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PubMed2006

Increasing the confidence of nursing staff to address the sexual health needs of people living with HIV: the use of motivational interviewing.

The need to promote safer sexual behaviour has taken on new urgency in the UK because of large increases in the number of sexually transmitted infections (STIs). The sexual health needs of people living with HIV and AIDS (PLHA) also require attention as part of health promotion efforts. Many sexual health clinics are however struggling with high demand and limited resources. Within this context, this paper describes an innovate attempt at STI prevention with PLHA. Specifically, nursing staff were trained in the use of motivational interviewing to address sexual health issues and safer sexual behaviour in PLHA. We describe the training package and the impact upon participants. We conclude that by providing a positive training experience, front-line health staff that see the highest volume of PLHA with repeat STIs, can be assisted in developing their skills and confidence in prevention work with clients.

Clinical Competence↗
PubMed1989

AIDS and children: some of the issues in haemophilia care and how to address them.

Haemophilia is a life-long, life-threatening inherited condition for which there is treatment but no cure. It affects not only the patient but all members of the family. This paper focuses on how AIDS/HIV, which shares these characteristics with haemophilia, has affected children with HIV, their siblings, those who have remained antibody negative and those with HIV infected fathers. The impact of haemophilia and AIDS on the family is considered and the ripple effect of AIDS on health care staff is addressed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Interactional problems of addressing 'dreaded issues' in HIV-counselling.

Addressing the patient's fears about the future is an essential task in HIV counselling. The paper examines with conversation analytical methods the interactional dynamics of such discussions in video- and audio-taped counselling sessions with patients coming for an HIV test and others diagnosed as HIV antibody positive. Two communication formats were found to be used in the sessions, one based on information delivery made by the counsellor and the other on interviewing the patient. The interactional tasks in the use of the interview format include persuading the patient to produce his/her own views of the future and moving from mere expression of troubles towards their management.

Communication↗
PubMedDate not supplied

Addressing weight-related issues in an elementary school: what do students, parents, and school staff recommend?

This study examined weight-related issues affecting elementary school children to gain insight into how best to address these issues within a school-based intervention. The study population included 21 students, 12 school staff members, and 21 parents from a school that serves an ethnically-diverse population. Data were collected using focus groups and individual interviews and were analyzed using qualitative research methodology. Weight-related teasing and poor body image emerged as prominent issues affecting students. Results suggest that programs aimed at the prevention of weight-related disorders should go beyond issues of nutrition and physical activity and include strategies to reduce weight-related mistreatment and to improve students' body image.

Body Image↗
PubMedDate not supplied

Addressing cultural orientations in fear appeals: promoting AIDS-protective behaviors among Mexican immigrant and African American adolescents and American and Taiwanese college students.

Fear appeals threatening the individual have been shown to be powerful persuasive devices in the cultures where they have been studied. However, most fear appeal research has been conducted with members of individualist cultures. Individualist cultures place self-needs above group concerns, while collectivist cultures place group needs above self-concerns. Little is known about the effectiveness of fear appeals (or other persuasive strategies) in collectivist cultures. Two studies assessed the effectiveness of AIDS-prevention fear appeals threatening the self versus fear appeals threatening the group (i.e., family) on members of individualist and collectivist cultures. The first study focuses on African American and Mexican immigrant junior high school youth. The second study focuses on U.S. and Taiwanese college undergraduates. The results indicated that fear appeals should address cultural orientation (i.e., individualist versus collectivist orientation) to achieve maximum effectiveness. The results also indicate that one cannot assume cultural orientation based on ethnicity.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Addressing the linkage between exposure to pesticides and human health effects--research trends and priorities for research.

In recent years, there has been escalating concern over the possible association between exposure to pesticides and adverse human health effects by a number of non-governmental organizations, professional and public interest groups. Recognizing the need to document the scientific basis of these concerns as a foundation for initiating a research theme devoted to linkages between exposures to pesticides and human health effects, the Canadian Institutes of Health Research (CIHR) requested a summary of recent research trends that address these linkages. Experts across Canada in the field of pesticide regulation and research were invited to participate in the review. The review summarizes the limitations of past and current studies related to pesticides and human health effects research and makes suggestions for future research priorities and proposed study designs that will improve the assessment of pesticide exposure, the associated health risks, and improved methodology for regulatory decision making.

Canada↗
PubMed2004

Addressing the realities [correction of realties] of health care in northern aboriginal communities through participatory action research.

