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Immunologic markers of AIDS progression: consistency across five HIV-infected cohorts. Multicohort Analysis Project Workshop. Part I.

OBJECTIVE: To provide background on five HIV-infected cohorts with documented seroconversion times and serum immunoglobulin (Ig) A and beta 2-microglobulin (beta 2M), CD4+ cell count and haemoglobin levels. To give a relative risks (RR) regression summary of the prognostic value of serial CD4+ cell count, IgA, beta 2M and haemoglobin measurements for clinical AIDS, and to examine whether cofactors such as current age, sex and exposure category affect these RR. DESIGN: The Multicohort Analysis Project (MAP) workshop was an international collaboration which brought statisticians, immunologists and clinicians from the five cohorts to work together for 10 days. A predefined restricted database was made available by each cohort for the workshop. SETTING: The Medical Research Council (MRC) Biostatistics Unit, Cambridge, UK hosted the MAP workshop from 19 to 30 April 1993. SUBJECTS: MAP workshop database comprised 1744 patients with documented HIV seroconversion times, with 407 women, over 900 injecting drug users (IDU) and over 500 homosexual men; 363 patients had AIDS and there were 308 deaths. MAIN OUTCOME MEASURES: Descriptive statistics on survival and progression to clinical AIDS by cohort and exposure category, CD4+ cell count at AIDS diagnosis and pre-AIDS zidovudine therapy. RR summarizing the joint prognostic significance of serial markers and cofactors such as age, sex and exposure category for progression to clinical AIDS. RESULTS: Slower progression to AIDS for IDU [95% confidence interval (CI), 0.35-0.71] and heterosexuals (95% CI, 0.19-0.98) compared with homosexual men was confirmed after adjusting for current age-group and serial CD4+ cell counts. CD4+ cell counts at AIDS diagnosis were much higher among homosexual men before than after 1988 (median, 150 and 90 x 10(6)/l, respectively). Little zidovudine use was observed among AIDS cases diagnosed before 1988 (2%) but increased use was recorded after 1988 and 1989 (24%) and even greater use after 1990 (59%). Low serial CD4+ cell count, haemoglobin levels and high serum IgA and beta 2M levels were associated with an increased risk of progression to AIDS. CD4+ cell count always provided prognostic information in addition to other markers; IgA and beta 2M (95% CI, 1.23-1.50 and 105-1.51, respectively) were jointly prognostic. beta 2M did not provide significant extra information (95% CI, 0.91-1.47) to the combination of serial CD4+ cell count and IgA, although haemoglobin did (95% CI: 0.74-0.91 for 10 g/l increase in haemoglobin). Interactions between cofactors, particularly exposure category and serial markers, were used to test for modifications in RR. The association between AIDS risk and serial CD4+ cell count was weaker, and with elevated IgA stronger, for homosexual men; RR associated with high beta 2M values were lower for IDU, in whom beta 2M may be elevated for reasons other than HIV disease. CONCLUSIONS: IgA and beta 2M, which can be measured in small volumes of stored blood, are jointly predictive of progression to AIDS. Results were broadly consistent between cohorts representing different age-groups, seroconversion periods and exposure categories. Some regression effect modifications by exposure category were noted, however, which merit further independent study.

Adult↗

Consensus workshop on advanced diagnostic andrology techniques. ESHRE (European Society of Human Reproduction and Embryology) Andrology Special Interest Group.

