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PubMed1998

Obstetric outcome in the unbooked mother.

This study aimed at determining the outcome of pregnancy in unbooked mothers with regard to maternal complications and foetal outcome. This retrospective study was based on investigations of medical records of 467 unbooked mothers who presented for delivery at the Obstetrics Unit at King Khalid University Hospital, Riyadh, during the period 1991 and 1992, and 415 booked mothers with regular clinic attendance selected as controls. Data collected from the records included patients' socio-demographic characteristics, past obstetric history, prevalence of pregnancy-related diseases, and data relating to labour, delivery, and foetal outcome. Chi-square test and Fisher's exact test were used for assessing the statistical significance of the association between the various factors which were investigated. The tendency for mothers to be booked was found to be significantly associated with their age, occupation, parity, and gestational age at delivery. Booked and unbooked mothers did not differ significantly in relation to the mode of delivery and foetal outcome, although the prevalence of previous complications of pregnancy was generally lower among unbooked mothers. There was no statistically significant association between the absence of antenatal care and outcome of pregnancies, unbooked mothers had a higher proportion of MICU admissions and dead babies compared with the controls. Educating the community about the benefits of receiving regular antenatal care, even if at primary care level, may be of great importance in improving the pregnancy outcome.

Adolescent↗
PubMed2001

Antidepressants for cocaine dependence.

BACKGROUND: Cocaine dependence is a common and serious condition, which has become nowadays a substantial public health problem. The past decade has witnessed a sustained search for an effective pharmacotherapeutic agent for the treatment of cocaine dependence. While administration of cocaine acutely increases intercellular dopamine, serotonin, and norepinephrine levels by blocking their presynaptic reuptake, chronic cocaine abuse leads to down-regulation of monoamine systems. Post-cocaine use depression and cocaine craving may be linked to this down-regulation. Antidepressant pharmacotherapy, by augmenting monoamine levels, may alleviate cocaine abstinence symptomatology, as well as relieving dysphoria and associated craving by general antidepressant action. OBJECTIVES: To conduct a systematic review of all RCTs on the use of antidepressants for treating cocaine dependence. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (from 1966 - 2000), EMBASE (from 1980 - 2000), LILACS (from 1982 - 2000), PsycLIT (from 1974 - 2000), Biological Abstracts (1982 to 2000). Other searches:reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of antidepressants on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. MAIN RESULTS: 18 studies were included in the review, with 1177 people randomised. Positive urine sample for cocaine metabolites was the main efficacy outcome, with no significant results obtained regardless the type of antidepressant. Compared to other drugs, desipramine performed better but showing just a non significant trend with heterogeneity present as revealed by the chi-square test (8.6, df=3; p=0.04). One single trial showed imipramine performed better than placebo in terms of clinical response according to patient's self-report. A similar rate of patients remaining in treatment was found for both patients taking desipramine or placebo. Results from one single trial suggest fluoxetine patients on SSRIs are less likely to dropout. Similar results were obtained for trials where patients had additional diagnosis of opioid dependence and/or were in methadone maintenance treatment. REVIEWER'S CONCLUSIONS: There is no current evidence supporting the clinical use of antidepressants in the treatment of cocaine dependence. Given the high rate of dropouts in this population, clinicians may consider adding psychotherapeutic supportive measures aiming to keep patients in treatment.

Antidepressive Agents↗
PubMed1974

Current status of biomedical book reviewing. I. Key biomedical reviewing journals with quantitative significance.

This is the first part of a comprehensive, quantitative study of biomedical book reviewing. The data base of the total project was built from statistics taken from all 1970 issues of biomedical journals held in the Science Library of the Massachusetts Institute of Technology. Of 285 so-called "life sciences" journals held by that library, fifty-four English journals (excluding Science and Nature) were found to contain bona fide book reviews (as contrasted with mere author-title lists) and were therefore selected for close study. The statistical results reveal that there were 3,347 reviews of 2,067 biomedical books in these fifty-four selected journals in 1970. Part I of the study identifies key biomedical reviewing journals of quantitative significance. The top ten journals, British Medical Journal, Lancet, Annals of Internal Medicine, Journal of the American Medical Association, Archives of Internal Medicine, New England Journal of Medicine, Quarterly Review of Biology, Bioscience, Canadian Medical Association Journal,(*) and American Journal of the Medical Sciences, accounted for 63.03% of the total number of reviews in 1970.

Book Reviews as Topic↗
PubMed2004

Adoption of innovations by specialised nurses: personal, work and organisational characteristics.

