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List randomization for prevalence estimation of sensitive behavioral data among women with HIV of reproductive age in Lilongwe, Malawi.

Self-reported data are subject to reporting biases, including social desirability bias. List randomization is one method that can help mitigate the impact of such biases. Here, we examined the utility of list randomization among women of reproductive age living with HIV in sub-Saharan Africa. In the Family Planning and Antiretroviral Therapy study, participants were randomized to answer 5 blocks of true/false statements via either direct or list response. Each block contained 3 nonsensitive statements and 1 sensitive statement related to either condom use or HIV disclosure. For each sensitive statement, we calculated the prevalence difference (PD) comparing list response to direct response overall and stratified by socioeconomic status. The PD for 4 of the sensitive statements was negligible. However, we found that self-report of always using a condom was reported by 53.1% at list response visits vs 34.7% at direct response visits (PD, 18.5%; 95% CI, 6.2%-30.7%), a difference that was attenuated among those with higher socioeconomic status. In this setting, list randomization did not meaningfully change the estimated prevalence for most questions, except for one question, which unexpectedly produced a higher estimate for a positive behavior. Examining this method in other settings and populations is warranted.

Humans

[Epidemiologic foundation for population studies of program MZ-XVII].

Epidemiological foundation included: aim of studies, knowledge about epidemiology of thyroid disorders in Poland, evaluation of radioiodine dose accumulated in thyroids of inhabitants of different age living in different par of Poland, information about relative diet iodine deficiency in different parts of Poland and identification of research teams (manpower) capable to carry on population studies. The final identification of epidemiological foundation was proceeded by pilot studies performed in 4 different regions of Poland. Finally it was decided that population studies would be performed in so called Regions of 6 different University Medical Schools (Białystok, Kraków, Lódź, Poznań, Szczecin, Wrocław). The sample will be selected randomly on the base of information from the voting lists (random selection of vovoidoship, then towns and villages, then streets and number of houses, then number of flats. All living in selected flat or house during Czernobyl accident and born between January 1974 and December 1985 (children) and between January 1926 and December 1973 (adults) will be considered "the sample". In all cases the sample will be examined by means of unified questionnaire and protocol of medical and laboratory examination. The same kits (of the same producers) will be used to evaluate serum TSH, T4, T3 and thyroid autoantibodies. The data obtained will be evaluated by unified computerized system. Separate studies involved the sample of newborns exposed to radioiodine during last trimester of pregnancy, found to be euthyroid and given potassium iodide in first days of life. Separate system was also used to investigate effect of radioiodine and of prophylactic dose of potassium iodide in those with past history of thyroid disorders.

Adult

Attitudes of certified registered nurse anesthetists toward AIDS and AIDS patients.

This study was intended to examine and identify the nature of CRNAs' attitudes concerning acquired immune deficiency syndrome (AIDS) and patients with homosexual lifestyles. This research question has been previously addressed using sample populations of registered nurses, physicians, and medical students. This inquiry was conducted using a sample population of nurse anesthetists. The target population was 500 CRNAs who reside in areas of high AIDS incidence--New York City, San Francisco, and Houston. The participants were equally divided among the three cities using a randomized list provided by the AANA. The design for this study was an experimental 2 x 2 factorial with two independent variables: disease of the individual, either leukemia or AIDS, and the sexual preference of the individual, either heterosexual or homosexual. The randomly distributed questionnaire consisted of three scales: the interpersonal attraction inventory, the prejudicial evaluation scale, and the social interaction scale. Multivariate analyses of variance (MANOVA) were conducted not only on the main effects, disease and sexual preference, but also on the interaction effects of disease and sexual preference. The significant findings of the MANOVAs were subjected to factorial analysis for each scale, and then the MANOVAs were conducted again. The statistical analysis indicated that CRNAs possess a negative attitude toward AIDS patients but not toward leukemia patients. Their attitudes are based on their perception that AIDS patients are responsible for their illness. Potential behavioral consequences were also reported by CRNAs, based on these attitudes.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome

Narcotic analgesia: fentanyl reduces the intensity but not the unpleasantness of painful tooth pulp sensations.