The Workshop reviewed four areas of advanced diagnostic andrology identified in the World Health Organization's 1992 Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction as 'research tests'. These were computer-assisted sperm analysis (CASA), acrosome reaction tests, the zona-free hamster egg penetration test and sperm-zona pellucida binding tests. For each topic, the Workshop Report comprises an overview of the particular field, a chronicle of the discussion that followed and a statement of the specific consensus points that were established. Free discussion allowed the elaboration of several general concepts that are presented here as the Workshop participants' perceived framework for future work in this area. While it was recognized that large-scale screening of male partners using advanced sperm function tests is almost certainly totally impractical on grounds of cost and lack of adequate services, urgent consideration was recommended for the development of a sperm function testing strategy capable of providing the likelihood of pregnancy for given diagnostic situations within certain timeframes. Establishing a clear definition of the role of diagnostic andrology in male infertility should be a primary focus of the Special Interest Group's activities. Further initiatives, including training courses, workshops, symposia and multicentre research studies, will be accorded high priority. Similar consideration will also be given to protocols for facilitating rational management decisions to ensure cost-effective therapeutic strategies, including consideration of the hierarchy of complexity and cost versus predicted fecundity. In addition, it was recognized that we need a greater understanding of the genetic basis of male infertility and how this impacts on the achievement of a viable pregnancy, while also minimizing the burden of genetic defects on the next generation.

Acrosome↗

The NHLBI workshop on Hypertension in Hispanic Americans, Native Americans, and Asian/Pacific Islander Americans.

In June 1994, the National Heart, Lung, and Blood Institute held a workshop entitled "Epidemiology of Hypertension in Hispanic Americans, Native Americans, and Asian/Pacific Islander Americans." The studies that served as the basis for the workshop along with a summary of two workshop panel discussions are being published as a supplement by Public Health Reports. In this article, the authors present graphs that compare results across these studies with data for non-Hispanic whites, blacks, and Hispanics from the Third National Health and Nutrition Examination Survey. The graphs indicate differences in mean blood pressure levels within and among these three population groups; such differences are also apparent in comparisons of these groups with the U.S. white and black populations. Although they appear modest, these differences are sufficient to result in increased mortality rates in populations with higher levels of hypertension. Environmental influences appear to underlie most of these differences. In all of these populations, blood pressure control rates are poor. Based on these studies, hypertension prevention and control programs should be undertaken. Special emphasis should be placed on the underserved minority populations that were the focus of the workshop.

Adult↗

[Participation in the IEC Workshop on Adolescent Sexual Health--a challenge to protect reproductive health/right in Latin America and Caribbean Region].

In order to explore the possibility of new global activity in nursing/midwifery to be performed by the WHO Collaborating Center for Nursing Development in Primary Health Care at St. Luke's College of Nursing, the center sent two faculty members to attend the IEC Workshop on Adolescent Sexual Health held in November 1996 in Mexico. The two representatives took part as resource persons and reported to the workshop on the activities of nurses and midwives for adolescent sexual health in Japan. During the session, they obtained information on the actual situation of adolescent sexual health in Latin America and Caribbean region and the novel strategies which were carried out in cooperation between governmental and non governmental organizations. The workshop also provided a good opportunity for international communication and information exchange with health workers in the region about adolescent sexual health. By participating in the workshop, we obtained first-hand information on various aspects of cooperation in international health.

Adolescent↗

Report of the National Institutes of Health (NIH) Workshop on the Development of Research Priorities in Eating Disorders.

The National Institutes of Health (NIH) Workshop on the Development of Research Priorities in Eating Disorders was convened in New York on April 24 and 25, 1996. The goals of the workshop were (1) to identify important unanswered questions in the study and treatment of eating disorders, (2) to discuss potentially fruitful approaches to answering these questions through basic and clinical research, and (3) to assist the NIH and other funding agencies in assigning priorities for research on eating disorders. The program consisted of a series of brief presentations by moderators, each followed by facilitated discussion of the topic with members of the audience. Three reporters (CMG, MJD, FMC) took detailed notes of the proceedings, which have been incorporated into this article. A summary of this workshop is presented, along with recommendations for future research that were identified by workshop participants.

Feeding and Eating Disorders↗

Evaluating the marginal student: a workshop for clinical faculty.