BACKGROUND: To gain insight in the factors that influence the adoption of professional information by specialised nurses, we studied the effects of individual, work and organisational characteristics on the extent to which continence nurses gained knowledge and made use of a book on nursing diagnosis and interventions for patients with urinary incontinence, which they received as a present. METHODS: Subjects were all members of the Dutch Association of Continence Nurses. Data collection took place via a postal questionnaire with closed questions. In total, 109 valid questionnaires (78%) were received back. Stepwise selected ordered logit models were estimated with reading the book and knowledge and use of five selected parts of it as dependent variables and individual, work and organisational characteristics as independent variables. RESULTS: The most important factors found to promote reading of the book and taking knowledge of the parts of it were a personal characteristic of the nurses called "information directedness" (or eagerness to acquire professional information from other sources), the presence of an "innovative atmosphere" at the department, and "relevance" of the information for daily nursing practice. The most important factors found to promote the use of the book are (again) information directedness, working at a (relatively) small department and having experience with nursing diagnosis. CONCLUSIONS: Results suggest that nurses differ in the degree to which they are open to innovations and that information directedness might be a useful indicator of this characteristic. In addition, the degree of innovativeness of the atmosphere at the department and the relevance of the innovation for nursing practice are important factors influencing the success or failure of innovations in nursing practice.

Age Factors↗
PubMed1998

[Books on anesthesiology and resuscitation published in Spain. An approach to their study].

INTRODUCTION: Few authors have examined the publication of medical books. Our aim was to analyze the nature of books published in Spain on anesthesiology and recovery. MATERIAL AND METHODS: Books listed by the Spanish ISBN agency were selected if they included anestesi* or reanima* in any field. Duplicates were removed. Multiple editions or references were considered single books, with data for the oldest edition entered into analysis. Multiple volume collections were grouped as complete works. Data analyzed for each book were year of publication, language (of publication and the original), subject (according to ISBN classification) and place of publication. Nine subject classifications were applied: general, recovery, anesthetic techniques, pharmacology, obstetrics/gynecology, pediatrics, veterinary anesthesia, dental anesthesia and miscellaneous. RESULTS: We analyzed 216 books. Years that saw publication of the greatest number of books were 1988 (17), 1993 (16) and 1979 (15), and the five-year period in which the most books were published was 1985 to 1989 (48 books, 22.2%). Most books (114, 52.8%) were originally written in English, Spanish being the second most common original language (58, 26.8%). All books were published in Spanish. The Spanish ISBN classification system identified 11 categories: general diseases/clinical medicine/therapy (161, 74.5%); drugs/pharmacology/physical therapy/toxicology (20, 9.3%); gynecology/obstetrics (9, 4.2%), veterinary medicine (9, 4.2%) and medicine (8, 3.7%). Classification by specific subjects showed a predominance of monographs or treatises on general aspects (42, 19.4%) followed by books on recovery (37, 17.1%), anesthetic techniques (25, 11.6%) and pharmacology (17, 7.9%). Most books were published in Barcelona (142, 65.7%), Madrid (36, 16.7%) or Saragossa (10, 4.6%). CONCLUSIONS: Spanish publication of books on anesthesiology and recovery has increased in recent years. Most books are translations usually from English. Spanish ISBN agency data, although it has limitations, can be useful for locating books published in Spain on anesthesiology and recovery. It would be useful to introduce keywords into the ISBN data base so that books on specific subjects could be classified and retrieved.

Anesthesiology↗
PubMed1992

Trust, but verify. The accuracy of references in four anesthesia journals.

To determine the accuracy of bibliographic citation in the anesthesia literature, we reviewed all 1988 volumes of ANESTHESIOLOGY, Anesthesia and Analgesia, British Journal of Anaesthesia, and Canadian Journal of Anaesthesia and sequentially numbered all references appearing in that year (n = 22,748). One hundred references from each of the four journals were randomly selected. After citations to nonjournal articles (i.e., books or book chapters) were excluded, the remaining 348 citations were analyzed in detail. Six standard bibliographic elements--authors' names, article title, journal title, volume number, page numbers, and year--were examined in each selected reference. Primary sources were reviewed, unless our institution did not own the source or could not obtain it through interlibrary loan, in which case standard indexes, abstracting services, and computerized databases were consulted. Each element was checked for accuracy, and references were classified as either correct or incorrect. A reference was correct if each element of the citation was identical to its source. Of the examined references, more than half (50.3%) contained an error in at least one element. The elements most likely to be inaccurate were, in descending order, article title, author, page numbers, journal title, volume number, and year. No significant differences (P = 0.283) existed in the error rates of the four journals; the percentage of citations containing at least one error ranged from 44% (Anesthesia and Analgesia) to 56% (British Journal of Anaesthesia). The citation error rate of anesthesia journals is similar to that reported in other specialties, where error rates ranging from 38% to 54% have been documented.

