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PubMed2002

Evaluation of patient information Internet web sites about menopause and hormone replacement therapy.

OBJECTIVES: To evaluate quality of web based information on the menopause and hormone replacement therapy, to identify whether site ownership is an indicator of both web site and content quality, and therefore to provide guidance for healthcare professionals over which sites are suitable for recommendation to patients. METHODS: A search of web sites was conducted using eight commonly used search engines and two key terms ('menopause' and 'hormone replacement therapy') limited to English language. Thus, a sample of 25 sites (of varied ownership) was generated. Using a specific scoring tool, each site was assessed on factual information provided and quality of site. For each criterion, a score of 1-5 was assigned, and two mean scores were generated. Each site was also assessed in a semi-structured qualitative manner. RESULTS: The mean informational value of the sites sampled was 3.129 (out of a maximum of 5) but with a range of 1.6-4.6. The mean value of the sample for the quality of web sites was higher (3.504) but again over a broad range (2.5-4.5). Certain types of ownership were associated with higher quality sites, including the pharmaceutical industry, community pharmacies, governments, and charities. CONCLUSIONS: The information about menopause and HRT on the web is often of dubious calibre, with incomplete information being commonly provided. Therefore it is recommended that healthcare professionals direct women to sites owned by the pharmaceutical industry, community pharmacies, governments, and charities. In doing so it would be prudent to advise women that commercial sites may be biased towards particular products.

Female↗
PubMed1993

Youth in detention and handguns.

The objective of this work was to describe the frequency and correlates of handgun ownership and firearm injury experiences among youth in a detention facility. A convenience sample of 89 males detained in the King County Youth Services Center, a short-term holding facility, voluntarily completed an anonymous survey. Results showed that 59% of the youth reported owning a handgun. Firearm experiences included carrying a gun to school (46%); firing at another person (68% of handgun owners); firearm injury to self (27%); death of a close friend or family member to firearm homicide or suicide (35%). Personal safety far exceeded recreational use of guns as motivation for self-arming (52% versus 4%). Handgun ownership was more common among youth who reported problem behaviors. Adjusting for age and controlling for covariation of the problem behaviors, gang membership [odds ratio (OR) 6.7; 95% confidence interval (CI) 1.7-26.1], committing assault and battery (OR 7.7; 95% CI 2.2-26.8) and selling drugs (OR 3.6; 95% CI 0.99-13.4) were associated with handgun ownership. Our conclusion was that firearm experiences for youth in detention pose health risks equal to or far exceeding other high-risk behaviors in this population.

Adolescent↗
PubMed1999

[The elderly and their pets. Supportive and problematic aspects and implications for care. A descriptive study].

Pet ownership by elderly people is very common. This phenomenological study investigated why elderly people keep pets and what illness of the animals or their loss means to them. Nine women and three men owning either cats, dogs, or birds participated in this study. Their average age was 84. The results confirm on the one hand that elderly people experience happiness and joy thanks to having pets, giving them an ingenious social function as well as helping overcome the frequent passivity of old age. The problems arising with the ownership of animals are accident endangering (falls) and overexertion. An additional concern is the support of the animals during illness of the owner. The loss of animals is often connected with serious grief reaction and disorganisation of daily life. Serious, long-lasting, and pathological grief reactions were shown after a forced separation from the pet. Four recommendations for nursing practice resulted from this study: to approve and support the ownership of pets and domestic animals as a factor of the "good old age"; to accept the pets as part of the 'family' and integrate them into nursing work, to encourage the owner to plan the future of the pet. Finally, to help overcome the loss of pets and animals a specific nursing therapeutic treatment is required.

Adaptation, Psychological↗
PubMed2003

Self-blood-pressure monitoring--a questionnaire study: response, requirement, training, support-group popularity and recommendations.

