomings were found to exist with regard to the fulfillment of some aspects of the monitoring. This however has no bearing on the results for the system as a whole, which is capable of detecting any epidemiological situation of importance and of suggesting appropriate measures for controlling the situation.

Cuba↗

Avoiding the pump in tricuspid valve endocarditis--vegetectomy under inflow occlusion.

BACKGROUND: Surgical treatment of tricuspid valve endocarditis (TVE) ranges from vegetectomy to valve replacement with the use of cardiopulmonary bypass (CPB), accompanied by risks of systemic and lung complications. We present our experience with tricuspid valve vegetectomy under inflow occlusion without CPB. METHODS: Between July 1998 and July 2001, seven patients with a mean age of 26 years underwent tricuspid valve vegetectomy under vena caval inflow occlusion (VCIO). Five patients were intravenous drug users. None of them had left-sided heart valve involvement. The clinical indications for operating were recurrent septic pulmonary emboli with significant bilateral lung infiltrates and intractable infection with signs of severe systemic sepsis, despite treatment with appropriate intravenous antibiotics for a mean duration of 126 hours. The echocardiographic indication was very large localized >1 cm vegetations in all patients. Six patients had methicillin sensitive staphylococcus aureus and one had streptococcus viridans positive blood cultures. Five patients had postoperative high volume veno-venous hemofiltration (HVVF). RESULTS: There were no deaths. VCIO time did not exceed 2 minutes (range time was 45 seconds to 2 minutes). All patients had resolution of sepsis and improvement in respiratory status within 48 hours. Five patients had trivial and two moderate tricuspid regurgitation. Six patients were discharged home within 14 days with no long-term sequelae. One patient required long-term dialysis for renal failure. One patient required a late thoracotomy for drainage of a loculated empyema. CONCLUSIONS: Tricuspid valve vegetectomy can be performed safely under VCIO. HVVF promotes removal of inflammatory mediators, thus improving recovery.

Adolescent↗

Finding your innovation sweet spot.

Most new product ideas are either uninspired or impractical. So how can developers hit the innovation sweet spot--far enough from existing products to attract real interest but close enough that they are feasible to make and market? They can apply five innovation patterns that manipulate existing components of a product and its immediate environment to come up with something both ingenious and viable, say the authors. The subtraction pattern works by removing product components, particularly those that seem desirable or indispensable. Think of the legless high chair that attaches to the kitchen table. The multiplication pattern makes one or more copies of an existing component, then alters those copies in some important way. For example, the Gillette double-bladed razor features a second blade that cuts whiskers at a slightly different angle. By dividing an existing product into its component parts--the division pattern--you can see something that was an integrated whole in an entirely different light. Think of the modern home stereo--it has modular speakers, tuners, and CD and tape players, which allow users to customize their sound systems. The task unification pattern involves assigning a new task to an existing product element or environmental attribute, thereby unifying two tasks in a single component. An example is the defrosting filament in an automobile windshield that also serves as a radio antenna. Finally, the attribute dependency pattern alters or creates the dependent relationships between a product and its environment. For example, by creating a dependent relationship between lens color and external lighting conditions, eyeglass developers came up with a lens that changes color when exposed to sunlight.

Commerce↗

[Computer simulation of the 10-year outcome of a cohort of heroin addicts in Ile-de-France].

The aim of this study is to develop a computer simulation model to describe imaginary cohorts of heroin users in the Ile de France (greater Paris) region. Because of the lack of well-designed cohort studies in France, this model is based on epidemiological data found in various different studies. The results of the simulation reveal horrifying outcomes in ten years' time: in the more optimistic scenario (an annual non-Aids mortality rate of 1%, an annual rate of permanent addiction curtailment of 10% and a syringe exchange rate of 10%), only 50% of heroin users curtail their consumption permanently without being HIV carriers after 10 years, 16% are HIV carriers and 10% have died. In conclusion, medical care should play an important part in the management of drug users, and secondary prevention aimed at reducing the health problems involved in heroin use should be intensified.

Acquired Immunodeficiency Syndrome↗

Tetanus experience in a public hospital in Western Saudi Arabia.

