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PubMed2003

Fetus at risk: prevalence of alcohol consumption during pregnancy estimated with a simple screening method in Swedish antenatal clinics.

AIMS: Maternal alcohol consumption is a major health hazard for the fetus. Sweden has an extensive system of public antenatal care clinics, whose mission is to detect and prevent this type of health hazards. However, very few cases of alcohol consumption during pregnancy are detected. The aim of this study was to examine the prevalence of hazardous or harmful alcohol consumption during pregnancy in a consecutive series of Swedish pregnant females. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The Alcohol Use Disorders Identification Test (AUDIT) was used to collect anonymous data from consecutive pregnant subjects admitted during 1 year to an antenatal clinic in Stockholm, and signing up for parental education offered routinely (n = 1327). Data were obtained from 1101 subjects, typically in pregnancy week 30. A complete AUDIT form was filled out referring to alcohol use during the year prior to pregnancy. A separate form with the consumption items from AUDIT was filled out to report behaviour during pregnancy. FINDINGS: For the year preceding pregnancy, 17% of subjects reported AUDIT scores of 6 or higher, indicating hazardous or harmful alcohol use in women. Few individuals reported scores of 13 or higher (indicating abuse or dependence), but almost half the subjects (46%) reported binge drinking (six standard drinks on a single occasion) once/month or more often, and 6% reported binge drinking on every occasion of alcohol consumption. One-third of the subjects (30%) continued regular alcohol use during pregnancy, and 6% reported consumption two to four times/month. In a logistic regression model, AUDIT scores for the year prior to pregnancy and subject age, but not education level were significant predictors of continued alcohol use during pregnancy. CONCLUSIONS: Alcohol use during pregnancy is more extensive than has been presumed in Sweden. Simple, clinically useful screening methodology detects hazardous consumption during pregnancy in a manner which regular antenatal care does not. If this methodology can be shown to have similar sensitivity when administered under non-anonymous conditions, it should be made part of routine antenatal care.

Adult↗

PubMed2006

Removing barriers to knowing HIV status: same-day mobile HIV testing in Zimbabwe.

OBJECTIVES: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were (1) to describe those using the services, (2) to assess the acceptability of such services, (3) to assess reasons for not testing previously, and (4) to compare those who used the services with those who did not to determine how to increase acceptability. METHODS: We provided free anonymous mobile VCT using 2 rapid HIV tests in 12 marketplaces in Epworth and Seke, Zimbabwe. Qualitative interviews were conducted to assess motivations for and barriers to testing. A subsample of HIV testers and individuals near testing vans who declined testing (nontesters) completed a questionnaire. RESULTS: A total of 1099 individuals participated in mobile VCT between March 2002 and August 2003. The proportion of participants infected with HIV was 29.2%. Overall, 98.8% of participants elected to receive HIV test results the same day. Reasons for not testing previously were often logistic (eg, inconvenience of hours [25.6%] and location [20.7%] or cost [8%]). Those who used the same-day mobile testing services (testers vs. nontesters) perceived themselves at higher risk for HIV infection (adjusted odds ratio [AOR] = 1.8) but were less likely to have known people with HIV (AOR = 0.49) or where to get tested (AOR = 0.57). CONCLUSIONS: Same-day HIV testing in community settings seems to be acceptable in sub-Saharan Africa. Barriers to HIV testing are often logistic and can be overcome with community-based strategies. These strategies need to be refined to address the needs of those not using mobile testing services.

AIDS Serodiagnosis↗

PubMed2006

Building an anonymized catalogued radiology museum in PACS: a feasibility study.