The objective of this study was to survey hypertensive patients' response to, requirement for and training in self-blood pressure monitoring (SBPM). A total of 222 hypertensives were invited to complete a questionnaire even when not participating in the project. Questions supplied information on demographics, monitoring frequency, convenience of attending the surgery, monitor ownership and preference for and ease of self-monitoring. Comments supplied qualitative data. Training group questionnaires supplied similar data as well as SBPM data before and after training. Of 133 respondents, a higher educated, younger, wider age range wanted to participate (76; 57.2%) and tended to self-monitor. However, only an increase in further education (FE) was associated with an increased probability of participation and inclination to self-monitor in the multivariate analyses. A positive relationship exists between age and frequency in both groups. About a sixth of respondents own monitors and ownership is correlated to FE. Although most patients found it convenient to visit the surgery, the percentage finding it convenient was lower in patients attending training sessions than in the original survey, possibly indicating that independence is important for SBPM. Younger, higher-educated patients tended to self-monitor although FE was again the significant factor. Training increased preference for the idea of SBPM, prospective monitor ownership (64.8% of non-owners) and self-monitoring intention (76.1%). Patients found recording card listed cardiovascular disease (CVD) risks valuable and 69.6% (32) wanted to establish a support group. Comments and interviews indicated haphazard knowledge, routines and uncertainty about SBPM. A standardised procedure including patient assessment, SBPM protocol and lifestyle education is needed for SBPM to be successful.

Adult↗
PubMed2001

Implementation and evaluation of local-level priority setting for stroke.

We aimed to develop and evaluate a prioritisation process to combine the evidence base with stakeholder involvement within a stroke programme for a Health Improvement Programme (HImP). Implementation involved: formation of a district stroke group (DSG); review of the evidence; survey of DSG members; survey of other key professionals; consensus within the DSG; consultation with local users of the service. Evaluation was through semi-structured interviews and documentary analysis. The process was accepted as appropriate and valuable by the majority of participants, and a district HImP implementation group allocated pound sterling 100 000 for stroke development as a result of this process. However, some felt that stroke itself had been an imposed, rather than an agreed, local priority. The priority setting process was not clear to all participants and change of personnel, particularly in the NHS trusts, led to some perceived lack of ownership. Professionals from secondary care participated, but later criticised the process when they felt that the priorities in the HImP could limit their ability to access money for other service developments. The user consultation days occurred too late to influence the 1999/2002 HImP. We have shown that it is possible to develop an approach that is broadly accepted by stakeholders and balance the evidence base with local ownership. The participation of stakeholders, clarity of procedures, local ownership and awareness of local politics are important in effective priority setting. The model developed will be of value in other settings.

Evidence-Based Medicine↗
PubMed2001

Prevalence, morbidity and management of adult asthma in South Australia.

This paper reviews asthma-related data obtained between 1987 and 1997 from self-report population surveys of adults in South Australia. A multistage, systematic, clustered area sample of adults (>15 years) was selected from a random sample of Australian Bureau of Statistics collector districts, and interviewed at home by trained health interviewers. The self-report prevalence of doctor-diagnosed asthma increased from 5.6% in 1987 to 12.2% in 1997. Morbidity measured as days lost from usual activities and nights awakened by asthma remained high, but hospitalization rates are trending down. The ownership of asthma action plans peaked in 1995 and has declined. The ownership of peak flow meters increased between 1992 and 1997, and the ownership of nebulisers remained constant. Evidence-based interventions are required to improve asthma management.

Adult↗
PubMed1991

Moving targets: bicycle-related injuries and helmet use among university students.

