SEARCH · Search PubMed

Results for “SHARE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources

PubMed1998

Injection and syringe sharing among HIV-infected injection drug users: implications for prevention of HIV transmission. Supplement to HIV/AIDS Surveillance Group.

Because HIV-infected injection drug users (IDUs) can transmit HIV infection, we investigated factors associated with sharing of syringes in the past year among IDUs infected with HIV. We analyzed data from an interview survey of 11,757 persons > or = 18 years of age with HIV or AIDS between June 1990 and August 1995 who were reported to 12 state or city health departments in the United States. Of the 1527 persons who had ever shared syringes and reported injecting in the 5 years before the interview, 786 (51%) had injected in the year before interview, and of these, 391 (50%) had shared during that year. IDUs who were aware of their HIV infection for >1 year were less likely to share (43%) than those who were aware of their infection for 1 year or less (65%, adjusted odds ratio=2.15, 95% confidence interval, 1.52-3.03). The only statistically significant time trend was that the proportion of IDUs from Connecticut who shared decreased from 71% in 1992 to 29% in 1995. This trend appears to be related to the 1992 changes in Connecticut laws that allowed purchase and possession of syringes without a prescription. Because many HIV-infected IDUs continue to inject and share, prevention efforts should be aimed at HIV-infected IDUs to prevent transmission of HIV. Early HIV diagnosis and access to sterile syringes may be important methods for reducing syringe sharing by HIV-infected IDUs.

Acquired Immunodeficiency Syndrome↗

PubMed2005

When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions.

BACKGROUND: Previous research has shown that patient cost-sharing leads to a reduction in overall health resource utilization. However, in Canada, where health care is provided free of charge except for prescription drugs, the converse may be true. We investigated the effect of prescription drug cost-sharing on overall health care utilization among elderly patients with rheumatoid arthritis. METHODS: Elderly patients (> or = 65 years) were selected from a population-based cohort with rheumatoid arthritis. Those who had paid the maximum amount of dispensing fees (200 dollars) for the calendar year (from 1997 to 2000) were included in the analysis for that year. We defined the period during which the annual maximum co-payment had not been reached as the "cost-sharing period" and the one beyond which the annual maximum co-payment had been reached as the "free period." We compared health services utilization patterns between these periods during the 4 study years, including the number of hospital admissions, the number of physician visits, the number of prescriptions filled and the number of prescriptions per physician visit. RESULTS: Overall, 2968 elderly patients reached the annual maximum cost-sharing amount at least once during the study periods. Across the 4 years, there were 0.38 more physician visits per month (p < 0.001), 0.50 fewer prescriptions filled per month (p = 0.001) and 0.52 fewer prescriptions filled per physician visit (p < 0.001) during the cost-sharing period than during the free period. Among patients who were admitted to the hospital at least once, there were 0.013 more admissions per month during the cost-sharing period than during the free period (p = 0.03). INTERPRETATION: In a predominantly publicly funded health care system, the implementation of cost-containment policies such as prescription drug cost-sharing may have the unintended effect of increasing overall health utilization among elderly patients with rheumatoid arthritis.

Aged↗

PubMed2005

Mental health status, drug treatment use, and needle sharing among injection drug users.

This study examined the relationship among mental health symptoms, drug treatment use, and needle sharing in a sample of 507 injection drug users (IDUs). Mental health symptoms were measured through the ASI psychiatric scale. A logistic regression model identified that some of the ASI items were associated with needle sharing in an opposing direction. Specifically, anxiety was significantly and positively associated with needle sharing. Using psychotropic medication was significantly and negatively associated with sharing needles. Those who had higher levels of drug injecting were more likely to share needles and those with an HIV-positive status were less likely to share needles. Finally, IDUs who reported high levels of drug treatment use (in the 75th percentile in terms of number of treatment admissions) were also more likely to share needles. Results suggest that treating mental health problems in IDUs who are not drug free could reduce HIV risk behaviors. The results also suggest the need to develop new intervention methods for high-level drug treatment users who may be "cycling" through treatment with low levels of treatment completion.

