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Case-control studies of the effect of environmental sanitation on diarrhoea morbidity: methodological implications of field studies in Africa and Asia.

The problems and prospects in the use of case-control studies to assess the effects of improvements in environmental sanitation on diarrhoea morbidity are discussed on the basis of two field studies. It is concluded that an adequate design is available for assessing the effects of a single improvement on diarrhoeal disease. The estimates of effect appear to be valid and sufficiently precise. For addressing more complex questions of interactions, sample sizes would have to be increased substantially. The experience with two field studies suggests that there is hope that a simpler protocol may be feasible, in which only limited information is collected, in which few home visits are made, and in which analytical techniques are simple. Until more field studies have been conducted definitive conclusions cannot be reached on the applicability of such a simple, rapid and inexpensive approach.

Child, Preschool↗

A methodology for sampling and accessing homeless individuals in Melbourne, 1995-96.

A methodology for sampling homeless populations in inner Melbourne was developed to study their health status and prevalence of tuberculosis. This paper describes the design, development and implementation of the project. The results of health status and tuberculosis analysis are published elsewhere. Involvement and interaction with local service providers and agencies to homeless people was central to the project throughout. A definitional construct of homelessness was developed, drawn from local and overseas literature and contemporary local experience. The study's aim was to obtain a representative sample of homeless individuals in various levels of accommodation and a convenience sample of those who were unaccommodated (streets and parks). A comprehensive sampling frame of accommodation options was constructed from available databases, and systematic sampling applied to produce a sample of 396 beds, from which 284 participants were enrolled. Convenience sampling of unaccommodated homeless individuals produced 100 participants. All agreed to undergo a comprehensive questionnaire, blood and Mantoux testing, the latter being completed successfully in 94%. Commonsense, cultural sensitivity and a non-threatening approach were critical to the success of the project and the security of the field workers. The methods described attempt to address recognised difficulties of sampling from homeless populations and should be reproducible both in the future and elsewhere. Potential for selection bias remains the main threat to validity, which the described methodology combined with adequate resources should help to address.

Health Surveys↗

Development of a new reference standard for microarray experiments.

Often microarray studies require a reference to indirectly compare the samples under observation. References based on pooled RNA from different cell lines have already been described (here referred to as RNA-R), but they usually do not exhaustively represent the set of genes printed on a chip, thus requiring many adjustments during the analyses. A reference could also be generated in vitro transcribing the collection of cDNA clones printed on the microarray in use (here referred to as T3-R). Here we describe an alternative and simpler PCR-based methodology to construct a similar reference (Chip-R), and we extensively test and compare it to both RNA-R and T3-R. The use of both Chip-R and T3-R dramatically increases the number of signals on the slides and gives more reproducible results than RNA-R. Each reference preparation is also evaluated in a simple microarray experiment comparing two different RNA populations. Our results show that the introduction of a reference always interferes with the analysis. Indeed, the direct comparison is able to identify more up- or down-regulated genes than any reference-mediated analysis. However, if a reference has to be used, Chip-R and T3-R are able to guarantee more reliable results than RNA-R.

Calibration↗

Non-destructive genetic sampling in fish. An improved method for DNA extraction from fish fins and scales.

DNA-based studies have been one of the major interests in conservation biology of endangered species and in population genetics. As species and population genetic assessment requires a source of biological material, the sampling strategy can be overcome by non-destructive procedures for DNA isolation. An improved method for obtaining DNA from fish fins and scales with the use of an extraction buffer containing urea and further DNA purification with phenol-chloroform is described. The methodology combines the benefits of a non-destructive DNA sampling and its high efficiency. In addition, comparisons with other methodologies for isolating DNA from fish demonstrated that the present procedure also becomes a very attractive alternative to obtain large amounts of high-quality DNA for use in different molecular analyses. The DNA samples, isolated from different fish species, have been successfully used on random amplified polymorphic DNA (RAPD) experiments, as well as on amplification of specific ribosomal and mitochondrial DNA sequences. The present DNA extraction procedure represents an alternative for population approaches and genetic studies on rare or endangered taxa.