This article outlines a workshop designed to assist faculty in identifying students who are marginal or borderline and difficult to evaluate. The workshop's curriculum was tested out in three separate contexts over a 15-month period. The article also presents the results of the evaluation of the workshop curriculum and illustrates the complexities of relevant issues by using case scenarios that reflect the concerns shared among an interdisciplinary health sciences faculty. Responses to a post-workshop questionnaire indicated that the participants had benefitted from it and recommended its continuance.

Attitude of Health Personnel↗

A template for cultural diversity workshops.

PURPOSE/OBJECTIVES: To present a model for a series of workshops designed to improve the ability of oncology nurses to understand and fulfill culturally based needs of racially and ethnically diverse patients with cancer. DATA SOURCES: Published literature and author experience. DATA SYNTHESIS: Most nurses work with patients from a variety of ethnic or cultural backgrounds yet know little of how this affects patients' cancer experiences. Four workshops were presented that focused on the most common ethnic groups in the geographic area. A content template was developed that worked well to ensure complete topic coverage. CONCLUSIONS: Workshops were well-received. Nurses identified barriers to care and interventions that are appropriate for diverse patient populations. The follow-up survey indicated that some anticipated program outcomes may not be feasible if attendees do not regularly work with target populations. IMPLICATIONS FOR NURSING PRACTICE: The model can be modified for use in any geographic area. Such workshops should be repeated at regular intervals.

Black or African American↗

[Scabies epidemic in a sheltered workshop--what should be done?].

Scabies is an infectious parasitic skin disease with a notable rising incidence in Germany. The disease is usually transmitted by close physical contact, but indirect spread e.g. by bedding is also possible. Due to its contagiousness, introduction of scabies into crowding living facilities, such as dormitories or kindergartens, can easily cause an epidemic outbreak. We describe an epidemic of scabies in a workshop for handicapped people in February 1998. A worker with severe scabies reported that numerous colleagues in both workshop and the associated hostel had complained of pruritus for months and that some of them already had undergone scabicide treatment. The number of contacts (staff, colleagues, friends, attendants, family) of our patient and the other already affected people was more than 460. The management of the workshop asked for help in handling the epidemic. We describe the cooperative efforts of the management, as well as hospital and private dermatologists, to evaluate all potential contacts and present a concept of treatment for the termination of such an epidemic outbreak of scabies.

Animals↗

Accessibility of government-run sheltered workshops to people with psychiatric histories.

Government-run sheltered workshops in the Netherlands are not as easily accessible to people with psychiatric histories as they are to other groups, such as those with physical and intellectual disabilities. This was found in a large-scale nationwide study in 21 such workshops, commissioned by the Dutch Ministry of Social Affairs and Employment. The workshops varied in their degree of accessibility. The more accessible ones placed stronger emphasis on social objectives and had shorter waiting periods and more lenient admission policies.

Persons with Disabilities↗

Do workshops improved the technical skill of vascular surgical trainees?

AIMS: Adjuncts to conventional surgical training are needed in order to address the reduction in working hours. This purpose of this study was to objectively assess the efficacy of workshop training on simulators. METHODS: Fifteen consecutive participants of the European Vascular Workshop in 2003 and 2004 were recruited to this study. Participants performed a proximal anastomosis on a commercially available abdominal aortic aneurysm simulator, were then given intensive training on sophisticated models for 3 days and re-assessed. Pre- and post-course procedures were videotaped and independently reviewed by three assessors (tapes were blinded and in random order). The operative end product was similarly assessed. Four measures of technical skill were used: generic skill, procedural skill; a five point technical rating of the anastomosis (assessed using validated rating scales) and procedure time. Non-parametric tests were used in the statistical analysis. RESULTS: The video assessment scores for aneurysm repair increased significantly following completion of the course (p=0.006 and p=0.004 for generic and procedural skill, respectively). End product assessment scores increased significantly post-course (p=0.001) and participants performed aneurysm repair faster following the course (p<0.05). Inter-observer reliability ranged from alpha=0.84-0.98 for the three rating scales pre- and post-course. CONCLUSION: Objective improvements in technical performance follow intensive workshop training. Participants' perform better, faster, and with an improved end product following the course. Such adjuncts to training play an important part in a focused integrated programme that addresses reduced work hours.