Adult↗

PubMed1994

Correlates of needle sharing among injection drug users.

OBJECTIVES: The sharing of contaminated injection equipment is the primary mode of human immunodeficiency virus (HIV) transmission for injection drug users. This study examined demographic factors, life events, and drug use practices that are potential risk factors for sharing injection equipment. METHODS: Between February 1988 and March 1989, 2921 active injection drug users were interviewed and questioned about their backgrounds, life-styles, and patterns of injection drug use. RESULTS: Of 2524 participants who reported injecting drugs within the 6 months prior to study enrollment, 70.4% reported recent needle sharing. A multivariate analysis found needle sharing to be more frequent among those with a history of arrest and lower socioeconomic status, even after accounting for other demographic and drug use variables. In addition, recent needle sharing was higher in male homosexual or bisexual men than in their heterosexual counterparts. CONCLUSIONS: These data suggest that injection drug users have an economic motive to share needles and that the availability of free and legal needles may reduce levels of needle sharing.

Adult↗

PubMed2005

The effects of prescription drug cost sharing: a review of the evidence.

OBJECTIVES: To determine whether patients respond to increased cost sharing by substituting less expensive alternatives for medications with higher levels of copayments or coinsurance, and to examine the body of evidence on the relationships between cost sharing and use of essential or maintenance medications, health outcomes, process-of-care measures (such as medication adherence and discontinuation), and costs. STUDY DESIGN: Literature review. METHODS: Healthcare reference databases and key journals were searched to identify peer-reviewed empirical studies that examined the effects of variation in the amount of prescription drug copayments or coinsurance on healthcare utilization patterns. Thirty studies met our search criteria. RESULTS: Higher levels of prescription drug cost sharing generally produce intended effects, namely, decreasing the consumption of prescription drugs and steering patients away from nonpreferred to preferred brand-name drugs. However, patients do not always switch to generic drugs. Although not consistently reported, the most troublesome effects associated with higher levels of cost sharing are treatment disruptions (such as lower levels of treatment adherence, continuation, and initiation) for chronically ill patients. At times, higher levels of cost sharing can affect the use of essential medications and outcomes of care. CONCLUSIONS: Cost sharing reduces the consumption of prescription drugs but may have unintended effects on the process and outcomes of therapy. Further research is warranted in this area. The central question for health plan managers and policy makers is whether we will continue to use cost sharing as is or make modifications to reduce unintended effects.

Choice Behavior↗

PubMed1995

Hepatitis C prevalence and needle/syringe sharing behaviours in recent onset injecting drug users.

AIM: To investigate the prevalence of hepatitis C antibody (anti-HCV) in injecting drug users (IDU), particularly amongst those of recent onset beginning since the advent of the needle-exchange programme. Secondly this study sought information on needle-sharing practices. METHODS: The records of injecting drug users over 2 years from January 1992 were examined for anti-HCV results and needle-sharing reports on initial assessment at the Wellington drug dependency clinic. RESULTS: Amongst 110 injecting drug users 92 (84%) were tested for anti-HCV, and 71 (77%) were positive. There was a significant (p = 0.02) association between the reported duration of intravenous drug misuse and the proportion of injecting drug users who were positive for anti-HCV. Of those injecting drug users who had reported use of less than 4 years, since the introduction of the New Zealand needle exchange programme, 53% were positive for anti-HCV. Needle-sharing was frequently reported to have ever occurred in 74% of these patients at some time, and in 64% of those who reported use of less than 4 years. These differences were not significant. However, in the period before presenting 67% had not shared over the last 3 months and 57% had not shared over the previous 1 year, which are improvements on previous studies of needle-sharing, considered to be the most important mode of transmission for blood-borne viruses in injecting drug users. CONCLUSIONS: These results suggest considerable potential for HIV infection rates among injecting drug users in New Zealand to increase from the current low level. There needs to be continuing emphasis on public health programmes to eradicate needle-sharing, and to promote safe injecting techniques for injecting drug users.