We conducted a cross-sectional study to evaluate bicycling habits and helmet use in a sample of university students in a southwestern state university. Thirty-one of 100 students in our sample owned bicycle helmets; of these, 17 (54.8%) wore helmets during most (more than three fourths) of their bicycle trips. Almost half of the students reported that more than 25% of their bicycling was done in heavy traffic but they rarely used bicycle trails. Sixty-five students in the sample had sustained at least one minor injury during the previous 5 years, and 18 had been hospitalized as a result of bicycle-related injuries. We found no substantial differences between male and female subjects in bicycle-related hospitalizations, although male subjects were more likely to sustain minor injuries than were females. Helmet ownership was most strongly associated with previous injury experience, especially hospitalization resulting from bicycling injuries (OR = 3.6; 95% CI = 1.3, 10.1). We also observed an association between helmet ownership and possession of insurance coverage for bicycling injuries (OR = 3.0; 95% CI = 1.2, 7.6). Ethnicity was a factor in helmet ownership--helmets were owned by 26 of 69 (37.7%) of non-Hispanic whites, in contrast to 1 of 24 (4.2%) of all other ethnic groups combined. Our survey data suggest that perceived risk is an important factor in bicyclists' use of safety helmets.

Adolescent↗
PubMed2006

Vehicles driven by teenagers in their first year of licensure.

OBJECTIVE: to determine access to vehicles, vehicle ownership and its correlates, and types of vehicles driven by teenagers during their first year of licensure. METHODS: About 3,500 Connecticut teenagers and their parents recruited at DMV offices participated in a study aimed at persuading parents to impose and maintain driving restrictions on their sons and daughters. Telephone interviews with teens and parents, which included questions on vehicles driven, were conducted upon licensure and at intervals throughout the year. RESULTS: The majority of both male and female teens owned vehicles immediately upon licensure. Family income and number of vehicles in the family were associated with early ownership. A year later 74% owned vehicles. Small cars, which provide inferior crash protection, were the most popular vehicle; the percent driving small cars increased from 36% to 42% over the year. About 25% were driving SUVs, pickups, or sports cars, which may increase crash risk for young beginners. One year after licensure, only 35% of teens were driving midsize or large passenger cars, the types of vehicles recommended for them, and about one-third of these vehicles were 10 or more years old. Owners were more likely than non-owners to drive older and smaller vehicles, to drive more miles, do more risky driving, and to have more traffic violations and crashes. DISCUSSION: Many teenagers in Connecticut were driving vehicles that rank low in crash protection or may increase crash risk. Attention to the young driver problem has been focused primarily on managing driving risks through graduated licensing systems. More attention needs to be given to the vehicles teens drive, and how decisions about vehicle type and ownership are made. Parents exert control over what vehicles their sons and daughters drive, and may benefit from information on how to make choices that better balance cost, safety, and other factors that go into these decisions.

Accidents, Traffic↗
PubMed2004

Intimate partner violence and the role of socioeconomic indicators in WorldSAFE communities in Chile, Egypt, India and the Philippines.

BACKGROUND: The literature documenting the influence of socioeconomic status (SES) on health and injury does not provide a clear consensus on how to account for socioeconomic indicators in population and health outcome studies across countries. The World Studies of Abuse in the Family Environment (WorldSAFE) consortium conducted a series of population-based, multi-stage probability sampling cross-sectional surveys in selected communities in five countries from 1997 to 2003 that allows for the examination of the relationship of SES with current physical and psychological intimate partner violence (IPV). METHODS: Women aged 15-49 years (n = 3975) from six urban low- and middle-income communities participating the the WorldSAFE consortium were interviewed. Using a standardized instrument, the following SES indicators were collected: dwelling ownership, land ownership, number of rooms in the house along with number of residents, toilet facilities, ownership of 13 specific individual/household items, current work status of the woman and her husband/partner, and years of formal schooling completed by the woman and her husband/partner. A family asset index was constructed using principal coordinate analysis. The outcome variables utilized in this manuscript were current (past 12 months) physical IPV, and current psychological IPV. Basic bivariate associations between the categorical predictors and outcome variables were followed by a multiple logistic regression analysis to investigate the effect of covariates on the study outcomes. RESULTS: The were considerable variability among the six sampled communities with respect to the relationship between socioeconomic indicators and current physical and psychological IPV. In general, the employment status of the woman was related to her experience of intimate partner violence, and her educational level and family's assets index were protective factors. When considered in multiple logistic regression models, the asset index was the only indicator that was consistently significant across communities. CONCLUSION: The derived asset index as an SES indicator was found to be associated with current psychological and physical IPV against women across the sampled six communities in four countries.

