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PubMed2004

[Application of the principles of minimum intervention by primary health care doctors--evaluation by patients addicted to nicotine].

The aim of the study was to analyze to what extend the principles of minimum intervention are applied by basic health care doctors in Mazovia. The study comprised 326 tobacco smokers, divided into two groups: group I--including 160 adults living in towns with a population below 10000 and group II--including 166 inhabitants of towns with a population above 100000. Each subject had their tobacco dependence rate (the Fagerström test) and the period of smoking (pack-years) calculated. Each subject evaluated application of the minimum intervention principles by their basic health care doctor anonymously. The data obtained were statistically analyzed. The study groups did not differ in terms of nicotine addiction rate. It was found that almost half of the patients smoking tobacco had never been asked by their doctor about smoking habit during consultation. An educational material concerning the harmfulness of smoking is received by every seventh smoker, and an attempt of a pharmacological therapy of addiction is undertaken only in every tenth patient. The minimum medical intervention principles in tobacco smokers are twice more often applied by basic health care doctors working in small towns.

Adult↗
PubMedDate not supplied

Predictors of condom use and human immunodeficiency virus test seeking among women living in inner-city public housing developments.

BACKGROUND AND OBJECTIVES: To examine prevalence and predictors of condom use and human immunodeficiency virus (HIV) test seeking among women living in inner-city housing developments. STUDY DESIGN: Between April and June 1994, 671 women living in low-income housing developments in five cities in the United States completed an anonymous self-report questionnaire eliciting information on acquired immune deficiency syndrome (AIDS) risk behavior and characteristics indicative of risk. RESULTS: Most participants were women of color who were economically disadvantaged. Fifteen percent reported multiple sex partners, and 30% of women with one sex partner believed he had sex with someone else in the past year. Predictors of condom use included increased rates of safe-sex negotiation, stronger risk reduction intentions, absence of condom barrier beliefs, and multiple sex partners. Women tested for HIV in the past year were younger, perceived themselves to be at risk for HIV infection, reported more conversations with other women about AIDS concerns, and had condoms readily available. CONCLUSIONS: HIV public health prevention interventions are urgently needed for women who live in low-income urban housing developments.

AIDS Serodiagnosis↗
PubMed1994

Early diagnosis and treatment of alcoholism: the Japanese experience.

The current status and problems concerning the early identification, diagnosis and treatment of alcoholism in Japan are outlined in this article. With regard to the early diagnosis of alcoholism, we focus on the following four aspects: (1) the drinking culture in Japan and the difficulties in early diagnosis of drinking problems because of this culture, (2) the social system which serves to the early diagnosis of alcoholism, (3) the education of specialists, and (4) screening tests and biological markers of alcoholism. The number of facilities offering specialized treatment of alcoholics has sharply increased in recent years, but it is clear that such facilities are still not sufficient to meet the demand. It also emphasizes that diversification of alcohol treatment facilities is essential to meet the therapeutic needs of newly emerging subgroups such as women, young people and the elderly. Finally, the characteristics of the two self-help groups in Japan, Danshukai (Japan Sobriety Association) and Alcoholics Anonymous (AA), are described and compared.

Adolescent↗
PubMed1991

Development of a "Steps Questionnaire".

Thousands of men and women have begun their recovery from alcoholism through the support of Alcoholics Anonymous (AA) and its well-known "12-Step" program. The purpose of the present study was to develop a scale to measure alcoholics' levels of agreement with the first three of AA's 12 Steps and to test the relationship between sobriety and belief in these three steps. Using both factor analysis and Rasch analysis, two versions of a "Steps Questionnaire" were developed. A 96-member subset of the original subject pool was assessed quarterly for 1 year following inpatient treatment to determine the predictive validity of the questionnaire. The results of this study suggested that agreement with AA's first three steps can be measured and that agreement with AA's first step correlates with number of sober days posttreatment. The dichotomization of Steps Questionnaire scores into total agreement versus partial agreement with Step 1, and from this the reduction of uncertainty in the prediction of abstention over a lengthy follow-up period, provides support for AA's contention that total surrender to one's powerlessness over alcohol is part of the process of achieving abstention.

Alcohol Drinking↗
PubMed1988

Characteristics of adolescents at risk for compulsive overeating on a brief screening test.

As part of a large survey of addictive behavior in high school students, 43% of a sample of 278 (26% of the males, 57% of the females) scored above the cutoff point set by Overeaters Anonymous on their scale for assessing compulsive overeating. While this at-risk group did not report poorer general adjustment, health, or school achievement than did the students not at risk, they did significantly more often perceive their life quality and relationship with the person closest to them as less positive. The at-risk subsample indicated the defensive effectiveness of overeating in their significantly more frequent report of dissociative experiences while eating, and less severe ratings of insecurity, worrying, and daydreaming. One of the most salient findings was the at-risk students' more frequent report of addictive problems in their parents (overeating, alcohol and drug use, and gambling).