Adult↗

PubMed2025

Quantitative Outcomes for Shared Assessment and Management in Forensic Mental Health: A Meta-Analysis and Systematic Review.

Despite leading models of mental health care encouraging user involvement, users in forensic mental health (FMH) report poor involvement given the difficulty in reconciling shared approaches with risk-averse and legally mandated settings. While previous research has demonstrated qualitative benefits to shared approaches in FMH and has led to a proliferation of self-rated assessment tools, there remains to quantify agreement on self-rated tools and to clarify the impact of shared approaches on care. This meta-analysis examines (1) the correlation between clinician and user ratings, (2) the predictive validity of self-ratings for violence, and (3) the effects of shared risk management on violence and restriction in FMH. Five databases were searched from inception to April 2024, selecting for adult FMH inpatients, shared risk assessment, needs assessment or violence management as interventions, and quantitative outcomes (correlation, agreement, predictive validity, and effect on violence or restriction rates). Fifteen quantitative evaluations were retained. One of three planned meta-analyses could be conducted, with seven records providing paired clinician-user t-tests. Eleven more records provided clinical recommendations on operationalizing shared approaches. Random-effects meta-analysis showed a significant and large paired standard difference of .95 (95% CI = [.49,1.42]) across tools, with significant differences in DUNDRUM-3, DUNDRUM-4, and CANFOR sub-models. While acknowledging between-study heterogeneity, results substantiate quantitative differences where clinicians generally rate more needs and lesser progress than users across tools, showing that self-ratings can and should be used to broach collaborative discussions on needs and progress during FMH treatment. There remains an evidence gap for quantitative benefits in care outcomes and a need to standardize agreement measures for future comparisons and clinical sub-group analyses.

Humans↗

PubMed1998

Evaluation of a clinic-based program to promote book sharing and bedtime routines among low-income urban families with young children.

OBJECTIVE: To evaluate a program of anticipatory guidance in which pediatric residents and nurse practitioners in a continuity practice gave parents books for their young children along with developmentally appropriate educational materials describing why and how to share the books and promoting reading as part of a bedtime routine. STUDY DESIGN: Comparison of 2 cross-sectional groups using consecutive, structured, face-to-face or telephone interviews of parents. One group was a historical control or a comparison group (group 1). The other was the intervention group (group 2), which included families who had received 2 books and educational materials for the children as part of the program to promote book sharing and bedtime routines. SUBJECTS: Before the institution of the program to promote book sharing and bedtime routines, the parents in 51 families with healthy children 12 to 38 months of age who regularly attended continuity clinics conducted by the house staff were interviewed; these families constituted group 1. Group 1 included a low-income population of Hispanic, African American, and non-Hispanic white families. Group 2 included 100 families with similar sociodemographic characteristics with healthy 12- to 38-month-old children who had received 2 books and educational materials at all 6- to 36-month well-child visits as part of the program. RESULTS: The intervention was found to be effective in promoting child-centered literacy activities. When asked openended questions, 4 (8%) of the parents in group 1 and 21 (21%) of the parents in group 2 said 1 of their child's 3 favorite activities included books (P=.04); 11 (22%) of the parents in group 1 and 42 (42%) of the parents in group 2 said 1 of their 3 favorite activities with their child was book sharing (P=.01); and 10 (20%) of the parents in group 1 and 35 (35%) of the parents in group 2 said that they share books 6 or 7 times a week at bedtime (P =.05). By mentioning 1 of these 3 important child-centered book-sharing activities, 17 (33%) of the parents in group 1 and 69 (69%) of the parents in group 2 (P <.001) demonstrated positive child-centered literacy orientation . A multiple logistic regression analysis controlling for parental education, ethnicity, and reading habits, as well as for the sex and age of the children, found child-centered literacy orientation more likely to be present in group 2 than in group 1 families, with an odds ratio (OR) of 4.7 (95% confidence interval [CI], 2.1-10.5; P<.001). Book sharing as part of a bedtime routine was more frequent in group 2 (mean+/-SD, 3.9+/-2.6 nights per week) than in group 1 (mean+/-SD, 2.5+/-2.7 nights per week; P=.002); however, no significant differences in prolonged bedtime struggles, parent-child co-sleeping, frequent night waking, or how children fell asleep were found between the groups. Instead, in multivariate analysis, bedtime struggles occurred more often with younger parents (P=.03) and fewer children at home (P=.02), while parent-child co-sleeping (P<.001) and frequent night waking (P=.04) were less likely to occur when children usually fell asleep alone in their own beds. CONCLUSIONS: This simple and inexpensive intervention by pediatric house staff, consisting of the provision of children's books and educational materials at well-child visits, resulted in increased enjoyment of and participation in child-centered book-related activities in low-income families. Primary care providers (ie, physicians and nurse practitioners) serving underserved pediatric populations may have a unique opportunity to promote child-centered literacy in at-risk groups.

