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PubMed2003

HIV and STD risk behavior among 18- to 25-year-old men released from U.S. prisons: provider perspectives.

Ninety-seven service providers, representing 83 agencies, were interviewed about sexual and drug use HIV/STD risk behaviors and their determinants among young men who have been released from prison. Providers believed that men frequently practiced sexual risk behavior, often in conjunction with substance use. Individual determinants of risk behavior primarily focused on "making up for lost time," being a man, degree of HIV/STD knowledge and vulnerability, desire to escape, and future orientation. Peers, partners, and family were portrayed as strong interpersonal influences on risk behavior, both positively and negatively. The dominant contextual determinant of risk behavior was the co-occurrence of sex and drug use. Structural determinants of reduced risk included stable housing, economic sufficiency, and positive community support for safer behavior (e.g., drug treatment access, needle exchange). The findings highlight the need for comprehensive, transitional case management for young men as they reintegrate into the community, including HIV/STD prevention.

Adolescent↗

PubMed1991

Using growth modeling to examine systematic differences in growth: an example of change in the functioning of families at risk of maladaptive parenting, child abuse, or neglect.

This longitudinal study provides an example of the use of exploratory growth modeling to examine changes over time in the functioning of 172 families who underwent treatment in an innovative prevention program, Project Good Start. Two types of research question are addressed: a within-family question (Does family functioning change over time in families at risk of maltreatment who are receiving special early support services?) and a between-family question (Are changes in family functioning systematically related to selected characteristics of family background and treatment?). Results of the study highlight the heterogeneity across families in the direction and rate of family function change and its systematic relationship with the family profile on entry into intervention. Although treatment seems successful in stabilizing and improving the family functioning of most at-risk families, problems of violence/maltreatment and distressed parenting act to defer successful treatment.

Adolescent↗

PubMed1999

Collaborative study to improve the quality control of rare earth element determinations in environmental matrices.

In order to control the quality of rare earth determinations in environmental matrices, the Standards, Measurements and Testing Programme (formerly Community Bureau of Reference, BCR) of the European Commission has started a project, the final aim of which is to certify four types of matrices (tuna muscle, mussel tissue, aquatic plant and estuarine sediment) for their contents of a range of rare earth elements (Sc, Y and the lanthanides: La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb and Lu). The elements U and Th were added to the study. The first part of this project consisted of an interlaboratory study which aimed to test the feasibility of preparation of environmental reference materials and to detect and remove most of the pitfalls observed in rare earth determinations. This paper presents the preparation of the four matrices for the intercomparison study and for the candidate reference material. The main results are presented of the interlaboratory study that was carried out prior to the certification campaign. This collaborative trial is the first attempt ever carried out at this scale to evaluate the state-of-the-art of rare earth determinations in the environment. Its impact on the improvement of chemical measurements will have positive effects on the comparability of data necessary for environmental monitoring.

Chemistry Techniques, Analytical↗

PubMed1999

Evaluation of the state-of-the-art of butyl- and phenyltin compound determinations in freshwater sediment prior to certification of a reference material.

In order to control the quality of butyl- and phenyltin compound determinations in sediment, the Standards, Measurements and Testing Programme (formerly BCR) of the European Commission has started a project, the final aim of which is to certify a freshwater sediment for its contents of a range of organotin compounds (mono-, di- and tributyltin, and mono-, di- and triphenyltin). The first part of this project involved an interlaboratory study which aimed to test the feasibility of preparation of candidate freshwater sediment reference material and to detect and remove most of the pitfalls observed in organotin determinations. This paper presents the main results of this interlaboratory study carried out prior to the certification campaign. The agreement obtained among laboratories for the six compounds determined was considered to reflect the state-of-the-art and was encouraging enough to decide upon the organisation of a certification campaign, which will be concluded in June 1999.

Environmental Monitoring↗

PubMed2000

Collaborative evaluation of the analytical state-of-the-art of platinum, palladium and rhodium determinations in road dust.