OBJECTIVE: Tetanus although rare, has not been eradicated and continues to present from time to time. Early diagnosis and management may be life saving. This study aims to evaluate all patients admitted with clinical diagnosis of tetanus in King Abdul-Aziz Hospital Jeddah, Kingdom of Saudi Arabia over the last 3 years. METHODS: All patients admitted with clinical diagnosis of Tetanus in King Abdul-Aziz Hospital and Oncology Center from January 2000 through to December 2002 were retrospectively reviewed and data was analyzed to determine the demographic features, clinical details, management, and outcome of treatment. RESULTS: A total of 11 patients were admitted during this period. All patients were diagnosed in emergency room by clinical examination. Their ages ranged from 22-68 years. The immunization status of these patients was unknown. All of them were males with 4 of them being injection-drug users. Eight patients had a definite history of injury mainly involving the lower limbs. The incubation period ranged from 5-30 days. Nine patients required mechanical ventilation for a period varying from 2-4 weeks. All patients received Tetanus Immunoglobulin with a dose ranging from 500-3000 unit. The spasms were mainly controlled by diazepam infusion with a maximum dose of 480mg/day. Magnesium sulphate was used in 6 patients to control spasms and autonomic dysfunction. Metronidazole was used in addition to benzyl penicillin in 9 patients. Out of the 11 cases 10 were discharged home and only one patient died 6 days after admission. CONCLUSION: Tetanus is still a problem in developing countries. It is a potentially fatal disease, without early medical intervention. Primary immunization and scheduled booster immunization are important preventive measures that have greatly reduced the incidence of tetanus.

Adult↗

Evaluation of the effects of orthodontic pacifiers on the primary dentitions of 24- to 59-month-old children: preliminary study.

This study was designed to compare the occlusions of 24- to 59-month-old children who used orthodontic or conventional pacifiers to the occlusions of a group of controls who had no sucking habits. Information on the habits was collected by parental questionnaires. Ninety-five children were examined for malocclusions involving overbite, overjet, canine, and molar relationships, and posterior crossbites. Users of orthodontic pacifiers had statistically significantly greater overjets, and there was a significantly higher proportion of subjects with open bite in the conventional pacifier group. There was a trend toward a greater number of subjects in the control and orthodontic pacifier group with overbites less than or equal to 50%. These differences were not clinically significant, however. There appeared to be only minor differences between the occlusions of the two pacifier groups.

Child, Preschool↗

Development and evaluation of a smokeless tobacco cessation program: a pilot study.

A multicomponent, cognitive-behavioral intervention program, offered to 25 chronic, adolescent male users of smokeless tobacco, was divided into three sessions and involved self-monitoring of smokeless tobacco use, awareness of health risks, behavioral coping strategies, frequent phone contact, and relapse prevention training. Biochemical (carbon monoxide and cotinine) verification of self-reports was obtained, information about subject and environmental characteristics collected, and a 3-month follow-up conducted. Twenty-one of the 25 subjects completed treatment; 9 participants were abstinent at the conclusion of the program, and 4 remained successful in quitting at the 3-month follow-up. Participants who did not achieve complete abstinence reported substantial reductions in smokeless tobacco use, and no increase in cigarette consumption occurred as a result of reducing or quitting use of it. Subjects successful in achieving cessation had consumed a smaller amount of smokeless tobacco at baseline and were more likely to be involved in school athletics.

Adolescent↗

Primary skeletal infections in heroin users: a clinical characterization, diagnosis and therapy.

Experience with 24 patients and 101 cases reported in the English literature demonstrate that primary skeletal infections occur in heroin users. In young individuals with no significant underlying disease, predominant involvement in the lumbar vertebrae and sternoclavicular joint, Pseudomonas aeruginosa was the dominant pathogen. Clinical manifestations, except for pain or local tenderness, and laboratory findings were of limited value. Diagnosis ultimately depended on isolation of the pathogens from either bone or joint fluid. The treatment, as indicated, was prolonged parenteral antibiotics, generally with an aminoglycoside, incision and drainage, and immobilization.

Adult↗

[Visual acuity and traffic accidents].