Adolescent↗
PubMed2001

A new integrated program for natural product development and the value of an ethnomedical approach.

There is a need for less expensive alternative therapies, especially in the treatment of chronic illnesses. This presentation addresses the issues inherent in the use of natural products in a drug-discovery or development program and reviews a model program developed by the U.S. National Institutes of Health (NIH) and administered by the Fogarty International Center at the NIH. Eighty percent (80%) of the world's population relies on medicinal plants for their primary health care. The World Health Organization has been promoting traditional medicine as a source of less expensive, comprehensive medical care, especially in developing countries. Natural products have also been successful in drug development. Over 50% of the best-selling pharmaceuticals in use today are derived from natural products. In a natural-product drug development program, it is the diversity of the natural products that is especially interesting. Thanks to technologic advances, now is a good time to be looking for new drugs in the natural-product arena. But there are major hurdles to overcome in a natural-products development program, namely, time-to-lead, supply, and ownership. Time-to-lead is complex because most natural products are mixtures or crude extracts. It can be very difficult to isolate the active principles and elucidate their structures. The difficulty of obtaining sufficient supply is often given as a reason for not becoming involved in natural-product drug development or discovery. This presentation details some ways these seeming hurdles can be overcome. The concept of ownership has changed dramatically in recent years. Until recently, genetic resources were considered to belong to no one and to therefore be the heritage of everyone. The United Nations Convention on Biodiversity and the meetings in Rio de Janeiro in 1992, redefined biodiversity ownership. Genetic biodiversity has a potential value and belongs to the country of origin. The International Conservation of Biodiversity Groups (ICBGs) was founded in 1992 to address such issues. This presentation discusses the importance of integrating efforts in conservation, economic development, and drug development into one program. The presentation details a collaboration that includes an ICBG based at the Walter Reed Army Institute of Research and its four partner organizations and discusses the associated programs the collaboration has underway.

Bioethics↗
PubMed1987

Cats--source of protection or infection? A case-control study of hemorrhagic fever with renal syndrome.

In the first case-control study analyzing risk factors in sporadic hemorrhagic fever with renal syndrome, 111 cases occurring in Shanghai in 1983 and 1984 and 136 matched controls were studied. Three factors were associated with risk of disease: travel in the month before onset of illness, intense exposure to rodents in the home, and cat ownership. Risk associated with cat ownership was not confounded by exposure to rodents in the home. Neither cat ownership nor risk associated with rodent exposure was confounded by history of travel. The role of cats as reservoir hosts of Hantaan virus is undefined, but this epidemiologic study indicates that infected cats may pose an important risk in the spread of this virus to humans. A survey of peridomestic animals in suburban Shanghai disclosed Hantaan virus infections in two rodent species and in an insectivore, Suncus murinus.

Adolescent↗
PubMed2003

Reliability of a short gun questionnaire.

BACKGROUND: The purpose of the study was to develop and test a short gun questionnaire and compare its reliability to a long gun questionnaire to identify youths who may have access to or ownership of a gun. METHODS: A seven-question short gun questionnaire asking about gun accessibility, ownership, and usage was modified from the much longer gun questionnaire. To determine reliability of the short tool, the results of the short gun questionnaire were compared with the long gun questionnaire. Both the long and the short gun questionnaires were administered to a convenience sample of 100 consenting young people aged 10 to 24 years old treated for any complaint. The study was approved by the institutional review board. RESULTS: Of the 100 youths, 66% of participants were black and 31% were Hispanic. The average age was 21 years and 39% were male. Two youths said that they had a gun, 38.0% said it would be easy to get a gun, and 25% said it would be impossible to obtain one. None of the youths had shared ownership of a gun and 4% said that there was a gun in their home, garage, or car. Eight percent of the youths had fired a gun in the past 6 months and 24% had fired a gun more than 6 months ago. The respondents' answers to all the questions in the short questionnaire were not statistically different from the responses in the long questionnaire at the P < 0.05 level. CONCLUSION: The developed short questionnaire provides results similar to the long questionnaire: a low number of gun owners but a high level of gun accessibility and availability.