Anesthesiology↗
PubMed1994

The pattern of antenatal visits with emphasis on gestational age at booking in Riyadh Health Centres.

1344 expectant mothers were selected by random sampling from the catchment population of 15 health centres in Riyadh. The health centres were taken to represent all areas of urban Riyadh. These mothers were asked to complete a pre-designed questionnaire in Arabic and undergo a structured interview by trained midwives to explore their knowledge, attitude and practice toward antenatal visits. It was found that the average gestational age at booking was 13 weeks. The number of antenatal visits achieved during the current pregnancy was 6. 97% of expectant mothers were aware of the importance of antenatal visits. Various demographic characteristics were studied in relation to the number of antenatal visits achieved and the gestational age at booking. It was found that the level of education of both husband and wife and poor obstetric history significantly affected gestational age at booking, (P-values) were less than 0.03 and 0.002 respectively). However the family income and gestational age at booking affected the number of antenatal visits (P-values were less than 0.0003 and 0.0001 respectively). The respondents' most striking reason for non-compliance was related to accessibility to health centre. 23.3% thought that the health centres were far away from their residence and they needed to involve the husbands in driving them to health centres. Recommendations were given to improve aspects of accessibility and inviting more antenatal visits in addition to improving quality of such service.

Adolescent↗
PubMedDate not supplied

Trial of scar and vaginal birth after caesarean section.

BACKGROUND: The caesarean section rate has increased to an alarming extent in the last three decades the world over and fear of rupture of uterus in subsequent pregnancy and labour has led to a high rate of repeat caesarean sections. The objective of this study was to determine the final outcome of a trial of scar and Vaginal Birth After Caesarean Section (VBAC) and develop guidelines to reduce the rate of unnecessary repeat caesarean section. METHODS: This study was carried out in Obstetric and Gynecology Unit 'A' of Ayub Teaching Hospital Abbottabad from 01.11.2002 to 31.10.2004. A total of 2652 patients were delivered during this period out of which 297 patients had history of one previous caesarean section. A total of 53 patients had an elective repeat caesarean section and rest of 244 was subjected to a trial of scar. RESULT: Out of 244 patients selected for trial of scar, 165 (67.2%) had a successful uncomplicated vaginal delivery, 7 (3.2%) were delivered by forceps, 11 (5.2%) with vacuum extractor and 61 (24.4%) required a repeat emergency caesarean section. 83% of the patients had a spontaneous onset of labour and 17% needed induction of labour with prostaglandin E2 pesseries and augmentation of the labour with oxytocin. However repeat caesarean section rate was high in the later group. 71.2% of the babies were born with Apgar score > 8 and 24.6% had an Apgar score between 6-8. There were 3 cases of scar dehiscence and one case of ruptured uterus and one baby was lost due to this complication. No serious maternal complication occurred. CONCLUSIONS: More than 75% of the patients with previous one caesarean section for non-recurrent cause can be successfully delivered vaginally. Antenatal booking and follow up, careful case selection for trial of scar and close observations during labour will achieve successful maternal and perinatal outcome. VBAC also saves any future caesarean sections, as currently previous two caesarean sections is an indication for elective caesarean section.

Cesarean Section↗
PubMed1997

Effectiveness of a dental preventive program on plaque index results in 8-year-old children of Bergamo, Italy.

The study presents the results of a preventive program based on a children's book and carried out in the elementary schools of Bergamo, Italy. The book was published to improve 8-year-old schoolchildren's knowledge of primary dentition, dental plaque, nutrition, oral hygiene, fluoride and regular dental visits. The study was experimental. A total of 440 schoolchildren were selected to test the effectiveness of the book. They were divided into four groups: two groups underwent the training program and the other two were control groups. Measurements were made using the Quigley-Hein index before and after the program. A significant difference reduction of the plaque index of -0.6 was observed (P < 0.005).

Attitude to Health↗
PubMed2005

Did Kettlewell commit fraud? Re-examining the evidence.

H.B.D. Kettlewell is famous for several investigations conducted in the early 1950s on the phenomenon of industrial melanism, which are widely regarded as the classic demonstration of natural selection. In a recent (2002) book-length popularization of this episode in the history of the science, science writer Judith Hooper draws attention to what she interprets as discrepancies in the results reported by Kettlewell in his first scientific papers on the subject. On the basis of correspondence among Kettlewell and his associates, a survey of scientific publications that mention outstanding questions surrounding the phenomenon, as well as interviews with his son, surviving colleagues, and scientists who have worked on industrial melanims, Hooper all but explicitly concludes that Kettlewell committed fraud. The following essay critically examines her evidence in support of this allegation, including her discussion of his character, the alleged motives, and whether fraud was even committed. None of Hooper's arguments is found to withstand careful scrutiny. The concluding section draws several conclusions about how history of science should be depicted to the public.