Animals↗

The use of network sampling for locating the seriously ill.

Network sampling, based on the experience of conducting the large-scale 1986 Robert Wood Johnson Foundation National Access to Health Care Survey, was shown to be a viable alternative to more conventional procedures for oversampling persons with a low incidence and prevalence of health conditions. The network sampling approach was a more economical and methodologically less obtrusive means of increasing sample size of persons with desired characteristics than conventional procedures. The approach requires estimating the incidence, prevalence, or both of the required characteristics in the population. As the proportion of persons in the population with the characteristic increases, network sampling may lose its attractiveness. However, this has to be judged both in economic terms and in terms of the methodologic consequences of using other procedures to increase the size of subgroups of interest. As discussed, additional methodologic work is required on the consequences of network sampling for study group representativeness and sampling bias. However, network sampling, in the authors' opinion, is sufficiently promising to warrant methodologic explorations to answer these and other relevant questions about its use.

Adult↗

Globalization and the cultural safety of an immigrant Muslim community.

AIM: This paper reports a study the aim of which was to further understanding of cultural safety by focusing on the social health of a small immigrant community of Muslims in a relatively homogeneous region of Canada following the terror attacks on 11 September 2001 (9/11). BACKGROUND: The aftermath of 9/11 negatively affected Muslims living in many centers of Western Europe and North America. Little is known about the social health of Muslims in smaller areas with little cultural diversity. Developed by Maori nurses, the cultural safety concept captures the negative health effects of inequities experienced by the indigenous people of New Zealand. Nurses in Canada have used the concept to understand the health of Aboriginal peoples. It has also been used to investigate the nursing care of immigrants in a Canadian metropolitan centre. Findings indicated, however, that the dichotomy between culturally safe and unsafe groups was blurred. METHOD: The methodology was qualitative, based on the constructivist paradigm. A purposive sample of 26 Muslims of Middle Eastern, Indian or Pakistani origin and residing in the province of New Brunswick, Canada were interviewed in 2002-2003. Findings. Participants experienced a sudden transition from cultural safety to cultural risk following 9/11. Their experience of cultural safety included a sense of social integration in the community and invisibility as a minority. Cultural risk stemmed from being in the spotlight of an international media and becoming a visible minority. CONCLUSION: Cultural risk is not necessarily rooted in historical events and may be generated by outside forces rather than by longstanding inequities in relationships between groups within the community. Nurses need to think about the cultural safety of their practices when caring for members of socially disadvantaged cultural minority groups as this may affect the health services delivered to them.

Adult↗

Childhood Experience of Care and Abuse (CECA): a retrospective interview measure.

The development of a retrospective, investigator-based interview measure of Childhood Experience of Care and Abuse (CECA) used with two community samples of adults in London is described. The component ratings are shown to have satisfactory inter-rater reliability and also validity as determined by agreement between sisters' independent accounts. The association between the different childhood scales is explored as well as the relationship of childhood experiences to adult depression. Methodological issues concerning investigator-based versus respondent-based measures of childhood are discussed and a case made for use of the former. Advantages of using the CECA, a retrospective, time-based measure of childhood, are outlined.

Adult↗

Measuring intrasubject variability: use of the jacknife in doubly labeled water experiments.

The doubly labeled water technique measures energy expenditure; however, very little has appeared in the literature regarding estimation of the intrasubject variation. By use of a statistical resampling procedure called the jackknife, the standard deviation of the determination of energy expenditure in each subject is evaluated. Jackknife methods exploit the regression techniques that are already used with the doubly labeled water technique and are very easy to implement. Estimates of sample sizes for future experiments can easily be done with the jackknife. These formulas give the number of determinations of isotopic enrichment of hydrogen and oxygen over time that are needed to achieve a given degree of accuracy in estimating energy expenditure. An example with two human subjects illustrates the methodology of the jackknife.

Body Water↗

[Carbohydrate-deficient transferrin. Methods of determination and clinical significance in the detection of alcohol abuse].