Adolescent↗
PubMed2025

Gene-environment interaction analysis in atopic eczema: evidence from large population datasets and modelling in vitro.

BACKGROUND: Environmental factors play a role in the pathogenesis of complex traits including atopic eczema (AE) and a greater understanding of gene-environment interactions (G*E) is needed to define pathomechanisms for disease prevention. We analysed data from 16 European studies to test for interaction between the 24 most significant AE-associated loci identified from genome-wide association studies and 18 early-life environmental factors. We tested for replication using a further 10 studies and in vitro modelling to independently assess findings. RESULTS: The discovery analysis showed suggestive evidence for interaction (p<0.05) between 7 environmental factors (antibiotic use, cat ownership, dog ownership, breastfeeding, elder sibling, smoking and washing practices) and at least one established variant for AE, 14 interactions in total (maxN=25,339). In replication analysis (maxN=252,040) dog exposure*rs10214237 (on chromosome 5p13.2 near IL7R) was nominally significant (ORinteraction=0.91 [0.83-0.99] P=0.025), with a risk effect of the T allele observed only in those not exposed to dogs. A similar interaction with rs10214237 was observed for siblings in the discovery analysis (ORinteraction=0.84[0.75-0.94] P=0.003), but replication analysis was under-powered ORinteraction=1.09[0.82-1.46]). Rs10214237 homozygous risk genotype is associated with lower IL-7R expression in human keratinocytes, and dog exposure modelled in vitro showed a differential response according to rs10214237 genotype. CONCLUSIONS: Interaction analysis and functional assessment provide evidence that early-life dog exposure may modify the genetic effect of rs10214237 on AE via IL7R, supporting observational epidemiology showing a protective effect for dog ownership. The lack of evidence for other G*E studied here implies that only weak effects are likely to occur.

Atopic eczema↗
PubMed2000

Hospital human resource planning in Slovakia.

The study is an attempt to provide empirical evidence, in the context of acute hospital care, of the current human resource practices in the health sector of the Slovak Republic. Using a sample of 72 acute care hospitals the research explored the perceived functions, typical customers and priorities of hospital human resource departments, ownership of a workforce plan, and the relationships between ownership of a workforce plan and type of hospital, as well as the degree to which different human resource activities are given priority. Cross-tabulation procedure revealed statistically significant relationships between ownership of a workforce plan and the degree of priority given to having a quick, efficient and cost-effective recruitment and selection system and, not surprisingly, the degree of priority given to ensuring that the human resource department has a workforce plan. The study evidence also indicates that, although the human resource staff in hospitals seem to be aware of their role in assisting hospital management in decision making, the human resource function in the Slovak hospitals still rather resembles that of a personnel administration than that of an important strategic human resource activity.

Health Services Research↗
PubMed2004

Mosquito nets and the poor: can social marketing redress inequities in access?

Treated mosquito nets are a practical malaria control tool. However, implementation of efficient delivery mechanisms remains a challenge. We investigated whether social marketing of treated mosquito nets results in decreased equity in rural Tanzania, through household surveys before the start of a social marketing programme and 3 years later. About 12,000 household heads were asked about ownership of nets and other assets including a tin roof, radio, or bicycle. A socio-economic status score was developed for each household. Net ownership was calculated for households in each quintile of this score, from poorest to least poor. In 1997, about 20% of the poorest households and over 60% of the least poor households owned a mosquito net. Three years later, more than half of the poorest households owned a net, as did over 90% of the least poor: the ratio of net ownership among the poorest to least poor increased from 0.3 in 1997 to 0.6 in 2000. Social marketing in the presence of an active private sector for nets was associated with increased equity.

Animals↗
PubMed2005

Early childhood environment related to microbial exposure and the occurrence of atopic disease at school age.