In order to control the quality of platinum, palladium and rhodium determinations in road dust, the Standards, Measurements and Testing Programme (formerly BCR) of the European Commission has started a project, the final aim of which is to certify a road dust reference material for its contents of platinum group elements. The first part of this project consisted of an interlaboratory study, which aimed to test the feasibility of the preparation of a candidate road dust reference material and to detect and remove most of the pitfalls observed in platinum, palladium and rhodium determinations. This paper presents the main results of this interlaboratory study carried out prior to the certification campaign. The concordance of the data obtained by the participating laboratories for the three elements was considered to reflect the state-of-the-art and was encouraging enough to decide on the organization of a certification campaign to be conducted during the year 2000. The progress made with respect to the analytical state-of-the-art for these elements will be of great benefit to the quality of measurements carried out in environmental monitoring in this particular field.

Dust↗

PubMed1997

The problems of researching mixed sex wards.

The following paper discusses the process of doing research on a sensitive and politically charged topic; 'mixed sex' psychiatric wards. It also highlights the conceptual and methodological difficulties of carrying out this enquiry. The particular deconstruction presented is suggested as knowledge or data alone, even though they are rarely found in finished research projects. It starts by setting the broader context of the research at The Bethlem and Maudsley Trust by looking at National policy, other studies in this subject area and media attention. It shows the triggers that caused a re-evaluation and changes in the original research question and assumptions about 'mixed sex' wards. It accounts for the research as it happens, rather than presenting a sanitised process of discovery. This forms the basis for describing some of the dilemmas for carrying out the in-depth research; showing how the reconfigured research subject became focused on the safety and effectiveness of 'mixed sex' wards for women. The grounded methodological approach to this study is outlined and the paradoxes it identified in psychiatric discourse are mentioned. Exerts of findings from three separate research studies at The Bethlem and Maudsley Trust are given and discussed. The conclusion analyses the complexities of the subject and suggests that the "mixed sex' ward problem may be the contemporary emergence of a much older and fundamental problematic inherent to psychiatry. Consequently, no simple answer is recommended.

England↗

PubMed2000

[Model project for updating neonatal screening in Bavaria: concept and initial results].

The newborn screening programme in Bavaria was confronted with several problems. Number of disorders and process quality no longer complied with screening guidelines. Mixed financing, distributed between the state (PKU, galactosaemia) and health insurances (hypothyroidism) had promoted an increasing dissipation of the system. Notified participation rates had dropped to < 80%. Increasing need for a second screening due to early discharge was an additional challenge. To overcome these problems, and considering the availability of improved screening methodology (tandem mass spectrometry) the programme was reorganised. The project, which started on Jan 1, 1999, is based on a cooperation model between laboratory (logistics, analysis), universities (treatment, scientific evaluation), and public health services (coordination, tracking). Time of blood sampling was predated to the third day of life. Screening was extended to biotinidase deficiency, congenital adrenal hyperplasia (CAH) and by introduction of tandem mass spectrometry for screening of many other disorders (besides PKU). Insurances now finance complete laboratory analysis which was transferred to the private sector. To enable all newborn to participate, the names of screened children are matched against birth lists by public health services on a regional basis. Recalls and conspicuous results are consistently followed up until disorders are either excluded or confirmed. Two clinical hotlines were established in the children's hospitals of the universities in Munich (Southern Bavaria) and in Erlangen (Northern Bavaria). Written consent is required for participation in the programme. Participation in the new programme could be continually increased; coverage is > 95% since April. In several cases screening was made up for not tested children by contacting their parents. Omitted screening was mostly due to misunderstandings regarding testing responsibility or lost samples. Altogether 52 cases of disorder were found in the 87,000 newborn screened until August 1999. Hence, the detection rate of children affected by inborn errors of metabolism was about twice as high than before changes. Among the newly screened diseases CAH was detected most often (11 cases). In 22 cases diagnosis was based on the use of tandem mass spectrometry. Among these (besides PKU, 9 cases) MCAD deficiency (6 cases) was detected most frequently. Whereas recall rates of most disorders were < 0.1%, screening for CAH still revealed a high recall rate, particularly in premature births. Second screening due to early discharge (< 48 h) was required in 1.3%. About 20% of pending recalls required contacting birth hospitals, doctors, midwives or parents. So far all affected children could be brought to treatment in time.

