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PubMed1997

Quality control study of H2 breath testing for the diagnosis of carbohydrate malabsorption in Italy. The "Tenue Club" Group.

BACKGROUND AND AIMS: H2 breath testing is increasingly used in Italy. The aim of this multicenter study was to assess the accuracy of this technique in the diagnosis of carbohydrate malabsorption. METHODS: An anonymous questionnaire was used to collect information about H2 breath testing methods and to design the quality control study. Fifteen out of 23 laboratories responded to the questionnaire and 12/23 completed the entire study. RESULTS: The survey revealed that a large variety of H2 testing methods are employed in Italy, but none have been previously tested for accuracy. This prospective study showed that these tests fail to identify > 20% of patients with malabsorption. In contrast, a new method based on single H2 breath measurement at 6 hours after lactulose ingestion and a cutoff value of greater than 5 ppm, had a sensitivity of 92% +/- 4% and a specificity of 94% +/- 0.5%. Increasing the cut-off to 10 ppm resulted in a sensitivity of 88% +/- 9% and a specificity of 100%. This improved accuracy was obtained with a much simpler testing procedure in which only one breath sample is analyzed, in contrast to the baseline and multiple subsequent samples that are analyzed using the currently employed techniques. CONCLUSIONS: A great improvement in the accuracy of the H2 breath test, as well as a considerable saving in terms of time and costs, may be possible through the use of a new, simplified H2 breath test followed by careful H2 analysis.

Breath Tests↗
PubMed2001

Autoclave performance and operator knowledge of autoclave use in primary care: a survey of UK practices.

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice. This has increased the risk of cross-infection with blood-borne viruses and the demand for sterile instruments. The aim of this study was to investigate the knowledge and training of medical personnel in England and Wales on aspects of autoclave use, and to test the effectiveness of their practice autoclaves. An anonymous postal questionnaire and autoclave performance survey using biological indicators was made of 700 general medical practitioners selected at random from FHSA lists from 12 Health Authorities in England and Wales. The overall response rate was 53.1% (N= 372) comprising 10% general practitioners and 90% practice nurses. Eighty-two percent of respondents used autoclaves with a mean age of 2.5 years, of which 91% had been serviced in the past year. While 35% of respondents made daily observation of gauges, 19% did not routinely monitor autoclave effectiveness. Six autoclaves failed to sterilize the spore test ampoules. Fourteen percent of respondents did not autoclave instruments after every patient. Only 33.1% reported wearing gloves during minor operations. Fifty five percent had training in cross-infection prevention. It was concluded that although there has been improvement in instrument decontamination procedures in general practice compared with previous surveys, further education of medical practitioners and practice nurses in the use of autoclaves and infection prevention and control is indicated. The failure of 2% of the autoclaves to kill spores suggests the need for increased monitoring of autoclave performance. Two-thirds of practitioners exposed themselves to increased risk of infection by carrying out minor surgery without the protection of gloves.

Cross Infection↗
PubMed1994

[Reasons for HIV testing. Casual sexual contacts are the most common reasons for voluntary HIV testing].

In Sweden, voluntary testing for HIV (human immunodeficiency virus)-antibodies has been given an important place in combating AIDS (acquired immunodeficiency syndrome). To elicit the reasons why people seek voluntary testing on their own initiative outside general screening programmes, during a three-year period (1989-91) applicants at a major urban testing locale were asked to fill in an anonymous questionnaire, which was completed by 68.6 per cent (831/1,212) of those eligible. Of the 831 respondees (both men and women), 88.9 per cent cited recent casual sexual contact as the reason why they might be at risk. Although in most cases no particular risk factors were reported to be associated with the sexual contact, in 17 cases (2.3 per cent) the partner was known to be an HIV-carrier. Of 664 people completing the item on the questionnaire 208 (31.3 per cent) reported the sexual contact to have occurred abroad. When the reason for undergoing the test was not possible recent exposure, the commonest reasons given were persistent anxiety or the establishment of a new sexual relationship. Only one of the 1,212 tests performed was HIV-positive.