The aim of this study was to test the feasibility of a software application that would allow the anonymization and cataloguing of whole DICOM datasets in order to build searchable radiology museums within PACS. The application was developed on a dedicated networked PC, using C# and HL7 coding. Whole DICOM datasets were pushed from PACS to a networked PC on which the application, Museum Builder, was developed. Museum Builder works by replacing the patient specific data (the forename, surname and hospital number) within each header of each DICOM file with terms from anatomical and surgical sieve menus. The date of birth is anonymized to 1 January of the same year. Whole DICOM datasets comprising hundreds of images can be anonymized and catalogued in a single episode. Museum Builder primes PACS with an HL7 script to receive a "new" patient. DICOM datasets are then pushed back to PACS where they are added to the database as "new" cases. The museum cases can then be searched for, on PACS, by any combination of terms that correspond to appropriate anatomical units, surgical sieve headings or radiological specialty. New radiology reports containing clinical histories, radiological descriptions, differential diagnoses and discussion can be added through the report window. Our institution has developed and used this tool to generate a PACS based radiology museum containing not only full DICOM datasets, but also relevant histological and clinical photographs. In conclusion, this technique offers a mechanism for generating anonymized catalogued radiology museums in PACS. Museum Builder represents a working prototype that demonstrates some of the archiving functions that are expected by teaching institutions from PACS.

Cataloging↗

PubMed1995

[HIV testing in Denmark in 1993: were the tests relevant?].

In order to describe HIV-testing activity among adults in Denmark, a cross-sectional study was designed using an anonymous questionnaire, which was forwarded with all HIV-test results in a given two-week period in 1993. Notified first-time identified HIV-positive cases were used for comparisons. The response rate was 50%. A total of 996 women and 834 men were included, among whom 68% of men and 62% of women were classified as having a behaviour that put them at increased risk for acquiring HIV, p < 0.02. Women were younger than men, p < 0.001. Around 1/3 of both men and women had previously been HIV-tested, a proportion that increased with increasing risk for HIV, p < 0.00001 for trend. HIV-tested adults were younger and less frequently living in the Copenhagen area than the first-time identified HIV-infected persons reported to the mandatory national HIV-surveillance system. The overall HIV prevalence was 0.3%, being 0.5% among men and 0.2% among women. Estimates showed that the yearly number of first-time identified HIV-infections among tested homo/bisexual men per 10(5) men were 100 times as high as among the heterosexual population. Also, 12% of Danish homo/bisexual men had an HIV test per year, a proportion that was 2.3% among adult women and 1.8% among adult heterosexual men without i.v. drug use. The yearly test-activity decreases with increasing age among both men and women. In conclusion, studies among the HIV-tested population along with results from systematic surveillance of first-time identified HIV-infections are useful in order to estimate the frequency and the relevancy of HIV testing in the entire population. Also, these results may help when planning national information campaigns.

Adult↗

PubMed1993

Factors affecting gay and bisexual men's decisions and intentions to seek HIV testing.

OBJECTIVES: This paper describes the relationships of sociodemographic, attitudinal, and behavioral variables to (1) decision to be tested, (2) expressed intention to be tested, and (3) reasons for not being tested for the human immunodeficiency virus (HIV) antibody. METHODS: A sample of 1295 men completed an anonymous questionnaire in gay-identified venues. Factor analysis was used to group reasons for not being tested and logistic and multiple linear regression were used to model the dependent variables. RESULTS: Fifty-three percent of the respondents had been tested, of whom 26% tested positive. Metropolitan residence and anal intercourse most strongly correlated with previous test-seeking. Previous test experience correlated most strongly with intention to be tested. Reasons for not being tested fell into three groups: (1) desire for anonymity, (2) self-perceived health, and (3) no benefit and denial. The odds were lower for gay men than bisexuals and men who did not participate in anal intercourse to express a desire for anonymity. CONCLUSIONS: Public health agencies should be prepared to individualize testing policies and education to deal with specific concerns and fears. Improving access to the test by removing some of the current psychological and physical barriers will enhance its medical and public health value.

AIDS Serodiagnosis↗

PubMed2003

The validity of HIV testing using sputum from suspected tuberculosis patients, Botswana, 2001.