In the first part of the study it was established that professional truck or bus drivers whose central photopic visual acuity in one or both eyes is less than 0.7 differ distinctly from their colleagues with fully adequate or only slightly reduced photopic vision in that they are involved in accidents more frequently (the difference is statistically significant, and in some respects highly significant). This applies in particular to accidents after 15 years' driving (known as late accidents) and accidents of the following types: priority infringements, ramming from behind, turning, and changing lanes. The first hypothesis on which the study was based, namely that accidents become more frequent as central photopic vision deteriorates, was confirmed. The second part of the investigation, which was likewise carried out with license-holders who drove professionally, produced a similar result: Drivers with considerably reduced twilight vision and/or considerably increased susceptibility to glare are more frequently involved in certain accidents at night than those who fully satisfy the minimum requirements for these visual functions. In particular, it was established that almost every fifth professional driver involved in a night-time collision with another road user (ramming, side-to-side collisions) has severely diminished twilight vision and that one out of four have increased susceptibility to glare. Thus, the second hypothesis, i.e., that the number of night-time accidents increases as twilight vision deteriorates and the driver's susceptibility to glare increases, seems fully confirmed.

Accidents, Traffic↗

Diazepam use and progression of breast cancer.

The relationship between diazepam and breast cancer was evaluated using data from a case-control study of breast cancer, in which 1075 cases and 1146 controls who were participants in a breast cancer screening program were interviewed. Diazepam use was negatively associated with extent of disease and lymph node involvement, and this effect seemed greatest for long-term users of diazepam. It is not certain to what extent these data reflect an ascertainment bias, an association with the reasons for which the drug was prescribed, or chance. Whatever the explanation, the findings do not support a previous contention that diazepam promotes or accelerates breast cancer growth.

Breast Neoplasms↗

Mycobacterium tuberculosis bacteremia in patients with and without human immunodeficiency virus infection.

PURPOSE: To determine the incidence of Mycobacterium tuberculosis bacteremia in a general hospital and to describe the clinical characteristics, therapy, and outcome of patients with bacteremic tuberculosis. PATIENTS AND METHODS: Clinical charts of all patients in whom M tuberculosis was isolated from blood cultures during a 5-year period were reviewed. Mycobacterium tuberculosis was detected by means of a nonradiometric blood culture system. RESULTS: Of 285 patients with culture-proved tuberculosis in whom blood cultures were obtained, 50 (14%) had M tuberculosis bacteremia. Of 42 patients analyzed, 34 (81%) were infected with human immunodeficiency virus (HIV) and eight (19%) were not infected with HIV. Blood was the only or the first positive specimen in 14 patients (33%). Most HIV-infected patients (79%) were intravenous drug users, and 40 (88%) had clinical and/or radiologic evidence of involvement of one or more organs. Lungs were affected in 71% of the patients. In-hospital mortality was 18% in HIV-infected patients with mycobacteremia. Among eight non-HIV-infected patients, four had an underlying disease, and none was immunosuppressed. Disseminated disease was diagnosed in three patients. Two patients died as a consequence of tuberculosis in this group. CONCLUSIONS: Mycobacterium tuberculosis bacteremia is common in HIV-infected patients and is possible in nonimmunosuppressed subjects. Blood cultures are helpful in making the diagnosis of tuberculosis and can help establish a diagnosis of disseminated infection.

AIDS-Related Opportunistic Infections↗

[Promotion of Moroccan national agricultural research in the area of sheep production--a project of German development cooperation].

With a population size of 14 mio. animals the sheep herders of Morocco produce 25-30% of the national red meat production. Moroccan sheep production is characterized by a low productivity of the females. With a support of the national research in the sector of sheep production, reasons for that, and possibilities of improvement should be found. The German development agency (Deutsche Gesellschaft für Technische Zusammenarbeit) promotes this fact with 2 scientific advisers. They will implement a problem and client-oriented research formation and advice in management and methodology activities of the project. Already in the stage of setting research priorities and formulate research subjects the later user of the research results (extension service, breeders) are actively involved. A stronger triangle relation Research-Extension-Breeder is the objective. Examples of the project work are given.

Animal Husbandry↗

Long-term effects of frequent cannabis use on working memory and attention: an fMRI study.

