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'I am not the kind of woman who complains of everything': illness stories on self and shame in women with chronic pain.

In this study, we explore issues of self and shame in illness accounts from women with chronic pain. We focused on how these issues within their stories were shaped according to cultural discourses of gender and disease. A qualitative study was conducted with in-depth interviews including a purposeful sampling of 10 women of varying ages and backgrounds with chronic muscular pain. The women described themselves in various ways as 'strong', and expressed their disgust regarding talk of illness of other women with similar pain. The material was interpreted within a feminist frame of reference, inspired by narrative theory and discourse analysis. We read the women's descriptions of their own (positive) strength and the (negative) illness talk of others as a moral plot and argumentation, appealing to a public audience of health personnel, the general public, and the interviewer: As a plot, their stories attempt to cope with psychological and alternative explanations of the causes of their pain. As performance, their stories attempt to cope with the scepticism and distrust they report having been met with. Finally, as arguments, their stories attempt to convince us about the credibility of their pain as real and somatic rather than imagined or psychological. In several ways, the women negotiated a picture of themselves that fits with normative, biomedical expectations of what illness is and how it should be performed or lived out in 'storied form' according to a gendered work of credibility as woman and as ill. Thus, their descriptions appear not merely in terms of individual behaviour, but also as organized by medical discourses of gender and diseases. Behind their stories, we hear whispered accounts relating to the medical narrative about hysteria; rejections of the stereotype medical discourse of the crazy, lazy, illness-fixed or weak woman.

Adult↗

Comparison of network-based pathway analysis methods.

Network-based definitions of biochemical pathways have emerged in recent years. These pathway definitions insist on the balanced use of a whole network of biochemical reactions. Two such related definitions, elementary modes and extreme pathways, have generated novel hypotheses regarding biochemical network function. The relationship between these two approaches can be illustrated by comparing and contrasting the elementary modes and extreme pathways of previously published metabolic reconstructions of the human red blood cell (RBC) and the human pathogen Helicobacter pylori. Descriptions of network properties generated by using these two approaches in the analysis of realistic metabolic networks need careful interpretation.

Algorithms↗

Clinical efficacy of Ginkgo biloba special extract EGb 761 in dementia of the Alzheimer type.

Among the psychiatric illnesses associated with old age primary degenerative dementia of the Alzheimer type (DAT) has gained increasing importance in recent years. Even though a curative treatment of the disease is currently impossible, various drugs can be used to slow down its progression. In the present study the influence of oral treatment with 240 mg/day of Ginkgo bilabo special extract EGb 761 (Tebonin forte, manufactured by Dr Willmar Schwabe, Karlsruhe) on the clinical course of DAT was investigated in a double-blind, randomized, placebo-controlled parallel-group design in 20 outpatients. The duration of treatment was 3 months. The primary outcome variable was the sum score in the SKT-test for the determination of attention and memory. Other psychometric tests (trailmaking test, ADAS, CGI) and electrophysiological investigations (EEG topography) were evaluated descriptively. Although the active-treatment group, with a mean sum score of 19.67 points in the, S.K.T., had a poorer baseline level than the placebo group (18.11 points), it experienced an improvement to 16.78 points under treatment with EGb 761 whereas the placebo group deteriorated to 18.89 points. The differences between the baseline and final values formed the basis for a statistical group comparison, which gave a result favourable to EGb 761, at a significance level of p < .013. In addition to this psychometric confirmation of efficacy, certain descriptive trends were found at the psychopathological (Clinical Global Impression) and dynamic functional (EEG findings) levels, which can be interpreted as evidence of effectiveness of Ginkgo biloba special extract EGb 761 in mild to moderate dementia and of local effects in the central nervous system. Inter-group differences in the ADAS cognitive and non-cognitive subscales did not reach statistical significance, probably because of the small sample size.

Aged↗

The relationship between ethanol intake and DSM-III alcohol use disorders: a cross-perspective analysis.