Adolescent↗
PubMed1975

Self-presentation: managing the impression of consistency when reality interferes with self-enhancement.

The manner in which an individual's self-perceptions affect related self-presentations was investigated. One hundred and twenty subjects believed that they would participate in a group task where their individual performance would either be known to the group or be completely anonymous. On the basis of bogus feedback from prior tests, subjects expected to perform either extremely well or very poorly on the group task; control groups received no such feedback. Before the task began, group members exchanged personal information that allowed them to vary their self-presentations. Factor analysis revealed two self-presentational factors: competence and interpersonal relations. A Performance Expectations X Anonymity interaction was obtained on self-presentational claims to personal competence. Under public performance conditions (where future public events could invalidate an unrealistically positive self-presentation), self-presentations were consistent with subjects' expectations of actual performance. However, under anonymous conditions, self-presentations were quite favorable and unaffected by expectations of actual performance. The results support an incentive model and fail to support a consistency model. Subjects seemed to desire as self-enhancing and approval gaining a public image as possible but conceded to the demands of public reality when necessary.

Achievement↗
PubMed2001

Knowledge of HIV/AIDS transmission and screening in United States blood donors.

BACKGROUND: Increased knowledge of HIV transmission and behavioral and test screening may encourage high-risk blood donors to self-defer. STUDY DESIGN AND METHODS: Knowledge of HIV transmission and screening and the association with demographics, screening test reactivity, and unreported deferrable risks (UDRs) was assessed by a 1998 anonymous mail survey sent to 92,581 blood donors, of whom 57 percent responded. Groups were compared by using weighted chi-square tests and logistic regression analysis. RESULTS: Four percent of the donors thought that it was very likely or somewhat likely for a person to contract HIV from donating blood, and 20 percent perceived a similar risk from blood transfusion. Only 60 percent of the donors knew that the available screening tests may not detect a recent infection. Thirty-seven percent either did not know or felt it was acceptable to donate blood to obtain HIV testing. Those most likely to answer knowledge questions incorrectly were more likely to have a higher prevalence of test reactivity or UDRs and to be <or=25 years old, members of a minority, less educated, non-US-born, or first-time donors. CONCLUSION: Innovative ways to increase donor understanding of the implications of risk behaviors and the limitations of current screening procedures should be developed. They might prevent high-risk individuals from donating blood.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Construction of a panel of canine-rodent hybrid cell lines for use in partitioning of the canine genome.

We have constructed a collection of canine-rodent microcell hybrid cell lines by fusion of canine fibroblast microcell donors with immortalized rodent recipient cells. Characterization of the hybrid cell lines using a combination of fluorescence in situ hybridization and PCR analysis of canine microsatellite repeat sequences allowed selection of a panel of hybrids in which most canine chromosomes are represented. Approximately 90% of genetic markers and genes that were tested could be assigned to 1 of 31 anonymous canine chromosome groups, based on common patterns of retention in the hybrid set. Many of these putative chromosome groups have now been validated by linkage analysis. This panel of cell lines provides a tool for development of genetic, physical, and comparative maps of the canine genome.

Animals↗
PubMed2003

An ATP-based method for monitoring the microbiological drinking water quality in a distribution network.

The titration of adenosine triphosphate (ATP) by bioluminescence permits rapid evaluation of the quantity of viable micro-organisms present in a water sample. During two sampling campaigns, Société Anonyme de Gestion des Eaux de Paris (SAGEP) tested a new extraction and titration system of bacterial ATP in the Paris drinking water distribution network. As far as the entire set of results of analyses of water in the network is concerned there is a linear relationship between log [ATP] and log(HPC-R2A/ml). Furthermore, as regards the drinking water originating from treatment of surface waters, some of the results obtained indicate a slight change as regards the Paris network in the microbiological quality. This is certainly linked to the distance travelled from the production location as well as to a reservoir effect observed on a site. Conversely, no change is apparent with regard to waters of underground origin. Lastly, despite changes in temperature and chlorine residual, no significant influence has been observed, essentially because of the very low density of culturable bacteria.