Beds↗

PubMed2003

Infant-parent bed sharing in an inner-city population.

BACKGROUND: In the United States, infant-parent bed sharing is a controversial and poorly understood practice. Proponents site potential advantages such as increases in bonding and facilitation of breastfeeding, whereas opponents site potential increases in risks of suffocation and sudden infant death syndrome, particularly among mothers who smoke. Few studies have examined normative practices in low-income populations. OBJECTIVES: To describe sleep practices in a cohort of infants born to predominantly low-income, inner-city mothers, to examine stability in sleep practices during the first 7 to 12 months of life, and to identify factors associated with bed sharing. DESIGN AND SETTING: Prospective birth cohort study in the District of Columbia, with recruitment taking place between August 1995 and September 1996 and follow-up from November 1995 to September 1997. PARTICIPANTS: Maternal-infant pairs were systematically selected from 3 hospitals. We interviewed 394 mothers shortly after delivery and at 3 to 7 months post partum. Of these, 369 were interviewed again at 7 to 12 months post partum. MAIN OUTCOME MEASURE: Usual bed sharing. RESULTS: At age 3 to 7 months (mean age, 129 days), 201 infants (51%) usually slept alone and 191 (48%) usually slept in a bed with a parent or other adult. Similarly, at age 7 to 12 months (mean age, 262 days), 190 infants (51%) usually slept alone and 175 (47%) usually slept in a bed with a parent or other adult. Of the infants who slept with a parent or other adult at age 3 to 7 months, 75% continued to do so at age 7 to 12 months. Similarly, of infants who usually slept alone at age 3 to 7 months, only 22% were reported to be usual bed sharers at age 7 to 12 months. In multivariate analyses, factors associated with bed sharing at both follow-up interviews included single marital status of the mother (first interview: odds ratio [OR] = 1.90; 95% confidence interval [CI], 1.11-3.27; second interview: OR = 1.81; 95% CI, 1.02-3.25) and 1 or more moves since the birth of the infant (first interview: OR = 1.82; 95% CI, 1.10-3.01; second interview: OR = 1.73; 95% CI, 1.05-2.86). Breastfeeding and household crowding were not significantly associated with bed sharing. CONCLUSIONS: Bed sharing was common in this inner-city population, and sleep practices were relatively stable during the first 7 to 12 months of life. These findings underscore the need for additional research clarifying the benefits and risks of bed sharing.

Adult↗

PubMed2004

Use of safe cribs and bedroom size among African American infants with a high rate of bed sharing.