SETTING: The World Health Organization recommends that sentinel HIV surveillance be conducted on tuberculosis patients. However, serum HIV testing is complicated in the TB clinic context, and may not be acceptable to patients. DESIGN: To determine the utility of the OraQuick HIV-1/2 Assay for the detection of HIV antibodies in sputum, we consecutively enrolled adult in-patients in Botswana who had sputum sent for acid-fast bacilli testing and serum sent for HIV ELISA testing. OraQuick HIV-1/2 Assay was applied to gingival secretions according to manufacturer's guidelines, and was also dipped into sputum specimens. A subset of 60 sputum specimens was also serially tested up to 72 hours after collection. RESULTS: Of 377 patients, 84% were HIV-positive by serum ELISA. Compared with serum ELISA, the OraQuick HIV-1/2 Assay detected HIV in gingival secretions with 98.4% sensitivity and 98.3% specificity (95%CI 97-99 and 92-100, respectively), and 97.1% sensitivity and 98.3% specificity on initial sputum specimens (95%CI 95-99 and 92-100, respectively). OraQuick HIV-1/2 Assay performance on sputum declined slightly when tested up to 72 hours after collection. CONCLUSIONS: When applied to sputum specimens, the OraQuick HIV-1/2 Assay demonstrates sensitivity and specificity comparable to its intended application on gingival secretions. This novel testing method will be valuable in anonymous sentinel HIV surveillance surveys among tuberculosis patients.

Adolescent↗

PubMed1999

Transcription and RNA processing of mammalian genes in Saccharomyces cerevisiae.

The recognition of mammalian genes encoded within a mouse yeast artificial chromosome (YAC) by the yeast transcription and RNA processing machinery was investigated. Transcripts from five genes known to be encoded by the YAC were all found in the total yeast RNA. Of 12 mouse introns assayed, six were correctly spliced by the yeast. However, an abnormal transcription of mouse DNA was also observed. Three genes of three tested were transcribed both from their sense and antisense strands and all tested microsatellite, inter-repetitive and anonymous mouse loci were detected in the YAC clone RNA. An RNA transcript from a well defined intergenic region of two head-to-head oriented mouse genes was detected by RT-PCR and by RNase protection assay. These results indicate the presence of multiple yeast-specific transcription sites in the mouse DNA. 3' RACE experiments demonstrated the inability of the yeast to use the mouse polyadenylation signals. Thus, a method for isolation of mammalian exons based on a YAC clone RNA is likely to produce a high background, because the enrichment with mammalian exons in the YAC RNA is low. Nevertheless, YAC clones can serve as in vivo test tubes to study the conservation of RNA processing sequences.

Animals↗

PubMed2006

HIV-related risk behaviors, perceptions of risk, HIV testing, and exposure to prevention messages and methods among urban American Indians and Alaska Natives.

The goal of this study was to describe HIV risk behaviors, perceptions, testing, and prevention exposure among urban American Indians and Alaska Natives (AI/AN). Interviewers administered a questionnaire to participants recruited through anonymous peer-referral sampling. Chi-square tests and multiple logistic regression were used to compare HIV testing by perception of risk and risk behavior status. Of 218 respondents with seronegative or unknown HIV status, 156 (72%, 95% confidence interval [CI]: 66-78%) reported some HIV risk behavior: 57 (26%, 95% CI: 20-32%) high-risk behavior, and 99 (45%, 95% CI: 39-52%), potentially high-risk. Among respondents reporting high-risk behavior, 44% rated themselves at no or low risk for HIV infection. Overall, 180 respondents (83%, 95% CI: 78-88%) had ever received an HIV test, 79 (36%, 95% CI: 31-57%) in the past year. HIV risk behaviors and perception of risk were independently associated with recent HIV testing after adjustment for gender, income, and homelessness (odds ratio [OR] = 3.6; 95% CI: 1.5-9.0 for high-risk behavior vs. no reported risk behavior, and OR: 3.2; 95% CI: 1.3-7.6, for high vs. no perceived risk). Addressing inaccurate perception of risk may be a key to improving uptake of HIV testing among high-risk urban AI/AN.

Adult↗

PubMed2002

Prevalence of drug use in commercial tractor-trailer drivers.