BACKGROUND: There is a growing body of evidence that the early childhood environment with respect to day care attendance, older siblings, pet ownership, and early life airway infections may protect from developing atopic disease. Few studies have distinguished between atopic sensitization and symptoms, and none have evaluated independent contributions for all of these different environmental conditions. OBJECTIVE: Examine independent effects on atopic sensitization and symptoms of day care attendance, older siblings, pet ownership, and early infancy's airway disease. METHODS: A cross-sectional survey among 8-13-year-old school children with complete data for 1555 children. RESULTS: After adjustment for confounders, atopic sensitization occurred less frequently in children that had attended a day care centre (OR: 0.73, 95% CI: 0.55-0.98) or had a cat or dog before 2 years of age (OR: 0.78, 95% CI: 0.61-0.99). Having older siblings yielded a nonsignificant trend towards protection (OR: 0.88, 95% CI: 0.70-1.11). For symptoms, there was no relation with having older sibs, day care attendance and pet ownership, although there was a trend towards protection for the combination of atopy and symptoms. In contrast, children with doctors' treated airway disease before age 2, more frequently reported recent symptoms of wheeze, asthma, rhinitis, or dermatitis (all P < 0.05). CONCLUSION: Early life environmental exposure to day care, or pets may protect against atopic sensitization. Protection against symptoms only occurred if atopic sensitization was present as well.

Air Microbiology↗
PubMed1976

The dynamics of owning and disowning: psychoanalytic and family perspectives.

The dynamics of owning and disowning one's inner life have both intrapsychic and transactional or interpersonal dimensions. Freud opened new vistas on our inner world using psycoanalysis as a tool. Although not unaware of the effects of family members upon each other, Freud's rejection of the seduction theory of neurosis in 1897 fatefully influenced the future course of psychoanalysis, placing the primary focus on intrapsychic relations. Until today, it has remained the task-perhaps the principal one--of psychoanalytic theorists to do justice to the interpersonal and family realm that Freud neglected, without sacrificing the enormous insights we owe to Freud. Three conditions for successful inner ownership are described: a capacity for self-object differentiation; tolerance of ambivalence; and a sense of physical integrity, of having a cohesive, nuclear ego. The pathology of inner ownership is related to a pathology of interpersonal ownership as transacted on the family level. One form of such relational pathology--parental overowning, as revealed primarily in families with schizophrenic members--is discussed, with a case example.

Dominance-Subordination↗
PubMed2000

Systematic review of controlled trials of interventions to promote smoke alarms.

AIMS: To evaluate the effects of promotion of residential smoke alarms. METHODS: Electronic databases, conference proceedings, and bibliographies were systematically searched, and investigators and organisations were contacted, in order to identify controlled trials evaluating interventions designed to promote residential smoke alarms. The following were assessed: smoke alarm acquisition, ownership, and function; fires; burns; and fire related injuries. Odds ratios (OR) were estimated by meta analysis of randomised trials. RESULTS: A total of 26 trials were identified, of which 13 were randomised. Overall, counselling and educational interventions had only a modest effect on the likelihood of owning an alarm (OR = 1.26; 95% confidence interval (CI): 0.87 to 1.81) or having a functional alarm (OR = 1.19; 95% CI: 0.85 to 1.66). Counselling as part of primary care child health surveillance had greater effects on ownership (OR = 1.93; 95% CI: 1.04 to 3.58) and function (OR = 1. 72; 95% CI: 0.78 to 3.78). Results were sensitive to trial quality, however, and effects on fire related injuries were not reported. In two non-randomised trials, direct provision of free alarms significantly increased functioning alarms and reduced fire related injuries. Media and community education showed little benefit in non-randomised trials. CONCLUSION: Counselling as part of child health surveillance may increase smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give away programmes apparently reduce fire related injuries, but these trials were not randomised and results must be interpreted cautiously. Further efforts to promote smoke alarms in primary care or through give away programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes.

Burns↗