BACKGROUND: Impoverishment and crowding are associated with an increased risk of sudden unexpected death among infants. Bed sharing likely increases this risk, particularly among African American infants. OBJECTIVES: To compare the sleep environment of African American infants who bed share with that of infants who do not share sleep surfaces and to compare access to a safe crib, and the space available for it, in the sleeping rooms of both groups of infants. METHODS: Home visits were made at approximately age 2 weeks to the homes of serially enrolled African American infants born between July 15, 2001, and November 1, 2001. Questionnaires were used to survey sleep practices, especially sleep surface used. The area of the floor space of rooms used for sleeping was calculated. A portable crib was provided for infants lacking access to safe sleep surfaces. RESULTS: Of these infants, 42 (41%) usually bed shared and 60 (59%) slept alone. The areas of the floor spaces were similar (mean +/- SD, 13.8 +/- 3.3 m(2) for bed sharers vs 12.7 +/- 3.7 m(2) for those who slept alone; 95% CI for difference, -0.34 to 2.51 m(2)). Infants sleeping alone were much more likely to have access to a safe crib (51 of 60 vs 13 of 42; P<.001), and 53 cribs were provided. Follow-up telephone calls made at approximately age 7 months to 43.4% of recipients suggested that the cribs were used on most nights, were durable, and were enthusiastically received. CONCLUSIONS: Crowding is not a strong explanation for bed sharing among impoverished African American infants in St Louis, Mo, who often bed share because there is not a safe crib available. Providing safe cribs may reduce the prevalence of bed sharing.

Black or African American↗

PubMed1999

Association of managed care market share and health expenditures for fee-for-service Medicare patients.

CONTEXT: Managed care has the potential to transform fundamentally the structure and functioning of the entire health care system, including the care provided to patients who are not enrolled in managed care plans. OBJECTIVE: To determine whether increasing health maintenance organization (HMO) market share is associated with decreased expenditures for the care of patients covered by Medicare's traditional fee-for-service plan, a group cared for well outside the boundaries of managed care. DESIGN AND SETTING: Data from the Health Care Financing Administration were used to compare expenditures for the care of Medicare fee-for-service beneficiaries for 802 market areas, representing the entire United States, for 1990 to 1994. These data were matched with data on system-wide (Medicare and non-Medicare) HMO market share in these areas. PATIENTS: All fee-for-service Medicare beneficiaries (1990-1994) except for those with end-stage renal disease. MAIN OUTCOME MEASURE: Average fee-for-service expenditure per fee-for-service Medicare beneficiary by market area. RESULTS: In a regression model, increases in system-wide HMO market share were associated with declines in both Part A and Part B fee-for-service expenditures per Medicare beneficiary (P<.001). Increases from 10% market share to 20% market share were associated with 2.0% decreases in Part A fee-for-service expenditures and 1.5% decreases in Part B fee-for-service expenditures. CONCLUSIONS: Managed care can have widespread effects on the health care system. Health care for individuals who are not covered by managed care organizations can be influenced by the presence of managed care. Lower expenditures in areas with high HMO market shares may indicate that traditional Medicare beneficiaries in areas with high market shares received fewer or less intensive services than traditional Medicare beneficiaries in other areas.

Fee-for-Service Plans↗

PubMed1999

Optimal allele-sharing statistics for genetic mapping using affected relatives.

The choice of allele-sharing statistics can have a great impact on the power of robust affected relative methods. Similarly, when allele-sharing statistics from several pedigrees are combined, the weight applied to each pedigree's statistic can affect power. Here we describe the direct connection between the affected relative methods and traditional parametric linkage analysis, and we use this connection to give explicit formulae for the optimal sharing statistics and weights, applicable to all pedigree types. One surprising consequence is that under any single gene model, the value of the optimal allele-sharing statistic does not depend on whether observed sharing is between more closely or more distantly related affected relatives. This result also holds for any multigene model with loci unlinked, additivity between loci, and all loci having small effect. For specific classes of two-allele models, we give the most powerful statistics and optimal weights for arbitrary pedigrees. When the effect size is small, these also extend to multigene models with additivity between loci. We propose a useful new statistic, S(rob dom), which performs well for dominant and additive models with varying phenocopy rates and varying predisposing allele frequency. We find that the statistic S(_#alleles), performs well for recessive models with varying phenocopy rates and varying redisposing allele frequency. We also find that for models with large deviation from null sharing, the correspondence between allele-sharing statistics and the models for which they are optimal may also depend on which method is used to test for linkage.