To address concerns about disruptions in the continuity of health care delivered to residents in three remote aboriginal communities in northern Ontario, Canada, the local health authority initiated a study in collaboration with the department of Health Canada responsible for ensuring that aboriginal reserves receive mandatory health services, and an inter-disciplinary team of researchers from two universities. The study focussed on the delivery of oncology, diabetes and mental health care, specifically, as well as systems issues such as recruitment and retention of health human resources and financial costs. The paper discusses the procedures involved, the benefits derived and the challenges encountered in doing this as a community driven participatory action research project. It also summarizes the findings that led to community formulated policy and program recommendations.

Canada↗
PubMed2003

Addressing the informational needs of healthcare professionals in dementia care: an explorative study in a Chinese society.

Many healthcare professionals in Hong Kong are now working in dementia care, but little is known about their informational needs in this area. This study explored the level of knowledge about dementia that healthcare professionals perceived themselves as having, and the informational needs of dementia care. 320 respondents, who were primarily nurses, social workers, and rehabilitation therapists, completed a questionnaire designed for this study. While 65% reported having sufficient knowledge of dementia, only 40% expressed having adequate knowledge of dementia-related services. Respondents who had relevant clinical experience demonstrated a significantly higher self-perceived knowledge level of dementia (p=0.000) and dementia-related services (p=0.000). The respondents ranked information leaflets (68%), the mass media (65%), and workshops (53%) as the three popular sources for obtaining dementia-related information. Similar to their western counterparts, over 75% of respondents expressed the need to lean more about clinical management and service provisions for people with dementia and their families. To enhance the knowledge of healthcare professionals about dementia care, it is recommended that healthcare professionals be encouraged to participate in continuing education programmes, and that education/resource centres for dementia care be developed to address the learning needs of local practitioners.

Adult↗
PubMed2002

Tobacco harm reduction: a call to address the ethical dilemmas.

The 2001 Institute of Medicine report Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction has helped to focus attention on the scientific basis for assessing tobacco harm reduction products. As the tobacco research and policy communities tackle the challenges of evaluating harm reduction, there are ethical issues that must also be addressed. There has, however, been very little writing on the ethics of this field. In an effort to spur research into answering these ethical questions, we present two complementary approaches. First we outline three overarching topics in tobacco harm reduction that would particularly lend themselves to study: (a) Is the pursuit of tobacco harm reduction an ethical goal? (b) What are the ethical considerations of tobacco harm reduction vis-à-vis pharmaceutical companies? and (c) What are the ethical considerations for harm reduction vis-à-vis tobacco companies? We then present one possible framework for analyzing the ethical issues that accompany particular tobacco harm reduction strategies. By considering the ethical dilemmas attendant to tobacco harm reduction in a prospective and thoughtful manner, we will be better prepared to handle the challenges that face us individually as researchers and collectively as a tobacco control community.

Drug Industry↗
PubMed2004

Issues that must be addressed for risk assessment of mixed exposures: the U.S. EPA experience with air quality.

Humans are routinely exposed to a complex mixture of air pollutants in both their outdoor and indoor environments. The wide diversity of these exposure scenarios and potential for regional transport present the health scientist with a challenge of how to appropriately address complex air pollution mixtures. Similarly, regulators are faced with mixture issues ranging from exposures, to health outcomes, and to associated uncertainties that are in need of more definitive and strategic information to support informed decisions. This article provides a perspective of an empiricist on the background related to the issue of air pollution mixtures. Historic and current regulatory platforms for dealing with mixtures are described. Using the topic of particulate air pollution, general guidance through the nuances of potential interactions among PM constituents is provided, along with alterative approaches and examples, and how these support scientific and regulatory agendas. The impact of new cell and molecular technologies is inevitable, and we must be prepared to take advantage of these and other cross-cutting methods as they become available. Such innovative approaches hold the secret to high-throughput biologic dissection of component interactions and mixture profiles, which will aid in the assessment of risk.

Air Pollutants↗
PubMedDate not supplied

Addressing residual risk issues at anthrax cleanups: how clean is safe?