Adenosine Triphosphate↗
PubMedDate not supplied

Prevalence of intimate partner abuse among nurses and nurses' aides in Mexico.

BACKGROUND: Nurses are the health professionals most frequently involved in the diagnosis and treatment of victims of family violence (FV). Understanding their personal experience with victimization is the key to shaping an appropriate role as advocates for medical recognition of FV and as integral members of the screening teams. We sought to determine the lifetime prevalence of intimate partner abuse among them and identify its risk factors. METHODS: In our cross-sectional study, 1,150 registered nurses and nurses' aides at 11 urban hospitals in Mexico City self-administered an anonymous survey. We calculated descriptive statistics, Fisher exact tests, and multivariate logistic regression models to analyze physical, sexual, and emotional abuse during adulthood. RESULTS: Physical/sexual abuse during adulthood was 13% for nurses' aides and 18% for nurses. Similar proportions (13% of nurses' aides and 14% of nurses) also reported childhood physical/sexual abuse. Additional respondents (39% nurses' aides, 42% nurses) reported emotional abuse during adulthood. Detecting no significant differences in abuse patterns between the two groups, we combined occupations for all subsequent analyses. Being separated or divorced (vs. married) (Apr = 3.41, 95% confidence interval (CI): 1.81-6.44) and having suffered physical/sexual abuse during childhood (Apr = 3.39, 95% CI: 2.26-5.08) were associated with physical/sexual abuse in adulthood. The same variables were associated with adult emotional abuse (separated/divorced: Apr = 5.33, 95% CI: 2.61-10.85, and childhood physical/sexual abuse: Apr = 2.58, 95% CI: 1.79-3.75). Younger women (between the ages of 23 and 28 years) reported more emotional abuse (Apr = 2.10, 95% CI: 1.48-2.98). CONCLUSIONS: Counseling for abused nursing staff may help break the cycle. Physical/sexual partner abuse among nurses appears lower than among the general Mexican population, but remains worrisome. Battling childhood abuse might prevent intimate partner violence.

Adolescent↗
PubMed1994

The prevalence of hepatitis B and C in an antenatal population of various ethnic origins.

A total of 3522 samples of serum, collected anonymously from women attending an antenatal clinic, was tested for hepatitis B surface antigen and antibody to hepatitis C. The prevalence of anti-HCV was low; only five confirmed positives were found (0.14%). The prevalence of hepatitis B overall was 0.56%, but was 1.04% in women from immigrant groups. Hepatitis B carriage is therefore four times more common than hepatitis C carriage in the antenatal population comprised of various ethnic origins. The patterns of infection in the two viruses are reversed, hepatitis B being more common in Asian, S.E. Asian and West Indian mothers and hepatitis C being more common in mothers of white Caucasian origin. Routine antenatal screening for anti-HCV is discussed.

Adolescent↗
PubMedDate not supplied

Physician attitudes about prehospital 12-lead ECGs in chest pain patients.

