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Association between contraceptive method accepted and perception of information received: a comparison of Norplant and IUD acceptors.

In the present study Norplant(R) and IUD acceptors who attended the same counseling sessions have been compared on their perception of the information received at the family planning clinic. The study covered 100 acceptors of each method quota matched by parity and years of schooling. Data were obtained through home interviews. The two groups presented no significant differences when selected socio-demographic characteristics were analyzed. Norplant users recalled more information on this method than did IUD acceptors, and the content of what they remembered was different. This included concepts as important as risk of pregnancy, menstrual and health effects, and method of removal. The results suggest that the intrinsic qualities of the new method and the presence of a group of women motivated to use one with its general characteristics, are not sufficient conditions for its acceptance.

Contraception

Saline lavage: a rapid, effective, and acceptable method for cleansing the gastrointestinal tract.

The standard preparation for cleansing the gastrointestinal tract for diagnostic studies such as barium enema usually involves dietary restrictions, purgatives, and cleansing enemas. This preparation is time consuming, often uncomfortable for the patient, and frequently unsuccessful. In this study, we examined the efficacy of saline lavage (without dietary restrictions or cleansing enemas) as a gentle, alternative method for cleansing the bowel, and compared lavage to the standard castor oil method of bowel preparation. Lavage cleansing was preferred by 75% of patients who had previously experienced a castor oil preparation. Although 11% of patients could not consume an adequate (4-liter) lavage volume, there was no significant difference in preparation success rate between the remaining lavage patients and the castor oil patients. Total preparation time for lavage (3 +/- 1 hr) was 60% less than for castor oil. The anticipated dehydration produced by castor oil and the hydration produced by lavage were confirmed. No significant changes were noted, however, in serum electrolytes with either method of preparation. Additional early studies are promising for the lavage method when used in inflammatory bowel disease patients and as a cleansing preparation for colonoscopy.

Barium Sulfate

[Psychotherapy in schizophrenic psychoses--historical development, effectiveness and currently accepted methods].

Psychotherapy has a long tradition in the treatment of schizophrenic psychosis. Individual therapies--based on psychoanalysis in continental Europe and in the first half of this century due to emigrants in England and the United States--were predominant. The development of family therapy then led to modified forms and in particular group therapy for relatives of schizophrenic patients. There is a variety of treatments available today: assistance in coping with the disease, cognitive therapies and social skill training, psychotherapy based on depth psychology, family therapy and work with the relatives of patients. Some encouraging studies on efficacy are already available. Drug treatment continues to be the dominant form of therapy, but modified psychotherapeutic programs for patients and their relatives have become an important supplement to neuroleptic therapy and relapse prevention, particularly since the "Vulnerability-Stress-Hypotheses" became widely accepted.

Combined Modality Therapy

A long-term study of mortality in men who have undergone vasectomy.

BACKGROUND: Vasectomy is a reliable and widely accepted method of contraception, but there is some uncertainty and few data about a possible long-term adverse effect on health. METHODS: We examined the relation between vasectomy and mortality rates from cardiovascular disease, cancer, and all causes in a retrospective cohort of husbands of members of the Nurses' Health Study. In 1989 we obtained data by questionnaire on 14,607 men who had undergone vasectomy as of 1976 and 14,607 men who had not. RESULTS: Among the men who were free of cancer at the start of the study, 1052 died: 446 of cardiovascular disease, 341 of cancer, and 265 of other causes. Vasectomy was associated with reductions in mortality from all causes (age-adjusted relative risk, 0.85; 95 percent confidence interval, 0.76 to 0.96) and mortality from cardiovascular disease (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.92). Vasectomy was unrelated to mortality from all forms of cancer (relative risk, 1.01; 95 percent confidence interval, 0.82 to 1.25). Among men who had a vasectomy at least 20 years earlier, the procedure had no relation to mortality from all causes (relative risk, 1.11; 95 percent confidence interval, 0.92 to 1.33) or that from cardiovascular disease (relative risk, 0.85; 95 percent confidence interval, 0.63 to 1.16). However, mortality from cancer was increased in men who had a vasectomy at least 20 years earlier (relative risk, 1.44; 95 percent confidence interval, 1.07 to 1.92). The excess risk of cancer in these men was due primarily to lung cancer. None of the observed associations were confounded by smoking habits, body-mass index, alcohol consumption, or educational level. CONCLUSIONS: Vasectomy is not associated with an increase in overall mortality or mortality from cardiovascular disease. Our study also found no increase in overall mortality from cancer after vasectomy, but there was an apparent increase in the risk of cancer 20 or more years after vasectomy that requires further study.

Adult

Control of ticks.