Animals↗
PubMed2001

The myth and history of some psychoanalytic concepts. Thoughts inspired by a reading of Orange et al., Working intersubjectively.

In this paper the author gives her reactions to a book on the intersubjective approach that deals with major issues such as the analyst's role in the psychoanalytic process, neutrality, technique and self-disclosure. Noting that the book often adopts an antagonistic and innovative stance towards Freud, she draws attention to aspects of his theories that deal with concepts deemed by the intersubjective school to be of fundamental importance. Chief among these is the influence of the analyst on the analytic process, in terms both of his 'defects' and of his individuality in general. In opposition to the 'myth of the isolated mind' attributed by the book to Freud, the author presents some selected passages from his works that emphasise the structuring function of the object and the influence of various groups on the individual. The aim of the paper is not only to counter the oversimplified view of Freud that emerges from the book but also to put forward a theoretical position with respect to a school that is exerting an increasingly powerful attraction on both sides of the Atlantic. The author's argument is based mainly on a discussion of the detailed clinical sequences featuring in the book. She also considers some possible cultural and social determinants of the development of the intersubjective trend.

Austria↗
PubMedDate not supplied

ADCS Prevention Instrument Project: pilot testing of a book club as a psychosocial intervention and recruitment and retention strategy.

Both psychosocial and biologic interventions may delay or prevent Alzheimer disease. Staying mentally active may help older people maintain their cognitive abilities. In the Alzheimer Disease Cooperative Study Prevention Instrument Project a book club was introduced as a recruitment and retention device. A 3-arm study was designed and included: a nonrandomized, self-selected group (n=211) who chose not to participate in the book club, and 2 groups randomly assigned to receive 2 books per year in individual self-improvement (n=210) or community involvement (n=207) categories. Participants reported their reactions to the selections and other reading behaviors. Results from the first 2 years revealed that most book club participants agreed with Likert-type statements indicating the readings were enjoyable (P<0.001), had an impact on their thinking (P=0.01), and were shared by them with others (P=0.002). Respondents in the community involvement group agreed more strongly with these statements than those in the self-improvement category. Comments from participants in response to open-ended questions in the reader survey revealed such themes as developing plans for successful aging and reflecting on attitudes and behaviors in their own lives. Further longitudinal analyses are planned to determine whether the book club influenced retention and whether participation was associated with slowing cognitive decline.

Aged↗
PubMedDate not supplied

Scope and impact of financial conflicts of interest in biomedical research: a systematic review.

CONTEXT: Despite increasing awareness about the potential impact of financial conflicts of interest on biomedical research, no comprehensive synthesis of the body of evidence relating to financial conflicts of interest has been performed. OBJECTIVE: To review original, quantitative studies on the extent, impact, and management of financial conflicts of interest in biomedical research. DATA SOURCES: Studies were identified by searching MEDLINE (January 1980-October 2002), the Web of Science citation database, references of articles, letters, commentaries, editorials, and books and by contacting experts. STUDY SELECTION: All English-language studies containing original, quantitative data on financial relationships among industry, scientific investigators, and academic institutions were included. A total of 1664 citations were screened, 144 potentially eligible full articles were retrieved, and 37 studies met our inclusion criteria. DATA EXTRACTION: One investigator (J.E.B.) extracted data from each of the 37 studies. The main outcomes were the prevalence of specific types of industry relationships, the relation between industry sponsorship and study outcome or investigator behavior, and the process for disclosure, review, and management of financial conflicts of interest. DATA SYNTHESIS: Approximately one fourth of investigators have industry affiliations, and roughly two thirds of academic institutions hold equity in start-ups that sponsor research performed at the same institutions. Eight articles, which together evaluated 1140 original studies, assessed the relation between industry sponsorship and outcome in original research. Aggregating the results of these articles showed a statistically significant association between industry sponsorship and pro-industry conclusions (pooled Mantel-Haenszel odds ratio, 3.60; 95% confidence interval, 2.63-4.91). Industry sponsorship was also associated with restrictions on publication and data sharing. The approach to managing financial conflicts varied substantially across academic institutions and peer-reviewed journals. CONCLUSIONS: Financial relationships among industry, scientific investigators, and academic institutions are widespread. Conflicts of interest arising from these ties can influence biomedical research in important ways.