The purpose of this investigation was to quantify the relationship between ethanol consumption and DSM-III alcohol use disorders using mathematical modeling techniques that allowed for the simultaneous control of several extraneous factors and the assessment of potential interaction. Although gender, education, ethnicity, and marital status were not identified as actual confounders in the logistic regression model, the ethanol intake-dependence association was found to be stronger among younger adults than in the later stages of life. Age was an influential confounder of the ethanol intake-abuse relationship, but the magnitude of the association was generally weaker for abuse than for dependence. Separate analyses in which the abuse and dependence criteria served as outcome measures qualified the interpretation of the overall ethanol intake-disorder associations. Implications of these results are discussed in terms of age differences in exposure and context of consumption, differential interpretation of withdrawal symptoms, and the relationship between abuse and dependence. The need for future research to refine our descriptions of risk of alcohol use disorders in relation to levels of intake is highlighted.

Adolescent↗

NMR-paramagnetic relaxation due to the high-spin d3 electron configuration: Cr(III)-TSPP.

Sulfonated metalloporphyrins (Me-TSPP, where Me = Cr(III), Mn(III), Fe(III), and Mn(II)) comprise a well-characterized series of water-soluble paramagnetic complexes with electron spins of S = 3/2, 2, 5/2, and 5/2, respectively, which provide important model systems for mechanistic studies of paramagnetic NMR relaxation in solution. Previous studies of Mn(III), Fe(III), and Mn(II)-TSPP have uncovered relaxation mechanisms which differ qualitatively from each other and exhibit numerous unexpected features. In this study, Cr(III)-TSPP was examined as a model system for the d3 S = 3/2 electron configuration. Magnetic relaxation dispersion (MRD) profiles of the water proton R1 were measured as a function of pH between pH 1 and pH 9. In acid samples, R1 results from acid-catalyzed prototropic chemical exchange involving the Cr(III)-TSPP x 2 H2O. In neutral and basic solution, this species deprotonates, and base-catalyzed prototropic exchange becomes important. The pH 1 data were analyzed quantitatively using theory that accounts for the role of the permanent zero field splitting (zfs) tensor and for the effects of Brownian reorientation. Two levels of theory were employed: (1) spin dynamics simulation, which accurately describes the effects of Brownian reorientation on the spin wave functions, and (2) the "constant H(S)" approximation, which incorporates the effects of multiexponential electron spin relaxation and facilitates the physical interpretation of the relaxation mechanism. It was found that neither level of theory alone provides a fully satisfactory quantitative description of the data due to the fact that both reorientational modulation of the spin wave functions and multiexponential electron spin relaxation are important. The zero field splitting parameter, D = 0.27 cm(-1), is well defined by the data and was measured.

Journal Article↗

Ecstasy pill testing: harm minimization gone too far?

Harm reduction has become the focus of public health initiatives and therapeutic intervention in the management of dependent drug use over the last 20 years. The last decade has seen such approaches being extended to recreational drug use. Most harm reduction initiatives have aimed to inform users about risks and ways of minimizing risk. The concept of providing illicit drug users with quality assessment of their chosen drug is one possible harm reduction intervention that until recently has received little attention. In response to well-publicized 'ecstasy'-related deaths organizations in some European countries and the United States have chosen to provide a 'pill testing service' for users. There are two broad categories of pill testing offered. Simple colour reagent test kits (Marquis Reagent and colour charts) form the most widely used on-site pill testing method. Less frequently, but more accurately, laboratory personnel with access to sophisticated chromatographic equipment (high performance liquid chromatography (HPLC) or gas chromatography-mass spectrometry (GC-MS)) may provide analysis of a pill. Pill testing kits have been advocated as a 'tool to protect yourself against the polluted XTC market'. We refute this line of reasoning. Of the different tests only techniques such as GC-MS can identify satisfactorily the psychoactive constituents present in ecstasy pills. Colour tests based on an interpretation of a colour response in the presence of a drug are, at best, subjective. Pill testing of any description does not guarantee safety, or protect the consumer against individual responses to pills. At best it gives an artificial 'shine of safety' to a group of diverse drugs that remain both illicit and potentially harmful. Other simpler harm reduction mechanisms are likely to be more effective.

Chromatography, Gas↗

Bayesian modeling of muscle biopsy contracture testing for malignant hyperthermia susceptibility.