Alleles↗

PubMed2004

Tests for covariate-associated heterogeneity in IBD allele sharing of affected relatives.

Linkage studies that aim to map susceptibility genes for complex diseases commonly test for excess allele sharing among affected relatives. Conventional methods based on identical-by-descent IBD allele sharing do not allow for possible differences among families, such as arise in the case of locus heterogeneity, and thus have reduced ability to detect linkage in the presence of such heterogeneity. We investigated two approaches to test for heterogeneity in allele sharing, using a family-level covariate that may be associated with different disease mechanisms leading to differences in allele sharing. Likelihood ratio tests for heterogeneity were formulated based on an extension of the linear and exponential likelihood models developed by Kong and Cox. Alternatively, we examined the asymptotic and permutation distributions of T-tests for differences between mean allele-sharing linkage scores from two covariate-defined family subgroups, assuming exchangeability. The size and power of heterogeneity tests were evaluated for S(all) and S(pairs) allele-sharing scoring functions using data sets of families with affected sibling and cousin pairs, generated under a model of locus heterogeneity. In certain simulation scenarios, the likelihood ratio test statistics did not follow the expected asymptotic distributions. The type I error estimates for the T-statistics conformed to nominal 5 and 1% levels in all scenarios considered, and corresponding power was comparable to that of the likelihood ratio tests. Application of these tests for heterogeneity detected significant differences in allele sharing between subgroups of families with inflammatory bowel disease.

Algorithms↗

PubMed1996

A structural model for TCR recognition of the HLA class II shared epitope sequence implicated in susceptibility to rheumatoid arthritis.

HLA molecules associated with rheumatoid arthritis (RA) contain a discrete structural element known as the shared epitope, a set of conserved amino acid residues located on the alpha helical portion of the class II beta chain. Each of the different HLA molecules associated with RA contain the same shared epitope sequence, although they may vary markedly in other regions of the class II structure, which also determine peptide-class II interactions. Previous mutagenesis studies and structural modelling indicate that key polymorphic amino acid side chains within the shared epitope sequence are in locations likely to contact the T cell receptor (TCR) during the trimolecular activation reaction between the HLA-peptide complex and TCR. We have evaluated the potential structural basis for such shared epitope recognition by analysing detailed molecular models of the arthritis-associated DRB1*0404 molecule and a T cell receptor from T cell clone EM025, specific for HLA-DR4 molecules which carry the shared epitope. A likely orientation for the trimolecular complex was deduced in which the EM025 alpha chain interacts with the DR alpha chain and the EM025 beta chain interacts with the DR beta chain; residues Q70 and R71 within the DR beta chain shared epitope region are positioned for hydrogen bond interactions directly with Q97 of the TCR beta CDR3 region, D30 of the TCR beta CDR1 region, and possibly N51 of the TCR beta CDR2 region, indicating a degree of specific selection and interaction which encompasses multiple TCR contacts. These findings suggest a structural basis for the genetic associations with the HLA shared epitope and the potential contribution of this region to oligoclonal T cell selection and expansion in RA.

Arthritis, Rheumatoid↗

PubMed1989

Differences between white and Chinese populations in human leukocyte antigen sharing and gestational trophoblastic tumors.

The prevalence of gestational trophoblastic tumors varies widely among different populations: it is lowest in whites (3 to 6/100,000) and highest in Chinese (68 to 202/100,000). This observation suggests that the origin of the disease is different in the two populations. To test this hypothesis, we examined couples in whom the woman developed a gestational trophoblastic tumor in a white population (Pittsburgh) and a Chinese population (Taiwan) for sharing of human leukocyte A, B, DR, and DQ antigens, which we consider markers for sharing of major histocompatibility complex-linked recessive genes affecting both embryogenesis and carcinogenesis. No human leukocyte antigen sharing occurred between partners in Pittsburgh, but there was significant human leukocyte antigen sharing in Taiwan. The latter couples shared human leukocyte antigen B (p less than 0.04) and human leukocyte antigen DQ (p less than 0.007) and shared three or more human leukocyte A, B, DR, and DQ antigens (p less than 0.02) significantly more frequently than did normal couples. However, there was no increased sharing of any specific human leukocyte antigen allele. These findings support the hypothesis that gestational trophoblastic tumors occur on a sporadic basis in whites and on a genetic basis in Chinese.