Since the 2001 attacks in which Bacillus anthracisspores were mailed to various media offices and two U.S. Senators, considerable interest has focused on developing estimates of the risk of contracting inhalational anthrax from exposure to such spores. Credible risk estimates would have significant utility in establishing future cleanup goals for contaminated sites. To perform a meaningful risk assessment, one needs sufficient data to identify the hazards, conduct dose-response assessment, and assess exposure. This report reviews the existing data on mortality produced by Bacillus anthracisspores in laboratory animals and humans. In particular, it focuses on the 11 cases of inhalational anthrax resulting from the 2001 attacks and their impact on hazard identification activities. It also addresses factors that may contribute to increased risk among exposed populations and the sources of uncertainty in dose response analysis. The article examines the state of the science for assessing exposure levels to Bacillus anthracis spores and concludes that significant challenges exist to performing robust assessments of risk. This conclusion supports the policy position of the U.S. Environmental Protection Agency (EPA) that there should be no growth of Bacillus anthracis spores from all postremediation environmental samples, for the cleanup of a site to be judged effective and for that site to be considered safe for reoccupancy. This has been the ultimate criterion for efficacy of cleanups performed in response to the 2001 anthrax attacks.

Animals↗
PubMed2002

Juvenile drug treatment courts in the United States: initial lessons learned and issues being addressed.

This paper provides an overview of the development of juvenile drug treatment court programs in the United States; the goals of these programs; a comparison of the traditional juvenile justice process and services with that of the juvenile drug treatment court; and principal areas in which the juvenile drug treatment court experience has differed from that of the adult drug treatment court. The paper also provides a description of early models and the modifications and enhancements that have subsequently been instituted to enhance program effectiveness; a summary description of the range of juvenile drug treatment court activity currently underway in the United States; the nature of substance use and other issues presented by participating youth; and the major challenges juvenile drug treatment courts are currently addressing.

Adolescent↗
PubMed2000

Chromosomal addresses of the cohesin component Mcd1p.

We identified the chromosomal addresses of a cohesin subunit, Mcd1p, in vivo by chromatin immunoprecipitation coupled with high resolution PCR-based chromosomal walking. The mapping of new Mcd1p-binding sites (cohesin-associated regions [CARs]) in single-copy sequences of several chromosomes establish their spacing ( approximately 9 kb), their sequestration to intergenic regions, and their association with AT-rich sequences as general genomic properties of CARs. We show that cohesins are not excluded from telomere proximal regions, and the enrichment of cohesins at the centromere at mitosis reflects de novo loading. The average size of a CAR is 0.8-1.0 kb. They lie at the boundaries of transcriptionally silenced regions, suggesting they play a direct role in defining the silent chromatin domain. Finally, we identify CARs in tandem (rDNA) and interspersed repetitive DNA (Ty2 and subtelomeric repeats). Each 9-kb rDNA repeat has a single CAR proximal to the 5S gene. Thus, the periodicity of CARs in single-copy regions and the rDNA repeats is conserved. The presence and spacing of CARs in repetitive DNA has important implications for genomic stability and chromosome packaging/condensation.

Cell Cycle↗
PubMed2006

The importance of addressing multidrug resistance and not assuming single-drug resistance in case-control studies.

BACKGROUND: Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug-resistant and multidrug-resistant bacteria. OBJECTIVE: To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug-resistant or multidrug-resistant bacteria were evaluated. DESIGN: Two retrospective case-control studies were performed with data on patients harboring Pseudomonas aeruginosa strains resistant only to ciprofloxacin (CRPA) and patients harboring P. aeruginosa strains resistant to ciprofloxacin and other antibiotics (multidrug-resistant P. aeruginosa [MDR-PA]). These 2 groups were compared with patients not harboring P. aeruginosa. SETTING: Two tertiary care hospitals. RESULTS: A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23]; P=.02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21]; P=.03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0]; P<.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0]; P=.001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1]; P<.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1]; P=.02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1]; P=.04). CONCLUSION: There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug-resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.

Case-Control Studies↗
PubMed2001

Office-based CO2 laser-assisted tympanic membrane fenestration addressing otitis media with effusion.