INTRODUCTION: The prehospital 12-lead electrocardiogram (ECG) has become a standard of care. For the prehospital 12-lead ECG to be useful clinically, however, cardiologists and emergency physicians (EP) must view the test as useful. This study measured physician attitudes about the prehospital 12-lead ECG. HYPOTHESIS: This study tested the hypothesis that physicians had "no opinion" regarding the prehospital 12-lead ECG. METHODS: An anonymous survey was conducted to measure EP and cardiologist attitudes toward prehospital 12-lead ECGs. Hypothesis tests against "no opinion" (VAS = 50 mm) were made with 95% confidence intervals (CIs), and intergroup comparisons were made with the Student's t-test. RESULTS: Seventy-one of 87 (81.6%) surveys were returned. Twenty-five (67.6%) cardiologists responded and 45 (90%) EPs responded. Both groups of physicians viewed prehospital 12-lead ECGs as beneficial (mean = 69 mm; 95% CI = 65-74 mm). All physicians perceived that ECGs positively influence preparation of staff (mean = 63 mm; 95% CI = 60-72 mm) and that ECGs transmitted to hospitals would be beneficial (mean = 66 mm; 95% CI = 60-72 mm). Cardiologists had more favorable opinions than did EPs. The ability of paramedics to interpret ECGs was not seen as important (mean = 50 mm; 95% CI = 43-56 mm). The justifiable increase in field time was perceived to be 3.2 minutes (95% CI = 2.7-3.8 minutes), with 23 (32.8%) preferring that it be done on scene, 46 (65.7%) during transport, and one (1.4%) not at all. CONCLUSIONS: Prehospital 12-lead ECGs generally are perceived as worthwhile by cardiologists and EPs. Cardiologists have a higher opinion of the value and utility of field ECGs. Since the reduction in mortality from the 12-lead ECG is small, it is likely that positive physician attitudes are attributable to other factors.

Attitude of Health Personnel↗
PubMed2006

Sensation seeking, alcohol use, and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa.

Alcohol use is associated with risks for HIV/AIDS. The association between alcohol and sexual risk may be accounted for by sensation seeking personality. However, sensation seeking in relation to substance use and HIV risk has not been examined in Africa. In this study, 292 men and 219 women receiving sexually transmitted infection (STI) diagnostic and treatment services in Cape Town, South Africa, completed anonymous behavioral surveys. Structural modeling was used to test a model of alcohol use and sensation seeking in relation to sexual risk behaviors. Results showed that sensation seeking and alcohol use in sexual contexts were related to HIV risks, controlling for gender and marital status. The association between sensation seeking and HIV risk was partly accounted for by alcohol use in proximity to sex. In contrast to studies conducted in the United States, sensation seeking was not related to alcohol-sex outcome expectancies. These findings suggest that alcohol use is an important HIV transmission risk factor for many STI clinic patients and that interventions for individuals who are characterized as sensation seekers are urgently needed in South Africa.

Adolescent↗
PubMed2002

Guidelines for the management of severe head injury: are emergency physicians following them?

UNLABELLED: The Brain Trauma Foundation published "Guidelines for the Management of Severe Head Injury" in 1995. These evidence-based clinical guidelines (CGs) recommended against prophylactic hyperventilation and glucocorticoid use and advocated for aggressive blood pressure (BP) resuscitation, and the careful use of mannitol. OBJECTIVE: To survey Michigan emergency physicians (MEPs) to test their adherence to these guidelines. METHODS: An anonymous mail survey was sent to all 566 MEPs who are members of the American College of Emergency Physicians. Three clinical scenarios involving severe head injury were presented, all with Glasgow Coma Scale (GCS) scores of 8 or less. The physicians were asked to choose from 15 diagnostic and treatment options, which included: intubation and hyperventilation, BP resuscitation, intravenous (IV) mannitol administration, and IV glucocorticoid administration. RESULTS: Three hundred nineteen (56%) surveys were returned. Forty-six percent [95% confidence interval (95% CI) = 40% to 51%] of the MEPs elected to use prophylactic hyperventilation; very few administered IV glucocorticoids. Seventy-eight percent (95% CI = 75% to 81%) corrected hypotension with systolic BP < 90 mm Hg; 83% (95% CI = 80% to 86%) also administered mannitol appropriately. CONCLUSIONS: A majority of MEPs are managing severe head injury patients in accordance with the "Guidelines for the Management of Severe Head Injury," with the exception of avoiding prophylactic hyperventilation. More education and/or exposure to the evidence regarding prophylactic hyperventilation of severely head injured patients may improve adherence to the guidelines.