Adolescent↗
PubMed1995

[Mandatory anonymous HIV-surveillance in Denmark. Experience with the new notification system].

A newly implemented mandatory, anonymous HIV surveillance system in Denmark is described. The system is based on a serially numbered form that is circulated among the laboratories, the physicians, and the national surveillance unit. All laboratories doing confirmatory tests for HIV antibodies must send a report form along with any positive test result. Before forwarding the form to the physician, the laboratory is to fill in the top part of the form with its own name, the name and address of the requesting physician and the date of testing. The back copy must be send to the surveillance unit. The Danish physicians are by law mandated to fill in the form with data on the patient and then send the original to the surveillance unit. The two copies are for the patient's file and for the physicians' own centralized filing system. After a revision of the system in 1992, a response rate of 95% was obtained during the first year. An increasing number and proportion of first-time identified HIV-infections in Denmark are acquired heterosexually, many of these infections are identified among foreigners. The newly developed mandatory HIV surveillance system is based on anonymous reporting but it allows routine evaluation of the completeness of reporting as well as nonresponding physicians to be reminded of their duty to report. Also, the system allows nested studies to be carried out among selected HIV-infected subpopulations of special research interest without compromising the anonymity of the patient.

Confidentiality↗
PubMed2001

Effects of aggressive behaviour and group size on collective escape in an emergency: a test between a social identity model and deindividuation theory.

This study models escape behaviour in emergency situations and compares the ability of deindividuation and social identity-based explanations in particular to account for responses. According to deindividuation theory, the larger the group, the higher the degree of anonymity and the stronger antisocial responses such as competitiveness will be. Moreover, the competition for escape should be more severe, and the escape rate lowered, in a large group, regardless of whether participants have an aggressive option. A social identity model predicts that when group members have an option of aggressive behaviour, the salience of the aggressive norm in a larger group will be stronger than that in a smaller group. In contrast, when participants only have concessive option, the salience of the non-aggressive norm in a large group is expected to be stronger than that in a small group. The results of Study 1 supported the social identity model. Study 2 tested how participants responded to their norm. The social identity model suggests a more conscious and socially regulated process whereas deindividuation theory implies an unconscious or unregulated process. The results showed that what directly affects norm formation is the density of stimulus, that is, the amount of aggression received from others and of others' escape activity divided by group size. The results suggest the conscious process of the norm formation and support the social identity model.

Aggression↗
PubMed2004

[Smoking habits among sixth-year medical students in Spain].

OBJECTIVE: To describe and analyze the smoking habits of sixth-year Spanish medical students. MATERIAL AND METHODS: The target population of this descriptive cross-sectional study was students completing their sixth year in Spanish medical schools. An anonymous, self-administered questionnaire was sent to the students' homes by ordinary mail. The relationships between the variables were analyzed using contingency tables, the chi2 test, the Student t test, and analysis of variance with a significance level of P< .05. The software package was SPSS. RESULTS: A total of 3840 questionnaires were distributed to students, and 1340 were returned completed (34.9%). Of the respondents, 27% were smokers (8.7% smoked only on weekends, and 18.3% were daily smokers). The mean (SD) number of cigarettes smoked per day was 10.54 (7.89). Consumption was significantly higher among men than among women. The mean age of initiation was 17.20 years. Of the students who were smokers, 32.54% stated that they had started smoking during their medical studies. The percentage of smokers who stated that they wanted to quit was 76.3%, and 56.6% said that they had already made at least one quit attempt. CONCLUSIONS: It is cause for concern that a large number of students start smoking after they enter medical school. One of the reasons for this is the lack of concern about smoking as a health problem within medical schools. The smoking habits of medical students are affected by the same phenomena that affect those of the general public, such as the increase in the number of women smokers, the influence of sociocultural factors, and the increasingly broader age range of initiation. The lower prevalence of smoking among medical students with respect to other populations is probably due to the fact that, in general, these students have better health habits than the general public, and/or the reasons that led them to study medicine also make them disinclined to smoke.

Adolescent↗
PubMed1990

Inpatient treatment of employed alcoholics: a randomized clinical trial on Hazelden-type and traditional treatment.