Female↗

PubMed2001

[Quality assurance of medical information in the internet--challenges for a seal of approval in gynecology].

The Internet offers a vast amount of medical information for laymen and experts. Many sites focus on gynecology and obstetrics. The multitude of information and lacking structure make it difficult to retrieve high-quality information and to distinguish them from dubious ones. Many projects were started to solve these challenges. Criteria for assessing medical information on the internet were published by several authors. Some information providers comply to such standards voluntary to show their quality standards. There are scientific councils who assess individual sits. The Concerted Action on Health Information Systems (Aktions forum Gesundheits informations systeme AFGIS) was founded by the German Federal Ministry of Health to coordinate existing activities. The knowledge of experts is essential to describe and rate internet resources. The cooperation of the scientific medical societies in Germany should be an aim to make a quality seal for information on gynecology and obstetrics possible.

Female↗

PubMedDate not supplied

[The "Lower Saxony/Northern Rhine-Westphalia" Neuroblastoma Screening Project: on the need for epidemiologic comparison].

The proof for the general evolution of metastatic neuroblastoma from localized disease by a low-speed process is lacking. The epidemiological approach would require the decrease of neuroblastoma related mortality by reduction of the number of metastatic cases per population unit as a result of a screening program. During 1983 through 1990 the neuroblastoma incidence in the FRG was 0.85-1.09 cases per 100,000 children less than 15 years of age. The mortality rate ranged between 0.25 and 0.49 deaths per 100,000 children. The project "Niedersachsen/Nordrhein-Westfalen" started April 1st, 1992 and is investigating urinary catecholamine metabolite excretion in infants at the age of 10-12 months and for a second time in toddlers at 17-19 months. The target population includes 24.7 million inhabitants with 267,000 births per year. The urine sampled on filter paper is analyzed using thin layer chromatography. Positive and questionable positive results are confirmed by HPLC and GC-MS. The aim of the study is to demonstrate the feasibility of the chosen approach. Furthermore first epidemiological data will be obtained. Until a population-based study on neuroblastoma mortality in screened versus controlled populations has proven the usefulness of the screening it cannot be recommended as a general service to the public.

Adolescent↗

PubMedDate not supplied

[Establishment of a uniform common data set for pediatric oncology. Applied Informatics Study Group of the GPOH (Society of Pediatric Oncology and Hematology)].

Large multicenter trials have made a major contribution to the improvement of treatment results in childhood malignancies. Coordination and central documentation ensure the quality of treatment and permit clinical and scientific investigations. This kind of cooperation requires a vast amount of documentation, which by itself has become a critical factor in answering important medical questions. The problems result from non-standardized documentation systems in different studies, from insufficient integration of clinical work and documentation and from a lack of application of modern computer based data management systems. The working group "Applied Informatics" of the German "Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH)" has started a project to create an uniform basic data set for the German pediatric oncology group. Relevant initial diagnostic data, information about planned and realized treatment as well as data concerning negative event had to be standardized. A minimal common data set with a substantially reduced documentation, which is applicable for all patients and trials, would have failed to fulfil the clinical as well as the research needs. The data set presented here is a detailed information structure introduced as a basic tool for the improvement of data management in the German pediatric oncology group. This first version of the basic data set will need further development, since some of the problems still need to be resolved and the requirements for such data pools are changing. Based on this data set new computer software and clinical information systems have to be developed to enable documentation and processing of all clinical and study related data.

Child↗

PubMed2004

How industry is approaching the search for new diagnostic markers and biomarkers.

In the diagnostic and the pharmaceutical industry there is a constant need for new diagnostic markers and biomarkers with improved sensitivity and specificity. During the last 5 years, only a few novel diagnostic markers have been introduced into the market. Proteomics technologies are now offering unique chances to identify new candidate markers. Before a marker can be introduced into the market, three successive developmental phases have to be completed: the discovery phase, in which a variety of proteomics technologies are applied to identify marker candidates; the prototype developmental phase, in which immunological assays are established and validated in defined sample collectives; and finally the product development phase, with assay formats suitable for automated platforms. The hurdles that a potential candidate marker has to pass in each developmental phase before reaching the market are considerable. The costs are increasing from phase to phase, and in industry a number of questions concerning the medical need and the potential return on investment have to be answered before a proteomics discovery project is started. In this review, we will cover aspects of all three developmental phases including the repertoire of discovery tools for protein separation as well as giving an outline of modern principles of mass spectrometry for the identification of proteins.