An enforcement emphasis project, "Operation Trucker Check," was established in order to determine the extent to which commercial tractor-trailer drivers were operating their vehicles while impaired by drugs. A total of 1079 drivers and their vehicles were assessed for driver and equipment violations, and drivers additionally underwent preliminary field sobriety tests conducted by drug recognition expert (DRE) officers. Anonymous urine specimens for drug analysis were requested, and 822 urine specimens were obtained in total. Compliance with the drug-testing portion was voluntary, and there was a 19% refusal rate. Overall, 21% of the urine specimens tested positive for either illicit, prescription, and/or over-the-counter drugs, and 7% tested positive for more than one drug. Excluding caffeine and nicotine, the largest number of positive findings (9.5%) were for CNS stimulants, such as methamphetamine, amphetamine, phentermine, ephedrine/pseudoephedrine, and cocaine. The second most frequently encountered drug class were the cannabinoids, with 4.3% of drivers testing positive for marijuana metabolites. Only 11 drivers (1.3%) were positive for alcohol. Sixteen truck drivers (1.6%) were charged with driving under the influence of drugs after a full DRE evaluation was conducted. The results indicate that in spite of comprehensive drug testing in the trucking industry, some tractor-trailer drivers are continuing to take illicit and other drugs with the potential of having a negative effect on their driving ability. On the other hand, only a few drivers were, in fact, deemed to be under the influence of drugs at the time of driving when evaluated by DRE officers.

Automobile Driving↗

PubMed1995

[Is there an increased risk of infection in trauma surgery emergency admission for medial personnel by unknown HIV-positive patient status?].

In the trauma emergency room 212 patients were asked--according to German law--for a blood sample for HIV-testing. Nine (4.2%) victims rejected the test, another 3 (1,4%) did not meet the study criteria since they were previously known to be HIV-positive or suffering from AIDS disease. None of the finally tested 200 patients was HIV-positive. On an anonymous questionnaire that was handed out additionally, 64% of the patients said they would accept HIV-testing without consent prior to operative treatment. 49% would reject HIV-testing without consent in non-operative treatment.

AIDS Serodiagnosis↗

PubMed1997

A blind testing design for authenticating ancient DNA sequences.

Reproducibility is a serious concern among researchers of ancient DNA. We designed a blind testing procedure to evaluate laboratory accuracy and authenticity of ancient DNA obtained from closely related extant and extinct species. Soft tissue and bones of fossil and contemporary museum proboscideans were collected and identified based on morphology by one researcher, and other researchers carried out DNA testing on the samples, which were assigned anonymous numbers. DNA extracted using three principal isolation methods served as template in PCR amplifications of a segment of the cytochrome b gene (mitochondrial genome), and the PCR product was directly sequenced and analyzed. The results show that such a blind testing design performed in one laboratory, when coupled with phylogenetic analysis, can nonarbitrarily test the consistency and reliability of ancient DNA results. Such reproducible results obtained from the blind testing can increase confidence in the authenticity of ancient sequences obtained from postmortem specimens and avoid bias in phylogenetic analysis. A blind testing design may be applicable as an alternative to confirm ancient DNA results in one laboratory when independent testing by two laboratories is not available.

Animals↗

PubMed1992

The epidemic dynamics of HIV-1 in Italy: modelling the interaction between intravenous drug users and heterosexual population.

Data gathered through the Latium HIV Surveillance System were used in conjunction with a compartmental mathematical model to describe the transmission dynamics of HIV-1 in Italy. In the Latium region, as in the rest of Italy, fewer than 1 in 5 cumulative cases of AIDS are attributable to male homosexual transmission, while 55-60 per cent of the cases have been observed among intravenous drug users (IVDUs). Moreover, the number of non-drug-using heterosexual cases is increasing (14 per cent of cumulative cases). Anonymous notification of positive HIV-1 tests, mandatory in Latium since 1985, were used to produce a time series of new HIV-1 diagnoses; just over 400 new cases of infection per quarter were diagnosed from mid 1989 to mid 1990, with no evidence of increasing incidence. A minimum of 6009 and a maximum of 10,000 individuals with HIV-1 as of the end of 1989 were estimated, 80 per cent of adult cases occurring among IVDUs. The model included two main subgroups: IVDUs and non-drug-using heterosexuals, both with behavioural heterogeneities. Sharing of needles among IVDUs and heterosexual contact were considered as possible ways of transmitting HIV-1. A mathematical framework was developed to reproduce different mixing patterns within and between subgroups. A scenario analysis of the model showed incident cases of HIV-1 among IVDUs peaking early, then declining dramatically and stabilising at low values, with a stable-state prevalence higher than 0.75. Heterosexual interaction with IVDUs resulted in a significant, but non-self-sustaining, virus spread in the general population, affecting females more than males. The extent of this spread is associated with the assortativeness of the sexual mixing pattern adopted. The qualitative features of the Italian epidemic are well represented by the model, which highlights the role of IVDUs as an infection reservoir. However, the need emerges for more accurate information on the key parameters influencing the transmission dynamics of HIV-1.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Increased drug use among old-for-grade and dropout urban adolescents.

