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PubMedDate not supplied

Concordance of three measures of cocaine use in an arrestee population: hair, urine, and self-report.

This article reports on the comparison of self-reported cocaine use with urinalysis outcomes and radioimmunoassay of hair samples for cocaine. The data is based on a voluntary sample of approximately 300 arrestees, tested and interviewed anonymously. The study reports high rates of request compliance for both urine and hair samples, and affirms a relatively high degree of underreporting of cocaine use. Radioimmunoassay of hair appears to detect considerably larger degrees of cocaine use than are detected by urinalysis. The differential rates of detection between hair and urine are less dramatic in subjects who appear to be high rate users.

Adult↗
PubMed2001

Evaluation of benzene exposure in children living in Campania (Italy) by urinary trans,trans-muconic acid assay.

The urinary benzene metabolite trans,trans-muconic acid (MA) was determined in 144 children living in Campania (Italy): 92 from Naples (1,300,000 inhabitants), designated as an urban source, and compared to 52 from Pollica (300 inhabitants), considered a rural, background exposure for benzene. The children participating in the study were tested by an anonymous questionnaire about the possible sources of exposure to benzene. Quantifiable levels of MA were found in 63% of the urine samples analyzed. Setting the value of nondetectable urinary samples at 7 microg/L MA, a value that is one-half of the instrument detection limit of 14 microg/L, the mean urinary concentration levels were 98.7+/-81.0 microg/L and 48.4+/-71.7 microg/L in Naples and Pollica, respectively; adjustment of these values to creatinine clearance resulted in MA levels of 141.2+/-145.4 microg/L in Naples and 109.8+/-133.2 microg/L in Pollica. Passive smoke exposure did not significantly affect urinary MA levels, but proximity of the home to traffic increased urine MA content. Data show that MA can be utilized as a biomarker for exposure; however, a clear-cut association to benzene requires personal monitoring and control of dietary sorbic acid.

Adolescent↗
PubMed2004

Incidence of hepatitis C virus infection and associated risk factors among Scottish prison inmates: a cohort study.

To gauge the incidence of hepatitis C virus (HCV) infection and associated risk factors among inmates during their imprisonment, the authors recruited adult males in a long-stay Scottish prison into a cohort study between April 1999 and October 2000. On two occasions (at 0 and 6 months), saliva was collected for anonymous HCV antibody testing and risk behavior data were obtained through a self-administered questionnaire. The participation rate was 85% at both initial recruitment (612/719) and follow-up (375/441; 171 men were ineligible for follow-up). For inmates who reported never having injected drugs, ever having injected drugs, having injected drugs during follow-up, and having shared needles/syringes during follow-up, HCV incidences per 100 person-years of incarceration risk were 1, 12, 19, and 27, respectively. Ever having injected drugs (relative risk = 13.0, 95% confidence interval: 1.5, 114.3) and having shared needles/syringes during follow-up (relative risk = 9.0, 95% confidence interval: 1.1, 71.7) were significantly associated with HCV seroconversion. The effectiveness of existing interventions, including the provision of bleach tablets for sterilizing injection equipment, was suboptimal. The development of methadone maintenance programs in prisons and the creation of drug courts to keep offending drug injectors out of prison might help to reduce transmission in this setting.

Adult↗
PubMed2004

Prevention of viral hepatitis C: assessment of a comic strip-based information campaign targeting adolescents.

BACKGROUND: The risk of exposure to hepatitis C virus increases markedly in adolescence, and students are thus a preferential target for information campaigns. The aim of this study was to evaluate the results of a hepatitis C information campaign targeting secondary-school students. METHODS: The study was done in 52 classes of 11 general and vocational secondary schools. Before the information meetings and two months afterwards, the students received an anonymous questionnaire to test their knowledge of hepatitis C. The information session was backed up by a comic strip depicting scenarios involving hepatitis C. RESULTS: The students were aged from 14 to 24 years (mean 15.9 years, SD 0.9 years). Respectively 1509 and 1419 questionnaires were completed before and after the information session. Answers to the first questionnaire showed that the students' knowledge of hepatitis C was poor. Scores improved significantly after the information session, from an overall mean of 6.2 (SD 2.0) to 8.5 (SD 1.7) (p<0.001). The largest score improvement concerned transmission due to illicit drug use, the potential severity of the disease, and lack of a vaccine. The improvement was significantly larger among pupils who said they read the comic strip than among those who did not (p=0.02). CONCLUSIONS: General and vocational secondary school students in France have mediocre knowledge of hepatitis C, particularly its modes of transmission and the lack of a vaccine. Knowledge improved significantly when measured two months after an information session, suggesting that subsequent at-risk behaviours might be reduced.