A number of different acaricides provide highly effective control of tick populations on dogs and cats. These acaricides are formulated as sprays, dips, dusts, or shampoos for use on the animal. Further protection of the animal from reinfestation with ticks can be achieved with the use of acaricide-impregnated flea and tick collars. Some of these acaricides are registered with the EPA for indoor and outdoor use as controls for free-living populations of ticks. Caution should be used when applying these materials. The label directions for the application of the acaricide and disposal of the acaricide containers should always be followed. Removal of underbrush and leaf litter, thinning trees, and frequently mowing grasses help reduce the number of free-living ticks. Any reduction in the amount of wildlife food sources and cover areas potentially decreases populations of ticks and thus reduces the potential of these ticks parasitizing a dog or cat. Application of an acaricide for area-wide control of free-living ticks in the spring, summer, and autumn also reduces the number of ticks. New approaches to area-wide control of ticks by use of acaricides that are focused on controlling the ticks attached to small mammal hosts are discussed. Although research has shown that reductions in tick numbers can be achieved using these methods, acceptance of these methods by regulatory agencies and the public requires further research.

Animals

Staphylococcus epidermidis biotype 4: epidemiological conclusions from five different typing methods.

There is presently no accepted method for marking individual strains of Staphylococcus epidermidis. Consequently, five parameters for distinguishing such strains were examined and compared for their epidemiological efficacy: biotyping, serotyping, proteinase grouping, aminopeptidase profiles and antibiograms. Both biotyping and proteinase grouping were of limited use in identifying a particular strain, although they were helpful in initially categorizing such strains. Antibiograms were least useful because of similarities in susceptibility patterns among isolates. Serotyping and amino-peptidase profiles provided the best means of identifying an individual strain for epidemiological use. The applicability of these typing methods was demonstrated during a one year epidemiological study at a chronic disease hospital.

Aminopeptidases

Trial of pyrethroid impregnated bednets in an area of Tanzania holoendemic for malaria. Part 1. Operational methods and acceptability.

In five Tanzanian villages, nets impregnated with permethrin or lambdacyhalothrin were given out. The people received them enthusiastically and brought their nets for re-impregnation at six monthly intervals. Bioassays showed that the insecticidal power of permethrin impregnated nets remained adequate for six months unless the nets were washed. Nets with 30 mg lambdacyhalothrin/m2 retained high insecticidal power despite washing, but this dose caused temporary cold-like symptoms in those sleeping under freshly treated dry nets. Methods by which durable bednets might be made affordable by Tanzanian villagers are discussed.

Animals

Single-operator comparison of early and mid-second-trimester amniocentesis.

We sought to determine whether early amniocentesis is a safe and acceptable method of genetic evaluation in early pregnancy. During the 54-month period from September 1986 to February 1991, 300 consecutive early second-trimester amniocenteses were performed transabdominally at 13-14 weeks' gestation and 567 consecutive mid-second-trimester transabdominal amniocenteses were performed at 16-18 weeks. Group assignment was nonrandomized, interoperator-dependent variables were eliminated, and analysis was performed in one cytogenetics laboratory. The median maternal age and indications for the procedure were similar in both groups. There were no significant differences between the early- and mid-second-trimester amniocenteses in failed sampling, ambiguous results, pregnancy loss from 4 weeks after the procedure to 28 weeks' gestation, preterm birth, or perinatal death rate. Pregnancy loss within 4 weeks of amniocentesis was more frequent in early- than in mid-second-trimester amniocenteses. We conclude that early amniocentesis is a safe and acceptable method of genetic evaluation.

Adult

Antimicrobial susceptibility testing of anaerobic bacteria.

Antimicrobial therapy of anaerobic infections is usually predicted on the basis of known patterns of susceptibility of anaerobic bacteria to antimicrobial agents rather than on results of in vitro tests of individual isolates. Routine susceptibility testing of anaerobic bacteria is not recommended, but there are instances of serious infection, i.e., endocarditis, or specific infecting organisms, e.g., Bacteroides fragilis, when in vitro testing of the specific infecting organism is indicated. No standard method has yet been accepted. Methods presently recommended are agar dilution or broth dilution tests. Other methods currently being evaluated are agar (disc) diffusion, broth-disc, and simplified broth and agar dilution tests. The advantages and limitations of the various methods are discussed.

Anti-Bacterial Agents

[Value of diagnostic procedures in heart failure].

Strategy for the diagnosis of heart insufficiency is directed to the accomplishment of distinct therapeutic aims. Main factors for diagnostic approaches are pathophysiology and progression of qualitatively and quantitatively different disturbances in cardiac performance. Anamnesis and clinical investigations are irremissible for the evaluation of congestive heart failure. For the detection of noncongestive cardiac insufficiency investigations during exercise are often necessary. Ventriculography ist the standard reference technique for measurement of the systolic and diastolic ventricular functions. For exercise and follow-up investigations non-invasive methods are widely used. Accepted methods are two dimensional and Doppler-echocardiography, quantitative radiocardiography with single-pass bolus technique, and radionuclid-ventriculography. We found a good correlation for the measurement of stroke volume when comparing impedance cardiography with uniplane ventriculography at rest. M-mode echocardiography did not yield sufficiently reliable volumetric data. The new imaging methods, positron emission tomography, magnetic resonance technique, and cine computed tomography are future tools for cardiac output measurements.