OBJECTIVE: To use the CO2 laser-assisted tympanic membrane fenestration in office settings, under local anesthesia, as the sole treatment for patients with chronic otitis media with effusion (OME). BACKGROUND DATA: This new treatment ensures artificial ventilation of the middle ear for several weeks, and provides an intermediate solution between ordinary lancet-made tympanocentesis and transtympanic ventilation tube insertion. The operative technique is already well codified, and preliminary studies have demonstrated that tympanic membrane fenestration does not expose patients to any major hazard. METHODS: We treated 30 ears in 21 children and 29 ears in 24 adults. All patients had presented with OME persistent for more than 3 months. The laser tympanostomy was performed under local anesthesia, as an outpatient procedure, using a CO2 flash-scanning laser in conjunction with a handpiece (OTOLAM). Using a power of 12 W to 17 W, a single laser pulse usually sufficed to create a 2-mm-diameter circular perforation in the anteroinferior quadrant of the eardrum. RESULTS: The tympanic membrane fenestration allows avoiding ventilation tube insertion in 63% of children and 75% of adults. CONCLUSIONS: The CO2 laser-assisted tympanic membrane fenestration seems a valid therapeutic option addressing OME. This study should be pursued on a larger scale to define more precisely the indications of the laser tympanostomy.

Adolescent↗
PubMedDate not supplied

Women's health centers and minority women: addressing barriers to care. The National Centers of Excellence in Women's Health.

New models of care delivery have been developed to better coordinate and integrate healthcare for women. In the United States, one of the challenges is to incorporate the needs of racial and ethnic minority populations into these newer care paradigms. This paper begins with a brief historical review of the experience of racial and ethnic minorities in the American healthcare system to provide a context for discussing barriers and limitations of more traditional models of women's healthcare. Specific approaches used by National Centers of Excellence in Women's Health are presented as examples of strategies that may be implemented by other communities to address these barriers.

Community Health Centers↗
PubMed2004

Application of the genome sequence to address concerns that Mycobacterium avium subspecies paratuberculosis might be a foodborne pathogen.

Johne's disease, a chronic inflammatory disease caused by infection with Mycobacterium avium subspecies paratuberculosis (M. paratuberculosis), is one of the most prevalent and costly diseases of dairy cattle worldwide. This ruminant pathogen is closely related to the ubiquitous animal and human pathogen Mycobacterium avium subspecies avium (M. avium), confounding the development of specific diagnostic reagents. Exacerbating this problem further is that most existing microbiological, serological, and immunologic assays for the identification of infected animals are inadequate. This is primarily because of the slow-growing nature of the organism, genetic intractability and the previous lack of information on M. paratuberculosis subspecies-specific genes or proteins that may enable the development of specific and sensitive assays. New detection tools are critically needed to definitively answer questions surrounding M. paratuberculosis as a foodborne pathogen as well as aid in determining if it is a contributing factor in Crohn's disease. Thus, the recent characterization of the complete genome sequence of M. paratuberculosis in our laboratories has been a major step forward in meeting this need. We have performed studies that utilize genomic information for the identification of specific DNA sequences and protein antigens in M. paratuberculosis. Based on a preliminary in silico comparison of the M. paratuberculosis genome sequence with that of M. avium, we have now identified at least 35 novel coding sequences that are unique to M. paratuberculosis. These in silico data were then confirmed and expanded by PCR amplification analysis with DNA from several species and isolates of mycobacteria. Finally, these unique sequences have been incorporated into an antigen discovery project that may allow reliable detection of the bacterium in antigen-based diagnostic tests. Application of these new tools in addressing foodborne related issues of M. paratuberculosis is discussed.

Animals↗
PubMedDate not supplied

Improving women's health during internatal periods: developing an evidenced-based approach to addressing maternal depression in pediatric settings.

The internatal period, the time between births of successive children, has become a focal point for risk assessment and health promotion in women's healthcare. This period represents a time when women are at high risk for a depressive disorder. The pediatric venue offers a unique opportunity for the identification and management of depression in the internatal period, as mothers who do not attend their own medical appointments are likely to accompany their child to pediatric visits. This paper discusses the role pediatric providers can undertake to improve women's health in the internatal period through the detection and management of maternal depression at well-child visits. Successful models of the management of depression in other primary care settings are explored for their potential for implementation in the pediatric venue. A specific model developed and implemented as part of a 3-year project is presented to highlight the feasibility of an evidenced-based approach to the management of maternal depression in the pediatric setting. We present evidence demonstrating that pediatric providers can successfully identify postpartum women with depression, monitor symptoms and treatment adherence, and communicate results to a woman's healthcare provider. Yet more investigation is needed to create preventive interventions for maternal depression that integrate evidenced-based practice standards for the treatment of depression in primary care venues into pediatric settings. Future programs and policies targeting maternal depression in the pediatric environment should address patient mental health literacy and stigma, the training and education of pediatric providers, and issues of privacy and reimbursement.

Adult↗