BACKGROUND: Phenotyping malignant hyperthermia (MH) by contracture testing has a low but quantifiable degree of inaccuracy, measured by its sensitivity and specificity. Quantifying the limitations inherent in diagnostic testing for MH can help resolve issues in clinical practice, such as the interpretation of a negative test and the apparent lack of complete genetic linkage to RYR1. METHODS: Bayesian models, mathematical descriptions of the outcome of diagnostic testing, were constructed. The inputs to the model include patient factors, summarized in a single number called pretest probability (PTP), and sensitivity and specificity that specify the accuracy of the entire test process. The outputs of the model include positive predictive value (PPV) and negative predictive value (NPV), which are numeric expressions of diagnostic certainty of positive and negative test results. A special case was constructed for equivocal results. RESULTS: The PPV, NPV, and efficiency of contracture testing for MH are functions of PTP, sensitivity, and specificity. The NPV is high for all clinical PTP, whereas PPV is clinically useful for moderate to high PTP. CONCLUSIONS: Diagnostic contracture testing for MH is clinically useful because of high NPV and can exclude MH with near certainty. For MH probands, the clinical grading scale for MH may guide PTP estimation, whereas for relatives of probands, PTP is a function of kinship to a known MH-susceptible relative. A sequential testing strategy optimizes diagnostic information by maximizing PTP within a pedigree. Incomplete testing of parents of an MH susceptible child can pose a significant risk of false-negative results for the untested parent. Even with optimal pedigree testing strategies, the PPV drift effect results in a considerable source of phenotypic uncertainty for genetic linkage studies.

Bayes Theorem↗

Electrical measurement of a high-frequency, high-capacitance piezoceramic resonator with resistive electrodes.

In a thin and large area PZT-ceramics piezoresonator (PR) with relatively low resonance impedance, caused by high-frequency resonance and high PR capacitance, the effect of electrode resistivity and parasitic resistive and inductive elements in the measurement fixture results in significant distortion of the measured thickness-mode (longitudinal TL, shear TS) resonance response-resonance frequency shifts and characteristics deformation. This distortion may not allow the precise measurement of the PR characteristic frequencies, quality factor, and electromechanical coupling coefficient so essential to a complete PR and material characterization. A theoretical description of the "energy-trap" phenomena in a thickness-vibrating PR with resistive electrodes is presented. To interpret electrical measurements, the electromechanical model, including for completeness both the PR with resistive electrodes (as a system with distributed parameters) and the measurement fixture, is developed. The method of two contact points on the electrode provides deep sharpening and exact determination of the PR resonance. For the optimal disposition of the contact fingers, the resonance bandwidth of a real PR with resistive electrodes is even more pointed than that for the ideal PR.

Journal Article↗

Men's experiences of vasectomy in the Brazilian Public Health Service.

BACKGROUND: Vasectomy was legalized in Brazil in 1996 and is freely available in some public health institutions. Nevertheless, the prevalence of vasectomy is less than 4.4%, demonstrating how rarely this contraceptive resource is used. The promotion of greater male involvement in reproductive health was one of the recommendations of the Cairo International Conference of Population and Development (ICPD). RESEARCH OBJECTIVE: To describe the experiences of a group of men who had had vasectomy. METHOD: The thematic oral history method was used. Twenty men vasectomized in a Sao Paolo State Health Service Clinic were interviewed. Each tape-recorded narrative was analysed through transcription, textualization, and transcreation, a process used to transform the oral history into written narrative form. From each narrative a 'vital tone' was extracted, revealing the essence of the individual experience. All the data were analysed under an inductive and interpretative process. The similarities among histories were identified, and submitted to a process of reduction in order to develop descriptive categories. RESULTS: The following descriptive categories were developed from the men's experiences: Misconceptions regarding vasectomy that were overcome after hearing positive results expressed by other men; Vasectomy was the last solution for a couple's troubles related to contraceptive methods; Satisfaction related to professional support received during the process of searching for a method and deciding upon vasectomy; Satisfaction was the main feeling expressed following vasectomy and they recommended this contraceptive method to other men; Men's behaviours towards postvasectomy control was divergent despite the professional guidance. CONCLUSIONS: An integrated public policy is required to promote male involvement in reproductive health. Family planning programmes must be meaningful socioculturally and the inclusion of men in these programmes is recommended. The use of anonymized videotaped narratives or the recruitment of the men themselves during counselling about this method would be helpful for the resolution of reservations related to vasectomy. All the interviewed men expressed satisfaction with vasectomy and this feeling was mainly based on the certainty of the preservation of sexual performance. LIMITATIONS: A third of those invited for interview did not attend.

Adult↗

Measurement of membrane elasticity by micro-pipette aspiration.