Biomarkers, Tumor↗

PubMed2004

Helicobacter pylori infection in Finland.

Helicobacter pylori causes chronic gastritis worldwide and it is the most important single factor in peptic ulcer disease. Up to half of H. pylori infected individuals develop atrophic gastritis over years and decades. H. pylori infection has also been classified as a class I carcinogen in human gastric cancer. Most infections are obtained in childhood, in Finland mainly before the age of 7 years but the exact transmission routes are not known. The infection shows an age-dependent pattern, the infection being rare among children but gradually becoming more prevalent among older age groups. As new infections are few in adults and the infection only rarely disappears without effective anti-microbial therapy, the occurrence of the infection in the old actually reflects the prevalence of the infection in their childhood. In developed countries, such as Finland, a rapid decline of H. pylori prevalence rate has been demonstrated. In order to speed up this natural decline of the infection, a unique population based 'screen and treat' project was started in Vammala, a semiurban south-western community in Finland. In this survey, young inhabitants were offered diagnosis and treatment for H. pylori.

Finland↗

PubMed1961

Changes in the spermatozoon during fertilization in Hydroides hexagonus (Annelida). II. Incorporation with the egg.

This, the last of a series of three papers, deals with the final events which lead to the incorporation of the spermatozoon with the egg. The material used consisted of moderately polyspermic eggs of Hydroides hexagonus, osmium-fixed at various times up to five minutes after insemination. The first direct contact of sperm head with egg proper is by means of the acrosomal tubules. These deeply indent the egg plasma membrane, and consequently at the apex of the sperm head the surfaces of the two gametes become interdigitated. But at first the sperm and egg plasma membranes maintain their identity and a cross-section through the region of interdigitation shows these two membranes as a number of sets of two closely concentric rings. The egg plasma membrane rises to form a cone which starts to project into the hole which the spermatozoon earlier had produced in the vitelline membrane by means of lysis. But the cone does not literally engulf the sperm head. Instead, where they come into contact, sperm plasma membrane and egg plasma membrane fuse to form one continuous membranous sheet. At this juncture the two gametes have in effect become mutually incorporated and have formed a single fertilized cell with one continuous bounding membrane. At this time, at least, the membrane is a mosaic of mostly egg plasma membrane and a patch of sperm plasma membrane. The evidence indicates that the fusion of the two membranes results from vesiculation of the sperm and egg plasma membranes in the region at which they come to adjoin. Once this fusion of membranes is accomplished, the egg cytoplasm intrudes between the now common membrane and the internal sperm structures, such as the nucleus, and even extends into the flagellum; finally these sperm structures come to lie in the main body of the egg. The vesiculation suggested above appears possibly to resemble pinocytosis, with the difference that the vesicles are formed from the plasma membranes of two cells. At no time, however, is the sperm as a whole engulfed and brought to the interior of the egg within a large vesicle.

Animals↗

PubMed1997

Handling nutritional advice in general practice in Norway.

General practitioners (GPs) in Norway are in a unique position to influence their patients' lifestyles during consultations. The specialty of family medicine has been recognized in Norway since 1985. In continuing medical education, nutrition issues are integrated with the discussion of relevant diseases. The first book on health education for Norwegian general practice (1990) contains a set of general dietary guidelines. GPs are informed of the results of the National Health Screening Service, which measures blood pressure and serum lipids and records smoking habits. Serum cholesterol concentrations and coronary artery disease mortality are declining. GPs have been involved in this achievement, although they were found in 1988 to set more conservative cutoffs of serum cholesterol concentrations for dietary advice than an expert committee. GPs have been directly involved in preparing the latest cholesterol guidelines. In 1994 Norwegian GP organizations started a project of quality indicators in general practice (SATS). Of the four conditions that are themes for the first project, treatment of diabetes mellitus has a major nutritional aspect.

Adult↗

PubMed2001

Development of a child health indicator system in Italy.