Forty subjects rated the magnitude of painful electrical stimulation of tooth pulp before and after the intravenous administration of either fentanyl, a short-acting narcotic, or a saline placebo. The responses were choices of verbal descriptors from randomized lists of either sensory intensity (that is, weak, mild, intense) or unpleasantness (annoying, unpleasant, distressing) descriptors. The fentanyl significantly reduced the sensory intensity without reducing the unpleasantness of the tooth pulp stimuli, indicating that the mechanisms of narcotic analgesia may include a significant attenuation in pain sensation in addition to effects on pain reaction. These results stress the importance of using multiple measures of pain.

Dental Pulp

[Cisapride and sucralfate in dyspepsia associated with duodenogastric reflux gastritis].

The present investigation was undertaken with the aim of evaluating the clinical efficacy on dyspeptic symptoms associated with duodenogastric reflux gastritis of two drugs belonging to two different groups: a prokinetic (cisapride) and a cytoprotective agent (sucralfate). A total of 18 patients with duodenogastric reflux gastritis diagnosed on the basis of symptoms, endoscopy and histology were studied. Nine were given 30 mg of cisapride/daily and 9 4 g of sucralfate/daily for two months according to a randomization list. Pyrosis, epigastric pain, sense of epigastric repletion and foul-tasting mouth were considered on a scale from 0 to 4 attributed by the patient. The total score of dyspeptic symptoms significantly decreased only after cisapride (p less than 0.05). Considering each symptom alone, neither cisapride or sucralfate were able to significantly improve them. Cisapride seems to the better than sucralfate in improving dyspeptic symptoms associated with duodeno-gastric reflux gastritis.

Adult

Effect of adrenaline on plasma concentrations of bupivacaine following lower limb nerve block.

Twenty-two patients undergoing total knee arthroplasty received combined sciatic plus femoral "3 in 1" blocks as adjuncts to general anaesthesia. Eleven patients received 0.375% bupivacaine 45 ml (168.75 mg) with adrenaline 1 in 200,000 and the remaining 11 received plain solution according to a previously prepared, randomized list. The mean maximum plasma bupivacaine concentration was significantly greater with plain solution than when adrenaline was added (1.66 micrograms ml-1 compared with 0.98 micrograms ml-1) (P less than 0.05). Bupivacaine concentrations were greater at all times in the plain group compared with the group receiving adrenaline. These differences were statistically significant at 10, 15 and 20 min (P less than 0.05). The greatest peak concentration recorded was 3.13 micrograms ml-1 in one patient receiving plain bupivacaine. No patient developed signs of systemic toxic effects. Peak plasma concentrations were related inversely to body weight in patients receiving solution containing adrenaline (P less than 0.005), but no relationship existed in patients who received plain solution.

Adult

Iomeprol vs iopamidol in intraarterial peripheral digital subtraction angiography.

The aim of this research was to compare the efficacy and tolerability of iomeprol, 150 mg iodine/mL, a new nonionic contrast medium, and iopamidol, 150 mg iodine/mg in intraarterial (IA) peripheral digital subtraction angiography (DSA) in 100 patients; a group of 40 patients were also submitted to a complete coagulation screening to check the influence of contrast media on blood clotting. The study was a comparative, double-blind clinical trial. The compound was assigned to each patient according to a randomization list. Small size (4-5 French) catheters were used in all patients to minimize arterial trauma and bedding time and to assess the quality of x-ray pictures in this condition. Vital signs, EKG tracings and laboratory parameters were monitored before and after the angiographic procedure; the coagulation screening included: thrombin time, prothrombin time, partial thromboplastin time, euglobulin lysis time, plasma thromboplastin antecedent, and plasminogen activator inhibitor (PAI). Both contrast media did not produce any adverse reaction or clinically significant alteration of studied parameters; in the 40-patient group subjected to massive coagulative screening, no important alteration after contrast media administration was reported. The score for contrastographic efficacy was very good with both media with a prevalence of better results in the iomeprol group.