Adolescent↗
PubMed2002

HIV-1 and HIV-2 seroprevalence and risk factors among hospital outpatients in the Eastern Region of Ghana, West Africa.

A cross-sectional study of 854 outpatients seen at three hospitals in the Eastern Region of Ghana, West Africa assessed HIV-1 and HIV-2 seroprevalence rates and associated risk factors. During mid-1999, patients were tested in an anonymous study linked to a questionnaire and abstracted record data in three distinct communities with differing levels of urbanization. Combined HIV seroprevalence rates were 19.2% for Agomanya, the most rural community, 5.1% for Akwatia, and 3.4% for Nkawkaw, the most urbanized community. HIV-1 infection alone accounted for 84.5% of cases, compared with 9.5% and 6.0% for HIV-2 and dual infection, respectively. In a multivariable model, the Agomanya location was significantly associated with HIV status (odds ratio [OR], 7.7; 95% confidence interval [CI], 2.9-20.1; p <.0001). Employed people were also more likely to be infected (OR, 4.3; 95% CI, 1.02-18.3; p =.047). Among prenatal patients, those from Agomanya were more likely to report no live-in partner or spouse compared with Nkawkaw and Akwatia (p <.0001). These findings suggest sexual partner exchange patterns may be more useful in explaining HIV seroprevalence rates than level of community urbanization. Intervention programs directed at these high risk populations for HIV infection in Ghana are urgently needed.

Adolescent↗
PubMed1995

Educating the diabetes care professionals in eastern Europe: a Bulgarian experience.

The first educational course for 30 medical doctors and 16 nurses, engaged in outpatient diabetes care in Bulgaria, was carried out with the aim of assessing the existing level of knowledge of diabetes, to implement a training programme matching the assessed needs, and to evaluate the efficiency of the education delivered. The initial level of knowledge was assessed by an anonymous pre-test questionnaire on general issues of diabetes care. After 5 days of training, a post-test questionnaire was administered which included more specific questions on matters that had been taught during the course. The results of the pre-test showed that, on average, 60.3 +/- 20.6 (SD) % of the doctors and 50.5 +/- 25.0% of the nurses gave correct answers. The results of the post-test were significantly improved (73.5 +/- 20.6% for the doctor and 70.8 +/- 23.5% for the nurses), although the post-test questionnaire had been expertly evaluated as more complex and specific. The analysis of the results allowed us to draw general conclusions regarding the educational needs, the optimal structure, and implementation of such training courses in the specific conditions of Bulgaria. Some of the results and conclusions might be useful for other countries from Central and Eastern Europe in their efforts to promote successful diabetes education programmes.

Adult↗
PubMed1989

Dental care of HIV-infected patients: attitudes and behavior among Danish dentists.

The aims of the study were to study Danish dentists' attitudes and behavior with regard to providing dental care to HIV-infected persons and to look for explanatory variables for the dentists' attitudes and behavior. Two hundred and twenty-eight Danish dentists responded to a questionnaire on dental treatment of HIV-infected patients and related problems (response rate: 91.2%). The dentists' attitudes differed a great deal from the current national policy as to where HIV-infected patients should be treated and with regard to the possibility of being tested for HIV anonymously. 64% of the dentists favored the idea of referral of HIV-infected patients to special dental clinics for routine dental treatment, and 93% disapproved of the idea that infected individuals themselves should decide whether they wish to inform their dentist or doctor of seropositivity. Older dentists were more reluctant to treat HIV-infected individuals than younger. Other differences with regard to a number of demographic variables were not found. No difference in attitude towards HIV-infected persons was found when compared to that towards HBV-infected individuals. The reluctance towards treatment of HIV-infected persons was present irrespective of any subsidy for an extra cost for treatment of HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey.