INTRODUCTION: In tracking the epidemic of drug use in our communities, much emphasis has been placed on identifying predictive variables. In this study, we examine the relationship between drug use and school progress among a sample of inner-city adolescents. METHODS: A blinded, anonymous questionnaire covering a variety of health risk behaviors was administered to 1,720 adolescent patients who visited our outpatient clinic. Participants were classified as age-appropriate for last school grade completed, older than normal for grade, or as a dropout. A urine specimen was also collected in a blinded, anonymous fashion from each participant, and tested for five common substances of abuse. RESULTS: Nearly 12% of participants tested positive for drugs. Participants who were old for grade were over 40% more likely to be positive for drugs than grade-appropriate respondents, while school dropouts were more than twice as likely to test positive. CONCLUSIONS: These results demonstrate that being old-for-grade (OFG) and being a dropout in our population are markers for being at higher risk of substance abuse.

Achievement↗

PubMed2001

Genomic analysis of gamma-ray-induced germ-cell mutations at the b locus recovered from the medaka specific-locus test.

To study how gamma-ray-induced germ-cell mutations are fixed at the early embryonic stage of the next generation, genomic alterations in the b locus mutants (colorless melanophores) detected during development in the medaka specific-locus test (SLT) were analyzed. First, nine anonymous DNA markers linked to the b locus were cloned and mapped into the region extending about 47cM surrounding the b locus. Next, losses of paternal alleles of these DNA markers were examined in each of the 51 gamma-ray-induced b locus mutants obtained after irradiation of sperm or spermatids. In these mutants, 47 were dominant lethals, three were semi-viable and one was viable. All the mutants examined had large deletions surrounding the b locus. One viable mutant had an interstitial deletion, while all the semi-viable and dominant lethal ones appeared to have terminal deletions. Deletions extending about 20-35cM were the most frequently observed in 18 of the 51 mutants examined. The largest one extended more than 40cM. These results suggest that most of the gamma-ray induced germ cell mutations recovered as total specific-locus mutants were accompanied by large genomic deletions, which eventually led the mutant embryos to dominant lethality.

Animals↗

PubMed2005

A multi-exonic BRCA1 deletion identified in multiple families through single nucleotide polymorphism haplotype pair analysis and gene amplification with widely dispersed primer sets.

The identification of intragenic rearrangements is important for a comprehensive understanding of mutations that occur in some clinically important genes. Single nucleotide polymorphism haplotypes obtained from clinical sequence data have been used to identify patients at high risk for rearrangement mutations. Application of this method identified a novel 26-kb deletion of BRCA1 exons 14 through 20 in patients from multiple families with hereditary breast and ovarian cancer. Clinical sequence data from 5911 anonymous patients were screened for genotypes that were inconsistent with known pairs of canonical haplotypes in BRCA1 that could be explained by hemizygous deletions involving exon 16. Long-range polymerase chain reaction demonstrated that two of six samples identified by this search contained a deletion in the expected region encompassing exons 14 through 20. The breakpoint was fully characterized by DNA sequencing and demonstrated that the deletion resulted from Alu-mediated recombination. This mutation was also identified twice in a set of 982 anonymous specimens that had negative clinical test results, but uninformative haplotypes. Three additional occurrences of this mutation were found by testing 10 other patients with the indicative genotype. An assay for this mutation was added to a comprehensive clinical breast/ovarian cancer test and eight more instances were found in 20,649 probands. This multiexon deletion has therefore been detected in 15 different North American families with hereditary breast/ovarian cancer. In conclusion, this primarily computational approach is highly effective and identifies specimens using existing data that are enriched for deletion mutations.