Aged

Serum lipid variations in women on copper intrauterine devices, triphasic oral contraceptives and monthly injectable contraceptives.

This is a longitudinal, prospective, comparative controlled study. Patient selection excluded smokers, overweighed, hypertensive, and aged greater than 34 years. 168 women were distributed by random list into four groups: A) fitted with inert IUD (control); B) with Nova T (Cu-IUD); C) received triphasic gestodene (OC); and D) monthly norethisterone enanthate 50 mg + estradiol valerate 5 mg (injectable). Serum lipid patterns were assessed at the beginning of contraceptive use and at 1, 6 and 12 months. The results of the Cu-IUD group did not show any difference with the control group. The OC group showed an increase of HDL and a significant lowering of LDL cholesterol at 6 months but this reverted by 12 months. On the other hand, in the injectable group, a sharp decrease of total lipids, total cholesterol and LDL was observed from the first month, lasting throughout 12 months, yielding significant difference with controls and also with pre-treatment values. In sum, the monthly injectable showed quite favorable patterns that would deserve further study, especially in view of the scarcity of hitherto available information concerning this formulation.

Adult

Nizatidine versus placebo in active benign gastric ulcer disease: an eight-week, multicenter, randomized, double-blind comparison. The Nizatidine Benign Gastric Ulcer Disease Study Group.

STUDY OBJECTIVE: To determine if 150 mg nizatidine twice daily or 300 mg nizatidine at bedtime are similarly effective and to compare each dose with placebo in healing benign gastric ulcers and relieving peptic ulcer symptoms. METHODS: This study was a randomized, double-blind, placebo-controlled parallel comparison. The study was conducted at 74 gastroenterology and internal medicine clinics in the United States and Canada. Four hundred fifty-six patients with active benign gastric ulcer documented by endoscopy participated in the study. On the basis of a computer-generated randomization list, patients were assigned sequentially to receive either 150 mg nizatidine twice daily (n = 151), 300 mg nizatidine once daily at bedtime and identically appearing placebo capsules in the morning (n = 153), or placebo capsules twice daily (n = 152). Treatment lasted for 8 weeks unless healing was documented by endoscopy after 4 weeks. Antacid tablets (aluminum hydroxide, magnesium hydroxide, simethicone combination) were supplied for relief of symptoms. MEASUREMENTS AND MAIN RESULTS: Both doses of nizatidine significantly improved healing rates at 8 weeks compared with placebo. Daytime and nighttime symptom severity was improved by both nizatidine regimens at end point (p less than 0.015 versus placebo, two-tailed test). Antacid use was similar for all groups in the end point analysis. Patient well-being was significantly better in patients treated with nizatidine than in patients in the placebo group ((p less than 0.04, two-tailed test). No clinically significant differences in the incidence of adverse clinical or laboratory events were noted. CONCLUSION: Nizatidine, 300 mg at bedtime and 150 mg twice daily, resulted in greater healing of benign gastric ulcers than placebo treatment after 8 weeks. Relief of the symptoms of gastric ulcer was significantly better in the patients receiving nizatidine treatment versus placebo treatment.

Capsules

Validity and sensitivity of ratio scales of sensory and affective verbal pain descriptors: manipulation of affect by diazepam.

The results of two experiments suggest that sensory and affective verbal descriptors provide a valid scaling method which discriminates between the sensory intensity and the affect, or unpleasantness, of electrocutaneous stimuli. Twenty-four subjects judged the sensory intensity and affect of noxious electrocutaneous stimuli by choosing verbal descriptors from randomized lists and by cross-modality matching to time duration and to handgrip force. The psychophysical functions for sensory intensity generated by the descriptor and the cross-modality functions for sensory intensity generated by the descriptor and the cross-modality methods are the same. Psychophysical functions for affect generated by thedescriptor and the cross-modality methods are different. However, only the descriptor method produces psychophysical functions for affect that are significantly different from all the sensory functions. This result suggest that only the descriptor method distinguishes between sensory intensity and affect. The discriminative power of the descriptor method is demonstrated further in an experiment in which 32 subjects rated either the sensory intensity or the affect of the electrocutaneous stimuli immediately before and after an i.v. administration of 5 mg diazepam. This common minor tranquilizer significantly lowered affective descriptor responses (P less than 0.005) without altering sensory descriptor and sensory and affective handgrip responses. These experiments indicate that sensory and affective verbal pain descriptors may be used as a valid and sensitive tool for the evaluation of pain and pain control methods.