STUDY OBJECTIVE: The aim was to validate a simple severity index of female urinary incontinence for subsequent use in an epidemiological survey. DESIGN: The index was created by multiplying the reported frequency (four levels) by the amount of leakage (two levels). The resulting index value (1-8) was further categorised into slight (1-2), moderate (3-4), and severe (6-8). It was validated against a 48 hour "pad weighing" test. Thereafter, an anonymous postal questionnaire survey was performed and the index was used to assess the severity of the leakage. A question about the impact of incontinence was also included. SETTING: The outpatient clinic of the Department of Gynaecology and Obstetrics, Trondheim University Hospital and the rural community of Rissa, Norway. PARTICIPANTS: Altogether 116 incontinent women referred to the clinic by their GP and all 2366 adult women living in Rissa. RESULTS: The difference in median pad weights between moderate and slight incontinence was 9g/24h (95% confidence interval 0-27). The corresponding difference between severe and moderate incontinence was 17g/24h (95% CI 5-30). In the epidemiological survey 29.4% reported urinary incontinence (response rate 77%). The prevalence tended to be highest in middle life and old age. Forty six per cent were classified as slight, 27% moderate, and 27% severe. There was a strong correlation between severity and impact (R = 0.59, p < 0.001). CONCLUSION: The severity index may be a useful tool for assessing the severity of female urinary incontinence in epidemiological surveys. It is confirmed that urinary incontinence is very prevalent in adult women, but most should not be regarded as potential patients.

Adult↗
PubMedDate not supplied

Comparison of four survey methods designed to estimate the prevalence of HIV among female prostitutes who inject drugs.

In Glasgow, during the period January 1990 to December 1992, 4 different methods were used to determine HIV prevalence among female prostitutes who inject drugs: the surveillance of prostitutes undergoing voluntary named tests, an unlinked anonymous survey of prostitutes attending a health care drop-in centre, a community-wide voluntary anonymous survey of injecting drug users including female prostitutes, and a voluntary anonymous survey of female prostitutes recruited in Glasgow's red-light area. HIV prevalence varied from 1.2 to 4.7% though overlapping confidence intervals indicated no significant differences. A comparison of each approach leads the authors to suggest that the former 2 methods which are relatively inexpensive should be conducted, if possible, on high risk groups such as prostitutes and injecting drug users on a continuous basis. If these indicate HIV rates which are stable and less than 5%, implementation of more sophisticated voluntary anonymous approaches need only be done every 3 to 4 years. However, if rates are unstable and/or greater than 5% then such surveys should be initiated more frequently, perhaps biannually.

Adult↗
PubMed1998

Adolescent heroin use: a review.

Use of heroin by American teenagers is beginning to show disturbing increases in national and statewide surveys. According to data from the 1997 National Institute on Drug Abuse monograph Monitoring The Future, heroin use by American high school 12th graders was 100% higher than it was from 1990 to 1996 (0.90-1.8%). In 1997, there was a further increase to 2.1%. Additional support for an increase in heroin use in the United States comes from analysis of recent survey data from California, Texas, and Maryland. Heroin imported from Colombia and from Mexico is now cheaper and of high potency, permitting novices to start with nasal administration of the drug. Most American adolescents now initiate heroin use by snorting it; however, frequent use of heroin by any route rapidly leads to tolerance and intense drug craving. Psychological dependence to heroin, and to the often exciting yet chaotic lifestyle of a heroin addict, is very difficult to overcome. Acute heroin withdrawal syndrome is usually not severe and most addicts in withdrawal can be managed in an outpatient setting. Naloxone must be used with great restraint and in smaller than usual doses in known heroin addicts. Successful long-term management often includes acute detoxification followed by long-term residential drug treatment. Managed care payment issues have impeded placement in appropriate treatment programs. Additional long-term management issues include regular attendance at 12-step meetings (Alcoholics Anonymous or Narcotics Anonymous), biweekly urine tests for drugs of abuse, attention to issues of dual diagnosis (group or family therapy), and reapproachment with family, school, and straight friends.

Adolescent↗
PubMed2002

Linkage and association with type 1 diabetes on chromosome 1q42.

Type 1 diabetes is a complex disorder with multiple genetic loci and environmental factors contributing to disease etiology. In the current study, a human type 1 diabetes candidate region on chromosome 1q42 was mapped at high marker density in a panel of 616 multiplex type 1 diabetic families. To facilitate the identification and evaluation of candidate genes, a physical map of the 7-cM region surrounding the maximum logarithm of odds (LOD) score (2.46, P = 0.0004) was constructed. Genes were identified in the 500-kb region surrounding the marker yielding the peak LOD score and evaluated for polymorphism by resequencing. Single-nucleotide polymorphisms (SNPs) identified in these genes as well as other anonymous markers were tested for allelic association with type 1 diabetes by both family-based and case-control methods. A haplotype formed by common alleles at three adjacent markers (D1S225, D1S2383, and D1S251) was preferentially transmitted to affected offspring in type 1 diabetic families (nominal P = 0.006). These findings extend the evidence supporting the existence of a type 1 diabetes susceptibility locus on chromosome 1q42 and identify a candidate region amenable to positional cloning efforts.