The first randomized clinical trial on the Hazelden-type of treatment showed that this AA-oriented treatment for alcoholism can result in significant improvement in drinking behavior as compared to a more traditional form of treatment. One hundred forty-one employed alcoholics were randomized to either Hazelden-type treatment (N = 74) or to traditional-type treatment (N = 67). The treatment groups were highly comparable. The bimonthly follow-up lasted one year. According to the COPES-questionnaire (short form), the treatment at the Hazelden-type institute was significantly more involving, supportive, encouraging to spontaneity and oriented to personal problems than at the traditional-type institute. In accordance the treatment drop-out rate was 7.9% at Hazelden-type institute and 25.9% at traditional-type institute (p less than 0.02). The participation in outpatient treatment was significantly better after the Hazelden-type treatment. The proportion of those abstinent (admitted ethanol consumption, 0 g/day; gammaglutamyl transferase, and mean cell volume were normal) was higher at Hazelden-type institute during the last (8-12 months) follow-up period (26.3% vs. 9.8%, p = 0.05). Fourteen percent of the Hazeldon-type institute patients and 1.9% of the traditional-type institute patients stayed abstinent during the whole 1-year follow-up period (p less than 0.05). The differences for the corresponding rates for controlled drinking (admitted ethanol consumption less than 40 g/day, GGT, and MCV normal) were in the same direction but did not reach statistical significance. Thus the Hazelden-type treatment obtained better results in 1-year abstinence rate than a more traditional-type treatment.

Adult↗
PubMed1987

The South Oaks Gambling Screen (SOGS): a new instrument for the identification of pathological gamblers.

The South Oaks Gambling Screen is a 20-item questionnaire based on DSM-III criteria for pathological gambling. It may be self-administered or administered by nonprofessional or professional interviewers. A total of 1,616 subjects were involved in its development: 867 patients with diagnoses of substance abuse and pathological gambling, 213 members of Gamblers Anonymous, 384 university students, and 152 hospital employees. Independent validation by family members and counselors was obtained for the calibration sample, and internal consistency and test-retest reliability were established. The instrument correlates well with the criteria of the revised version of DSM-III (DSM-III-R). It offers a convenient means to screen clinical populations of alcoholics and drug abusers, as well as general populations, for pathological gambling.

Adult↗
PubMed2003

A comparison of evaluations of male and female psychiatry supervisors.

OBJECTIVE: To assess whether male and female psychiatry supervisors are evaluated differently by psychiatry residents. METHODS: The University of Toronto Department of Psychiatry compiled anonymous supervisor evaluations completed semiannually by psychiatry residents over a period of 3 years. Male and female psychiatry supervisors' ratings were compared by using t-tests, effect estimates, and chi-square analyses. Results from these ratings were discussed in a resident focus group. RESULTS: Female psychiatry supervisors (n=76) were rated significantly lower than male supervisors (n=222), both overall (P<0.05) and in the areas of enthusiasm (P<0.05), clarity (P<0.05), and knowledge (P<0.001). CONCLUSIONS: Future studies comparing evaluations of supervision by male and female psychiatrists must control for academic rank, numbers of publications, and hours of teaching. Comparing evaluations of the various male-female supervisory pairs will be useful to assess for gender biases.

Adult↗
PubMed1986

Personal and social difficulties faced by women and men entering alcoholism treatment.

Personal interviews were conducted with 67 Anglo women and 54 Anglo men who were currently in treatment at alcoholism treatment facilities. Women experienced more personal and social difficulties in entering treatment. Women had less favorable attitudes toward seeking general health care and perceived greater social costs to be associated with having entered alcoholism treatment. Almost half of the women but less than 20% of the men experienced one or more costs because of entering treatment, such as problems with family, money or friends. Women encountered opposition to treatment from family and friends significantly more often than men, for whom such opposition was rare.

Alcoholics Anonymous↗
PubMedDate not supplied

Use of the theory of planned behavior to explain HRT decisions.

OBJECTIVE: To test the theory of planned behavior (TPB) and other variables to discriminate among women who have made various decisions about hormone replacement therapy (HRT). METHOD: An anonymous survey was completed by a diverse sample of 641 women employed at a community college. RESULTS: Survey response rate was 64.3%. Results from a discriminant analysis showed that HRT use was most strongly associated with perceived behavioral control and reliance on one's physician as a source of HRT information. CONCLUSIONS: The TPB is a useful framework for explaining HRT decisions in a period of uncertainty about risks and benefits of the therapy.

Adolescent↗
PubMedDate not supplied

[Social and economic aspects of administration of new antiepileptic drugs].

The necessity of analysis of the cost of treatment of patients with epilepsy becomes of primary importance in Poland as a consequence of recent economic transformations affecting the efficiency of health service. The reasons are: high number of patients with epilepsy (approaching 400,000 in a population of about 40 mln) and long time course of illness, taking into account steady, gradual rise of the cost of treatment, even if we accept greater efficiency of the new antiepileptic drugs. However, the analysis of questionnaires provided by patients with epilepsy indicates that optimation of their treatment with introduction of new antiepileptic drugs may be a procedure leading to diminution of the global expenses associated with care of epileptic patients. Identification of factors influencing cost of antiepileptic treatment before and after introduction of new antiepileptic drugs. A group of 150 people chosen at random from a population of persons taking new antiepileptic drugs (vigabatrin, lamotrygin, topiramate, gabapentin, tiagabine) received anonymous questionnaires concerning the time course of their illness. 80 questionnaires were returned. The questions concerned the situation before and after treatment. Statistical analysis included t test for dependent samples-including items such as: number of epileptic seizures and number and days of hospitalization, etc. per year of observation. Significant decrease of the number of epileptic seizures (p < 0.05), number of hospitalizations (p < 0.001), days of hospitalizations (p < 0.001) and neurological consultations (p < 0.001) occurred after optimalization of treatment. Results of our research illustrate significant reduction of direct costs of treatment associated with introduction of new antiepileptic drugs.