BACKGROUND: The need for a uniform, comprehensive and action-oriented child health indicator system is widely recognised. As part of a Ministry of Health project, a working group was established in Italy in order to develop a proposal for a minimum set of health indicators to be adopted at the regional and local health authority levels, where the planning process takes place. METHODS: The indicators proposed cover 17 areas of perinatal, child and adolescent health. The informing principles for the choice were relevance to the main health problems, availability of a reliable data collection system, feasibility of the collection and analysis process at the two health system levels proposed and extent to which the information provides clues for policy options. RESULTS: The main difficulties arise from a lack of uniform systems of classification and data collection for disabilities, as well as adequate tools for assessing quality of care and quality of life. A basic framework for analysis is suggested, including further breakdown of the indicators proposed, such as analysis by birthweight and by cause of neonatal death and by mother's education and father's employment. The information provided by the health indicators put forward needs to be evaluated within the broader scenario of the child's situation so that associated factors may be identified and clues found for intersectoral policies. Two research projects were started to evaluate the feasibility and reliability of data collection and the impact on the planning process at both the regional and local health authority levels. CONCLUSION: A European-wide initiative is proposed to tackle existing methodological problems effectively and develop a common child health indicator system.

Adolescent↗

PubMed1986

Continuing medical education for isolated rural general practitioners--a journal project.

County Sligo in the Republic of Ireland is a rural area where general practitioners generally work single-handed and in geographical isolation from library facilities. In order to facilitate access to current medical journals for general practitioners a project was started to supply them with the contents pages of recently received general practice literature from a central medical library. Following telephoned or written requests, reprint articles of interest were forwarded by return post. The detailed costs and analysis of the exercise for one year are included.

Cost-Benefit Analysis↗

PubMed1986

Health care and health promotion in southern Italian communities.

Health promotion projects may be regarded as responses to insufficient health care in Europe, where modern health problems, consumer needs, participation and life quality are neglected. In Southern Italy and especially in Naples the situation is particularly difficult (poverty, poor accessibility of health care, high infant mortality, epidemics etc.); nevertheless there exist elements of everyday life which are advantageous for health promotion. The health projects described started around Naples in the 'seventies. They focused on the psychosocial problems of marginalized people (elderly people, women, mentally and physically handicapped men, big families etc.). Different elements of health care (prevention, primary health care, health education), social work and political and cultural activation were linked together in the local centres of social medicine. Thus the accessibility of health care was improved, social distance between suppliers and users reduced, and poor and disadvantaged people better integrated into the social life of the community. One important step in the realization of such aims was the stimulation of politically and socially defined homogeneous target groups with similar interests and needs. The specific measures, organizational structures and the personal staff are directed to these target groups in an integrated way. They are based on the teamwork of different professions and cooperation with other related organizations, and they include explicitly political, social and cultural activities, different from the self-help activities related only to health in most of Central Europe.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Health Centers↗

PubMed1994

Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers.

There is new evidence that smokers of all ages benefit from cessation of smoking. Although most older smokers, like younger smokers, prefer to quit on their own, at the time this project was started, there were no materials or programs targeted to older smokers. Using the literature, focus groups with older smokers and a national survey of older smokers, we created Clear Horizons, a self-help guide for older smokers, and a telephone counseling protocol tailored to the needs of older smokers (age 50-74). Smokers were recruited from around the United States and assigned randomly to a control guide, Clearing the Air, Clear Horizons alone or Clear Horizons and two counselor calls. Follow-up of nearly 2000 smokers was conducted by telephone 3, 6, 12 and 24 months after delivery of the self-help guides. This report focuses primarily on results at 3 months because that was the measurement for reactions to the interventions. At the 3 month interview, those in the tailored interventions rated their guides more highly than did those in the control group. They also read more of their guides and were more likely to reread them. Quit rates were significantly higher among smokers who received a combination of the tailored guide and telephone counseling. At 3 months, the combination of the guide and telephone counseling was most effective in helping smokers to quit. By 12 months, both the tailored guide alone and the tailored guide and calls groups had higher quit rates than the control guide but were not statistically different from one another.

Age Factors↗