Chromosome Mapping↗
PubMed1987

Development and evaluation of an adult asthma self-management program: Wheezers Anonymous.

The efficacy of an adult asthma self-management program, Wheezers Anonymous (WA), was tested utilizing 79 adult asthmatic patients. Subjects were randomly assigned to a treatment or waiting-list control group. Baseline data gathered included measures of symptom severity, health-care utilization, knowledge of asthma, attitudes about asthma, and self-efficacy. All subjects completed the same measures 1, 2, and 3 months following the WA intervention. Knowledge about asthma increased in the treatment group relative to the waiting-list controls; the number of attacks decreased in the treatment group only, thus demonstrating the efficacy of the WA program.

Adult↗
PubMed2006

Hawaii veterinarians' bioterrorism preparedness needs assessment survey.

The purpose of this study was to assess the objective bioterrorism-related knowledge base and the perceived response readiness of veterinarians in Hawaii to a bioterrorism event, and also to identify variables associated with knowledge-based test performance. An anonymous survey instrument was mailed to all licensed veterinarians residing in Hawaii (N = 229) up to three times during June and July 2004, using numeric identifiers to track non-respondents. The response rate for deliverable surveys was 59% (125 of 212). Only 12% (15 of 123) of respondents reported having had prior training on bioterrorism. Forty-four percent (55 of 125) reported being able to identify a bioterrorism event in animal populations; however, only 17% (21 of 125) felt able to recognize a bioterrorism event in human populations. Only 16% (20 of 123) felt they were able to respond effectively to a bioterrorist attack. Over 90% (106 of 116) expressed their willingness to provide assistance to the state in its response to a bioterrorist event. Veterinarians scored a mean of 70% correct (5.6 out of 8 questions) on the objective knowledge-based questions. Additional bioterrorism preparedness training should be made available, both in the form of continuing educational offerings for practicing veterinarians and as a component of the curriculum in veterinary schools.

Adult↗
PubMed2002

Sonic hedgehog signaling modulates activation of and cytokine production by human peripheral CD4+ T cells.

Sonic hedgehog (Shh) is important in the growth and differentiation of a variety of cell types, including the development of T cells in the thymus. This prompted us to investigate whether Shh signaling is a functional component of the physiological response of human mature CD4(+) T cells following Ag recognition. In this study, we demonstrate that Shh and its receptor Patched (Ptc) are expressed on resting and activated human peripheral CD4(+) T cells. In approximately one-half of the randomly selected, anonymous blood donors tested, exposure of anti-CD3/28 Ab-activated CD4(+) T cells to the biologically active N-terminal Shh peptide increased the transcription of ptc, thereby demonstrating that Shh signaling had occurred. Furthermore, the addition of exogenous Shh amplified the production of IL-2, IFN-gamma, and IL-10 by activated CD4(+) T cells. The synthesis of IL-2 and IFN-gamma, but not IL-10, by CD4(+) T cells was down-regulated by the addition of neutralizing anti-Shh Ab. Cell surface expression of CD25 and CD69 on activated T cells was up-regulated by exogenous Shh, whereas in the presence of the neutralizing anti-Shh Ab expression it was reduced. Collectively, our findings demonstrate that Shh-mediated signaling is a physiological component of T cell responses, which acts to modulate CD4(+) T cell effector function.

Adjuvants, Immunologic↗
PubMed2006

Survey of psychiatric treatment among psychiatric residents in Manhattan: evidence of stigma.