Adult↗
PubMed2003

A national survey of genitourinary medicine clinic attenders provides little evidence of sexual transmission of hepatitis C virus infection.

OBJECTIVE: To determine the prevalence and genetic diversity of hepatitis C virus in genitourinary medicine clinic attenders and to assess the extent of sexual transmission of the virus. METHODS: A cross sectional, unlinked, anonymous survey in 14 genitourinary medicine clinics situated in England, Wales, and Northern Ireland. Serum specimens from genitourinary medicine clinic attenders, retained as part of the Unlinked Anonymous Prevalence Monitoring Programme (UAPMP) serum archive, were tested in small pools, for the presence of antibody to hepatitis C virus (anti-HCV). The main outcome measures were prevalence of antibodies to hepatitis C virus and identification of hepatitis C virus genotypes. RESULTS: Testing of 17,586 specimens from 1995 showed an adjusted prevalence of anti-HCV in genitourinary medicine clinic attenders of 1.03% (95% CI: 0.89 to 1.16) overall and 0.65% (95% CI: 0.51 to 0.78) among those who did not report injecting drug use. Prevalence in injecting drug users attending genitourinary medicine clinics was 36.9% in both 1995 and 1996. Heterosexual injecting drug users had a higher prevalence of anti-HCV than homosexual/bisexual injectors. The most common hepatitis C genotypes were types 3a and 1a. There was a high degree of concordance between genotype and serotype. CONCLUSIONS: The low prevalence of anti-HCV in genitourinary medicine clinic attenders who deny injecting drugs suggests that the majority of hepatitis C infections have been acquired in adult life, mostly by injecting drug use, and that the hepatitis C virus is rarely transmitted sexually. The use of needle exchanges may explain the relatively low prevalence observed in the injecting drug users.

Adult↗
PubMed1994

Use of anonymous newborn serosurveys to evaluate antenatal HIV screening programmes.

OBJECTIVE: To evaluate the extent to which antenatal HIV screening programmes identify HIV infected women who go to term. DESIGN: Comparison of results of two surveillance systems. An anonymous neonatal HIV serosurvey was used to estimate the numbers of HIV infected women giving birth; reporting by obstetricians was used to assess the proportion who had been identified. SETTING: Three Thames regions. RESULTS: 729,105 neonatal blood samples were tested, of which 484 were HIV seropositive. Newborn HIV seroprevalence is increasing, at different rates, in inner London, suburban London, and in non-metropolitan districts. During the past four years the proportion of infected women who have been identified before delivery is 16.9%, but less than half of these were diagnosed during pregnancy. In 1993 only five of the 128 (4%) previously undiagnosed infected women delivering babies were identified by antenatal screening. CONCLUSION: Despite increased emphasis on antenatal testing for HIV in areas of higher prevalence the number of undiagnosed women delivering babies continues to increase. Consideration should be given to alternative strategies for offering antenatal HIV testing. Antenatal screening programmes should be monitored continuously by comparing anonymous neonatal seroprevalence with clinical reports from obstetricians.

Confidence Intervals↗
PubMed2000

Factors related to delayed diagnosis of HIV infection in southeastern France. EVALVIH group.

We aimed to identify risk factors associated with delayed diagnosis of HIV infection in a French region highly affected by AIDS. Data were collected in southeastern France through the HIV-surveillance system based upon anonymous declarations by laboratories and physicians prescribing HIV testing. From January 1996 to December 1997, 825 persons were diagnosed for the first time as HIV infected (female: 32%; >40 years: 28%); 46% had been infected through heterosexual intercourse, 26% through homosexual intercourse, and 19% through intravenous drug use. The semestrial (6 monthly) incidence rate decreased from 122.7 to 69.7 per million inhabitants (P<0.001). County of residence, age, sex, country of birth, and transmission category did not change significantly during the observation period. Twenty-seven per cent had a delayed diagnosis of HIV infection. This proportion did not differ significantly according to sex or country of birth, or during the observation period. However, after controlling for the other factors, delay was more frequent among injecting drug users (IDUs) (35%, P<10(-2)) than other transmission categories; it was also positively associated with age (47% above 50 years vs 13% under 30 years, P<10(-2)). This study highlights that, in spite of the current AIDS prevention policy and wide access to HIV screening, the proportion of delayed diagnosis of HIV infection remains high. Physicians should concern themselves with this public health issue, and campaigns should target people insufficiently aware, especially IDUs and older people. Further research is needed to understand better the causes of delayed diagnoses and of inequalities in access to HIV screening.