Coronary Disease

Method comparison--a different approach.

The commonly accepted method of analysing data from method comparison studies is regression analysis, a method which has limitations. This study illustrates the use of a graphical presentation of data, the difference plot, which can be used as an alternative to least squares regression analysis. The data from comparison studies performed on five methods were analysed both by Deming's regression analysis, with calculation of the correlation coefficient, and by the difference plot. The results show that in most cases much more relevant information was obtained from the difference plot.

Androstenedione

Bile acid analysis: methods and problems.

What is the ideal method for analysis of faecal bile acids? Selection of an ideal system for a specific situation requires consideration of several factors, eg the information sought, availability of equipment and time constraints. Each laboratory will select procedures based on these constraints. A situation in which a large number of subjects are to be screened for total bile acid concentration might suggest use of single-day collections, lyophilization prior to homogenization, extraction using the Evrard and Janssen method and quantification by 3 alpha-hydroxysteroid dehydrogenase. However if the ratio of glycine to taurine conjugates and the daily excretion were of interest, separation of subclasses with Lipidex 1000 followed by both gas chromatography (of free bile acids) and HPLC (of conjugated bile acids) would be selected. There is not a best method for all situations. What does the future hold for improving this methodology in order to improve our ability to use faecal bile acid analysis clinically? The biggest problem facing the application of faecal bile acid analysis to clinical situations in the lack of ability to devise a rapid method (24-48 h) which retains the accuracy of current methods. One promising development is the potential application of immunological methods to faecal bile acids. These detection methods have been applied primarily to serum to date but if extraction and/or purification methods could be coupled with this method of quantification, a clinically acceptable method may result.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile Acids and Salts

Postponement of withdrawal bleeding with a monophasic oral contraceptive containing desogestrel and ethinylestradiol.

This study investigated the ability of a monophasic sub-50 oral contraceptive, containing desogestrel and ethinylestradiol, to postpone withdrawal bleeding in normal healthy women. In the analyzed group of 105 regular users of Marvelon, about 75% did not experience any vaginal bleeding during the 21 days of postponement. A 95% confidence interval was calculated which suggests that the percentage of women able to postpone their withdrawal bleeding successfully for 19 days ranges between 67.0% and 83.5%. Women with no vaginal blood loss in the postponement period were more willing to try this method of postponement again, compared to women who experienced vaginal blood loss in the postponement period. This difference was statistically significant. Nevertheless, the majority of women with vaginal blood loss were also willing to try this method again if necessary. The study results suggest that Marvelon offers an effective and acceptable method of postponing withdrawal bleeding for three weeks for most regular users of this contraceptive.

Adolescent

Percutaneous feeding tube method for use in children.

Surgical gastrostomy has been a widely accepted method for introducing a percutaneous feeding tube for many years. However, complications are frequent, and many children who need them are not good surgical candidates. This study examines imaging guided percutaneous placement of feeding gastrostomy catheters as a safe and effective alternative to surgery.

Barium Sulfate

Continued use of contraception among Philippine family planning acceptors: a multivariate analysis.

The factors that contribute to continued use of contraception are examined through a multivariate analysis of data gathered in the course of the Philippine 1974 National Acceptor Survey. Twenty-five independent variables were utilized in the analysis, of which only three were found to have an appreciable effect upon continuation: the method accepted, age, and husband's attitude regarding family planning. When the sample was divided into method subgroups, several features of the service process explained variance in pill continuation, and fecundability explained variance in rhythm continuation. The findings suggest that there is considerable potential for improving the effectiveness of the Philippine program through administrative action. Better IUD services and information, more emphasis on the needs of husbands, and improvements in the ongoing support of pill users could substantially improve the amount of contraceptive protection offered by the program.

Adolescent

[Radiological heart volume determination--a new method carried out in the sitting position (author's transl)].

A method is described for the determination of cardiac volume with the subject in a sitting position. The results correspond with those of other accepted methods, but there are several significant advantages: 1. The position is easily maintained by the subject and the method is therefore acceptable for patients with cardiac disease. 2. The risks connected with a Valsalva effect are reduced. 3. There is no need to change the position of the x-ray tube during the examination. 4. Contrary to the traditional technique, the x-ray room does not require a very high ceiling. 5. Because of even blood distribution, the cardiac volume determinations also provide information regarding the lungs.

Adult

[Modified method of ultramicroelectrophoretic protein fractionation].

A modification is described for the method of ultramicroelectrophoretic fractioning of proteins in polyacrylamide gel in capillaries 400--100 microns in diameter. The original construction of the assembly of apparatuses is offered which can be assembled from details made in the USSR. The operation of dosed filling of capillaries is significantly facilitated. The optimal quantity of protein in one sample reaches 1.5--0.1 mkg (depending on the capillary diameter). The reproducability and sharpness of protein fractions by the offered method are not worse compared with the generally accepted method of macro-disc electrophoresis.

Cell Fractionation