OBJECTIVE: Psychiatric trainees seek personal psychiatric treatment for a variety of reasons including educational objectives, symptoms relief, or functional impairment. Data on the rate of psychiatric treatment among residents and the attitudes of residents toward personal treatment are limited. The purpose of this study was to determine the frequency and types of psychiatric treatment among residents and to assess residents' attitudes toward treatment. METHOD: A 51-item questionnaire was mailed to all postgraduate year (PGY)-2 through PGY-4 psychiatric residents training in Manhattan in the spring of 2002 (N = 288). Questionnaires were anonymous. Significance was tested using McNemar test of symmetry, dependent-groups t tests, or 2-way contingency table analysis where appropriate. The study was conducted from March 2002 through June 2002. RESULTS: Forty-eight percent of residents returned the questionnaire. Among respondents, 57% were in individual psychiatric treatment, predominantly individual psychotherapy or psychoanalysis. The rate of medication treatment was 18%, corresponding to a 31% rate of medication use among those in psychotherapy. Residents felt that their training programs explicitly encouraged psychotherapeutic treatment but not medication treatment, and they were more likely to tell other residents and faculty about personal psychotherapy as compared with personal medication use. Residents felt that the use of medication carried "significant" stigma, while personal psychotherapy did not. CONCLUSION: In this sample, residents believe there is "significant" stigma associated with the use of psychotropic medication, while psychotherapy is seen as a respected and valued educational and therapeutic experience. These findings deserve the attention of educators and emphasize the need for further research in this area.

Attitude of Health Personnel↗
PubMedDate not supplied

[Degree of hepatitis C infection risk in the health care setting].

BACKGROUND: Hepatitis C virus is the most important aetiologic agent for non A-non B hepatitis. The study of the prevalence of hepatitis C in health care workers is of primary interest because of the possible chronic evolution and the risk of cirrhosis and liver cancer. OBJECTIVES: The purpose of this study was to determine the prevalence of HCV among health care workers in 5 main hospitals and local health units in Turin and analyze the influence of occupational and non occupational risk factors. METHODS: Health care personnel were administered anonymous questionnaires and testing for anti-HCV antibody was performed. RESULTS: Prevalence rates in 4517 health care workers was 1.97%; the prevalence was higher in elderly workers (> 45 years) than in younger ones. The risk analysis did not reveal any significant correlation between HCV seroconversion and accidental blood exposure. However, a significant correlation was found with non-occupational risk factors. Unapparent infection was an unimportant risk factor for seroconversion. CONCLUSIONS: Hepatitis C prevalence in the population under study was comparable to that found in the general population. These results point to the need to reconsider the assumption that there is an increase of risk of seroconversion for health-care workers, in the absence of any occupational accidental exposure to hepatitis C virus.

Adult↗
PubMed2002

Training primary care physicians in community eye health. Experiences from India.

This paper describes the impact of training on primary-care physicians in community eye health through a series of workshops. 865 trainees completed three evaluation formats anonymously. The questions tested knowledge on magnitude of blindness, the most common causes of blindness, and district level functioning of the National Programme for Control of Blindness (NPCB). Knowledge of the trainers significantly improved immediately after the course (chi 2 300.16; p < 0.00001). This was independent of the timing of workshops and number of trainees per batch. Presentation, content and relevance to job responsibilities were most appreciated. There is immense value addition from training primary-care physicians in community eye health. Despite a long series of training sessions, trainer fatigue was minimal; therefore, such capsules can be replicated with great success.

Clinical Competence↗
PubMedDate not supplied

Regional variation in HIV prevalence and risk behaviours in Ontario injection drug users (IDU).

OBJECTIVES: To measure HIV prevalence, risk behaviours, and further service needs in needle exchange programs throughout Ontario, and to conduct regional comparisons. METHODS: Injection drug users (IDU) recruited through the efforts of needle exchange programme (NEP) staff in 9 Ontario cities during 1997-98 completed questionnaires about their drug use and behaviours and provided saliva and/or dried blood samples for anonymous unlinked HIV testing. RESULTS: Demographic and drug use characteristics of participants showed great regional variation. HIV prevalence by region ranged from 1.4% to 14.7%. In addition to region, HIV positivity was associated with injecting for more than 5 years, use of (powder) cocaine, use of crack, binge injection (10 or more times per day at least once in the previous 6 months), and being a longer-term NEP user. Sharing of injection equipment, and especially of other drug injection materials such as water and cookers, remain important issues, although much of the sharing reported is with only one other person. Unmet demand for methadone treatment was identified despite changes in regulation of methadone provision designed to make it more accessible. CONCLUSIONS: This study suggested significant further HIV prevention needs among IDU throughout Ontario. There is also evidence of potential to provide additional services such as methadone at NEPs if the required resources are invested. NEPs that have succeeded in gaining the trust of high-risk IDU offer a means to provide access to needed services.

Adolescent↗