Asian People↗

PubMed1991

Ethical issues in sharing epidemiologic data.

Concurrent with the explosion in large data files and computers capable of handling both linkage of large data sets and analyzing multiple studies for meta-analysis, this decade has seen a rise in professional concern about the need for researchers to share their data. As scientific groups began to address this question, its importance and complexity became quickly apparent. In this paper recent developments on the ethics of data sharing in statistics, sociology, psychology, and other fields related to epidemiology are summarized, followed by a discussion on why data should be shared, what kinds of data should be shared, who among epidemiologists should be sharing data, when it is appropriate to share data, and how data sharing should be conducted.

Access to Information↗

PubMed2004

Use of the egg-share model to investigate the paternal influence on fertilization and embryo development after in vitro fertilization and intracytoplasmic sperm injection.

OBJECTIVE: To investigate whether sperm from different males can influence fertilization and embryo development. DESIGN: To use an egg-sharing model, in which the eggs from one woman are shared between herself and a recipient, and different spermatozoa are used to fertilize the eggs. SETTING: Assisted Conception Unit, Birmingham Women's Hospital, Edgbaston, United Kingdom. PATIENT(S): Infertile women undergoing egg sharing. INTERVENTION(S): In vitro fertilization (IVF). MAIN OUTCOME MEASURE(S): Fertilization rates and the mean day 2 or 3 embryo score (cell number X grade) were examined for egg-sharing pairs. A comparison was also made for pairs in which intracytoplasmic sperm injection (ICSI) and IVF was used as the insemination method. A paired samples t-test was used to compare the sharer and recipient results. RESULT(S): Pregnancy rates did not differ between sharer and recipient couples. Interestingly, when comparing fertilization, there was a significant difference (P<.05) in favor of IVF over ICSI. When comparing embryo development between egg-sharing pairs, we found that approximately 30% of patients showed a difference in mean embryo score of >or= 5 in all embryo development and 14% in the quality of embryos available for transfer. CONCLUSION(S): We showed that the egg-sharing model is a successful alternative for the treatment of women who required donated eggs. More important, the egg-sharing model shows that, in a certain percentage of couples, differences in early embryo development are paternally influenced.

Embryo, Mammalian↗

PubMed2005

Competency in shaping one's life: autonomy of people with type 2 diabetes mellitus in a nurse-led, shared-care setting; a qualitative study.

BACKGROUND: In the Netherlands diabetes specialist nurses play an important role in specialized, long-term care for the chronically ill. One of the goals of nurse-led, shared care is to encourage chronically ill people to participate actively in selecting the organisation and interventions of care. This paper reports the findings of a study to determine which concepts of autonomy people with type 2 diabetes use in a nurse-led, shared-care setting. OBJECTIVES: The aim of this article was to portray how people with type 2 diabetes mellitus who are being cared for by diabetes specialist nurses in a shared-care unit view autonomy. DESIGN AND SETTING: This qualitative study used in-depth interviews and was carried out in a nurse-led, shared-care unit in the Netherlands. PARTICIPANTS: The study population consisted of 15 people who were enrolled for at least 1 year at the nurse-led, shared-care unit and who lived independently at home. METHOD: Data were analysed with a grounded-theory-like method. RESULT: The core category, 'competency in shaping one's life', described how people with diabetes exercise their autonomy. Seven categories that emerged were considered dimensions of autonomy. The dimensions were: identification, self-management, welcomed paternalism, self-determination, shared decision-making, planned surveillance, and responsive relationship. CONCLUSION: Autonomy is a multi-dimensional, dynamic and complex construct. Further research is needed to investigate which decision-making processes patients with type 2 diabetes use in a nurse-led, shared-care setting.

Aftercare↗