Adolescent

Evidence for language recoding in autistic, retarded and normal children: a re-examination.

In a replication and extension of earlier studies by Hermelin & O'Connor, language recoding abilities in autistic, retarded and normal children matched for mental age and digit span, were compared in a verbal recall task. Random word lists, sentences, and anomalous sentences, eight or 12 items in length (for high and low memory span subgroups) were presented and the number of words recalled from each type of input was scored. All low span children recalled sentences better than random lists with normal children superior to retarded and autistic children and the latter group poorer than the retarded group. Autistic children showed a recency effect with both types of input. There were no group differences amongst high span children and sentences were again better recalled than random lists. In Expt II sentences were better recalled than anomalous sentences, with autistic and retarded children equivalent in performance and poorer than normal children. Although low span autistic children were clearly deficient in recall of sentence material when compared with the two control groups, the effect of conditions showed that they were able to use structure to improve recall. Since high span autistic children did not perform differently from controls it is suggested that results from this kind of study may not be generalizable, and that claims for a specific coding deficit in autistic children need further substantiation.

Autistic Disorder

Color context as a factor in encoding and as an organization device for retrieval of word lists.

One hundred twenty female undergraduates were presented hierarchically organized or randomly arranged word lists within a context of hierarchically organized or randomly arranged color patterns. Recall scores were significantly higher with a hierarchic color pattern than with a random color pattern; this facilitating effect occurred for both hierarchic organizations and random arrangements of the word lists. The results suggest that Ss may use context as both a cueing of differentiating factor in encoding and as an organizational device for retrieval.

Color Perception

Outpatient wound preparation and care: a national survey.

STUDY OBJECTIVE: To sample the practice styles of emergency physicians caring for acute traumatic wounds. DESIGN: Written survey. SETTING: US emergency departments obtained from the American College of Emergency Physicians mailing list. SUBJECTS: Randomly selected ACEP members. MAIN RESULTS: One hundred fifty-one of 285 (53%) survey mailings were returned. Eighty-six percent of respondents were primarily clinicians, and the majority (61.6%) worked in EDs with annual patient visits between 21,000 and 50,000. The majority of respondents (64.2%) were certified by the American Board of Emergency Medicine. Nineteen percent managed wounds based on provider preference despite the existence of written wound management protocols. We identified a variety of practices that are contrary to current literature and textbook recommendations. Fifty-eight (38%) soaked wounds, whereas 21% used either 10% povidone iodine or hydrogen peroxide to cleanse wounds. One hundred one (67%) scrubbed the entire wound surface using, among other methods, cotton gauze (59%) or a coarse, bristle-laden sponge (38%). Forty (27%) irrigated wounds using techniques that have not been proven to deliver the 5 to 8 psi necessary for adequate tissue cleansing. Delayed primary closure, a treatment option for lacerations at increased risk for infection, was infrequently or never practiced by 76% of respondents. All respondents administered IV antimicrobials at least occasionally for simple outpatient lacerations. CONCLUSION: Methods of preparing, treating, and following outpatient wounds vary among emergency physicians, and these results support the idea that no de facto standard of care exists for this clinical problem. Outpatient wound care techniques routinely practiced (ie, soaking, scrubbing, use of full-strength hydrogen peroxide or full-strength povidone iodine) may be harmful based on limited animal and human research, whereas other proven techniques (ie, delayed primary closure) are infrequently practiced by many emergency physicians.