Academies and Institutes↗
PubMed1992

Sterol molecule: structure, biosynthesis, and function.

This review briefly summarizes key researches on the structure of the sterol molecule from its very beginnings to the definitive elucidation in 1932. Cholesterol biosynthesis treated in somewhat greater detail covers the period from the 1930s to the 1960s. As a historic contribution, it presents researches previously published in numerous books, reviews, and original papers. The selection of topics, dictated by limits of time and space, is necessarily arbitrary and a personal choice. Readers of this journal will be familiar with the relevant chemical structures. Structural formulas are therefore omitted.

Cholesterol↗
PubMed2006

Factors that shape young people's sexual behaviour: a systematic review.

BACKGROUND: Since nearly half of new HIV infections worldwide occur among young people aged 15-24 years, changing sexual behaviour in this group will be crucial in tackling the pandemic. Qualitative research is starting to reveal how social and cultural forces shape young people's sexual behaviour and can help explain why information campaigns and condom distribution programmes alone are often not enough to change it. We undertook a systematic review to identify key themes emerging from such research, to help inform policymakers developing sexual health programmes, and guide future research. METHODS: We reviewed 268 qualitative studies of young people's sexual behaviour published between 1990 and 2004. We developed a method of comparative thematic analysis in which we coded each document according to themes they contained. We then identified relations between codes, grouping them accordingly into broader overall themes. Documents were classified as either primary or secondary depending on their quality and whether they contained empirical data. From the 5452 reports identified, we selected 246 journal articles and 22 books for analysis. FINDINGS: Seven key themes emerged: young people assess potential sexual partners as "clean" or "unclean"; sexual partners have an important influence on behaviour in general; condoms are stigmatising and associated with lack of trust; gender stereotypes are crucial in determining social expectations and, in turn, behaviour; there are penalties and rewards for sex from society; reputations and social displays of sexual activity or inactivity are important; and social expectations hamper communication about sex. The themes do not seem to be exclusive to any particular country or cultural background, and all themes were present, in varying degrees, in all countries assessed. INTERPRETATION: This study summarises key qualitative findings that help in understanding young people's sexual behaviour and why they might have unsafe sex; policymakers must take these into account when designing HIV programmes. Considerable overlap exists between current studies, which indicates the need to broaden the scope of future work.

Adolescent↗
PubMed2002

Development of a preference-weighted health status classification system in France: the Health Utilities Index 3.

The Health Utilities Index is a generic multiattribute preference-based system for assessing health-related quality of life, devised by Torrance et al. It is being used in cost-effectiveness evaluations in North America and in international multicentre studies but was not available in France. Following adaptation of the HUI3 classification in France, the purpose of the reported investigation was to derive French preference weights. This article provides a reminder of the theoretical foundations used to model the multiattribute utility function. Within this framework, a multiattribute multiplicative aggregate utility function was constructed in accordance with the explicitly decomposed approach. The study took place in June 1999 over a sample of 365 persons from the French general population, aged between 20 and 65, and not suffering from any chronic or incapacitating illness. The recruitment procedure was based upon a random selection of individuals, using the phone book. Interviews took place in the homes of the interviewees. The methods of revelation (VAS and SG) were applied by setting the value of the best possible state of the HUI3 a priori at 1, and leaving a choice between two states (worst possible state, death) for 0. The aggregated individuals (person-mean and median) were calculated and the multiplicative utility functions constructed. A comparison of the calculated utilities with the observed ones provides a primary indicator of the validity of the person-mean or median functions constructed. The slight absolute differences obtained between observed and calculated utilities and the low RMSE scores lead us towards a favourable conclusion.

Adult↗
PubMed1998

Assessing the new public management: the case of the National Health Service.

AIM: This paper reviews the origins, core principles and impact of New Public Management (NPM) in the UK public services, with particular attention paid to the emergence of NPM in the National Health Service (NHS). BACKGROUND: NPM represents a distinct break from traditional forms of public sector administration. Whilst its origins are grounded in economic crisis and New Right ideology, NPM philosophies and practices have since found wider acceptance. ORIGINS OF INFORMATION: Selective review of key journal papers, books and policy documents. KEY ISSUES: NPM is characterized by: managers being 'free to manage'; public sector disaggregation; competition; concern for efficiency; concern for outcomes; concern for quality; individualism rather than collectivism; and identification of the public service user as 'customer', 'consumer' or 'citizen'. CONCLUSIONS: NPM has taken root in the NHS. Future reform of the health service is likely to modify some aspects of NPM, though many of the core themes of NPM in the NHS look likely to remain for the foreseeable future.

Decision Making, Organizational↗