Last decade witnessed the increasing use of serum levels of carbohydrate-deficient transferrin (CDT) as a highly specific and sensitive marker of chronic alcoholism. This paper deals with the explanation of the physiological principle of the test and the development of laboratory techniques of CDT measurement. The evaluation of the state-of-art of CDT tests is based on published data as well as on the practical experience of the author with three commercial diagnostic kits. The second part of the review article draws attention to some still open questions of how to harmonize the different methodologies used. The use of the CDT measurement in various clinical settings, the specificity and sensitivity of CDT in different population samples and/or in comparison with already established markers such as GGT is discussed.

Alcoholism↗

Coupling pH-stat and DO-stat titration to monitor degradation of organic substrates.

A combined titration methodology at constant pH and dissolved oxygen concentration to monitor the degradation of organics as carbon dioxide evolution rate (CER) and oxygen uptake rate (OUR) is presented. Equations necessary to assess CER from alkali titration rates and the instrument used to test the technique are described. Experiments were performed on samples of activated sludge from a domestic wastewater treatment plant using glucose and ethanol as substrates. OUR and CER were calculated for both substrates, as well as the respiratory quotient RQ = CER/OUR and biomass to substrate yields coefficients. RQ data for ethanol compared better with corresponding stoichiometric values than those for glucose.

Biodegradation, Environmental↗

[Coping with disease from the psychosomatic-psychotherapeutic viewpoint exemplified by pancreatectomized patients].

In the past few years psychosomatic medicine, apart from investigating the psychosocial sources of bodily disorders, has begun to focus also on the opposite side of the problem, the question of how people experience illness and cope with it. This "somatopsychic" view can be regarded as a supplement to the so far prevailing psychosomatic perspective and its approach. The present study describes and analyzes various strategies of coping with illness as observed in a group of pancreatectomized patients, a group of patients which has not been investigated before in this field of research. Based upon the experience of long-term psychotherapeutic care, the study differentiates between the more problematic and the more beneficial forms of coping, and empirically verifies their prevalence and adaptivity in a sample of pancreatectomized patients, not selected with regard to the extent of care needed. The findings are discussed from the methodological and the psychosomatic-psychotherapeutic point of view.

Adaptation, Psychological↗

Menu planning competencies in administrative dietetic practice. II. Practitioners' ratings of competence.

A nationwide sample of administrative and generalist dietitians rated five competencies with sub-competencies and ninety-two descriptors related to menu planning. Each item was rated numerically for importance and frequency of time consideration. Data were grouped according to three levels of practitioner experience. It was concluded that an effective methodology was developed for analyzing competencies for dietetic practice.

Administrative Personnel↗

Assessing research methodology training needs in emergency medicine.

OBJECTIVE: To determine the perceptions of emergency medicine (EM) academic faculty leaders and other academic emergency physicians regarding importance and knowledge of specific research methodology content areas and training priorities. METHODS: The authors conducted a confidential mail survey of 52 EM academic chairs, 112 residency directors, 116 research directors, and 400 randomly selected other members of the Society for Academic Emergency Medicine (SAEM). Respondents rated the importance of knowledge about each of 12 content areas for enhancing research productivity, rated their own knowledge of these areas, and identified training priorities. Standard descriptive statistics were used to characterize the study population; subgroup differences were examined by nonparametric statistics. RESULTS: 551 (81%) of those sampled returned surveys. Most (90%) respondents thought that knowledge about all selected content areas was important for enhancing research productivity; however, 7-37% (depending on the topic) reported little knowledge or experience in specific areas. Research directors reported highest overall knowledge levels (p < 0.001), followed by chairs, residency directors, and other SAEM members. Top training priorities (identified by all subgroups) included study planning (70%), problem identification/hypothesis construction (41%), and proposal writing (38%). CONCLUSIONS: These data support the continued need to offer broad training in research methodology, but suggest that greater emphasis be given to concepts involved in initiating and planning a study and to strengthening research proposal writing skills. These results should be of interest to academic departments who must address their own training needs, and help support the development of research methodology curricula on regional and national levels to advance the state of research in the specialty of EM.