Anastomosis, Surgical↗

Visions and strategies to improve evaluation of health information systems. Reflections and lessons based on the HIS-EVAL workshop in Innsbruck.

BACKGROUND: Health care is entering the Information Society. It is evident that the use of modern information and communication technology offers tremendous opportunities to improve health care. However, there are also hazards associated with information technology in health care. Evaluation is a means to assess the quality, value, effects and impacts of information technology and applications in the health care environment, to improve health information applications and to enable the emergence of an evidence-based health informatics profession and practice. OBJECTIVE: In order to identify and address the frequent problems of getting evaluation understood and recognised, to promote transdisciplinary exchange within evaluation research, and to promote European cooperation, the Exploratory Workshop on "New Approaches to the Systematic Evaluation of Health Information Systems" (HIS-EVAL) was organized by the University for Health Sciences, Medical Informatics and Technology (UMIT), Innsbruck, Austria, in April 2003 with sponsorship from the European Science Foundation (ESF). METHODS: The overall program was structured in three main parts: (a). discussion of problems and barriers to evaluation; (b). defining our visions and strategies with regard to evaluation of health information systems; and (c). organizing short-term and long-term activities to reach those visions and strategies. RESULTS: The workshop participants agreed on the Declaration of Innsbruck (see ), comprising four observations and 12 recommendations with regard to evaluation of health information systems. Future activities comprise European networking as well as the development of guidelines and standards for evaluation studies. CONCLUSION: The HIS-EVAL workshop was intended to be the starting point for setting up a network of European scientists working on evaluation of health information systems, to obtain synergy effects by combining the research traditions from different evaluation fields, leading to a new dimension and collaboration on further research on information systems' evaluation.

Education↗

Reality orientation versus sheltered workshops as treatment for the institutionalized aging.

The effects of two psychosocial treatments, Reality Orientation and Sheltered Workshops, were evaluated against an assessment-only control. Thirty nursing home residents (mean age, 64.4 years) were randomly assigned to one of two groups in one of the three experimental conditions. Residents assigned to therapy conditions met for 15 group sessions led by trained nursing home personnel. Program effects were assessed before and after treatment using three variables: the Life Satisfaction Index-A, nurses' ratings, and behavior observations. The Sheltered Workshop treatment produced significant gains in Life Satisfaction Index-A scores and staff perceived social interest; Reality Orientation resulted in nonsignificant decrements in Life Satisfaction Index-A scores. Neither treatment produced effects on observer-rated on-ward behavior. The results underscore the importance of empirically evaluating therapy effects with the institutionalized aging and suggest that Sheltered Workshops may be more beneficial for this population than has previously been recognized.

Adult↗

Effects of phenytoin withdrawal on matching to sample and workshop performance of mentally retarded persons.

The present study was designed to examine the effects of gradual phenytoin withdrawal on the matching to sample performance of three mentally retarded person. The percentage of correct responses per session served as the dependent variable, and the sample and comparison stimuli were red, green, and blue illuminations of translucent response windows. With two of the subjects, the sensitivity of a workshop assembly task to phenytoin effects was explored retrospectively. The dependent variables were percentage of time on task, number of completions, and number and type of prompts required per session. The results showed that doses of phenytoin considerably lower than the suggested optimum therapeutic level impaired the performance of mentally retarded individuals on both matching to sample and workshop assembly tasks. As doses were reduced for each subject, there were increases in the percentage of correct responding on the matching to sample task with the highest percentage correct being obtained after, and only after, the 0-mg dose was reached. In the workshop setting, the greatest number of assemblies completed and the lowest number of prompts required occurred only after the 0-mg dose was reached. The results are discussed in terms of generality, the tasks being well suited ot the study of drug effects with mentally retarded individuals, and implications for habilitation.