AIDS Serodiagnosis↗
PubMed1986

16PF items discriminating recidivists and long-term recovered polyaddicts.

Responses to 65 of the 187 items on Cattell's 16PF test were skewed by 83 members of Alcoholics Anonymous. Seventeen of those items had significantly different distributions when the 18 recidivists were compared to the 8 who had remained clean of all addictive substances and compulsive behaviors during the 2-year period studied. Another 14 items had significantly different distributions when the recidivists were compared to all the others. Comparisons with non-drug-disadvantaged groups and non-AA recovering addicts are suggested in order to isolate empirical predictor items for "addictive" versus "cured" scales.

Alcoholics Anonymous↗
PubMed2000

[Genetic counseling in presymptomatic testing for Huntington disease].

Norwegian law and international guidelines require genetic counselling before, during and after presymptomatic testing for Huntington's disease. The genetic counselling of at-risk persons who considers taking tests, includes explanation of the possible implications of a test result for both participant and relatives. The test is performed only when explicitly requested by the participant and after informed consent. The participant decides if and when the test should be conducted. The participant also has major influence on the timing of the consecutive phases of the testing procedure, in compliance with medical and ethical recommendations. This paper reviews main issues raised during genetic counselling and the preparation period preceding the test and communication of the test result. We illustrate different individual situations and backgrounds for considering presymptomatic testing for Huntington's disease by describing three anonymized cases and associated pedigrees.

Adult↗
PubMedDate not supplied

[Hereditary hemochromatosis].

Hereditary hemochromatosis is an inherited autosomal recessive disease, associated to a mutation in the recently described HFE gene, which is located on the short arm of chromosome 6. The product of this gene combines with the beta-2-microglobulin and the ferritin receptor, and regulates the iron absorption in the small intestine crypt cells. It is possible that the mutation may cause the increased iron uptake by the intestinal cells. The disease is very much common in men after the forties, and its expression is influenced by concomitant alcoholism, iron rich diet, oral and parenteral iron administration, menstrual blood loss or abnormal hemorrhages, blood donations, pregnancy, lactation, and iron malabsorption clinical conditions, like celiac disease. Many patients are asymptomatic, and the diagnosis may be suspected by hepatomegaly of unknown cause, abnormal iron metabolism tests, increased serum aminotransferase levels, diabetes mellitus, and anonymous arthropathy. Less commonly hereditary hemochromatosis presented by symptoms and signs of chronic liver disease, or by the classic triad described by Trousseau skin pigmentation, hepatomegaly and diabetes mellitus. The diagnosis is confirmed by the increased serum ferritin levels and transferrin saturation, and the stainable iron in hepatocytes, measured by scale devised by Scheuer et al, or the measurement of the hepatic iron. The C282Y mutation was found in 64 to 100% of patients; eventually, subjects with hepatic iron overload identical to hereditary hemochromatosis has no mutation, and homozygous for the C282Y mutation do not express iron overload. Iron is best and quickly removed by weekly or twice-weekly phlebotomy of 500 ml, containing approximately 250 mg iron. One to 3 years of weekly phlebotomy may be required to reduce stores to normal. As a guide to long-term maintenance therapy, is recommended phlebotomy every 3 months and the serum ferritin level should be maintained by less than 50 ng/ml.

Adult↗