The classical micro-pipette aspiration technique, applied for measuring the membrane bending elasticity, is in the present work reviewed and extended to span the range of pipette aspiration pressures going through the flaccid (low pressures) to tense (high pressures) membrane regime. The quality of the conventional methods for analysing data is evaluated using numerically generated data and a new method for data analysis, based on thermodynamic analysis and detailed statistical mechanical modelling, is introduced. The analysis of the classical method, where the membrane bending modulus is obtained from micro-pipette aspiration data acquired in the low-pressure regime, reveals a significant correction from membrane stretching elasticity. The new description, which includes the full vesicle geometry and both the membrane bending and stretching elasticity, is used for the interpretation of micro-pipette aspiration experiments conducted on SOPC (stearoyl-oleoyl-phosphatidyl-choline) lipid vesicles in the fluid phase. The data analysis, which is extended by detailed image analysis and a fitting procedure based on Monte Carlo integration, gives an estimate of the bending modulus, that agrees with previously published results obtained by the use of shape fluctuation analysis of giant unilamellar vesicles. The obtained estimate of the area expansion modulus, is automatically corrected for contributions from residual thermal undulations and the equilibrium area of the vesicle is resolved.

Computer Simulation↗

Neuropsychological assessment of Asian Americans: demographic factors, cultural diversity, and practical guidelines.

Asian Americans belong to 1 of the most rapidly growing ethnic minority groups in the United States. Clinical neuropsychologists unfamiliar with Asian American peoples and cultures may not be able to perform an adequate evaluation with an individual of Asian descent because of lack of understanding of how cultural variables might affect the assessment. This article attempts to provide some basic knowledge and principles by which to guide neuropsychologists who might work with an Asian American patient by (a) familiarizing the reader with basic information and descriptions of some of the major specific Asian subgroups, (b) providing a context within which neuropsychological test selection and interpretation can be adjusted to account for cultural and linguistic factors, and (c) providing practical suggestions for working with Asian American clients in a neuropsychological setting.

Acculturation↗

State legislative activities related to elimination of health disparities.

How have state legislatures acted to address racial and ethnic disparities in health care? This article examines trends over time in state legislation related to disparities in care and access, proposed legislation during one biennial session, and contemporary legislative attitudes and awareness of the issue. The mix of strategies adopted across the states reflects the differing ways that states understand gaps in minority health and changing strategies over time. Historically, California, Florida, and Louisiana (all states with substantial minority populations) have been the most active in dealing with minority health issues through statutes. In the eighteen months of the 2001-2002 legislative session that we studied, the most common bills called for studies of disparities and appropriations for identifiable minority health initiatives. Measures that successfully cleared the legislature include measures related to cultural competence and minority health awareness month. Finally, the article discusses issues and limitations in using legislative action to measure the level of state policy activity with regard to health disparities. To ground the description of trends in disparity legislation, the authors integrated comments by state legislators with a discussion of problems in interpreting legislative activity.

Cultural Diversity↗

[Phenomenology as a methodological alternative for research: some considerations].

The authors present the fundamental ideas of the phenomenology as an epistemology aiming human sciences which is concerned with the past experiences of the subjects and necessarily uses reflection as a way to consider the facts as they show up. As a methodological alternative for research, the phenomenology seeks the essence of the posed phenomenon and, to analyse its structure the investigator gets descriptions of the subjects who undergo the situation, aiming the formation of significant units. Hermeneutics is a kind of interpretation which must rely on a philosophical body of experience.

Humans↗

Why did black life expectancy decline from 1984 through 1989 in the United States?

OBJECTIVES: The objective of this study was to partition the change in US life expectancy into those major causes of death and age groups that contributed most to the decline in life expectancy for Black males and females and to the increase in life expectancy for White males and females in the period from 1984 through 1989. METHODS: By means of a life table partitioning technique, the positive and negative contributions of age and cause of death to changes in life expectancy were estimated. RESULTS: Causes contributing most to the decrease in life expectancy for Black males included human immunodeficiency virus (HIV) infection (< 5 and 20-69 years of age) and homicide (1-4 and 10-34 years of age); for Black females the causes included HIV infection (< 5 and 20-59 years of age) and cancer (65-79 and > or = 85 years of age). CONCLUSIONS: Mortality trends between the two major race groups in the United States diverged sharply, and without precedent, during the late 1980s. A description of these trends in terms of contributions to change in life expectancy may help us better analyze and interpret changes in the health of these groups and may contribute to a better allocation of resources for research, education, and public health programs.