BRCA1 Protein↗

PubMedDate not supplied

Evaluation of a virtual reality simulator for arthroscopy skills development.

We evaluated a virtual reality shoulder arthroscopy simulator using a standardized skills-assessment algorithm in 3 specific groups with various degrees of surgical expertise. The simulator (Mentice Corp, Gothenberg, Sweden) consists of a computer-based, dual-force feedback system with video monitor. Modeled structures include cartilage, labrum, ligaments, biceps tendon, and rotator cuff. The study included 3 groups of volunteers: group 1, medical students interviewing for orthopaedic residency (n = 35); group 2, orthopaedic residents interviewing for sports medicine fellowship (n = 22); and group 3, experienced faculty at a shoulder surgery course (n = 21). Data were collected anonymously and subjects completed a standardized test protocol designed to assess accuracy and efficiency. Subjects used the probe to "touch" a sphere that appeared at various locations within the joint (11 positions total). The sphere changed location immediately on contact with the tip of the probe. The following parameters were calculated by the computer: time (from touching the first ball until touching the eleventh ball), path ratio (percent of measured path length relative to the ideal path), collisions (number of times the probe / arthroscope contacted any tissue), and injuries (collisions beyond a threshold force). Test time and path ratio differed significantly as a function of surgical experience. There was no significant difference in probe collisions between the groups. Arthroscope collisions and injuries averaged 2 or less in all of the groups. There was significant correlation between path ratio and time to complete the test in groups 1 and 2 (r =.527 and r =.827, respectively, P <.001), but not in group 3 (r =.376, P =.10). There was essentially normal distribution of time performance in groups 1 and 2. Time was shorter and more consistent in group 3, suggesting greater consistency in the experienced surgeons. These data suggest that this arthroscopy simulator facilitates discrimination of arthroscopic skills. Computer-based simulation technology provides a major opportunity for surgical skills development without morbidity and operating room inefficiency.

Arthroscopy↗

PubMed1989

Counterintuitive findings on the hypnotizability of state and nonstate theorists: a brief communication.

17 research psychologists, identified as reflecting state or nonstate theoretical positions regarding hypnosis, were requested to provide anonymous information about their personal hypnosis test scores. There were no differences between the state and nonstate groups in mean scores on the Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor & E. Orne, 1962) or the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & Hilgard, 1962), and no differences in the numbers who reported that they used hypnotherapy to treat patients. Small sample size suggests caution in interpretation of the present results, but it appears that commitment to a state or nonstate theory is not necessarily related to the hypnosis researcher's personal experience with hypnosis.

Humans↗

PubMed2004

Multi-professional education in diabetes.

Multi-professional education (MPE) is a forward-looking educational strategy that is both innovative and clinically needed. The primary goal of this program was to assess the potential of MPE in diabetes care. Objectives included knowledge increase in type 2 diabetes care and examining the effect of uni-professional versus multi-professional small groups on learning outcomes. A total of 61 baccalaureate nursing students, four pharmacy students and 56 family practice residents participated in a half-day program. Participants were randomly assigned to multi-versus uni-professional groups. A questionnaire assessing knowledge, attitudes and perceived role responsibilities was anonymously completed in a pre-test/post-test manner. The program was delivered in two sessions that combined larger and small group activities. Quantitative data were analyzed using repeated measures Anova/Manova, Wilcoxon signed rank and Pearson chi-square tests. Participants and educators showed interest in multi-professional education. While no change in knowledge was found, moderate changes in attitudes (with a lessening of attitudinal differences) and significant changes in perceptions of role (from uni-professional responsibility to shared responsibilities) were noted. Nurses in uni-professional groups demonstrated the greatest attitudinal and role perception changes. The contribution of the patient as teacher was prominent. Further exploration and rigorous analysis of the utility of MPE in diverse settings is warranted.

Adult↗