RATIONALE: Excessive use of cannabis may have long-term effects on cognitive abilities. Mild impairments have been found in several cognitive domains, particularly in memory and attention. It is not clear, however, whether these effects also occur with moderate, recreational use of cannabis. Furthermore, little is known about underlying brain correlates. OBJECTIVES: The aim of this study is to assess brain function in frequent but relatively moderate cannabis users in the domains of working memory and selective attention. METHODS: Functional magnetic resonance imaging was used to examine verbal working memory and visuo-auditory selective attention in ten frequent cannabis users (after 1 week of abstinence) and ten non-using healthy controls. Groups were similar in age, gender and estimated IQ. RESULTS: Cannabis users and controls performed equally well during the working memory task and the selective attention task. Furthermore, cannabis users did not differ from controls in terms of overall patterns of brain activity in the regions involved in these cognitive functions. However, for working memory, a more specific region-of-interest analysis showed that, in comparison to the controls, cannabis users displayed a significant alteration in brain activity in the left superior parietal cortex. CONCLUSION: No evidence was found for long-term deficits in working memory and selective attention in frequent cannabis users after 1 week of abstinence. Nonetheless, frequent cannabis use may affect brain function, as indicated by altered neurophysiological dynamics in the left superior parietal cortex during working memory processing.

Adult↗

Individual and district scale determinants of users' satisfaction with primary health care in developing countries.

The paper has two aims: to explore possible determinants of user satisfaction based on a broad conception of the health care system involving both individual and district scale variables, and to add to the limited knowledge and empirical study about such determinants in developing countries. The study was carried out in one of Brazil's poorest states, Ceará, in the northeast of the country. Brazil has a policy of an increased role for the population in management together with decentralised management to the local administrative (municipio) scale. For user views on health care to be useful in management, understanding their determinants needs to explore not only individual scale factors but also influences from the local health system and wider society, here termed district scale factors. The study design took different angles on users' satisfaction to build three measures: the particular health event (termed perceived quality); a generalised perception (termed satisfaction); and, satisfaction with the Community Health Worker (termed CHW satisfaction). Potential determinants explored at the individual scale (17 variables) are grouped into: socio-demographic and economic characteristics; health outcome; health care provision; and, awareness of space for local voice in planning. Potential determinants explored at the district scale (50 variables) are grouped into: formal organisation and management (health system inputs, management capacity, outputs and outcomes); informal organisation (population awareness of health system activities, staff characteristics, district management style); and, local political culture (geographic and socio-economic population profile, commitment to the district of local leaders, norms and values of staff regarding practice). Three determinants were key for all three user evaluation measures: getting an appointment, getting better, and the type of district (rural-urban). Our primary conclusion from this study is that there are limitations to the extent that user satisfaction can fulfill the claims made for it. On a more positive note, with these limitations noted, user satisfaction can prove a useful management tool more modestly at a local, context-specific scale.

Brazil↗

The role of the general practitioner in the community care of people with HIV infection and AIDS: a comparative study of high- and low-prevalence areas in England.

BACKGROUND: Policy for the care of people suffering from HIV and AIDS has changed over the past decade. Schemes for shared primary and secondary care have been met with varying success, and patients may be reluctant to become involved. No systematic evaluation comparing the views of primary care providers and users in areas of varying HIV prevalence has been published. AIM: To examine the role of general practice in areas of England with low and high human immunodeficiency virus (HIV) prevalence and to compare barriers to general practice care in each area. METHOD: We used focus groups, semistructured questionnaires and interviews in north London (high HIV prevalence) and Nottingham (low HIV prevalence). RESULTS: Four focus groups took place in London. A total of 411 general practitioners (GPs) in London and 405 in Nottingham replied to postal questionnaires. Overall, 121 primary care staff in 40 London practices and 26 staff in five Nottingham practices were interviewed. In all, 54 people infected with HIV were interviewed in London and 20 in Nottingham. Providers and users regarded the 24-hour availability and the familiar environment of general practice as its key assets. Lack of expertise and time were its disadvantages. Providers were concerned about inadequate communication with specialist services. Although providers were concerned about confidentiality, whether they had liberal and sympathetic attitudes was more important in deciding whether people with HIV used the service. In the low-prevalence area, general practice involvement was the result of individual initiatives, and practices were not integrated into specialist care. In the high-prevalence area, HIV care was more usual in general practice, but there was also little integration with HIV services. CONCLUSIONS: In high-prevalence districts, a strategy to make HIV care routine for all GPs may be appropriate. In low-prevalence areas, a network of selected, strategically located, relatively high-involvement practices may be more effective in meeting the primary care needs of people with HIV infection and acquired immunodeficiency syndrome (AIDS).

Community Health Services↗