Attitude of Health Personnel↗

'I feel totally at one, totally alive and totally happy': a psycho-social explanation of the physical activity and mental health relationship.

This paper reports findings from a qualitative investigation into the relationship between physical activity and mental health from the experiences of participants on exercise referral schemes. A grounded theory methodology was adopted which used focus groups and semi-structured interviews with participants from three exercise referral schemes in England. Schemes were representative of different types within the UK, and included a local authority leisure centre, a private health club and a local authority leisure centre scheme with organized countryside hikes. Pre- and post-exercise referral intervention focus groups, and interviews with purposively sampled individuals, were undertaken. Eighteen people participated and interviews were audio-taped, transcribed and analyzed. A conceptual framework emerged, and provides a psycho-social explanation for the physical activity and mental health relationship from the perspectives of the participants' who experienced it. The explanation of the relationship from this perspective identifies the core category 'self-acceptance', and the importance and interrelationship of context-related factors (such as social support and the physical environment), for the elicitation of positive experiences for people on exercise referral schemes. Investigating participant's experiences within the social contexts of exercise referral schemes provides an understanding about whether schemes have the potential to influence the mental health of referred patients.

Aged↗

A generalized modified-chi2 analysis of categorical bacteria survival data from a complex dilution experiment.

A well-known method of estimation for the density of bacteria in a sample solution is the most probable number (MPN) procedure. This paper considers the change in density through time of bacteria populations which are undergoing extinction. The MPN with its estimated variance for a fixed time point is a basic module of these investigations and is treated as a general implicit function of the cell proportions in linear categorical data analysis. These quantities are then used to fit exponential decay models over time by weighted least squares. When such models are supported by the data, comparisons of decay rates between populations under possibly different experimental conditions can be undertaken. This methodology is illustrated with an example pertaining to the survival experience of Leptospira autumnalis.

Bacteriological Techniques↗

Emotion in language and speech: methodological issues in naturalistic approaches.

Researchers currently seek to improve validity in speech and language studies by adopting naturalistic procedures In emotion-display research, validity is threatened by standard experimental controls which diminish the naturalism of stimuli and response ranges. We report two experiments comparing the adequacy of naturalistic with standard procedures. Experiment 1 had 158 judges code 89 samples of naturally-occurring emotional speech with free-choice emotion labels, and later with labels from a standard set. When free-choice labels were similar across judges, they were consistent with standard labels, but showed a range of intensity and contextual relevance. We recommend that future studies include wider options for judges when coding emotions. Experiment 2 compared valency ratings of words when presented in, or out of, context. Standard procedures score lexical valencies using affective dictionaries, disregarding natural contexts. Experiment 2 compared 23 judges' valency ratings of words presented individually, and later in their original context. Between 30% and 44% of words were rated differently in context (depending on the statistical significance level adopted). We concluded from Experiment 2 that, where small corpora adequately model a domain, the improved accuracy of valency rating achieved by presenting words in their natural context justifies the extra procedures required.

Adult↗

Thiocyanate levels in human saliva: quantitation by Fourier transform infrared spectroscopy.

A new quantitative method, based on Fourier transform infrared spectroscopy, was developed to evaluate the thiocyanate concentration in human saliva. Saliva samples were collected following a typical protocol and infrared spectra obtained from very small volumes (5 microl) deposited on a barium fluoride substrate. Exogenous potassium thiocyanate was used for calibration of the endogenous thiocyanate. This methodology does not require separation or extraction procedures. Human saliva spectra contain a characteristic marker band, due to thiocyanate, at 2058 cm-1. The integrated area of this band can be used for linear regression analysis and provides a good correlation between band area and thiocyanate concentration. Recovery of thiocyanate added to saliva was 100%. Centrifugation and dialysis experiments demonstrated that thiocyanate in saliva exists as a free or loosely bound ion. Saliva collected in the afternoon from 25 different subjects had a thiocyanate concentration of 0.83 +/- 0.42 (mean +/- SD) mmol/liter. In 4 subjects whose circadian pattern was investigated there was evidence of a higher thiocyanate concentration in saliva samples collected in the morning hours.

Cyanates↗