Adolescent↗

A report with consensus statements of the International Society of Nephrology 2004 Consensus Workshop on Prevention of Progression of Renal Disease, Hong Kong, June 29, 2004.

This report summarizes the discussions of the International Society of Nephrology (ISN) 2004 Consensus Workshop on Prevention of Progression of Renal Disease, which was held in Hong Kong on June 29, 2004. Three key areas were discussed during the workshop: (1) screening for chronic kidney disease; (2) evaluation and estimating progression of chronic kidney disease; and (3) measures to prevent the progression of chronic kidney disease. Fifteen consensus statements were made in these three areas, as endorsed by the participants of the workshop. The ISN can make use of and take reference to these statements in formulating its policy for tackling chronic kidney disease, a disease with significant global impact.

Hong Kong↗

Report of recommendations from the National Dental Public Health Workshop, February 10-12, 2002, Bethesda, MD.

A two-and-a-half day workshop was held beginning February 10, 2002, to review the current state of dental public health training in the United States with the aim of creating recommendations that would address identified problems and lead to improvements in the quality of dental public health training. This workshop, held in Bethesda, Maryland, was sponsored by the Health Resources and Services Administration (HRSA) through a contract with the American Association of Public Health Dentistry (AAPHD). Workshop invitees included the program directors of all accredited dental public health residency programs in the United States and Canada, selected dental public health residents, and additional consultants invited based on their expertise in dental public health education. The recommendations have been placed into three categories: training, financing, and workforce development. Along with background and process summaries, these recommendations are reported here.

Canada↗

Workshop for disabled survivors of severe head injury.

Existing services for the disabled do not cater for the needs of lame-brain survivors of severe head injury who may be capable of productive work though they may never become employable. A grant from the Nuffield Provincial Hospitals Trust made it possible to set up in 1967 a special workshop in premises provided by the regional hospital board. The hospital management committee assumed financial responsibility for the centre after three years, and after five years the Department of Health and Social Security purchased adjoining premises, which will double the present accommodation for about 35 persons. Though 45% of the 101 patients attending the workshop have returned to work, no financial support has yet been received from the Department of Employment. A suitably staffed hostel is needed for patients who live too far away to travel daily to and from the workshop. This undertaking has shown a need for special facilities for some of the victims of severe head injury, who differ in many important ways from other disabled persons.

Brain Damage, Chronic↗

The case for a flexible, long-term sheltered workshop for psychiatric patients.

In making his case for a flexible, long-term sheltered workshop, the author presents seven propositions that he supports with reviews of outcome studies in psychiatric treatment and rehabilitation. He submits that it is unrealistic to expect a lasting cure for many psychiatric patients; that despite rehospitilizations, many patients spend most of their lives in the community, where their vocational performance is poor; that total vocational rehabilitation is an unrealistic goal for many of the patients but that in our culture employment is essential to self-respect; and that hospital patients can and will work in hospital workshops and in community workshops after discharge. In addition, he describes a work-for-pay program affiliated with a psychiatric day hospital.

Day Care, Medical↗

Concurrent feelings of power and dependency in a sheltered workshop for chronic neuropsychiatrics.

The present study investigated the reported feelings of power and dependency of chronic neuropsychiatric patients in a sheltered workshop. Self-evaluations of dependency were assessed in relation to one real-life role (i.e. disabled welfare recipient), and evaluations of power feelings were assessed in relation to another real life role (i.e. worker in a sheltered workshop), with a complementary work-related performance measure. While dependency and power feelings were independent of each other, it was also found that: 1) dependency feelings positively predicted the number of mental hospital admissions; and 2) feelings of power in the workshop negatively predicted work performance. These results provide direct evidence that feelings of dependency and power can be role specific and not indicative of generalized behaviours. They also provide indirect evidence of a role theory interpretation of learned helplessnesslike phenomena.

Achievement↗