Adolescent↗
PubMed2001

[New recommendations for evaluating the effectiveness of treatment of solid tumors and principles of the Guidelines for Clinical Practice (GCP)].

A new WHO protocol for measuring tumor during clinical studies using upgraded methods of tumor diagnosis was released in 1994. The recommendations based on the examination of over 4,000 patients included measuring greatest diameter of tumor and evaluation of treatment effect by changes of a sum total of largest diameters. Therapeutic effect is established by a decrease in the sum by at least 30%, while tumor progression--by an increase by at least 20%. The GCP provide standards for planning, implementing, monitoring, auditing and documentation of clinical trials and submitting their findings. These standards guarantee the accuracy and reliability of data, patients' rights of health protection and anonymity of those taking part in trials. Today, these rules are binding for the European Community, Japan and the USA. All Russian medical establishments running clinical tests are to observe the rules.

Clinical Trials as Topic↗
PubMed2003

Impact of universal preadolescent vaccination against hepatitis B on antenatal seroprevalence of hepatitis B markers in British Columbia women.

Countries with a low risk of hepatitis B (HB) lack data on the effectiveness of universal HB vaccination programs for children. British Columbia began a program in 1992, offering HB vaccination to 11 year olds. We conducted an anonymous, unlinked serologic survey 7 years later, analyzing a random sample of specimens (n = 1215) from women aged 15-44 years who had undergone antenatal rubella testing. Among those aged 15-19 years inclusive there was no evidence of chronic HB (HB surface antigen), the proportion with evidence of acute HB (anti-HB core antibody) was only 0.6% (compared with 6.5% for the entire sample), and evidence of protective immunity was strong: the prevalence of anti-HB surface antibody (anti-HBs) was 79.1% (compared with 41.4% for the entire sample) and the geometric mean titre was 34.9 IU/mL (compared with 0.6-0.8 IU/mL for the older groups [p < 0.001]).

Acute Disease↗
PubMed2002

[Study of HIV seroprevalence in patients with pulmonary tuberculosis in 1999 in Chad].

Tuberculosis is the most common opportunistic disease occurring in the course of human immunodeficiency virus (HIV) infection. With the development of HIV infection in Chad, tuberculosis has quickly become a major public health concern. The purpose of this cross-sectional study in two tuberculosis centres (Moundou and Ndjamena) was to evaluate HIV seroprevalence, epidemiological characteristics and risk factors in patients with tuberculosis. All patients with positive sputum-smears who had never been treated for tuberculosis previously were eligible. A total of 466 patients (sex ratio M/F: 1.96) were included during the six-month period between January and June 99. Each subject was asked to fill out an anonymous standardized questionnaire with detailed information on demographic characteristics, sexual behavior and other risk factors for HIV infection. Data were compared using the Chi-square test, Student's T test and multivariate analysis (logistic regression). One third (33.2%) of patients was seropositive for HIV-1. Mean age was 31.1 years in HIV-positive group and 33.6 years in the HIV-negative group (p = 0.02). The age groups with the highest risk for HIV were 20-29 years and 30-39 years (p < 0.01). Women were more often seropositive that men (39.5% versus 30.1%; p = 0.04). Seropositive patients were more likely to have multiple sexual partners (mean: 1.76; p < 0.01) and a history of sexually transmitted disease (19.9% versus 8.1%; p = 0.01). The mean age at the time of first sexual relations was 16.3 years in the HIV group and 17.1 years in the control (p < 0.01). The percentage of seropositive patients was 39.6% at Moundou and 29.8% at N'djamena (p > 0.01). Multivariate analysis showed that early age of first sex relation (OR = 0.85; 95% IC: 0.74-0.97), higher number of sexual partners (OR = 1.8; 95% CI: 1.4-2.4) and level of education were strongly correlated with HIV infection. The prevalence of HIV in tuberculosis patients is a good indicator of HIV-infection in developing countries. Prevalence of HIV infection is high in tuberculosis patients in Chad. Surveillance for tuberculosis and AIDS must be strengthened in Chad. Mores cooperation is needed between tuberculosis and AIDS control programs. Emphasis should be placed on screening for tuberculosis, early tuberculosis treatment and diagnosis of HIV in tuberculosis patients.

Adolescent↗