Ambulatory Care

The level-of-focal-attention hypothesis in oral reading: influence of strategies on the context specificity of lexical repetition effects.

Two experiments examined the influence of level of focal attention--text or lexical--on benefits from lexical repetition in speeded oral reading of coherent texts and random word lists. Experiment 1 showed that with coherent targets, direction of attention to the text level resulted in benefit only from a previous reading of the same coherent paragraph. However, when attention was directed to the lexical level, equal benefit resulted from a previous reading of either the same coherent paragraph or a scrambled version of the paragraph. Experiment 2 showed that level of focal attention did not influence benefit with scrambled targets. Thus, the linguistic structure of the target is important to repetition benefits and their modulation by attentional strategies.

Analysis of Variance

Effects of fetal androgen on childhood behavior.

The effects of fetal androgen excess or deficiency on postnatal behavior were examined in 7 males and 14 females with congenital adrenal hyperplasia or hypoplasia aged 3 to 21 years. The subjects were divided into 3 groups: those with androgen excess (A+) comprised a group of 13 patients with classical 21-hydroxylase deficiency and one with 11-beta-hydroxylase deficiency; a normal or reduced androgen (a+) group was represented by one patient with late-onset 21-hydroxylase deficiency and one with congenital adrenal hypoplasia; and a group with absent androgen (A-) consisted of 5 patients with a cholesterol side-chain cleaving-enzyme deficiency. Behavior was evaluated as male (M) or female (F) according to the pattern of play, classification of which was based on data of prevalent play in 1,275 preschool and 400 school boys and girls. Play prevalent in both sexes was classified as neutral (N). The mothers of the patients were requested to check the preferred play during childhood from a randomized play list. The androgen excess group showed M or bisexual (M/F) type, whereas all of the androgen deficient group revealed F type irrespective of gender. In preschool children, coincidence of M or F play type with genetic sex, social sex and androgen exposure was 38%, 53% and 90%, respectively, indicating androgen-dependency of playing patterns. This persisted into school age, although the coincidence rate was slightly changed by environmental effects. These results suggest that fetal androgen plays a role in the sexual differentiation of the central nervous system.

Adolescent

Transfer of categorial clustering set in mildly retarded adolescents.

The relative effectiveness of instructions to adopt an organizational strategy vs. exposure to category labels was investigated. Twenty-four retarded adolescents were assigned to each of three conditions (blocking plus instructions, blocking plus labels, and blocking) for pretraining and training. Immediately after training, all subjects received a transfer task consisting of a new randomly organized list containing words from the same (training) categories for one-half of the subjects and from different categories for the other half. When exposure to category labels accompanied blocking, results indicated increased clustering and recall during the training phase and a trend toward increased clustering during the transfer phase.

Adolescent

Potential drug interactions in an ambulatory geriatric population.

Drug interactions are a common cause of iatrogenic disease in geriatric patients. Computer programs now exist which allow one to analyse groups of drugs for potential interactions. In an audit of charts of 100 geriatric patients seen in the Family Practice Center at Barberton Citizens Hospital, a computer printout was obtained, listing all patients aged 60 years and over who were seen at the Center during 1989. Names were selected randomly from this list by the head nurse and their charts were obtained for review, generating information on patient identification number, age, sex, diagnoses, medications, and allergies. The medications were analysed using the Hansten Drug Interaction Knowledge Base Program, which identified 27 patients as being on a combination of medications which had one or more potential drug interactions. A total of 37 potential drug interactions were identified in this group of 27 patients. Relative risk ratios were determined using the computer program, 'Epi Info,' for sex (female versus male), age (greater than or equal to 75 vs. 60-75 years), number of diagnoses greater than or equal to 3 vs. 0-2), and number of medications (greater than or equal to 4 vs. 0-3). The five medications, or groups of medications, which were most likely to be involved in potential drug interactions were digoxin, beta-blockers, oestrogen, oral hypoglycaemic agents, and diuretics.

Aged