Adolescent↗

The nature of clinical reasoning with groups: a phenomenological study of an occupational therapist in community mental health.

OBJECTIVE: The purpose of this paper is to examine the clinical reasoning of an occupational therapist in group practice in mental health. It emerged from a larger phenomenological study of expert occupational therapy practitioners in community mental health. METHOD: Data were gathered through intensive, semi-structured interviews with 1 day of participant observation. Analysis was an iterative process in which emerging themes were identified for reflection and interpretation. Previously established categories of clinical reasoning were used as a structure for describing the results. RESULTS: A rich description of clinical reasoning in psychosocial task groups is presented using interactive, narrative, conditional, and pragmatic reasoning. The gestalt of community practice is illustrated, as the therapist describes the multiple levels of consciousness used in her consideration of, and response to, clients within the context of the larger environment. CONCLUSION: This study suggests that an examination of occupational therapy with psychosocial groups is a rich area for research to extend our understanding of clinical reasoning in occupational therapy.

Community Mental Health Services↗

[Norwegian and Australian physicians' attitudes to adverse events].

BACKGROUND: As "second victims", doctors may find it difficult to meet patients and relatives with an open and regretting mind after adverse incidents. MATERIAL AND METHODS: In a series of six workshops 103 doctors, 46 from Australia and 57 from Norway, were included. Initially the participants completed a questionnaire about possible reactions after serious adverse events, experiences with formal complaints and legal charges, and an option to describe a personally experienced adverse event. This was followed by an interactive educational session, where prevention and management of adverse events were discussed. A descriptive analysis based on a combination of questionnaire data and notes from the discussions has been performed. RESULT AND INTERPRETATION: The questionnaire responses showed that Australian and Norwegian doctors mainly did agree about the most appropriate ways of responding after a serious adverse event. Subsequent discussions showed that certain issues were recurrently and similarly discussed among the participants through all the workshops. Although the majority principally did agree on an open approach, an underlying sceptical attitude emerged, partially connected to experiences of being thoughtlessly blamed by colleagues in the wisdom of hindsight. The study outlines a strategy to raise doctors' understanding of the importance of openness in order to reinforce trust in relation to all involved parties--patient, relatives, colleagues and self--after adverse events.

Attitude of Health Personnel↗

Computers in clinical laboratory management in Singapore.

In 1974, an off-line mini-computer system was introduced in the Clinical Biochemistry Laboratories of the Government Department of Pathology in Singapore. With the resiting of the 24-hour emergency biochemistry laboratory on the same floor as the Haematology Department within the new Singapore General Hospital, an on-line computer system was installed in 1983 to serve both the emergency biochemistry and haematology laboratories. An almost identical on-line system was also purchased in 1984 to replace the aged off-line system at the Department of Pathology. A description of the new computer systems based on Eclipse S/140 computers and Medical Information Technology (Meditech) software using Meditech Interpretive Information System (MIIS) language will be given. The specific features required and the selection criteria for the on-line systems are also discussed. The systems are used for the acquisition and processing of all patient and test data of the laboratories, direct capture of data from automated instruments, generation of work schedules and laboratory reports, compilation of work done, workload and revenue statistics and a variety of other reports. Patient cumulative records and quality control statistics are available on a real-time basis, thus greatly facilitating enquiries on patient results and monitoring of analytical performance. Prior experience with an off-line system and careful planning have been helpful in greatly shortening the preparatory period required for the smooth implementation of the on-line systems. Use of the systems has significantly improved laboratory management and has resulted in improved quality, and higher efficiency and productivity.

Chemistry, Clinical↗

[The application of a dynamic feedback control model to the estimation of the expenditure-dependent growth plateauing in forest stands].

In addition to the time-dependent description of growth an expenditure-dependent parameter is necessary, with the help of which it is possible to interpret quantitatively the expenditure of economically motivated silvicultural measures in forest stands. The solution of a differential equation contains the desired expenditure parameter, the time-dependent and site-index-dependent courses of pine stands are discussed in this paper as normal and additional expenditure for obtaining an additional increment by fertilisation.

Agriculture↗